Applying Lean Principles in Hospital Renovation and Redesign: A Case Study
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Transcript of Applying Lean Principles in Hospital Renovation and Redesign: A Case Study
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Angela Beck, RNSix Sigma Black Belt
Global Lean, Six Sigma & Business Improvement SummitOctober 16th, 2008Orlando, Florida
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LEAND.M.A.I.C.
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Formed with the merger of Clarkson Hospital and UNMCs University Hospital in 1997
690 Beds Private Not-for-Profit Hospital Tertiary/Quaternary Academic Medical Center
$651 FY2007 Annual Revenues 26,404 inpatient discharges (including newborns) 143,070 patient days (FY2008) 456,678 outpatient visits (FY2008)
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J.D. Power & Associates; 2007 DistinguishedHospital for Cardiovascular Excellence
J.D. Power & Associates; Three consecutive yearsOutstanding Patient Experience for Inpatient Services
Ranked nationally in U.S. News & World Reports Americas Best Hospitals 2008, 39th Cancer Care and 41st Neurology & Neurosurgery
First in the State: Named Blue Distinction Center for Complex and Rare Cancer by Blue Cross Blue Shield of Nebraska
Awarded the American Heart Association Gold Performance Achievement Award for performance in treating stroke patients using the Get With The Guidelines program.
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The Three GoodsAchieve better clinical outcomes and service for our patients and their families
Make operations more efficient and effective for serving our customers and maintaining financial stability
Make jobs easier to do for our staff and physicians
Achieve better clinical outcomes and service for our patients and their families
Make operations more efficient and effective for serving our customers and maintaining financial stability
Make jobs easier to do for our staff and physicians
Glenn Fosdick, FACHEPresident and CEO
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Radiology Department Completed 227,846 radiological studies* in FY 2008.
* includes Diagnostic Xray, Mammography, Interventional Radiology, CT, MRI, Ultrasound, Nuclear Medicine/PET
Twelve phase renovation plan. Planning and design for all project areas completed
up to 5 years ago. First department renovation completed August 2006.
Departments/Areas Designated for Lean Assessments1. Ultrasound2. Waiting Room3. Remote Reading Room4. Main Reading Room5. Diagnostic Radiology
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Facilities Management & PlanningSenior Facility Analyst
Architect PartnerProject Architect
Construction PartnerProject Manager
Subject Matter Experts
Process experts withineach department
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Music during the exam was the number one
patient request
Staff requested comfortable,
adequately sized work areas in the new space
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Tech Work RoomTech Work Room
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Exam RoomExam Room
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Reduce traffic in and outof tech work room
Centrally locate frequently used items for staff and
patients
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Wednesday waiting room
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2004 numbers 2007 numbers 2012 numbers
Wednesday waiting room
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Who is in the Waiting Room?
Patients56%
Adult Family Members
33%
Children7%
Wheel Chairs4%
Who is in the Waiting Room?
Patients56%
Adult Family Members
33%
Children7%
Wheel Chairs4%
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Entry
Coffee Bar
Child Area
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6Six Sigma
Centrally located frequently Centrally located frequently used itemsused items
Adjustable height desks/chairsAdjustable height desks/chairsStraight desk tops for optimal Straight desk tops for optimal
teaching purposesteaching purposesDoors/walls located to reduce Doors/walls located to reduce
light light Modular walls used between Modular walls used between
workstations for easier workstations for easier relocation relocation
Task lights controlled on desk Task lights controlled on desk to reduce repetitive tasksto reduce repetitive tasks
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4 entrances 8 specialties 31 workstations No clear path thru dept
Under-utilized spaces
ChestPeds
UltrasoundN. Campus
Neuro
G.I.
Bone
Nuc MedN. Campus
Details
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1. Translated learnings from Remote Reading Room mock up
2. Translated recommendations from ergonomic assessment done during Remote Reading Room project
3. Provided virtual tour of proposed floor plan for Radiologists
4. Lean challenge of floor plan by Black Belts/Lean Process Consultant
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1. Reduction in Transportation
Relocated electrical closet and equipment alcove Located view boxes in/near each specialty
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1. Reduction in Transportation
Relocated electrical closet and equipment alcove
Located view boxes in/near each specialty
2. Reduction of Under-Utilized/Wasted Space
Relocation of work stations in each specialty
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1. Adjusting room locations: Move high-volume rooms to ideal locations Move lead office into work area
2. Standardizing work areas: Reorient Exam Rooms 3 and 4 Room interior (i.e. sinks, cupboards)
3. Adjusting room entry ways: Increase access to tech workroom Increase access to rooms 5 and 6
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1. Adjusting room locations: Move high-volume rooms to ideal locations Move lead office into work area
2. Standardizing work areas: Reorient Exam Rooms 3 and 4 Room interior (i.e. sinks, cupboards)
3. Adjusting room entry ways: Increase access to tech workroom Increase access to rooms 5 and 6DEXADEXA
CXRCXR
PACSPACS
OO
ExamExam
22
ExamExam
11
ExamExam
55
ExamExam
66Pt
Hold
Pt Pt
HoldHold
Outpatient Waiting Room
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1. Adjusting room locations: Move high-volume rooms to ideal locations Move lead office into work area
2. Standardizing work areas: Reorient Exam Rooms 3 and 4 Room interior (i.e. sinks, cupboards)
3. Adjusting room entry ways: Increase access to tech workroom Increase access to rooms 5 and 6
DEXADEXA
CXRCXR
OO
ExamExam
44
ExamExam
33ExamExam
22
ExamExam
11
ExamExam
55
ExamExam
66Pt
Hold
Pt Pt
HoldHold
ExamExam
44
ExamExam
33
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1. Adjusting room locations: Move high-volume rooms to ideal locations Move lead office into work area
2. Standardizing work areas: Reorient Exam Rooms 3 and 4 Room interior (i.e. sinks, cupboards)
3. Adjusting room entry ways: Increase access to tech workroom Increase access to rooms 5 and 6
DEXADEXA
CXRCXR
OO
ExamExam
22
ExamExam
11
ExamExam
55
ExamExam
66Pt
Hold
Pt Pt
HoldHold
ExamExam
44
ExamExam
33
Outpatient Waiting Room
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Avoidance for Techs:
1,245 mi/yr
Avoidance for Techs:
1,245 mi/yr
102 ft difference @ 5,369 trips/month102 ft difference @ 5,369 trips/month101 ft difference @ 484 trips/month101 ft difference @ 484 trips/month
Avoidance for Techs & Pts:
111 mi/yr
Avoidance for Techs & Pts:
111 mi/yrAvoidance for Techs & Pts:
41 mi/yr
Avoidance for Techs & Pts:
41 mi/yr
9 ft difference @ 2,110 trips/month9 ft difference @ 2,110 trips/month
Tech Total
Patient Total
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12 weeks$48,750Waiting Room
7 weeks$43,000Main Reading Room
69 weeks$378,750Totals
26 weeks$225,000Diagnostic Radiology
14 weeks$5,500Remote Reading Room
10 weeks$56,500Ultrasound
Construction Schedule Impact
Cost Avoidance
Project
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Proactive Application of Lean & Six Sigma ToolsBlack Belt deployed full time in Facilities Management &
Planning department with responsibilities including:
Project leadership of renovation and new construction projects as well as participation in Master Plan Development. Mentoring of Facilities staff on facilitation/quality improvement tools and methods. Supporting Facilities department on internal process improvement.
Receiving project requests prior to departments making requests for more physical space.
Cardiac Rehabilitation Patient Flow & Capacity
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D M A I C
Based on cardiology as a center of excellence, the outpatient
cardiac rehab department is not able to accommodate the
increased volume of patients due to broadening coverage of
diagnoses in the current space. Limited time and space leads to
patient, staff, physician and overall customer dissatisfaction and
patient safety concerns.
Based on cardiology as a center of excellence, the outpatient Based on cardiology as a center of excellence, the outpatient
cardiac rehab department is not able to accommodate the cardiac rehab department is not able to accommodate the
increased volume of patients due to broadening coverage of increased volume of patients due to broadening coverage of
diagnoses in the current space. Limited time and space leads todiagnoses in the current space. Limited time and space leads to
patient, staff, physician and overall customer dissatisfaction apatient, staff, physician and overall customer dissatisfaction and nd
patient safety concerns.patient safety concerns.
(Original)
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D M A I C
Attendance Policy: Class time to be released after 14 consecutive days of patient absences Equals 6 class sessions Reserved class time released
Data collection: Historical data Two 3 month time frames
Patients
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# of Absences When Class Time Was Released
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D M A I C
Class Sessions 7 class sessions offered Mondays, Wednesdays and Fridays Patients allowed each class is dependent on staffing max is 12
Data Collection:
Real time data Two week time frame historically, a high volume time period
# of Patients
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Max Pts Allowed Total Pts Scheduled Total Pts Attended
Class Session Info
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D M A I C
Goal Statement
Cardiac rehab wants to increase capacity of phase II patients to
80% (orientation and class attendance). This will be
accomplished by increasing patient and staff accountability, as
evidenced by increased patient attendance and consistent
implementation of department policies and procedures by staff.
Goal StatementGoal Statement
Cardiac rehab wants to increase capacity of phase II patients toCardiac rehab wants to increase capacity of phase II patients to
80% (orientation and class attendance). This will be 80% (orientation and class attendance). This will be
accomplished by increasing patient and staff accountability, as accomplished by increasing patient and staff accountability, as
evidenced by increased patient attendance and consistent evidenced by increased patient attendance and consistent
implementation of department policies and procedures by staff.implementation of department policies and procedures by staff.
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D M A I C
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80% Goal(total utilization)
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The collaboration of Subject Matter Experts with
Facilities, Architecture and Construction partners
on the Radiology project resulted in significant
cost avoidance and construction delays.
The use of full scale mock ups, 3D imaging and
virtual tours have proved to be invaluable tools
during the design process.
The learning process has taught us that we need to
refine our processes and examine workflow to
before the construction process starts.
We are moving toward a culture of proactively
using Lean tools in areas who have spatial
challenges in order to examine opportunities to
increase operational efficiencies.
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Angela Beck402.559.3631