Going Lean in Healthcare - Applying all the Tools

1. Page 0 GOING LEAN Tools in Your Toolbox Using Lean Concepts & Tools to Provide an Optimized Care Delivery System and Inform Healthcare Facility Design Debbie Hoffman Debbiedetech@gmail.com

2. Page 1 Today’s Topics

4. Over the last 35 years, while the nation’s spending on all goods and services has risen at an average annual rate of 7.2 % the amount spent on healthcare as grown at a rate of 9.8 %..as a consequence, Americans simply cannot afford adequate care.1

5. If Federal government spending remains relatively constant % of GDP, the rising cost of Medicare within that budget will crowd out all other spending.1

6. If governmental financial statements reported the liabilities they face from contractual commitments to provide healthcare for retired employees, every city and town in the US would be bankrupt. There is no way for them to pay except by denying funding to other projects or raise taxes to extremely levels. 11 The Innovator’s Prescription – A Disruptive Solution for Health Care, Christensen,Clayton 2008 Can we afford to continue doing business as usual?

7. Page 3 There are two types of costs that need to be considered in the optimization of health care delivery- first time building cost & continuing operational costs. Staffing Efficiency Physician / Staff Satisfaction Quality of Care Optimized Health Care Delivery Adaptability / Flexibility/ Sustainable Operational Process Patient Satisfaction Planning for Optimized Care Delivery

8. Page 4 What does LEAN bring to the table? LEAN Laying the Foundation for Process Change Predictability of workflow- standardization of processes Decrease cycle times = decrease ALOS Adaptability of space allowing flexibility – increasing utilization and decrease obsolescence Space requirements reduced- elimination of duplicity Balancing spaces needs versus utilization Less process steps = less handoffs = less errors Development of a “future state”

10. What does the client want to solve?

11. Everyone having a seat at the table

12. Consensus building

13. Sharing of all documents

14. Value analysis throughout design Creating a New Level of Collaborative Design Environment

15. Page 6 Project Flow – Key Elements Value Stream Modeling / Narravtive Simulation Modeling “What if’s” – Case Study Application of Metric Tools in the Tools Box

17. Define functional adjacencies

18. Determine optimal departmental area allocations

19. Detail room-by-room / needs

20. Identify key trends and growth patterns

21. Define program & facility priorities

22. Feasibility Study

23. Identify service line configurations

24. Prepare workload projections

25. Quantify staffing needs

26. Value Stream Modeling

27. Blocking and stacking diagrams

28. Internal and external department flows

29. Project oversight

30. Risk assessment

31. Draw flow charts

32. Data collection

33. Pilot program

34. Test “what-if” scenarios

35. Optimize adjacencies based on care delivery efficient Simultaneously Project Flow

37. Pre-registration

38. Pre-certification

39. Financial counseling

40. Clinical information capture

41. Patient instruction transmission

42. Appointment confirmation

44. Way finding

45. Orientation/directions

46. Building amenities

48. Financial/business services

49. Patient & family waiting

50. Consent for service

51. Rooming

52. Prep or assessment

53. Chaperoning

54. Clinician notification

55. Care delivery

56. Clinical documentation

57. Ordering/ prescribing

58. Education & research

59. Patient tracking

60. Schedule follow-up:

61. Visits

62. Patient referrals

63. Testing or procedures

64. Urgent consultations

65. Sub-acute care or therapies

66. Patient satisfaction survey

67. Chart completion

68. Billing

69. Results reporting

70. Referring physician communication

71. Patient communication

72. Patient monitoring

73. Prescription managementAreas to Consider for Modeling Key Flows

75. Decreases handoffs

76. Reduces steps and cycle times

77. Increases predictability of workflow

78. Decrease staffing requirements

79. Improves quality of outcomes

80. Defines constraints and enablers

82. Fewer dedicated spaces

83. Removes walls that create silos

84. Minimizes patient movements

85. Increases opportunity to “Broadband”Current State - From this….. Future State- to this! Value Streaming Patient Flow

86. Overall VSM- Patient Access to Treatment Mall- Future State Page 10

87. VSM- Single Clinic Visit Page 11

88. VSM to Design Implications Page 12

89. Recommendations Page 13

90. Page 14 Inside Simulation Modeling

91. Page 15 Simulation Model - Example

92. Page 16 Simulation Model - Example

94. User participation to improve project buy-in and staff morale

95. Test program with changes in operational assumptions (e.g. extended hours, increased volume)

96. Identify prep/recovery configuration that can adequately support peri-operative areas

97. Quantifying the number of rooms and resources needed to staff the new hospital

98. Identify amount of room within space program for future growthCase Study Benefit and Value

99. Page 18 ~ 2.5 miles Lincoln Park Lake Michigan CMH Current Facility Northwestern University Feinberg School of Medicine Navy Pier New CMH Campus/ Medical School Case Study – Children’s Memorial Hospital

100. Page 19 Facility Entrance Point Critical Care How many trauma and urgent care rooms are needed? How often does each room type reach capacity? What are the implications of a bi-level ED? Emergency Dept. What are the average wait times for a machine? How many prep and recovery spaces are needed per modality/floor? Critical Care NICU/PICU Diagnostic Imaging What is the max number of rooms demanded? How often is the max reached? What prep/recovery configuration is most economical? How many spaces are required? What efficiencies are gained by sharing prep and stage II areas? Prep/Recovery/Obs Acute Procedure Suite What is the max number of rooms demanded? How often is the max reached? What happens to the ED when the Acute IP is full? What is the average and max wait times for a bed? What time will the OR’s finish their cases at the end of the day? What operational issues arise from a bi- or tri-level operating room? Psych Medical Patients Surgical Patients IP Units Questions Asked

101. Page 20 Inpatient Max Utilization Acute Census Will the IP units reach capacity during peak months? How much space is there for program growth? What are the implications of adding another machine or extending operating hours on wait times? What is the impact of a full IP on the ED? How late will ORs need to stay open to finish projected caseloads? What is the impact of reducing turnaround? Questions Answered

103. Printed reports of value added, business value added, and non-value added classifications

104. Quantification of staff required to maintain certain utilization rates and to ensure proper staffing resources

105. Lean value stream mapping to understand which processes add value to a work flow

106. Identify opportunities in reducing turnaround times, cost implications of standardizing medical instruments, ideal departmental adjacencies, and recovery configurations

107. Effectively track equipment utilization patterns across time

108. Illustrate outcomes of utilizing resources with different treatment times

109. Count the number of scans machines in radiology will incur in defined set of time for capital planning purposesConclusions

110. Page 22 Comments Your Comments & Questions For additional information or case studies please call Debbie Hoffman 949 395-1482 Or Email Debbiedetech@gmail.com