Time and Motion Studies

1. Time and Motion Studies AKA Spaghetti Mapping Video- from Productive Ward in the UK. No omnicells of pyxis. Psych RN retrieving an emergency medication Calculate how much time it takes her to retrieve the medication Identify non-value added time from value-added time. Think about processes within your own facility that would make a good spaghetti map (e.g. MCMC – housekeepers room cleaning procedure)Video- from Productive Ward in the UK. No omnicells of pyxis. Psych RN retrieving an emergency medication Calculate how much time it takes her to retrieve the medication Identify non-value added time from value-added time. Think about processes within your own facility that would make a good spaghetti map (e.g. MCMC – housekeepers room cleaning procedure)

2. Purpose: Identifies wasted motion and time. Used to enhance efficiency and productivity of staff time. Also used to create a visual of a process. Use your VSM to create a visual path. How to do it: Follow a staff member conducting a task. Use a map of the area the task is being conducted. Use a stopwatch to calculate time between each step of the process. May also count steps, however time yields better cost data. Calculate value added time=time spent completing the particular task (e.g. doing a lab test), non-value added but necessary time (e.g. calibrating the lab equipment), and non-value added time (e.g. walking 50 steps to a storeroom to retrieve lab testing supplies because they weren’t stocked in the lab). Example: Following a nurse on her shift using a map of the unit This particular nurse spent 91 minutes of her 8 hr. shift searching and retrieving supplies for patient care. The 91 minutes is non-value added time that is not spent on direct patient care. Purpose: Identifies wasted motion and time. Used to enhance efficiency and productivity of staff time. Also used to create a visual of a process. Use your VSM to create a visual path. How to do it: Follow a staff member conducting a task. Use a map of the area the task is being conducted. Use a stopwatch to calculate time between each step of the process. May also count steps, however time yields better cost data. Calculate value added time=time spent completing the particular task (e.g. doing a lab test), non-value added but necessary time (e.g. calibrating the lab equipment), and non-value added time (e.g. walking 50 steps to a storeroom to retrieve lab testing supplies because they weren’t stocked in the lab). Example: Following a nurse on her shift using a map of the unit This particular nurse spent 91 minutes of her 8 hr. shift searching and retrieving supplies for patient care. The 91 minutes is non-value added time that is not spent on direct patient care.

3. Time and Motion Studies By implementing measures to reduce or eliminate non-value added time we reduced the non-value added time to O. non-value added but necessary time= retrieving medications, calling physicians, etc. value added time is time the nurse spent directly with the patient. eliminated 3 of the six inventory carts saving the dept $1500/mo.By implementing measures to reduce or eliminate non-value added time we reduced the non-value added time to O. non-value added but necessary time= retrieving medications, calling physicians, etc. value added time is time the nurse spent directly with the patient. eliminated 3 of the six inventory carts saving the dept $1500/mo.

4. 8/18/2012 4 Following multiple providers using color coding. Difficult to do without video taping. Shows inefficiencies of work for a designated team of caregivers. Good for developing standard work processes for a team Advantages of videotaping Can be replayed many times Observe things you may not have seen while being the moment. Time stamp Disadvantages Makes staff very nervous. Must provide clear explanations of what you are doing and how the information will be used and not used. Patient privacy. Faces must be shadowed.Following multiple providers using color coding. Difficult to do without video taping. Shows inefficiencies of work for a designated team of caregivers. Good for developing standard work processes for a team Advantages of videotaping Can be replayed many times Observe things you may not have seen while being the moment. Time stamp Disadvantages Makes staff very nervous. Must provide clear explanations of what you are doing and how the information will be used and not used. Patient privacy. Faces must be shadowed.

5. This is an example of categorizing activities . May want to use it to get ideas of what categories of care to look at when mapping. This is an example of categorizing activities . May want to use it to get ideas of what categories of care to look at when mapping.

6. 5S Reducing Time and Motion

8. 8/18/2012 8 What is 5S: technique used to organize a particular area of work Purpose: enhance efficiency and save time and generally make the area more pleasurable to work in. All supplies needed for work should be within arms reach for the greatest efficiency and productivity. This is called standard work. How to do it: Completely clear out the room being 5S’d. Tag items for trash, retain but store elsewhere, retain in existing room. Clean the room. Organize like items together (i.e. all IV supplies are stored together to decrease motion when retrieving). Label shelves, containers. Tape parking squares along the floor for storage of equipment (i.e. wheelchair). Place a laminated picture of the item on the wall above the parking space so it’s obvious what’s missing. Make sure areas are all clear for ease of movement when retrieving supplies. Make an inventory list of everything that belongs in that room. Set par levels if necessary. Audit monthly to ensure the room stays 5S’d. 5S is probably one of the most popular and easiest techniques to do. You will get the biggest bang for your buck when doing a 5S project. It provides instant gratification because it’s visual. EVERYONE understands the value of 5S. What is 5S: technique used to organize a particular area of work Purpose: enhance efficiency and save time and generally make the area more pleasurable to work in. All supplies needed for work should be within arms reach for the greatest efficiency and productivity. This is called standard work. How to do it: Completely clear out the room being 5S’d. Tag items for trash, retain but store elsewhere, retain in existing room. Clean the room. Organize like items together (i.e. all IV supplies are stored together to decrease motion when retrieving). Label shelves, containers. Tape parking squares along the floor for storage of equipment (i.e. wheelchair). Place a laminated picture of the item on the wall above the parking space so it’s obvious what’s missing. Make sure areas are all clear for ease of movement when retrieving supplies. Make an inventory list of everything that belongs in that room. Set par levels if necessary. Audit monthly to ensure the room stays 5S’d. 5S is probably one of the most popular and easiest techniques to do. You will get the biggest bang for your buck when doing a 5S project. It provides instant gratification because it’s visual. EVERYONE understands the value of 5S.

9. 5S Use this diagram as a poster for units that are being 5S’d or COMING SOON—Orthopedic storeroom will be 5S’d.Use this diagram as a poster for units that are being 5S’d or COMING SOON—Orthopedic storeroom will be 5S’d.

10. 5S 5S – a process to ensure work areas are systematically kept clean and organized Places a team in control of their work place Begins the focus on waste elimination Establishes a foundation on importance of Standards Improves employee morale 5S ensures work areas are systematically kept clean and organized, ensuring patient and staff safety while providing the foundation on which to build a Lean Healthcare system. 5S ensures work areas are systematically kept clean and organized, ensuring patient and staff safety while providing the foundation on which to build a Lean Healthcare system.

11. 8/18/2012 11 Taking a minimalism approach is the goal for 5S. Just what you need when you need it and how fast can you retrieve it. Sorting is the first order of business. Red TagTaking a minimalism approach is the goal for 5S. Just what you need when you need it and how fast can you retrieve it. Sorting is the first order of business. Red Tag

12. Red Tag Use the “red tag” strategy Garbage Misplaced Out of date “Up for grabs” 8/18/2012 12 Red tag in handouts Explanation of how to use Red Tags in your handouts. Sort items into categories. Remove from dept., repair, keep in dept.Red tag in handouts Explanation of how to use Red Tags in your handouts. Sort items into categories. Remove from dept., repair, keep in dept.

13. The 5Ss Store A place for everything and every-thing in its place, clean and ready for use – Simplify - use footprints, boards, labeling & color 8/18/2012 13 Be creative when using visuals. Yellow bins for urinary supplies Blue for respiratory Red for IVBe creative when using visuals. Yellow bins for urinary supplies Blue for respiratory Red for IV

14. 8/18/2012 14 Note like items are together so one doesn’t have to travel all over the room to retain supplies.Note like items are together so one doesn’t have to travel all over the room to retain supplies.

15. 8/18/2012 15 Note organizers in drawers for like items. May also put the name of the item and par level on the organizer sections. Take a picture of the drawer and hang in on the inside door of the cupboard so everyone knows what the drawer is supposed to look like.Note organizers in drawers for like items. May also put the name of the item and par level on the organizer sections. Take a picture of the drawer and hang in on the inside door of the cupboard so everyone knows what the drawer is supposed to look like.

16. 8/18/2012 16 Notice color coded cards and bins. Good for paper flow.Notice color coded cards and bins. Good for paper flow.

17. 8/18/2012 17 Identifies where each notebook belongs to maintain orderIdentifies where each notebook belongs to maintain order

18. Using “Visuals” to Keep Everything in it’s Place Easy to identify when something is not in it’s place. Use pictures liberally. Better than written signs.Easy to identify when something is not in it’s place. Use pictures liberally. Better than written signs.

19. Before After Wasted space filled with items that were not used frequently. Put items needed for patient care close to where patients are located. Wasted space filled with items that were not used frequently. Put items needed for patient care close to where patients are located.

20. Target Condition Sheet ? ? Put sizes in order (i.e. ascending or descending) so it’s easy to retrieve the item and also see when a size is missing. Should not have to move items out of the way to retrieve needed supplies. Put sizes in order (i.e. ascending or descending) so it’s easy to retrieve the item and also see when a size is missing. Should not have to move items out of the way to retrieve needed supplies.

21. Where is this instrument’s home? Shadow diagrams make it easy to know where an item goes even if you don’t know the name of the item.Shadow diagrams make it easy to know where an item goes even if you don’t know the name of the item.

22. These are some signs meant to be used on the floor of the parking space for each of these items. available from a site on the internet. Laminated pictures are easy and cheaper. Hang pictures on the wall above the parking place for a particular item. Everyone knows what belongs there. These are some signs meant to be used on the floor of the parking space for each of these items. available from a site on the internet. Laminated pictures are easy and cheaper. Hang pictures on the wall above the parking place for a particular item. Everyone knows what belongs there.

23. The 5Ss Shine Unnecessary items removed Supplies organized and labeled Floors and aisles clear Equipment clean and functional Work instruction in proper place 8/18/2012 23 Oregon Association of Hospitals & Health Systems Rooms will most always need a thorough cleaning, but not necessarily painting. Keep costs low. Pictures, tape, organizers, and shelving are relatively inexpensive. Staff time is always limited and expensive so do all your organization of the project (i.e. supplies needed) before starting the sorting process.Rooms will most always need a thorough cleaning, but not necessarily painting. Keep costs low. Pictures, tape, organizers, and shelving are relatively inexpensive. Staff time is always limited and expensive so do all your organization of the project (i.e. supplies needed) before starting the sorting process.

24. The 5Ss Standardizing Document and follow the best known methods – revisit steps 1-3 Conduct weekly audits Determine root cause of abnormalities Implement countermeasures for prevention 8/18/2012 24 Oregon Association of Hospitals & Health Systems Calculate the costs of returning unused items to central supply. That money can be used for your 5S expenses. ALWAYS calculate your savings from the 5S project (e.g. how much time is saved when a staff member doesn’t have to spend 10-15 min. searching for a patient care item. Calculate the costs of returning unused items to central supply. That money can be used for your 5S expenses. ALWAYS calculate your savings from the 5S project (e.g. how much time is saved when a staff member doesn’t have to spend 10-15 min. searching for a patient care item.

25. The 5Ss Sustaining Hold the gains, continue to improve, and make 5S a way of life Everyone must be committed Use checklists for monitoring Quantify results of workplace inspections Display each area’s results 8/18/2012 25 Oregon Association of Hospitals & Health Systems Display before and after pictures in the 5S area to remind everyone what the area looked like before 5S. They do FORGET. Staff rotation for auditing. Make it easy and quick.Display before and after pictures in the 5S area to remind everyone what the area looked like before 5S. They do FORGET. Staff rotation for auditing. Make it easy and quick.

26. Stabilize – 5S We’ve just reviewed the five phases of steps to 5S. Each S has its own process to complete. Each of the photos above show examples of 5S in action. We’ve just reviewed the five phases of steps to 5S. Each S has its own process to complete. Each of the photos above show examples of 5S in action.

27. How to do 5S in one area

28. Benefits of 5S Implementation Benefits to Patients Benefits to Providers and Staff Benefits to Your Organization Let’s discuss some of the benefits of 5SLet’s discuss some of the benefits of 5S

29. Benefits to Patients A neat and clean healthcare facility: Produces fewer clinical defects Means patients do not wait so long for treatment Is cheaper to operate and helps reduce healthcare costs Promotes a sense of well-being that contributes to and provider morale Fewer clinical defects Clutter leads to mistakes, delays, greater expense, and staff frustrationFewer clinical defects Clutter leads to mistakes, delays, greater expense, and staff frustration

30. Benefits to Providers and Staff Opportunity to provide creative input regarding how your workplace should be organized and how your work should be done. Make your workplace more pleasant to work in. Make your job more satisfying. Help you know what you are expected to do and when and where you are expected to do it. Make it easier to communicate with everyone you work with. Be creative! There are no creative RULES in 5S. You as many visuals as you like Think about how easy it will be to train a new staff member in a 5S’s environment. Visuals greatly improve communication for everyone. Staff won’t have to ask where an item is located or what an item is if they don’t know. People take pride in clean and efficient workplace. If you have ever moved into a brand new hospital or even a brand new home, you know the feeling of wanting to keep that environment pristine. Be creative! There are no creative RULES in 5S. You as many visuals as you like Think about how easy it will be to train a new staff member in a 5S’s environment. Visuals greatly improve communication for everyone. Staff won’t have to ask where an item is located or what an item is if they don’t know. People take pride in clean and efficient workplace. If you have ever moved into a brand new hospital or even a brand new home, you know the feeling of wanting to keep that environment pristine.

31. Benefits to Your Organization Raising quality Lowering costs Reducing the time patients wait for treatment Promoting safety Building patient loyalty Promoting financial growth for the organization.

32. Zero Defects Brings Higher Quality Clinical defects result from many causes, including using the wrong medicine and treating the wrong patient. Sort and Set in Order prevent these types of errors. Keeping equipment and the work environment clean reduces the amount of walk time spent searching for missing supplies The effects of 5S implementation increase hours at the bedside and contribute to fewer clinical defects.Clinical defects result from many causes, including using the wrong medicine and treating the wrong patient. Sort and Set in Order prevent these types of errors. Keeping equipment and the work environment clean reduces the amount of walk time spent searching for missing supplies The effects of 5S implementation increase hours at the bedside and contribute to fewer clinical defects.

33. Zero Waste Brings Lower Cost Healthcare facilities are storehouses of waste. 5S implemenation can help eliminate the following types of waste: Excessive amounts of supplies Use of excessive amounts of storage space Searching or waiting for medication or equipment that are hard to find Motion waste, stemming from poorly located equipment and suppliesHealthcare facilities are storehouses of waste. 5S implemenation can help eliminate the following types of waste: Excessive amounts of supplies Use of excessive amounts of storage space Searching or waiting for medication or equipment that are hard to find Motion waste, stemming from poorly located equipment and supplies

34. Zero Delays Mean Patients Don’t Wait In healthcare facilities that lack thorough 5S implementation, deadlines whiz by and patients wait while everyone is busy trying to remember what they didi to the last patient, searching for equipment and supplies, waiting for doctors to make rounds, waiting for laboratory results, etc. It’s difficult to keep patients from waiting in the face of problems such as wasteful motion and too manyu errors and clinical and administrative defects. When these problems are eliminated, processes become more reliable and patients are treated when they need to be seen.In healthcare facilities that lack thorough 5S implementation, deadlines whiz by and patients wait while everyone is busy trying to remember what they didi to the last patient, searching for equipment and supplies, waiting for doctors to make rounds, waiting for laboratory results, etc. It’s difficult to keep patients from waiting in the face of problems such as wasteful motion and too manyu errors and clinical and administrative defects. When these problems are eliminated, processes become more reliable and patients are treated when they need to be seen.

35. Zero Disorder Promotes Safety Injuries to patients or staff can be expected when equipment, medications, and supplies are left in hallways and when supplies are pile dhigh in storage areas, or when work surfaces and equipment are covered with dust and other contaminants.Injuries to patients or staff can be expected when equipment, medications, and supplies are left in hallways and when supplies are pile dhigh in storage areas, or when work surfaces and equipment are covered with dust and other contaminants.

36. Zero Abnormal Conditions Bring Better Process Availability When daily maintenance tasks are intefrated with daily cleaning tasks, providers notice problems in the process before they cause clinical defects and delays. In this way, work areas and equipment are more consistently ready for use. Clean weel maintained work areas and equipment mean that processes break down less frequently and are easier to diagnose and repair when breakdowns do occur.When daily maintenance tasks are intefrated with daily cleaning tasks, providers notice problems in the process before they cause clinical defects and delays. In this way, work areas and equipment are more consistently ready for use. Clean weel maintained work areas and equipment mean that processes break down less frequently and are easier to diagnose and repair when breakdowns do occur.

37. By moving linen cart next to the blanket warmer, it saves a distance of 85 feet each way at an average of 15 lbs. of blankets per trip! St. Charles WOW project.St. Charles WOW project.

38. 528.52-499.69-54.38$83.21 $83.21 x 365 Days = $30,371.65 Savings/Year  $83.21 may not sound like much but when you multiply it over a year’s time you can see how significant the savings is. When you consider each department in a hospital could be doing multiple small implementations like this one, the savings easy can reach hundreds of thousands of dollars.$83.21 may not sound like much but when you multiply it over a year’s time you can see how significant the savings is. When you consider each department in a hospital could be doing multiple small implementations like this one, the savings easy can reach hundreds of thousands of dollars.

39. Handout Review and How To 5S Scorecard (Audit Tool) 5S Visual Workplace Audit Tool 5S Workplace Checklist Time Study Worksheet (to combine with Spaghetti Map) Red Tag Red Tag Log Spaghetti Map Time Collection Tool

40. Assignment Spaghetti map Small process (e.g. cleaning a patient room, medication administration) 5S Small area (e.g. desk, countertop of a med room, one shelf of a storeroom) Use visuals (e.g. tape, pictures, color-coded organizers 8/18/2012 40 Get ideas from your staff members. What takes a long time to do with lots of unnecessary motion? What items are constantly missing in a unit or are difficult to retrieve because the item is buried behind other equipment. Get ideas from your staff members. What takes a long time to do with lots of unnecessary motion? What items are constantly missing in a unit or are difficult to retrieve because the item is buried behind other equipment.

41. Web Resources www.the5sstore.com www.5ssupply.com www.creativesafetysupply.com

42. 42 8/18/2012

43. 43 Oregon Association of Hospitals & Health Systems 8/18/2012

44. Today’s Speakers NameTitle NameTitle NameTitle NameTitle 44 Oregon Association of Hospitals & Health Systems 8/18/2012

45. Thank you. Kelly Rinehart krinehart@oahhs.org 503-487-6113