Using Lean Methods to Cash In On the Trifecta: Time, Space & Supplies Sharon Cusanza, MSN, RN, CPHQ
Presenter Disclosure Information Sharon Cusanza, MSN, RN, CPHQ Using Lean Methods to Cash in on the Trifecta: Time, Space & Supplies Financial Disclosure: None Unlabeled/Unapproved Uses Disclosure: None
Learning Objectives Describe the 5S Lean methodology Identify at least two strategies to reduce waste associated with healthcare delivery in any acute care facility
Complexity Compression Complexity Compression* defined: What nurses experience when expected to assume additional, unplanned (unexpected) responsibilities while simultaneously conducting their usual, multiple responsibilities during a work shift. *Krichbaum, K., Diemert, C., Jacox, L., Jones, A., Koenig, P., Mueller, C., & Disch, J. (2007)
Setting Strategic Priorities CNO Span of Control and Influence Setting future direction Getting organizational buy-in Determining priorities understanding the environment Measuring impact through small planned steps
The New Model for Magnet
Transformational Leadership Transactional Leadership Adapted from McGuire & Kennerly (2006). Nursing Economic$, 24(4), 179-185.
OMC Irritants about your work situation that can t t be changed by you Predominate themes/subthemes Workload Nurses care practices Communication Technology/equipment Lateral violence Staffing Supply/demand Unfairness Leadership Mistrust Disengagement Insufficient leadership
OHS Work arounds you have used Workload Hoard supplies Keep par levels high Hide equipment Don t wait on others, do everything yourself Staffing Redivide assignments amongst selves
Setting OHS Strategic Priorities Lateral violence Crucial conversations Communication Texting Hunting / Gathering Lean 5S Boomers Gen X Jones Gen Y
LEAN The relentless pursuit of the perfect process through waste elimination A set of operational concepts A set of tools used in a variety of industries to improve business processes that include Service industries Healthcare A philosophy that helps drives Efficiency Employee empowerment Change at the grass roots Just-in-Time Customer Focus Continuous Improvement Standardization Kaizen
Benefits of Lean Increased process velocity Reduced waste Improved customer experience Reduced cycles Better delivery More capacity Better quality/ fewer errors Improved productivity BEFORE AFTER Work. Value added time Wait/Waste. Non-Value added time Lean attacks waste here
What is unique about Lean? Energizing your staff through process improvement Teams are composed of process experts, the people that do the job everyday Staff have direct input into the changes that will take place in the workspace, helps sustain change Opportunity to pilot improvements to understand how they affect workflow by try storming ideas 5S events lay the foundation for quality as abnormalities can be detected immediately
5S SORT: : Separate the needed items from the un needed needed items which are then removed to a red tagged location SET IN ORDER: : Arrange items so that they are easy to find and put away SHINE: : Clean the area and maintain equipment on a regular basis STANDARDIZE: : Ensure sort, set in in order, and shine are consistently followed across all users SUSTAIN: : Maintain and improve sort, set in in order, shine, and standardize
5S Data Collection Methods I think Circle of Work Observations for MD, RN, Unit Secretary & RT Spaghetti Map MD, RN, Unit Secretary & RT 5S Scorecard Voice of the Customer Interviews with staff What works and what doesn t
Circle of Work Observations
Spaghetti Map
5 S Scorecard
5S Kaizen Event Assign the 5S team Two leaders 12 to 15 members including nurses, materials management, plant operations, pharmacy, respiratory Divide into groups Equipment team Medication Room/Nurses Station Supply Team Do the work over 4 days Evaluate outcomes
Kaizen Event
Before & After
Before & After
30 Day Action Plan to Sustain No 1 Issue Area designated for broken equipment Owner Target Date Julie May 10, 2009 Update Comments 2 Shredder Bin & Form Holder for Station 1 Jarrett May 4, 2009 3 Forms Closet Shelving & Light Jarrett May 4, 2009 4 Phones for Nursing Stations Juanita May 10, 2009 5 Add shelf at Case Mgmt/Social Worker/Md Work Stations Jarrett May 15, 2009 6 Supply needs in OR (revisit supply cabinet contents) Jarrett May 15, 2009 7 Schedule Floor Cleaning Jarrett May 15, 2009 8 Shelves above Pyxis Jarrett May 4, 2009 10 Wall Patch work and painting Jarrett May 17, 2009
5S Strategies
5 S Scorecard 2009 5S Scorecard WB ED BR - Telemetry BR - 5th Kenner - OR WB - ICU Location WB - 3rd WB - 4th WB - OR OMC - OR OMC - IMTA OMC - 11th OMC - 9th 0 Back Sliding 5 Just Beginning10 Maintaining 15 20 Standards 25 30 the basics Consistent Visual Workplace Established Taking it to the next level Baseline Score Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09
Summary Findings from a study on Complexity Compression at OHS uncovered workarounds that fostered inefficiency. Transformational leadership was used to develop innovative interventions. Lean processing became the methodology to improve efficiencies. 5S strategies include SORT, SET IN ORDER, SHINE, STANDARDIZE, and SUSTAIN
References Chalice, R. W. (2005). Stop rising healthcare using Toyota lean production methods. Milwaukee, WI: Quality Press. Ebright, P. R., Patterson, E. S., Chalko, B. A., & Render, M. L. (2003). Understanding the complexity of registered nurse work in acute care settings. Journal of Nursing Administration, 33(12), 630-638. Florida Organization of Nurse Executives (FONE) Research Committee (Brown, C.L., Schmidt, L.A., Rivers, R., Byers, J.). Environments that support nursing: Research shows Magnet status makes a difference. Atlanta, GA: Eleventh National Magnet Conference: October 3, 2007. Krichbaum, K., Diemert, C., Jacox, L., Jones, A., Koenig, P., Mueller, C., & Disch, J. (2007). Complexity compression: Nurses under fire. Nursing Forum, 42(2), 86-94. McGuire, E. & Kennerly, S. (2006). Nurse managers as transformational and transactional leaders. Nursing Economic$, 24(4), 179-185.
ACKNOWLEDGEMENTS OHS Lean Leaders Deanna Davis, BS, MBA Sarah Roberts, OT, BS, MHCA Paul Tobin, MSW, MS David Griener, BS, MHA Jeff Donaldson, BS, MBA Melissa Adams, BS, RN, MHCA Ann Moll, BS, RN, CNOR Megan Halbrooks, BBA LSU Industrial Engineering Graduate Students
ADDITIONAL ACKNOWLEDGEMENTS Karen L. Rice, DNS, APRN, ACNS BC, ANP SueEllen Pinkerton, PhD, RN, FAAN Kathy Jankowski, RN, MSN, MBA
Star 7 Strategies QUESTIONS???