LEAN CS PRINCIPLES. Using Lean Methodology Real Applications for CS. Presented by John Kimsey

Transcription

1 LEAN CS PRINCIPLES Using Lean Methodology Real Applications for CS Presented by John Kimsey

2 LEAN FOR HEALTHCARE Don t try this at work. These are highly trained lean experts implementing lean in healthcare. 2

3 LEAN FOR HEALTHCARE 3

4 TODAY S AGENDA What is Lean? Understanding the CS Environment Real Applications of Lean in CS 4

5 WHAT IS LEAN? Lean is a one word catch phrase to summarize operational best practices developed by Toyota focused on maximizing efficiencies. Lean is about maximizing customer value while using minimal resources. You don t have to only use the Toyota principles you can create your own best practices! 5

6 WHAT IS LEAN? $ Hours 3 Phone Calls Different Inputs for Same Output? $80 7 Hour 0 Calls Un-Happy Customer Happy Customer 6

7 WHAT IS LEAN? Lean CS is developing an operational plan to minimize resource use to produce a product or service that meets the Customer s requirements. 7

8 7-Jul 8-Jul 9-Jul 10-Jul 11-Jul 12-Jul 13-Jul 14-Jul 15-Jul 16-Jul 17-Jul 18-Jul 19-Jul 20-Jul 21-Jul 22-Jul 23-Jul 24-Jul 25-Jul 26-Jul 27-Jul 28-Jul 29-Jul 30-Jul 31-Jul 1-Aug # Trays WHAT IS LEAN? With your lean operational plan in hand, you ll need to measure your performance to know if you re on or off plan Backlog Trays in Assembly Trays in Backlog # Trays Processed

9 WHAT IS LEAN? Lean also realizes that every process must be actively managed or else things tend to fall apart. What am I supposed to do? Your Leadership Team Your Staff Clear leadership routines are a must for every business! 9

10 WHAT IS LEAN? Lean is not a one-time event, doesn t have a final destination, and isn t something you ll finish. Toyota got it right when they decided to continuously strive to be a better car maker never being satisfied with their performance. 10

11 WHAT IS LEAN? One more important point lean is a team effort! Employee engagement is critical if you want to unleash the total potential of your operations 11

12 LEAN IS Meeting Customer Requirements Developing a Lean Plan Measuring Performance Implementing Leadership Routines Engaging Your Team Minimizing Resource Use Improving Continuously 12

13 WHAT IS LEAN? Do I need Green Belts and Black Belts and all day training sessions? NO! What you do need is people dedicated to finding a better way to do the work and a system to sustain the improvements. Experienced or knowledgeable facilitators can help start the process. 13

14 Eliminate Waste Employee Engagement Continuous Improvement LEAN CS LEAN CS Measurement & Leadership Routines Lean Operational Plan Customer Requirements Brazil CME Lean Presentation by STERIS 14

15 THE CS ENVIRONMENT A quick review of the CS environment. Transport to Storage Transport Dirty Instruments to CS Clean / Disinfect Instruments Sterilize Instruments Re-assemble Instruments 15

16 THE CS ENVIRONMENT Know your environment you really are running a small business. Surgical Instrument Reprocessing Services 100% Complete, 100% Sterile, 100% On-Time, all at a Reasonable Price!!!!!! 16

17 THE CS ENVIRONMENT Running your small business. What are your customer requirements? What resources are you using? Are you improving your performance? Are you measuring your performance? How engaged is your staff? Not working in CS? The same principles apply to your department as well! 17

18 REAL APPLICATIONS OF LEAN 18

19 % of Respondent Anwers REAL APPLICATIONS OF LEAN Step #1a: Customer Requirements Surveys Measurable Indicators Service, Quality, Cost Instruments and Trays - # of Responses by Score Instrument trays are clean 2. Instrument trays are assembled correctly 3. Instrument trays are complete and accurate 4. Instrument in the trays work properly 5. Turn around time for trays is acceptable 6. Tray packaging is in tact (no holes, tears etc) 7. Instrument trays are labeled correctly 8. Instrument sheets are completed & signed 9. Trays have appropriate chemical indicators 50% 10. Trays have appropriate labels w/ descriptions 11. Trays seem to be delivered sterile on time 40% 30% OR Customer Survey Summary 2014 OR Survey Results 2013 Desired Results Excellent Good Average Fair Poor 20% 10% 0% Excellent Good Average Fair Poor 19

20 REAL APPLICATIONS OF LEAN Step #1b: Develop a CS Charter Measurements Everything you do should tie back to your Charter General Medical Center CS Charter Patient Expectations Complete, Sterile, and Working Supplies, Equipment, and Instrumentation Ready for Surgery When Required Operating Room Satisfaction Survey Average Customer Satisfaction greater than 4.1. Average Customer Perception of CS Service greater than 8.0. Operating Room Expectations 100% Instrument Trays Complete 100% Instrument Trays Clean and Sterile 100% Instrument Trays On-Time 100% Case Carts Complete 8 Hour Turn Around for Normal Processing 4 Hour Turn Around for Terminal Sterilization Quick Turns 1 Hour Turn Around for Immediate Quick Turns Hospital Floors & Clinics 100% Complete, Clean, Sterile Instrumentation Orders Fulfilled Within 4 Hours of Receipt CS Operational Expectations Zero Work Place Injuries or Health and Safety Issues < 10 Trays on the Shelf Waiting to be Assembled at 7am < 50 Trays on the Shelf Waiting to be Assembled at 3pm < 20 Trays on the Shelf Waiting to be Assembled at 11pm 100% Compliance to Work Instructions and Department Policies > 90% Productivity 20 CS Staff Satisfaction Survey Average Staff Satisfaction greater than 4.1. Average Staff Perception of CS Service greater than 8.0.

21 REAL APPLICATIONS OF LEAN Step #2: Develop a Lean Operational Plan 21

22 REAL APPLICATIONS OF LEAN Step #2a: Determine Customer Demand / Volume Activities Frequency Month, Week, or Day Volume per Frequency Decontamination of OR Items (5.6 trays per case) Week 2499 Decontamination of Clinics and Floor Trays (220 per week) Week 220 Daily Decontamination clean up Day 2 Daily washer and detergent checks Day 1 Daily washer tests and record results Day 1 Endoscopy tower cleaning Day 2 22

23 REAL APPLICATIONS OF LEAN Step #2b: Determine Resource Requirements Activities Frequency Month, Week, or Day Volume per Frequency Standard in Minutes (per 1 volume) Decontamination of OR Items (5.6 trays per case) Week Decontamination of Clinics and Floor Trays (220 per week) Week Daily Decontamination clean up Day Daily washer and detergent checks Day Daily washer tests and record results Day Endoscopy tower cleaning Day FTE's Setting Time Standards: Start with something doesn t have to be perfect or fastest but set a baseline and then improve. 23

24 REAL APPLICATIONS OF LEAN Step #2c: Create a Balanced Process 29 Average Incoming Items Line Balancing: Items Per Hour 43 Peak Incoming Items 30 Prep Sink Capacity 48 Washer Capacity 31 Assembly Capacity 59 Sterilizer Capacity Average Incoming Items Line Balancing: Items Per Hour Peak Incoming Items Prep Sink Capacity 48 Washer Capacity 40 Assembly Capacity 45 Sterilizer Capacity Balancing the Process: Start with the basics don t get too complicated. 24

25 REAL APPLICATIONS OF LEAN Step #2d: Build a Value Stream Workflow: Series of activities / processes through which a product or service passes. Example: A workflow may encompass 15 activities taking 12 hours to complete. 25

26 REAL APPLICATIONS OF LEAN Step #2d: Build a Value Stream Value Stream: Activities required to add value to the product or service to meet customer requirements and changes the fit, form or function of the item. Example: The value stream within the workflow may encompass 10 activities taking only 6 hours to complete. 26

27 REAL APPLICATIONS OF LEAN Step #2d: Build a Value Stream Lean: Removes the gap between current workflow and the value stream. Example: Moving from 15 activities to 10 activities and reducing processing time from 12 hours to 6 hours. 27

28 REAL APPLICATIONS OF LEAN Step #2d: Build a Value Stream Simple Value Stream Map Instrument Processing Transport to CS Transport to Storage Wait Wait Decontam Sterilize Wait Wait Assembly Missing Item 28

29 OR Procedure Procedure required for handling instruments at completion of case Procedure ends Procedure Cancels Need to define method for tagging and communicate repair issue Used Items: Scrub Tech - Cleans instruments and returns to correct tray - Verifies instrument count - Places peel packed instruments in available instrument set Unused Items: Scrub Tech - Unused supplies are placed in plastic bag or plastic bin and placed on top of case cart - Unused instruments are placed on top of case cart Clean Case Cart pushed to hallway by OR Decontam with X on Pick List PA2 restocks instruments and then pushes cart to OR Decontam or holds cart for possible use on another case How are OR Turnarounds identified so OR staff know it? CS or PA2 places OR items on OR restock rack in blue bins PA2 restocks OR stored supplies and instruments Variance in OR Turnaround use of form and instructions Quick or 4- Hour? - Fill out Turnaround Form - Verbally tell CS - May not fill out form OR or PA2 takes instrument to OR Decontam Inst. Repair required? Yes Tag for Repair - White or red pipe cleaner - Sticker - Paper note - How to handle contamination of note? - Does OR keep some items needing repair? Unused Items CS places CS items on CS restock rack in grey bins PA2 scans instruments to storage location Should there be an instrument check / assembly for OR Turnarounds? Barcode Scan No No Quick 4-Hour (rarely used) CS, OR, or PA2 starts washer or washes instrument Yes OR Turnaround? No Instruments placed in Case Cart OR pushes Case Cart to hallway outside of OR Decontam CS takes CS restock rack to CS via clean elevator Variance in how instrument returns to OR and notification that it s ready Keep in OR? Yes Some carts pushed into clean room, some left in hallway, some put in elevator Should verify OR procedures to ensure they are not washing in OR Paper and instrument sent downstairs No assembly verification of instruments should there be? OR washes and/or keeps clean instrument Used Items CS restocks supplies to storage location Barcode Scan When, who, how is restocking done? Need procedure Scanning compliance OR or PA2 gets instrument or CS delivers OR flashes instrument Scan instrument to new OR CS staff brings case cart into OR decontam Scanning compliance and ensure staff has generic login for computers Instruments observed being left in OR Core Barcode Scan CS sprays instruments, scans to decontam, some take out filters, some breakdown instruments Variance in how staff handles case carts in OR Decontam Case cart taken to CS via dirty elevator When, how, who, need clear procedure for bringing case carts to CS Hand washed items manually washed Automated wash items prepared for washer Case Carts and containers sent through cart washer Need correct washer rack to position containers on their side for proper washing Need to following mfg instructions and have them on file On Source? Carts Variances on pre-cleaning, sonic use, pre-assembly, and handling instruments Pass through window Instrument washed and sent to Assembly Priorities - Dr. Trays, CVT Trays, Vascular/Heart Trays, Synthes, Trauma Tech selects tray to assemble based on priority Trays are placed on generic shelves Multiple priorities, conflicts, and lack of compliance need to simplify and agree to 1 st shift coordinator creates Priority list based on OR schedule and memory of inventory 3 rd shift PA2 creates Priority list based on missing instruments from case carts Barcode Scan Start Assembly process, scan in Impress Need to improve and clarify how to return a repaired/ ordered instrument Set is complete, print Count Sheet Repair Maintenance flag for instrument Set missing instruments Supervisors/ Coordinators should know what s missing Extra instruments or peel packed instruments in set Need to clarify and set procedure for missing instruments Place in Repair / Maintenance Bin Some tell Coordinator missing info, some print count sheet and highlight No Instrument replacement available? No Extra is taped and belongs in another set Extra is taped and is a single OR Service item Extra is a single item Coordinator empties bin and runs daily Impress report to see missing instruments Yes No formal system to monitor backup inventory Hold Set and attach missing list Make substitution, write on Count Sheet if needed Send incomplete set for sterilization How do we track par levels of inventory? Place instrument from inventory into set Place instrument in Yellow Bin by Service or in set if available Peel Pack immediately some put in Yellow Bin Place in singles inventory for future use Barcode Scan Staff feels they waste time looking instruments could be better organized Determine need to order or repair, track in spreadsheet Set scanned to Hold location, supervisor reviews daily Some staff get supervisor ok before sending to sterilization Staff empties bins and finds a home for them Not currently happening could be process improvement Instrument returned and placed on rack in clean area or given to staff Attach orange sticker with missing info or yellow if implant No clear system or expectations for handling missing instruments Options: - Instrument sits - Add in tray when assembling - Pull sterile tray - Need better communication - Need to clarify process - Add Implact sticker if implant tray - Place tray in container or wrap - Set on steam sterilizer rack or Sterrad rack No clear expectation on how to handle, process variance Barcode Scan Log Breast Sizers in book for usage Instruments scanned to sterilizer, load label applied, BI and Challenge Pack added for implant trays Sterilization Parameters kept in 3-ring binder, special parameters posted on sterilizer door Process variance on time to hold in chamber and in cool down area Barcode Scan Run sterilizer and hold in chamber for cool down period For steam items, move to Cool Down area for required time CS Scans to OR location and takes items to OR for PA2 to put away Pick List prints from OR printer, PA2 sort them by case start time Loaners not included on pick list Pick List prints from CSPD printer, staff sort them by case start time Loaner management is separate process PA2 picks suture for all cases first and stages on rack Case carts taken to OR by start time order Highlight missing items and write on front page and surgery schedule Select empty Case Cart, write number on Case Cart sheet, and start picking first case for next day Clean Case Carts staged in CS supply storage area AM Decontam person degowns and pushes carts into clean area PM Case Cart person pulls carts out into clean area Variance in unloading Cart Washer PA2 picks soft goods top offs for all cases next PA2 stages case carts in hallway outside of OR Pods PA2 picks instruments last to finish case cart Variance and compliance issues with documenting missing items Missing soft goods highlighted, not written on front Instrument available? No Variance in how cases are picked, multiple vs single at a time, pick from unused return items Barcode Yes Scan No clear process to find missing supplies Scan instrument to case cart and then case cart to OR room Highlight missing instruments on Pick List No effort to find missing instrument on 2 nd shift. Case carts taken to rooms missing instruments OR scanning not implemented at this time 3 rd shift PA2 highlights missing instruments on Instruments Requested for Cases report Need process to help find missing supplies besides leaving it up to OR staff OR Turnaround Yes Missing instruments 1 st cases taken into OR room, rest staged in hallway 3 rd shift CS works to complete missing instruments Need clarification on handling missing instruments for case carts Yes No How to notify OR and CS of need? Find alternative option for missing instruments How do we notify OR and CS for turnaround needs? No Cancel case? Yes No Open instruments? No Yes Hold instruments not opened returned as unused OR - Verifies instrument sterility - Verifies instrument count including peel packs and singles Need formal quality reporting process Quality issue? Yes Options - Call CSPD - CSPD - Enter PSN - Write on Count Sheet - Do Nothing Yes What is the process to let CS and OR staff know of turnaround needs? No Additional instruments needed? Yes Instruments needed for later case? Yes Notify CS of instrument Rapid Turn requirement No No Not scanning to OR rooms at this time Barcode Scan Procedure ends No Instrument issue? Procedure begins Scan instruments to OR room REAL APPLICATIONS OF LEAN Step #2d: Build a Value Stream Detailed Value Stream Map Instrument Processing Pre-Procedure Set-Up MetroHealth - Instrument and Case Cart Process Flow DRAFT AS OF 03/24/11 Assembly Post Procedure Decontamination and Transportation Sterilization Case Cart OR Procedure D A B C C CURRENT PROCESS SLOGAN: THE WAY I DO IT FUTURE PROCESS SLOGAN: THE WAY WE DO IT A D B X 29

30 REAL APPLICATIONS OF LEAN Step #2e: Implement Standard Work Standard Work is key to: Ensuring staff are performing tasks The Way We Do It not The Way I Do It Ensuring regulatory compliance Creating a culture of adherence Involving staff participation Improving Supervisory follow-up 30

31 REAL APPLICATIONS OF LEAN Step #2e: Implement Standard Work Standard Work is The Wedge Without standardization, all my improvements will disappear over time Standardization is a tool that ensures your improvements will be sustained. 31

32 REAL APPLICATIONS OF LEAN Step #2f: Drive for Continuous Flow Process Cycle Time: Continuous Flow OR Case Ends Wait Transport Tray to CS Wait Prep for Washer Wait Washer Cycle 0 Mins 0 Mins 10 Mins 0 Mins 6 Mins 0 Mins 35 Mins Wait Assemble Wait Sterilize 0 Mins 15 Mins 0 Mins 60 Mins Cool Down 120 Mins Wait Transport to Storage 0 Mins 10 Mins 256 Minutes Processing Time or Cycle Time (4 hrs 16 mins) Activities = 256 Mins Wait = 0 Mins 32

33 REAL APPLICATIONS OF LEAN Step #2f: Drive for Continuous Flow Example - Realistic Continuous Flow OR Case Ends Wait Transport Tray to CS Wait Prep for Washer Wait Washer Cycle 0 Mins 10 Mins 10 Mins 15 Mins 8 Mins 32 Mins 35 Mins Wait Assemble Wait Sterilize 60 Mins 20 Mins 30 Mins 70 Mins Cool Down 120 Mins Wait Transport to Storage 15 Mins 10 Mins 435 Minutes Processing Time or Cycle Time (7 hrs 15 mins) Activities = 273 Mins (+17) Wait = 162 Mins 33

34 REAL APPLICATIONS OF LEAN Step #2f: Drive for Continuous Flow Example - Broken Continuous Flow OR Case Ends Wait Transport Tray to CS Wait Prep for Washer Wait Washer Cycle 0 Mins 15 Mins 15 Mins 30 Mins 10 Mins 32 Mins 35 Mins Wait Assemble Wait Sterilize 360+ Mins 25 Mins 30 Mins 70 Mins Cool Down 120 Mins Wait Transport to Storage 90 Mins 15 Mins 847+ Minutes Processing Time or Cycle Time (14 hrs 07 mins) Activities = 290 Mins (+34) Wait = 557 Mins 34

35 REAL APPLICATIONS OF LEAN Step #2f: Drive for Continuous Flow Process Cycle Time Continuous Flow 256 Minutes Cycle Time 435 Minutes Cycle Time 847+ or Longer Cycle Time 94% of the longer cycle time is due to waiting time - only 6% is due to slower people or equipment performance The biggest opportunity is not in increasing staff or equipment performance but eliminating wait time 35

36 REAL APPLICATIONS OF LEAN Step #2f: Drive for Continuous Flow No Continuous Flow Real Examples Dirty case carts backlogged at OR elevator Case carts and instruments backlogged in decontamination for hours Instruments sitting on staging racks in assembly for hours and days Assembled instrument trays sitting at assembly tables instead of flowing to the sterilizers Instruments sitting in CS sterile and cool waiting to be taken to storage 36

37 CONTINUOUS FLOW EXAMPLE Continuous Flow real examples 37

38 6 INHIBITORS TO CONTINUOUS FLOW Inconsistent workload volumes Out of balance cycle times Staff schedules Staff work assignments Interruptions Lack of standardization 38

39 # of Occurrences INCONSISTENT WORKLOAD VOLUMES OR Cases Per Day Histogram Cases per Day 39

40 INCONSISTENT WORKLOAD VOLUMES Busy Days All Staff In Production No Non-Tray Activities Per Diem Staff Flex Staff No Days Off Overtime Prioritize Slow Days Some Staff Out of Production Training Education Cleaning Non-Tray Activities Days Off 40

41 7:00 8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 0:00 1:00 2:00 3:00 4:00 5:00 6:00 INCONSISTENT WORKLOAD VOLUMES % OR Cases End Time by Hour Avg End Times Actual End Times 20.0% 15.0% 10.0% 5.0% 0.0% 41

42 INCONSISTENT WORKLOAD VOLUMES Managing the Day Staff decontamination for no backlogs Workload Triggers for Additional Staff Washers even out the flow for Assembly Hourly peaks caught up in hourly valleys 42

43 OUT OF BALANCE CYCLE TIMES 43

44 7:00 8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 0:00 1:00 2:00 3:00 4:00 5:00 6:00 STAFF SCHEDULES 18.0 Creating 16.0 Backlog CS Staff Required vs Scheduled Decontam Assembly Sterilize Staff Scheduled Catching Up

45 7:00 8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 0:00 1:00 2:00 3:00 4:00 5:00 6:00 STAFF SCHEDULES 18.0 Mid-shifts for 16.0 Better Alignment CS Staff Required vs Scheduled Decontam Assembly Sterilize Staff Scheduled Reduce reliance on 3 rd shift for

46 STAFF WORK ASSIGNMENTS Does staff have multiple work assignments? Assembly Staff: assemble, unload washer, unload cart washer, answer phone, answer pick-up window, help OR find items, etc. Multiple work assignments inhibits the staff s ability to focus on the continuous flow of instruments. 46

47 INTERRUPTIONS Are your staff able to work uninterrupted? Similar to Work Assignments, can you find ways to reduce and eliminate the interruptions staff face while performing their primary activity? This is most important and usually violated in Assembly with phone calls, unloading washers, answering questions, and many other reasons to stop assembling. 47

48 LACK OF STANDARDIZATION Not an obvious inhibitor to continuous flow A balanced workflow only works if the people work to the designed standards Time standards how long it should take Practice standards how it should be done Strive for consistent, repeatable, and reliable performance 48

49 STEPS TO CONTINUOUS FLOW Balance the production line Align staff schedules Create Standard Work Set staff performance standards Train to standard work Reduce interruptions Develop key performance indicators Create leadership routines 49

50 CONTINUOUS FLOW RESULTS The following slides show actual hospitals that have implemented the lean concept of Continuous Flow. 50

51 LEVEL 1 TRAUMA HOSPITAL Improving CS throughput resulted in quicker turnaround of trays, decreased backlog of trays in CS, and less labor spent per tray. 51

52 LEVEL 1 TRAUMA HOSPITAL 52

53 MAJOR TEACHING HOSPITAL Improvements from Continuous Flow Tray Backlog in Assembly at 7AM % Complete Trays % Improvement 47% Improvement % 94% 92% Sep-13 90% Feb-14 88% 94% Sep-13 Feb % % 82% 86% 53

54 MAJOR TEACHING HOSPITAL Improvements from Continuous Flow Monthly IUSS Cycles % Errors per Tray 14% Improvement 55% Reduction % 14.0% 12.0% 10.0% Sep % Feb % 4.0% 2.0% 0.0% 14.6% 6.6% Sep-13 Feb-14 54

55 MAJOR TEACHING HOSPITAL Improvements from Continuous Flow Monthly IUSS Cycles % Errors per Tray 14% Improvement 55% Reduction % 14.0% 12.0% 10.0% Sep % Feb % 4.0% 2.0% 0.0% 14.6% 6.6% Sep-13 Feb-14 55

56 MAJOR TEACHING HOSPITAL Improvements from Continuous Flow SPD Monthly Overtime SPD Labor Hours per Tray 28% Reduction 15% Reduction Sep Feb Overtime Hours per Tray Sep-13 Feb-14 56

57 MAJOR TEACHING HOSPITAL 7AM Before Improvements 57

58 MAJOR TEACHING HOSPITAL 7AM After Improvements 58

59 SMALL 10 OR HOSPITAL 7AM Before Improvements 59

60 SMALL 10 OR HOSPITAL 7AM After Improvements 60

61 CONTINUOUS FLOW HINT Continuous Flow provides a nonthreatening process improvement objective for staff and leadership to tackle while providing the opportunity to tackle the department s core operational issues of process capacity and throughput, staffing schedules and assignments, standard work, and leadership routines. 61

62 LIFE AFTER CONTINUOUS FLOW Continuous Flow is a start on a never ending process improvement / quality roadmap Two natural next steps to address after implementing continuous flow are Workflow management when volumes or resource are not balanced (spikes, busy day, short staffed) Quality of products / services 62

63 REAL APPLICATIONS OF LEAN Step #3: Measure Performance 63

64 REAL APPLICATIONS OF LEAN Step #4: Implement Leadership Routines Now I know what to do! Your Leadership Team Your Staff Ensuring real time operations are performing to plan. 64

65 REAL APPLICATIONS OF LEAN Step #4: Implement Leadership Routines Step #1: Set a production or throughput plan for the day Step #2: Define a process, time of day, and method for Leadership to monitor production Throughput on schedule? Backlog status? Document reasons production is off-schedule: staffing, performance, equipment, in flow of material Step #3: Develop and implement Standard Work Step #4: Add follow-up to support implementation of Standard Work 65

66 REAL APPLICATIONS OF LEAN Step #4: Implement Leadership Routines Leadership Routines are not only for on-the-floor supervisors they affect all levels of leadership Lead Tech/Supervisor: Hourly routines, staff working to standard work at planned performance levels, off-schedule or off-plan issues documented Manager: Daily round with Supervisor to ensure they are following their Standard Work, review issues and assign responsibility for action plans, track performance measurements, walk the floor and ask questions 66

67 REAL APPLICATIONS OF LEAN Step #4: Implement Leadership Routines Director: Weekly round with Manager to ensure they are following their Standard Work, status of action plans, performance measurement review, walk the floor and ask questions V.P.: Weekly or Monthly review of Lean Management System and Leadership Routines, action plans, performance measurements, walk the floor ask questions Are we setting a plan, working the plan, and improving performance? 67

68 REAL APPLICATIONS OF LEAN Step #5: Engage Employees Develop Self Directed Work Teams Provide Clear Mission and Vision Believe in the Charter and Performance Measures Measurements of Success # Improvement Suggestions per Month per Staff # Implemented Suggestions per Month Lean Improvement Suggestions # Suggestions # Implemented Jan Feb Mar Apr May June 68

69 REAL APPLICATIONS OF LEAN Step #6: Eliminate Waste Step #7: Continuously Improve Only after building the foundation and roof and engaging the staff, can a department truly be ready to begin the Lean journey of Eliminating Waste and Continuous Improvement. 69

70 REAL APPLICATIONS OF LEAN Step #6: Eliminate Waste Removing the non-value added activities, motions, clutter and other items that slow down the process, waste resources, cause poor quality, and inhibit meeting customer expectations. Step #7: Continuously Improve Changing how activities are performed to improve performance and set new standards. 70

71 REAL APPLICATIONS OF LEAN Waste In order of importance to CS Waiting Products and people Defects Excess Motion Products and people Transportation Products and people Underutilized People Excess Inventory Overproduction Excessive Processing 71

72 REAL APPLICATIONS OF LEAN Waiting Eliminate It! Implement continuous flow Align staff schedule to workload Increase staff skills Ensure staff never have to wait to start a task, move to a secondary task, or ask what to do next Maximize uptime on bottleneck operations 72

73 REAL APPLICATIONS OF LEAN Defects Eliminate Them! Prevent Errors at the Source Create standard work Ensure documented instructions are current Create visual controls to ensure compliance Ensure proper training and follow-up is in place Measure errors and address root causes Utilize technology to provide information and error proofing visual aids at point of work 73

74 REAL APPLICATIONS OF LEAN Excess Motion Reduce It! Movement of people, material, or products that does not add value Layout department to minimize movements Move required supplies, materials, products closer to the work stations Avoid double handling of items one touch is the goal cut your touches in half Set up Workstations ergonomically to minimize walking, reaching, bending 74

75 REAL APPLICATIONS OF LEAN Excess Motion Reduce It! Simple everything routinely used within easy reach Streamlined and Simplified in Decontamination 75

76 REAL APPLICATIONS OF LEAN Transportation Reduce It! Design the workspace to minimize the distance for work to be moved, remove cross-flow, minimize handling Clean up the preference cards to eliminate 30% return unused rates from case carts Never walk to or from someplace without taking or bringing back something Cut floor runs or restocking trips in half and save the walking 76

77 REAL APPLICATIONS OF LEAN Decontamination Eliminate Waste People or instruments waiting Instruments not cleaned Supplies not close by Excess movement OR mixes dirty and clean instruments Visual management Manage productivity Continuously Improve Match staff to workflow Navigator position Linear flow / inline sinks Technology for information 77

78 REAL APPLICATIONS OF LEAN Decontamination Examples Case Cart DETERGENT ROOM Case Cart Case Cart Case Cart Case Cart Case Cart Case Cart Case Cart Low Temp Sterilizer Case Cart Low Temp Sterilizer Case Cart Case Cart Case Cart Case Cart Case Cart Case Cart Case Cart Case Cart Case Cart Case Cart Case Cart Case Cart Case Cart Case Cart Case Cart Case Cart Case Cart Case Cart Case Cart Case Cart Case Cart Navigator staff handles carts, scans, delivers work to stations and maintains flow Wash technicians stay at stations working to improve throughput Container Rack Low Temp Sterilizer Prep / Pack Table 3' x 6' Hand Wash Staging Table 3' x 4' Sonic Sonic Sonic Sonic Sonic Sonic LOW TEMP AREA Low Temp Assembly Staging Table 3' x 6' Pass Through Dryer Quick Turn Washer Container Rack Container Rack Pass Through Counter Windows Work Table Work Table 44" x 97" 44" x 97" Hand Wash Prep / Pack Table Prep / Pack Table 3' x 6' 3' x 6' with Two Pass Prep / Pack Table Prep / Pack Table 3' x 6' 3' x 6' Through Windows Prep / Pack Table Prep / Pack Table 3' x 6' 3' x 6' Prep / Pack Table 3' x 6' Prep / Pack Table 3' x 6' Inline Sinks Prep / Pack Table Prep / Pack Table 3' x 6' 3' x 6' Prep / Pack Table Prep / Pack Table with Sonic 3' x 6' 3' x 6' Close to Washer Prep / Pack Table Prep / Pack Table 3' x 6' 3' x 6' Prep / Pack Table Prep / Pack Table 3' x 6' 3' x 6' Low Temp Assembly and Sterilization with Storage Area Case Cart AIR LOCK CHANGING ROOM Vendor Room with Windows WASTE AREA GLASS WALL VENDOR DROP OFF Staging Table 3' x 4' SCOPE CLEANING Scope Scope Scope Process Process Process or or or Pass Through Scope Cabinets 78 GLASS WALL Scope Room SCOPE PICK- UP VENDOR PICK-UP

79 REAL APPLICATIONS OF LEAN Assembly Eliminate Waste Supplies not close by Reduce interruptions Looking for missing instruments Work assignments Visual management Manage productivity Quality inspections Incorrect incomplete count sheets Continuously Improve Match staff to workflow Navigator position Wrapping position Linear flow Separate low temp Reduce # of instruments in trays Technology for information 79

80 REAL APPLICATIONS OF LEAN Assembly Examples Conveyor to move trays to sterilizer person 80

81 REAL APPLICATIONS OF LEAN Sterilization Eliminate Waste Supplies not close by Reduce interruptions Visual management Manage productivity Secondary work assignment Continuously Improve Match staff to workflow Linear flow Technology for record keeping Technology for quality systems 81

82 REAL APPLICATIONS OF LEAN The Three D s of a Lean Journey DELAY: Remove delays, backlogs, and waiting from your process DEFECTS: Remove errors, defective products DEVIATION: Remove variance in processes and how staff perform their work 82

83 REAL APPLICATIONS OF LEAN Real Life CS Results: Reduced Delay, Defects, and Deviation Performance Measurements Baseline Min-Avg-Max Results Min-Avg-Max Trays Waiting to be Assembled 7am % Complete Instrument Trays 90% - 96% - 99% 93% - 97% - 99% % Complete Case Carts 42% - 76% - 96% 89% - 97% - 100% # of Quality Errors per Day Insufficient Data CS Productivity = Hours Per Tray

84 % of Respondent Anwers REAL APPLICATIONS OF LEAN Real Life CS Results: Improved OR Satisfaction OR Customer Survey Summary OR Survey Start of Project OR Survey End of Project Desired Results 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Excellent Good Average Fair Poor 84

85 REAL APPLICATIONS OF LEAN Real Life CS Results: 7AM Before Lean 85

86 REAL APPLICATIONS OF LEAN Real Life CS Results: 7AM After Lean 86

87 Eliminate Waste Employee Engagement Continuous Improvement QUESTIONS Copies of Principles of LEAN CS available. Lean CS Principles Prepared by STERIS Professional Services LEAN CS Measurement & Leadership Routines Lean Operational Plan Customer Requirements Brazil CME Lean Presentation by STERIS 87