Craig L. Miller, CCM Senior Project Manager Jacobs NYC and Long Island Office. Safety Minute. Learning Objectives

Transcription

1 What Providers Need To Prosper The Next 50 Years: Planning Meets Operations October 4, :00 9:00 AM Craig L. Miller, CCM Senior Project Manager Jacobs NYC and Long Island Office Safety Minute CPR/AED or 1st Aid Classes are available at your local American Red Cross or hospital. Learning Objectives According to the American Red Cross: Sudden cardiac arrest, leading cause of death in adults, accounts for 325,000 deaths per year. Treatment delay of 4-5 minutes decreases survival rate as much as 40%; 10 minutes or longer results in 95% chance death. More information can be found at: 1) Strategize, plan, integrate, and design logistics and operational needs to deliver over the long term a high performance healthcare facility. 2) Measure and evaluate the results, value, and performance received from various solutions. 3) Explore how new trends, best practices, and approaches can be used to plan a high performance hospital, and how they differ from traditional practices. 4) Asses, build, and balance goals with available resources. 1

2 Understanding Your Roles and Challenges Typically involved early with planning From a logistics/operations perspective, your asked to: Optimize performance / improve efficiency Reduce waste Incorporate flexibility, provisions/infrastructure Create system wide logistics vision, leverage standardization Investigate off-site service/support center options Tight budgets Space restrictions / constrained sites Other? Industry Wide Challenges 32-million newly insured Americans as a result of health care reform (Modern Healthcare magazine) Cuts in Medicare and Medicaid funding Aging workforce Over-crowded ED s, and Trauma Centers Cutting edge clinical technology, and procedures Mergers, acquisitions, and private entities Lower operating budgets; a do more with less approach The list goes on.. Typical Hospital Org. Structure Finance Human Resources Information Technology MCE / Facilities Safety Security Leadership Legal 2

3 Developing the Plan and Paving the Way What do Providers Need To Prosper The Next 50 Years? How will Planning Meet Operations? Strategy C-Suite (CEO, CFO, COO) and stakeholders Imperatives/Drivers Logistics and operational vision Interoperability Goals and objectives Guiding Principles Key Performance Indicator's (KPI's) Service Levels Identify measures Sustainability Flexibility Integrated Planning Master Planning High level ROI Analysis Develop Basis of Design for Logistics and Operations Application of Process, Distribution, Storage/Retrieval, IT, and Purchasing Identify systems Integrate industry best practices Develop road map Dashboards Execution All phases of design including Concept, Schematic, Development, and Construction Develop detailed business cases for systems considered Link/network systems for interoperability Commissioning/ Activation Measure performance Make adjustments Medical Supplies Medications Med Surg Floor Soiled Linen Recalls Linen Patients Returns Existing Hospitals Newly Planned Mergers and Acquisitions Individual Buildings and Departments Systems with multiple Hospitals and Clinics Food Trays F&N Supplies Administrative Supplies Lab Testing Blood Mail & Parcels Medical Records Staff Housekeeping Supplies Minor Medical Equipment Logistics can be defined as resource management. Stated another way, logistics strategy is applying the 5 rights: Right resources (drug) Right time (frequency) Right quantity (dose) Right location (patient) Right path (route) Lab Samples Soiled Food Trays Trash Medical Records Bio-Waste Minor Medical Equipment Expired Medication 3

4 Trends in Logistics / Resource Management Automation Robotics Integrated Software Systems Pneumatic Transport Service Center vs. Off- Site Warehouse Simulation GS1 Data Standardization Interoperability Connects Clinical, Support Services, Operations Includes EMR and Compliance Process Efficiency (e.g. Lean) with a view to the outside Robotics Automation Pneumatic Transport Moving away from elevators, less FTE s, more efficient, less touch points Integrated Systems Examples: Supply Chain / Materials Management, Pharmacy, EVS, Dietary, Labs, SPD 4

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6 Automated Waste Collection Air Intake Trash in Trash Soiled Linen Recycle Simulation Fan Room Air Exhaust Velocity monitoring Trash out Central Collection Plant Central Processing and Monitoring Optimize, While Balancing Resources & Goals / Objectives Resources Goals / Objectives Rooms Equipment Staff Supplies Volumes Utilization Schedule Current & Future 6

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8 Automated Guided Vehicle Example Mail and Parcels Resources? Goals? Materials Management Resources? Goals? Pharmacy EVS Resources? Goals? Resources? Goals? Dietary Resources? Goals? Sterile Processing Resources? Goals? Respatory Therapy Resources? Goals? GS1 8

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11 Best Practices 11

12 Process Flow Store / Retrieve & Enter / Exit Distribution Store / Retrieve & Enter / Exit Information Technology Purchasing Process Flow Simulation Store / Retrieve & Enter / Exit Distribution Store / Retrieve & Enter / Exit Infection Control Optimization and Improvement Strategies Information Technology Handoff Process and Value Stream Mapping Purchasing Just In Time Delivery 12

13 AGVS Point-Of- Use Systems Vertical Transport ATL&Recyc Vertical Lift Modules Carousel Systems Gravity Chutes P-Tube Product Slotting, Storage, Retrieval Mini-Load AS/RS Automated, Semi Auto, Manual Low Unit Of Measure Integration PPI Data Cleansing IT Management Product Selection Standardization RFID Data Standardization Assessments Software & Hardware Data Mining Data Synchronization Value Analysis 13

14 Operating Efficiency Patient Safety Ancillary Services Plan Layout Design Organize Equip Operationalize Clinical Services Integrate Tailor Organize Equip Operationalize Ancillary Services Plan Layout Design Organize Equip Operationalize Expenses and Waste Clinical Services Integrate Tailor Organize Equip Operationalize Case Studies & Value Propositions Diagnostics Platform $4.5M Value Added Highlights Reduced original program by: 1 MRI 1 PET-CT Identified early in the process the need to add: Clinical Modeling Cases 12 centrally located Prep / Hold / Recovery Bays 1 Echo 1 ECG / Holter 1 Stress Lab Additional value opportunities were identified early in the process for spaces which could be deferred: 2 Neuro-diagnostic room 1 Device Clinic room 2 Ultrasound 2 Nuclear Med More than $4.5 Million worth of opportunities was realized by Rush in the form of optimized patient throughput, space reductions, staff, equipment, construction, and resources which could either be eliminated or reallocated to other programs. Simulation modeling was very beneficial for planning our new ED. It really added great value by helping us understand the appropriate balance of rooms while achieving our level of service goals. This tool will serve us well for future operational plans whether related to expansions, financial opportunities, or expanding surge capabilities Dr. Dino Rumoro Chairperson Associate Professor Department of Emergency Medicine Simulation is a very effective way to test and vet operational assumptions before committing capital or resources. I found it to be invaluable in creating an efficient operational model Bernard F. Peculis, MS, MBA Administrative Director Department of Diagnostic Radiology and Nuclear Medicine Emergency Department $1.5M Value Added Highlights Validated patient throughput for initial move-in and future volumes Confirmed optimum distribution of room types in order to achieve waiting room times of less then 30 minutes Quantitative results which supported optimizing the number of Critical Care rooms to 9 Identified early in the process an opportunity to defer outfitting or utilize for back-up / surge the following rooms: Acute Isolation Confirmed department could integrate pediatric with adult care, thus eliminating the need for a separate pediatric pod. Modeling assisted in ROI analysis of a pediatric pod. Over $1.5 Million worth of strategic decisionmaking capabilities and opportunities was realized by Rush in the form of space allocation, equipment, and resources which could be deferred, eliminated, or reallocated to other programs. 14

15 Out Of Control Returns = Waste Out Of Control Returns = Waste Eliminate Annual Write-Offs: >$650K/Year Some of the Issues No Reverse Logistics plans Hiring and Resigning Expiration Return processing Recalls Limited IT integration Limited schedule alignment with Clinical needs Loss of trust and confidence between clinical and support Rogue purchasing, and limited procurement process Solutions Develop and Implement Reverse Logistics Program Integrate IT with RFID, GS1 Data Standardization, and Systems (Finance, HR, Supply Chain, Clinical, etc) Service agreements, schedules, and procurement procedures Results Reduced write-offs by ~$425K/Year; still improving Developed and Implemented system wide logistics program Rolled-out 1 st phase GS1 Re-established trust and confidence Some of the Issues Tight budget - Expand & Build New Hospital while Reducing Expenses Long horizontal travel distances Aging work force Infection Control Safety Limited funds to add FTE s Maximum 20 Minute delivery of Food Trays Automation Solutions Develop and determine if there is a favorable business case Explore available systems Develop Simulation Model to optimize systems Design systems, and issue RFP to vendors Results Reduced Annual Operating Expenses by over $2.5Million 2-4 Year payback Improved Patient & Staff Safety Used to distribute almost all resources across campus Re-established trust and confidence Instrument Losses Eliminate Annual Re-Purchasing Surgical Instruments: >$750K/Year Some of the Issues Instruments, accessories missing after surgery Limited IT integration Rogue purchasing, and limited procurement process No reverse logistics in place Solutions Develop and Implement Reverse Logistics Program Integrate IT with RFID, GS1 Data Standardization, and Systems Develop new equipment Other Results Reduced write-offs by ~$675K/Year; still improving Developed and Implemented system wide logistics program Rolled-out 1 st phase GS1 Deployed new equipment 15

16 Thank You and Get Home Safe Strategy C-Suite (CEO, CFO, COO) and stakeholders Imperatives/Drivers Logistics and operational vision Interoperability Goals and objectives Guiding Principles Key Performance Indicator's (KPI's) Service Levels Identify measures Sustainability Flexibility Integrated Planning Master Planning High level ROI Analysis Develop Basis of Design for Logistics and Operations Application of Process, Distribution, Storage/Retrieval, IT, and Purchasing Identify systems Integrate industry best practices Develop road map Dashboards Execution All phases of design including Concept, Schematic, Development, and Construction Develop detailed business cases for systems considered Link/network systems for interoperability Commissioning/ Activation Measure performance Make adjustments 16