Case Study Applying Lean And Six Sigma To The Surgical Services Process

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Transcript of Case Study Applying Lean And Six Sigma To The Surgical Services Process

  • 1. Case Study: Applying Leanand Six Sigma to the SurgicalServices ProcessA Successful, SustainableImplementation must first understand Jim Pearson James@JOPconsulting.comthe culture of change and the Goalsof the Organization. Revision 4Copyright 2011 JOP Consulting

2. AgendaImproving Revenue and Reducing CostsThe ProblemAnalyzing the ProcessThe Implementation PlanWas the Implementation Successful?The Impact of Process Improvement on your Clinical StaffHow your Measurement Systems can Negatively impact changeWhat Actions are Necessary to Assure Success?Copyright 2011 JOP Consulting 2 3. The ProblemsThe GoalsEfficiency in the OR was not Improve Operational EFFICIENCYacceptable Improve the FINANCIALS forTurn Around Times were EveryoneExcessive Enhance Surgeon PRODUCTIVITYFinancial Pressure to ReduceStaff Cost Improve Patient LOYALTY Implement SUSTAINABLE SolutionsCopyright 2011 JOP Consulting 3 4. Surgical Services Value Stream Functional Goals Currently Drive the ProcessPre- Same Surgical OR PACU DischargeDay AdmitTest* Sterile Processing Department (SPD) analysis part of ORCopyright 2011 JOP Consulting 4 5. Pre-Surgical Test Metric: Chart Prep Owner: Surgeon/Hospital Quantity (In, Out) of cases Time (Ave, SD) Completeness, ReworkMetric: Approval Rate Owner: Surgeon Quantity (In, Out) of cases Case Type Time (Ave, SD) per case Revenue PotentialMetric: SPD Prep Owner: Hospital Quantity of cases needingspecial instruments Cost Holding CostsCopyright 2011 JOP Consulting Labor5 6. Operating Room Metric: Arrival Rate Owner: Hospital Quantity (In, Out) Case Type Scheduled/Unscheduled Ratio Time (Ave, SD) per caseMetric: Turn Around Time Owner: Hospital Case Type Surgeon OR Room Time (Ave, SD) per caseCopyright 2011 JOP Consulting6 7. Understanding TAT*Patient In RoomPatient OutClose ofIncisionIncision Procedure DurationAnesthesia AnesthesiaInductionEmergent Case Duration* Turn Around TimeCopyright 2011 JOP Consulting7 8. A More Realistic View of OR TATAnesthesia Prep, (InterviewPatient), Plan of Care Initiated in Surgeon in RoomSDSCloseIncisionSURGEON StartCompleteTransfer T AnesthesiaAnesthesiaPatient to iANESTHESIA InductionProcess PACU w/RNm e CleanPatient Position oComplete Charts BreakSet upDown OR, OR,Prep uNURSING Enters ORRoom AnesthAnesthDrapet RN Patient Chart Review in SDARN transfersPatient to OR Patient #1 Leaves Room Patient #2 Enters RoomTATTATActual Anesthesia Start - Wheels Out Wheels In Incision Start Notes: - Block Sizes are relative TAT- SPD included in Analysis Actual vs. Scheduled Copyright 2011 JOP Consulting8 9. Heat Map Showing Active OR Rooms Tuesday Hour of Daydaydate01 234567 8 9 10111213141516171819 20 21 22 23 Tue02-Feb 6 6 6 6 6 5 554 1 3 2 Tue09-Feb 7 7 7 6 7 7 666 4 3 2 Tue16-Feb 7 7 6 6 5 3 224 4 4 3 Tue23-Feb 6 6 6 6 6 6 556 2 3 3 231 Tue02-Mar 6 7 7 7 7 6 555 3 1 1 Tue09-Mar 118 8 6 7 7 6 665 5 4 2 111 Tue16-Mar 3 4 4 6 7 5 554 4 3 1 Tue23-Mar 116 6 6 5 5 6 667 4 2 1 22221 Tue30-Mar 6 6 6 6 6 7 774 2 1 1 1 Tue06-Apr 5 5 6 5 6 5 312 3 3 1 Tue13-Apr 1 6 7 6 6 4 333 4 4 2 11111 Tue20-Apr 7 7 7 7 7 7 788 5 2 1 111 Tue27-Apr 1 7 7 7 5 6 6 665 4 3 3 222Avg/hr .2 .2.0 .0 .0 .0 .0 5.8 6.3 6.2 6.0 6.2 5.6 5.1 5.0 4.8 3.5 2.8 1.7 .8 .7 .5 .3 .2 Heat Map Darker Colors show more rooms in use. Number indicates active cases.Copyright 2011 JOP Consulting 9 10. Actual Anesthesia Start Time Incision Time By Specialty Notes: Variation within a Specialty is less but can vary between plus and minus 9 to 14 minutes A component of Variation is driven by Procedure type that is typically fixed Ortho Variation is higher than General and Neurology. It is predictable and can be proactively managed to Surgeon(All)improve Block Schedule performance. Anesthesia Type(All)DAY Patient Type SURGERY classElectiveGeneralNeurology Orthopedics Anesthesiologist NameCountAverage Std Dev CountAverage Std DevCount Average Std Dev 12 18 3517 6 6 3010 15 21 5628 912 3410 15 19 410 24 410 3410 21 20 617 23 6 6 2610 23 23 9730 7 9 42 8 28 241210 28 711 3612 14 22 821 2812 9 3612 11 2511929 9 8 2514 31 19 813 261518 3211 18 26129291213 3815 18 21 9 4 28 913 4526 21 18 410 24 8 8 3012 10 26 5 1 34 13 221718 27810 30 9 Grand Total250 21 9 140 269 133 3414Copyright 2011 JOP Consulting10 11. Actual Anesthesia Start Time Incision Time By Surgeon by AnesthesiologistNotes: One Anesthesia Type Gen. Endotracheal Tube Anesthesi Variation from Procedure, ologist NameDataSetup, Prep Total Total Total Count ofAverage StdDev of incisionof incision incision start - start - start - actualactualactual start time, start time, start time, MM (J)MM (J)MM (J) Count ofAverage of StdDev of Count ofAverage of StdDev of Count ofAverage of StdDev of Count ofAverage of StdDev of incision start incision start incision start incision start incision start incision start incision start incision start incision start incision start incision start incision start - actual start - actual start - actual start - actual start - actual start - actual start - actual start - actual start - actual start - actual start - actual start - actual start Surgeon Anesthesia Type time, MM (J) time, MM (J) time, MM (J) time, MM (J) time, MM (J) time, MM (J) time, MM (J) time, MM (J) time, MM (J) time, MM (J) time, MM (J) time, MM (J) General Endotracheal Tube 7 18.14 2.4825 20.004.274 18.503.32420.00 6.064019.534.06 General LMA 3 17.67 2.89320.001.00 320.67 5.03 919.443.24 General/Epidural Block1 36.00#DIV/0! 136.00#DIV/0! MAC1 32.00#DIV/0!132.00#DIV/0! Spinal 114.00 #DIV/0!114.00#DIV/0!11 19.645.90 29 20.414.554 18.50 3.32 819.50 5.295219.964.80 General Endotracheal Tube11 34.0012.8412 44.33 18.516-41.33186.15534.6011.173424.44 80.04 General LMA2 28.502.121 21.00#DIV/0! 323.67 5.13 624.834.54 MAC 3 16.006.001 20.00#DIV/0! 1 27.00#DIV/0! 117.00 #DIV/0!618.675.7914 30.14 13.82 15 40.60 18.248-25.00160.22929.0010.834623.74 68.61 Block 1 25.00#DIV/0! 125.00#DIV/0! General Endotracheal Tube 1 47.00#DIV/0! 9 40.67 8.50 4 43.50 General LMA 1 40.00#DIV/0!Anesthesia1138.00Anesthesia 2#DIV/0! 6.45 1#DIV/0!3 53.00 27.67 11.02 155 42.67Anesthesia 3 32.207.879.98 Anesthesia 4 General/Femoral Blk/SciaticBlk1 39.00#DIV/0! 1 48.00#DIV/0!243.506.36 General/Femoral Block3 46.335.69 1 60.00 #DIV/0! 449.758.26 General/Scalene Block Surgeon 1 7.07 242.00 5Ave: 10.2118 min 74.5050.20 2 Ave: 1 20 min 24.7541.00 #DIV/0!10 Ave: 16.42 52.5018.5 min Ave:20 min MAC1 22.00 #DIV/0! 122.00 #DIV/0! Other, see notes Spinal11 St Dev: 2.5 min60.0045.00#DIV/0!#DIV/0!St Dev: 4.3 min 11St 60.00 #DIV/0! min Dev:#DIV/0! 45.00 3.3 St Dev: 6.6 min639.178.11 20 45.45 9.17 9 49.2219.78 535.4013.814044.10 13.03 Grand Total31 28.1612.5764 32.9715.6321 15.10 101.552227.0011.41 13828.22 41.35 Surgeon 2 Ave:34 min Ave:44 minAve:--- minAve:34.6 min St Dev: 12.8 min St Dev: 18 minSt Dev: --- minSt Dev: 11.1 min Surgeon 3 Ave: 47 minAve: 40 min Ave: 43 minAve: 53 min St. Dev : ---St. Dev : 8.5 min St. Dev : 6.5St. Dev : --- Surgeon 1 GastroCopyright 2011 JOP ConsultingSurgeon 2 Cardio11 Surgeon 3 - Ortho 12. Actual Anesthesia Start Time Incision TimeBy Physical Operating RoomSurgeon(All)Notes:Anesthesia Type(All)Why significant variation within each specialty OR?Patient Type DAY SURGERYWhy significant variation by Anesthesiologist? CountAverage Std DevTotalTotalTotalAnesthesiolo* Count Average StdDgist NameOR 1 OR 2 OR 3 OR 4 OR 5 OR 6 OR 7 OR 8 OR11 OR 1 OR 2 OR 3 OR 4 OR 5 OR 6 OR 7 OR 8 OR11 OR 1 OR 2 OR 3 OR 4 OR 5 OR 6 OR 7 OR 8 OR11 A4171110 83321 23 13 37 24 21 17 23 36 3 563511 38 21 8 B 6 852 9 9523 25 14 2732 21 31 411 71210 910 44 2510 C 1 8 463 7 94327 22 24 20 3322 23 29 28495217813 5 45 24 9 D 1131095 39 5213 21 23 44 2127 18 26 295779 6 4310 4 57 2531 E 5 7 441 1213625 31 27 36 2025 20 34 45 214 37 656 52 2711 F102 92 12038 23 22 33 3331 21 35 366014 011 714 55 27 12 G 1 222 5 37 8721 26 232535 21 27 411109 12 13 61655 2612 H 21055 33 3330 27 272720 19 27 32 012 111112 491934 2611 I 3156 64 614410 31 19 22 20 3331 21 32 35 22 710 92212 10 12 1268 2512 J 2 61216 2 14 410 26 24 27 25 2749 24 40 37 012 13 10 15 210 16 572913 K 1114 12 15 5821 19 26 18 3234 26 48 4446 714 32 24 38 31 20 L 4162114 14 3428 19 20 26 29 16 25 35 26 66103816 67 22 10 M 5 1 5 26 34 251 8 11 26 6 N 3 7 856 1 78237 27 23 26 3035 15 31 26 36 22 510 10 291147 2614Grand Total27 117 113 76 3848 125 58 66 27 23 23 28 2828 21 31 37 16 9928 1110 813 15 668 2615 Copyright 2011 JOP Consulting12* OR 4 Neurology Block Time, M-W-F 13. SummaryWas the Implementation successful?Use of Tools and Data AnalysisLeanSix SigmaTrainingCopyright 2011 JOP Consulting13 14. SummaryWhat went wrong?Key StakeholdersMeasurement SystemMarket ShareCopyright 2011 JOP Consulting14 15. SummaryLessons LearnedCultureMeasurement SystemCopyright 2011 JOP Consulting15 16. Questions and More Information? Jim Pearson J.O.P. Consulting, Inc. www.JOPConsulting.com James@JOPConsulting.com 508-429-4823Copyright 2011 JOP Consulting 16