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Park Nicollet Vision. Everyone Caring. Everyday. Creating with the Individuals We Serve Optimal Health and Greater Value. Our Core Strategy. Passionate about best possible outcomesA world-class continuum of careBroad base of primary careValue-added seamless handoffs with excellent specialty programsNew value (and revenue) streams by medical condition.
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1. Park Nicollet Health Services 5S & 3P Lean Case Study in a Healthcare Environment - Facilities
2. Park Nicollet Vision
3. Our Core Strategy Passionate about best possible outcomes
A world-class continuum of care
Broad base of primary care
Value-added seamless handoffs with excellent specialty programs
New value (and revenue) streams by medical condition
4. Health Care - A Crisis of Value
5. The crisis in value is recognized globally as a business opportunity Global market for health care
Health care is growing as a percent of the world’s economy
“The World Is Flat” dynamics include the digitization of services
Entrepreneurial opportunities
Massive investment lining up
GE
AOL
Target
Microsoft
Private capital
6. “World is Flat” global competition coming to health care Nighthawk radiology
Apollo Hospitals - India
Cleveland Clinic E-consults
NHS Admissions to the US
e-mobile medical records still to come
8. Why Toyota? Most advanced management system in the world
Effective in removing all 7 forms of waste:
motion
time (Waiting)
inventory
over-production
transportation
defects
processing
It is a system of productivity & Quality
It keeps on ticking; 40+ year history at Toyota
9. LEAN – the 7 “sees”: See for yourself (“go to the ‘gemba’”)
See what people do (standard work)
See how people spend their time (stopwatch, time observation sheet)
See where people go (spaghetti chart)
See what really happens to your patients (value stream maps)
See who your teammates really are (value stream maps)
See the wasted effort (muda)
10. Our Commitment Kaizen Promotion Office (KPO) staffed (11)
Kaizen Operation Teams (KOT) staffed (25)
135 leaders pursuing Certification
(This includes experiences on factory floor at Genie and Japan gemba kaizen)
100 leaders pursuing Certification Maintenance
Intern program in place 5 /W 12 completed
11. Our Commitment (cont.) 250 RPIWs completed
Over 1200 staff members have participated
9 “3P” workshops completed
(TRIA, Chanhassen, HVC, Endoscopy, Chronic Disease, OB, Cancer Center, EDI, Methodist Hospital)
Visibility Room operational
5S Campaigns - 10 projects per month
12. 3 Main Methods for implementing Lean 5S – making our workspaces clean, organized and visual
RPIWs – “Rapid Process Improvement Workshop” weekly workshops aimed at eliminating waste, in its many forms
3P – “Production Preparation Process” – used to create a new process or totally redesign an existing process; “PDCA”
13. 5S & 3P Integrated Timeline
14. 5S – Creating a physical environment in support of Lean 5S is a strategy for organizing the workplace to minimize waste of time. Having everything clean, neat, and in the proper location enhances quality and productivity because it helps make things easier to find and problems more visible.
“A place for everything, and everything in its place, clean and ready for use”
15. 5S – Workplace Organization Sorting - Remove excess or unused products, furniture and equipment. Keep only what is needed.
Simplifying - Make the workplace easy to understand where products and equipment can be found. Place products used to do the work close to the worker to avoid steps.
Sweeping - Visual checks will help indicate that everything is in its place and in sufficient quantity. Establish simple signals to assure inventories are replenished in small quantities.
Standardizing - Make the workplace the same in layout and products used in the work.
Self-discipline - Adopt the habit of making regular visual checks to maintain the improvement.
22. 5S Results for 2006 94 teams
Involving 397 employees
A total of 14,414 red tagged items were sent to the 5S warehouse. Items re-deployed, sold, donated or thrown away
Items valued at $1.2 million
23. 3P “Production Preparation Process” Model process for designing quality service
Used when demand dictates increased capacity required or new product introduced
Process design or service delivery changes
24. 3P “Production Preparation Process” (cont.) Patient (customer) the focal point
Programming and Space Planning condensed into one week.
15-20 Participants (stakeholders, decision makers, customers, lean experts, patients, architect)
Outcome sets project scope – no work around (stick to the plan)
25. Approach to Construction Traditional Lean
Progress from 3P, Cost Estimate 5d 5d
Schematic Design 35d 20d
Design Development 40d 30d
Contract Documents 50d 30d
Bid and Award 15d 15d
Construction 100d 90d
Move-in 5d 5d
250d 195d
26. 3P Tools Patient Quantity Analysis (PQA)
7 flows (Yarn measurements)
7 ways (think like 12 year old)
Simulation/Modeling (post-it notes & Lego's)
Mock-ups
Layouts
27. 7 Flows Flow of Patients
Flow of Providers
Flow of Medications
Flow of Supplies
Flow of Information
Flow of Equipment
Flow of Instruments/Processes
28. Steps Define scope and team membership
Fishbone current process
Create preferred process flow; examine alternatives (from nature)
Develop and evaluate 7 options
Narrow selection and present results
Complete equipment design and layouts
29. Involving Patients 3P patient participation
Patient Provider Council
30. 3P: “Intelligent Design” of our workspaces (mockup, try, practice)
31. 3P Tools (fishbone diagram)
32. 3P Tools (string model)
33. 3P Tools (string model)
34. 3P Tools (string model)
35. 3P Tools (simulation)
36. 3P Tools (mockup/layout)
37. 3P Results - Chanhassen Decrease walking:
For patient reduced 27%
For nurse reduced 27%
For clinician reduced 42%
Reduce inventory:
Reduced 21 exam rooms
Reduced 1 procedure room
Reduced construction cost $196,200
Total project reduction $357,300
20% reduction of square footage:
Created flexibility, team work among disciplines; lean concept of 'open room'; less steps for patient and staff; improved flow and visual control.
38. 3P Results - HVC Patient walking distance decreased 73% in nuclear, interventional and chest x-ray
Staff walking distance decreased 30%
Estimated cost of changed $400,000 including design, change orders, materials/equip
Cost avoidance of $140,000 in staffing assumptions
Capacity gains result in opportunity for additional $2.5 million in gross charges
39. 3P Results - TRIA We could have institutionalized poor processes in the facility design & customers (external &internal) would not always be served well.
Good data is essential.
Next room available increases capacity.
"Expert" opinions are often wrong. Data and modeling proved this.
By using 3P, movement could be cut by 50%, patient time in facility by 30%, labor costs by 20% and time to patient payment by 30%
40. Summary of 3P’s Lessons Learned Have defined scope/goal from the start
Clearly articulate/communicate your scope/goal to team
Measurement and good data are critical to the process
Participation from patients is essential
Standard work is necessary for efficiency
Flexibility is achieved by breaking down department barriers
Interdisciplinary groups should always design facilities
Visualization is a key to understanding flow and processes
Simulation is enlightening, it changes peoples’ views on flow
41. Lessons LearnedDavid Wessner, CEO “…… it’s humbling that I have to admit we’re relearning how to get everyone involved in taking the waste out of work. The more you learn about waste, the more you see it.”
42. Lessons LearnedSam Carlson, MD Chief Medical Officer “Standard work and reducing variation in processes are key components of safe and productive work practices and conflict with professional autonomy.”
“Accept the challenge!"
43. Lean Resources
44. Thank You