Laguna Honda Hospital and Rehabilitation Center Value Stream #1 Admissions Kaizen Workshop #3 Room Readiness Report out.

Transcription

1 Laguna Honda Hospital and Rehabilitation Center Value Stream #1 Admissions Kaizen Workshop #3 Room Readiness Report out June 12 16, 2017

2 Value Stream Future Map Nov 2016 This is how the value stream mapping team envisioned the future room readiness process, after a bed/room becomes vacant. Pre-Admissions February Kaizen 1 Clinical Assessments April Kaizen 2 Room Readiness June Kaizen 3 2

3 A3 A3-T TEAM CHARTER Date: rev. 8/15/17 Reporting Unit: Laguna Honda Hospital & Rehab Ctr Theme: New Admissions Processes original date - 12/2/16 PROBLEM STATEMENT By 2020, the percent of seniors (>60 years old) in San Francisco will increase to 21%. LHH has a 150 year history of providing underserved adult with disabilities and seniors needing acute and skilled nursing services. In FY 15-16, LHH served 1,214 residents, with 65% over 60 years of age, and admitted 483 new patients. As DPH and SFHN prepares for value based care, it is important that LHH addresses patient experience, fiscal stewardship and quality care. First impressions to a new care setting for new patients and their families make a difference. Our current admission process is flawed: increased redundancies, multiple messaging, complaints from referral sources, increased wait list for approved patients, chaotic workflows, breakdowns in communications, staffing inconsistencies and problems with internal relocations. We have the greatest opportunity to improve how we welcome and care for San Franciscans needing post acute care at Laguna Honda Lead Time (Days) Wait Time Version 14 rev. 8/15/17 PROPOSED ACTIONS The ideas w ere categorized into major themes. Key ideas and concepts w ithin these categories are listed below : Improvements to Pre-Admissions Clinician Workflow Electronic Notification EVS Terminal Cleaning Food Services Operations Analysis 2014 rona consulting group TARGET STATEMENT While we moved to the new hospital six years ago, the admissions and referrals process and staff working on these processes have changed overtime. New steps and processes have been added on top of existing systems and documentation in place, thus increasing duplication burder for the Admissions & Screening Committee and also referring agencies/organizations. In addition, we have received feedback fhtat our admissions referrall process was cumbersome. Within 18 months, Admissions at LHH will achieve the following targets (subject to change based o n Kaizen team wo rksho p) : M ATERIALS AND SUPPLIES Locations and Par Levels of supplies and materials are standardized. DELIVERY Reduce Admission Lead Time by 50% Admit patients within 2 days of admission approval 75% of vacant beds are filled with new patients the next day QUALITY Staff satisfaction COST Reduce cost per patient bed by 10% Our observations find the following issues contributing to the current state: Lead Time (Days) Wait Time ACTION ITEM KW 1 : Pre-Admit Process KW 2 : Team Clinical Assessments KW 3 : Room Readiness PROJ 1 : RCT Notification Upon Resident Arrival/Admission PROJ 2 : Patient Arrival PROJ 3 : Timely Completion of Documents H & P for Coding PROJ 4 : Advance Directive Upload PROJ 5 : PASRR Upload IMPLEMENTATION PLAN RESPONSIBILITY Donna Dr. McShane John Grimes Jennifer and Elizabeth Sheri and Irin Debra and Michael Jennifer and Michelle Michelle and Elizabeth DUE DATE Feb Apr Jun Jun May Jul Jun Mar JDI 1 : Admit Donna Dec JDI 2 : Upload "follow me" forms Michelle Feb Key: KW - Kaizen ANALYSIS PROJ - Project Color Key: JDI - Just Do It - plan has been completed Completed! Not Yet Done CHECK AND ACT 1) Projects Status Checks: Monthly eview with Responsible Parties. As of 8/15/17, all Projects 1, 2, 4 & 5 are completed. Project 3 has been started with monitoring in place. 2) Just Do Its Status Checks: Weekly review with Responsible Parties. As of 8/15/17, all Just Do Its are completed. 3) Kaizen Events: Monitor implementation of Kaizen improvements weekly and workshop targets with completion of 30, 60 and 90 day reports as well as audits of standard work. As of 8/15/17, the 3 Kaizens have been completed. Refer to specific Kaizen documents. 4) Quarterly reviews with executive team. As of 8/15/17, updates were provided at Exec and/or Quality Council meetings. 5) Development of visual workplace and communication vehicles. As of 8/15/17, the visibility wall ouside A3219 is updated, as well as the production board posted outside the Strategic and Performance Management Department's Office by Administration. 3

4 Kaizen 3 Room Readiness A3 Problem Statement: Vacant rooms are scheduled to be occupied by a new admission within 24 hours of discharge. However, the process of cleaning and repairing a room after a discharge can take several days, which often leaves rooms unprepared and/or not presentable when new residents arrive. During Kaizen week, there were 13 rooms/beds that were vacant for an average of 28 days. Of the 13, 69% of the rooms were not ready. 4

5 Initial Target Sheet Three Targets: 1) 100% Facility Assessment when room is vacant 2) 100% Room Readiness Checklist completion by Facility Services, EVS and Nursing 3) 100% room is ready within 24 hours of vacancy 5

6 Current State of Room Readiness 6

7 Current Process Cleaning the Room Utility worker changes curtains Nurses (PCA) makes the bed Porter mops the floor 7

8 Genchi Genbutsu (Going To See) In the Gemba (Real Place) Go see. Ask questions. Show respect. -Taichi Ohno We went to the gemba to understand how rooms are prepared for the new patient. 8

9 Gemba Walk 9

10 Resident Experience 10

11 Waste Gathering 11

12 Wastes Observed from the Gemba Inventory Low beds in vacant rooms Motion Porter kept leaving room to get supplies Overproduction Bed needed to be made twice due to stained linen Defect Broken shower head Overprocessing Multiple communication methods in vacant room notification Waiting Work order entry incomplete, requiring engineer to go find out the problem 12

13 Idea #1: Create Standard Workflow <Insert 1-2 photo(s) of idea generation session here> Pictures of groups, and ideas 13

14 Idea #2: Submit Work Order Timely 14

15 Understanding Nursing and EVS roles 15

16 Room Readiness Checklist Checklist Team in action 16

17 Running experiments define, run, evaluate results, improve Simulation experiment at the Gemba 17

18 Simulation S3 Facility Assessment 18

19 Simulation S3 Nursing Assistant cleans bed 19

20 Simulation S3 Porter cleans room 20

21 Standard Work Instructions: 6 21

22 Interdepartmental Collaboration Sequence Steps Checklist 22

23 Work Product #1: Low Bed Inventory Problem: Where are all our low beds? Tools Needed: Inventory Assessment Fang created a data collection tool to get a snapshot of where low beds are on the LHH neighborhoods Experiment: Ed Guina coordinated and centralized the data collection. Data received within 3 hours of requesting to complete the spreadsheet. Results: 2 low beds not in use were found. We can save money by returning the rental beds. 23

24 Work Product #4: Standard Work for Resident Belongings Problem: Resident belongings were not packed after discharge and variation in how and where it is stored. Tools Needed: Standard work instructions Packing boxes Labels Experiment: Test standard work instructions for packing resident belongings. Results: Developed standard work instructions for nursing staff. Two new forms now on the Intranet forms Resident belonging label Notice of unclaimed property 24

25 Work Product #3: Work Order New Feature Problem: Unclear work order entries Tools Needed: Work order data field change Experiment: Added a new field in the work order entry, requesting to enter the name of the person who found the problem/issue New entry field: First and Last Name of who reported problem Results: Without informing users, 78% entered a name in the newly created field. This will reduce the time wasted in locating the person who submitted the work order to get more details and/or the Facility Services staff can fix the problem quicker. 25

26 Improvement Summary Using Lean Focus Impact/Lean Principle Agreement on definition of room readiness Interdepartmental room readiness checklist and sequencing of steps by Facility Services, EVS and Nursing Standard work for completing discharged residents belongings, packed in boxes, labeled and moved to K5 Creating a Low bed inventory process Improve work order entry field Residents are admitted to a room that has passed inspection from Nursing, EVS and Facility Services (respect for people) Vacant room notification sets up sequence of room preparation steps for Facility Services, EVS and Nursing (achieving flow benefits of pull production and signaling) Decreases excess motion, resources, and overprocessing from duplication and repetitive work (eliminating wastes) By ensuring availability of inventory, Residents have the right type of bed that meets their clinical care needs (appropriate care and mistake proofing) By identifying the person who reported the issue/problem in the vacant room, the Facility Services staff assigned to fix the reported problem will be able to receive more information (standard work instructions) 26

27 Questions and Comments Thank you. Room Readiness Kaizen Improvement Event Executive Sponsor: John Grimes Process Owners: Diana Kenyon, Jacky Spencer-Davies and Maxwell Chikere 27