Mater Campus Hospital Development October 2013 Issue #11 Welcome to the MCHD Special LEAN edition, which coincides with the Inaugural Mater LEAN Symposium. For the past two years MCHD have sponsored the LEAN Programme in the Mater Hospital, culminating in this important Symposium, which demonstrates how LEAN processes can successfully be used in healthcare and other business environments. At the heart of LEAN is the voice of the customer, or client, or patient, something we in MCHD have been passionate about in developing the new Whitty building for the Mater Hospital. Creating a caring environment where patients can be treated with dignity, and within which staff can operate to their full capacity, has been the driving mission of the development company. And so as the physical development comes to a conclusion over the coming months we would like to congratulate all the Mater staff who have undergone LEAN training, and whose projects will have a direct, positive impact on patient care and wellbeing, and we wish them every happiness in their new building. Whitty Building Entrance, North Circular Road e LEAN Issue — Celebrating the use of LEAN Six Sigma in assisting successful moves to the Whitty Building
Transcript
Mater Campus Hospital Development
October 2013Issue #11
Welcome to the MCHD Special
LEAN edition, which coincides
with the Inaugural Mater LEAN
Symposium. For the past two years
MCHD have sponsored the LEAN
Programme in the Mater Hospital,
culminating in this important
Symposium, which demonstrates
how LEAN processes can
successfully be used in healthcare
and other business environments.
At the heart of LEAN is the voice
of the customer, or client, or
patient, something we in MCHD
have been passionate about
in developing the new Whitty
building for the Mater Hospital.
Creating a caring environment
where patients can be treated
with dignity, and within which staff
can operate to their full capacity,
has been the driving mission of
the development company.
And so as the physical development
comes to a conclusion over the
coming months we would like to
congratulate all the Mater staff who
have undergone LEAN training, and
whose projects will have a direct,
positive impact on patient care and
wellbeing, and we wish them every
happiness in their new building.Whitty Building Entrance, North Circular Road
� e LEAN Issue —Celebrating the use of LEAN Six Sigma in assisting successful moves to the Whitty Building
“Lean is not mean. It is based on the principles of respect for people and society and doing more within existing resources. It is not about cutting jobs” Dan Jones & Alan Mitchell, Lean � inking in the NHS
“LEAN Six Sigma is a philosophy, rather than a set of tools, that embraces the culture, values and dynamics of an organisation and its members.”
Where did LEAN come from?
The seeds of LEAN were sown by
many different innovators but Toyota
is credited as being the forefather
of LEAN as we know it today.
At the turn of the 19th century,
Japanese weaving loom expert
Sakichi Toyoda invented a powered
loom that saved material and time,
revolutionising the weaving industry.
His son Kiichiro Toyoda went on to
start the Toyota Motor Company in
1930, taking with him his father’s
talent for innovation and clean design.
In the 1940’s Toyota was struggling
after the war, and Toyoda decided to
analyse the production methods of
their American counterparts, Ford,
to see how they could emulate
effi cient manufacturing processes
in order to stay competitive, and
to learn from their problems.
While of course he was extremely
successful, Ford had not developed
a “pull” system driven by customer
requirements for annual model
changes or different colours. The
Ford factory also often suffered
from over-production and therefore
surplus stock, - and all Ford
cars were standard black!
By adding more customer focused
elements Toyoda developed the
universally respected Toyota
Production System, with its key
concepts of continuous improvement,
elimination of waste and clever
use of people and machines.
Why Lean at the Mater?
6 ways LEAN Six Sigma can deliver more:
MATER CAMPUS HOSPITAL DEVELOPMENT
MCO PROJECTS introduced and managed the LEAN Programme for the Mater Hospital in order to address process issues that arose as a result of moving from the old hospital to the new.
» Concise Problem Defi nition
» Accurate Data Collection and Measurement
» Robust Data Analysis
» Realistic Implementation Plan
» Structured Follow Through
» Supportive Facilitation
Defi ne
Measure
Analyse
Implement
Control
» The problem
» Process map the problem area and collect data
» Analyse data, identify root causes of problems, take out wasteful steps
» Draw up the improvement plan and implement solutions
» Monitor and sustain change and draw up roll-out plan
LEAN was chosen because we
needed a structured methodology
to address these issues – one that
recognised that in most instances:
» Staff know the problems – butoften the problems are not
‘owned’ by any one department
» Staff understand the answers – but need facilitation to brainstorm and implement suggested solutions
» LEAN is a non-confrontational and structured way of addressing the questions and converting the answers into action
With the support of staff already
trained in LEAN and the impetus
provided by the move to the new
Whitty Building, LEAN Six Sigma
was identifi ed as a methodology that
could help the hospital implement the
process changes required to make
the new building work for all. MCO
PROJECTS have been working with
the LEAN Steering Group and Five
Workstream Teams in the Mater for
the past two years. Through a “post-
box” event suggestions were taken
from all staff on problem areas
that existed within the hospital and
which required improvement.
SQT Training Ltd. trained more
than 50 staff in the principles
of LEAN, and MCO PROJECTS
facilitated more than 13 groups of
interdisciplinary staff to successfully
address 13 key hospital issues
using LEAN methodology. Based
on this experience the following
observations can be made in
relation to what makes LEAN work:
LEAN follows the DMAIC methodology - the 5-step framework
#1Reduce length of time a
patient spends waiting for
procedures, diagnostics,
a bed, and appointments
#2
Maximise use of expensive
resources and equipment
#3
Release more clinical time
to direct patient care
#4
Reduce unnecessary waste
of resources – food; printing;
cleaning; supplies; storage
#5
Streamline patient-related
communications and
discharge planning
#6
Streamline processes and
manage change when moving
to new physical environments
LEAN
workstream 1Integrated Discharge Planning
workstream 4Wards
workstream 5Ambulatory Care (Out Patients Department)
orkstream 4orkstream 4
LEAN
workstream 2Theatres and Diagnostics
workstream 3Campus Wide Issues
WardsOur Daily Bread Project Reduced food wasted and assisted those unable to feed themselves
Clean Sweep Project Walking waste reduced from projected 22.5 hours to 15 hours per cleaning shift in the 5 Whitty Wards resulting in a cost avoidance of €225,000 per annum
Drug Rounds Project Length of 8a.m. oral drugs rounds on two pilot wards reduced by 30mins
Ask Me, Ask Me, Ask Me » Process changes implemented
to reduce interruption to nursing time by a target of 27%
Campus Wide Issues Replacing the Book - Portering ProjectIdentifi cation of solutions to reduce communication defects resulting in saving of 480 hours of wasted trips per year
Effi cient Printing Project Printing costs reduced by €110,000 for 2013 and €30,000 per annum thereafter
Integrated Discharge Planning Ed to WardsPatient Experience Time from ED to Wards reduced by 26%
Community Care Project Process for referrals to Dublin North Central community for AHP services streamlined with the amalgamation of 37 different referral destinations to one central offi ce and one standard MDT form
Theatres & Diagnostics Reducing Theatre Turnaround Time Project Target theatres downtime reduced by 20 hours per week, following theatre relocation to new Whitty building
Echo Reporting Project Average turnaround time for Echo reports reduced by 60.3%
Ultrasound Waiting Time Project » Patient wait time on day of
appointment reduced by 42% » Working towards reducing waiting times
to KPI of 70 days within 6 months
OPDDoor to Doc – Self-Check-In Project Installation of Self Check-In Kiosks in Mater to improve the patient journey to Outpatient appointments and reduce the number of requests for directions to staff which equate to approximately 1, 800 manhours – 240 days per annum
OPD DNA Project » New OPD DNA Policy implemented » Initial pilot results showing
improvement in DNA Rates
OCTOBER 2013 • ISSUE 11MATER CAMPUS HOSPITAL DEVELOPMENT
LEAN
� e Mater LEAN Programme involved 5 Workstreams, representing core areas of activity within the hospital. Within each Workstream, problem issues were identi� ed by sta� and turned into projects during Green Belt training. � e following is a synopsis of the results so far from the 13 completed projects.
“Before the project, everyone had a di� erent way of carrying out the oral medication round. Now everyone knows which trolley the drugs are for and knows that they will be put away- the pilot helped structure and standardise”Mary Cleary CNM2 St. Agnes's Ward
"Lean programme provided the tools to approach a complex issue in a focused and structured manner"Chris Roche, CNM3,
Emergency Department
MATER CAMPUS HOSPITAL DEVELOPMENT OCTOBER 2013 • ISSUE 11
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A Lean Case Study:Clean Sweep
A Lean Case Study: Drugs Round Project – low cost solutions allowing sta� to do more with existing resources
� e Process
The new hospital is larger than the
old, which resulted in increased
quotes for cleaning. Clean Sweep was
generated by the hospital’s need to
minimise these costs while maintaining
compliance with external standards.
The LEAN Six Sigma system was
applied to identify and reduce waste
inherent within the existing process
to achieve these objectives.
De� ning & Analysing � e Process
The daily morning cleaning processes
on St Vincent’s ward in the existing
hospital were mapped, timed and
projected onto the plans of the new
ward. The most effi cient route was
identifi ed, measuring distance travelled
in cleaning processes, combined with
the number of journeys that a
cleaning operative was required
to make. When these two walking
distances were combined, it was
identifi ed that cleaning operatives
would spend 13 km in transit cleaning
just one ward! By identifying and
analysing the root causes – lack of
appropriate equipment, high number
of journeys, and a need for a clear
communication system with the
nursing staff – the LEAN Workstream
team were able to trial new systems
to improve the process applying the
LEAN Six Sigma philosophy.
Improving & Controlling � e Process
Integrated cleaning trolleys were
designed by the project group and
introduced in order to impact the
identifi ed issues. Existing mobile
waste cages were also reconditioned
and used in bin collection to reduce
the walking required by the cleaners.
The number of bins and trolleys
were reviewed and reduced on the
ward, with recycling schemes also
put in place. A waste tally, checklists
and escalation paths all helped
to make the ward more effi cient
in their waste management.
� e Results So Far
The project resulted in a reduction
of walking required for cleaning
operatives from 13km to 2km.
Furthermore the total time taken to
clean a ward reduced from 22.5 hours
per ward down to 15 hours per ward.
� e Process
The oral drug administration round
is one of the fundamental roles
performed by nursing staff, providing
one of the most direct associations
with patient recovery and accounting
for up to 20% of a nurse’s working
day. Before the LEAN project, an
average 8a.m. oral medication drug
round was taking 125 minutes.
The goal of this project was to
reduce the time it takes to complete
drugs rounds by fi rst identifying
and then eliminating non-essential
steps and reducing distractions
/ interruptions to nurses carrying
out the round. In LEAN terms,
removing the waste and adding value.
Ultimately, the improvements aimed
to reduce the risk of medication
errors and release nursing time
back to direct patient care.
Improving and controlling the process
Interruptions being experienced by
nurses carrying out drugs rounds
ranged from interruptions from
patients and colleagues, to drugs
not available on the trolley, to queries
regarding prescriptions on patient
charts. Visual cues were used to
prevent staff, patients and visitors
from interrupting and if interruption
did occur, they were redirected to
a nurse not administering drugs.
The white board in the clean utility
room was utilised to improve
communication regarding supply of
drugs not available on the ward at
the time of the drugs round. This
improved standardisation of how drugs
were ordered and stored, assisting
both ward and pharmacy staff.
A 5S was carried out on the drugs
trolleys in the pilot ward and a
standardised methodology for how
drugs are stored on the trolley was
agreed. Andons (visual indicators)
were utilised to indicate when stocks
needed to be replenished and when
there were queries on drug charts.
A checklist for Drug Round
Preparation was laminated and
attached to the inside of the
trolley for ease of reference.
� e Results So Far
A 5 week pilot on two wards resulted
in a time saving of 30 minutes on the
8am drugs round. This equates to
a saving of 365 man hours/30days
per year which can be re-directed
to patients. The process has now
been adopted permanently on St.
Agnes’s ward and a programme for
roll-out to other wards is planned.
Interruptions reduced by 36.5%, and
variation in drug round completion
times was reduced by 27 minutes.
90% of staff who participated in
feedback survey felt the changes
had improved drugs rounds.
� e risk to a drug administration increases by 12.7% with each interruption, is doubled if interrupted 4 times and tripled if interrupted 6 times
"� e LEAN methodology gave us a new outlook on our service- a structured way of reviewing our processes and increasing our e� ciencies"Eileen McGovern - Contract Manager, Noonan
Project Group: Eileen McGovern - Contract Manager, Noonan and Sharon Toal, HR Business Partner, MMUHFacilitated by Aileen Igoe for MCO Projects
Project Group: Mary Cleary - CNM2 St. Agnes's Ward, Mariosa Kieran - Clinical Pharmacy Services Manager and Maria Creed - Drug Safety Facilitator Facilitated by Aileen Igoe for MCO Projects
