Transcript No Slide Title

Applying Toyota Lean Principles
in a Healthcare Supply Chain
Partnering between Supply Chain &
Clinicians
WSHMMA
Spokane 2006
Ken Fortune: Director of Purchasing &
Distribution
Allen Caudle: VP Supply Chain Management
Swedish Health Services
Seattle, Washington
Swedish Health Services
Home Health
& Hospice
Hospital
Division
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Physician
Division
Joint
Ventures
Foundations
Largest Hospital System in the Pacific Northwest
4 Acute Care Facilities
25 City Blocks and 5.5 million Ft2
1,286 Total Beds
Not for Profit – 501c3 Organization
Net Revenues - $1.1 billion (2006 budget)
6,970 Employees
1,744 Physicians
54 Operating Rooms
Approximately 40,000 Surgical Procedures
$170M Total Supply Spending
Research &
Education
MOBs
Supply Chain Vision
The Gold Standard
Treat the patient care constraint like Gold -- Align the
organization and deliver The Gold Standard to our
customers and clinical service partners!
Pyxis
Med Surg Supply
Implementation RPI
Periop Services
Supply Chain
Clin. Info System
RPI Redesign
Patient
Care
Nursing Unit
Storeroom 5S
Critical Use
Equipment RPI
Bed Turnover RPI
Environmental Services
Forms Process
Improvement RPI
What is the Toyota Production
System or “Lean Thinking?”
Request
Value Stream Time Line
Revenue
1. Value - define precisely what delights customers
2. Value Stream = Service Lines - identify all processes
3. Flow - make value steps flow by removing waste in
every form
4. Just-in-Time - design & provide precisely what
customers want precisely when they want it
5. Perfection - pursue through Daily Management
10 Leadership Practices for Managing
& Sustaining Lean Operations
Employee
Development
Establish a Good,
Two-way Relationship
Select & Orient Staff
Set Context
Coach & Develop Staff
Plan &
Resource
Assess Judgment
& Discretion
Goal
Achievement
Assign Tasks
Recognizing &
Rewarding
Staff
Reassign,
Correct
or Dismiss
Improve Work
Continuously
• Quality
• Patient
Satisfaction
• Lead-time
Success Requires 3 Stratum
Leadership & Management
Guidance Team
Management Guidance Team
• Epidemiology & Nursing
CEO
COO
• Cross-org. alignment -- BioMed,
Envir. Services, Sterile Processing
VP
VP
3 Stratum Leadership
DIR
Mgr
DIR
Mgr
DIR
DIR
Mgr Mgr
• Authorizing manager
• Process Manager
• Experts in the Process
Customer
Our RPI Project
Management Process
Executive
Commitment
ASSESSMENT
Go/No Go?
Sustainable
Improvement
PLAN
RPI
Blueprint
WORKSHOP
WEEK Hold the
Gains
RPI
A
S
P
D
30 Day
Review
60 Day
Review
DAILY MANAGEMENT
(RPI Newspaper)
Activities of the Four
Phases
Assessment
Initial
meeting
Process review
Site Visit
Assess
managers
Feedback
- Opportunities
- Risks
- Scope
Go/No
Go
decision
Planning
Workshop
Objectives
Process
boundaries
Timing set
Participant
preparation
Management
preparation
Data
collection
Agenda set
Workshop
Learn
tools
Analyze
process
Eliminate
waste
Implement
short-term
plans
Develop
follow-on
plans
Daily Mgmt
Complete
workshop
actions
Implement
Daily Mgmt
Check results
and hold gains
Spread to
other areas
Roles in the RPI Management
Guidance Team

Provide uninterrupted team member
participation.
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Remove barriers for the workshop participants.

Empower and support the workshop participants
to implement changes (i.e. provide resources).

Notify and coach workshop participants for their
role in the workshop
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Participate with team to resolve issues and
mediate differences.
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Advocate for the need of customers and “the
whole” vs. a particular unit of people.
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Take risks and encourage workshop participants
to do the same.
3 Actuals Walk
“The time that provides me with the most vital
information about management is the time I
spend in the plant, not in the vice president’s
office.” -- Taiichi Ohno
to the Actual Place
 Talk to the Actual People
 Observe the Actual Process
 Go
The 5S’s
Sort
Separate the needed from the not
needed (waste).
Simplify
A place for everything & everything
in its place, clean & ready to use.
Sweep
Sweep to clean and visual sweep to
understand.
Standardize
Develop common methods for
consistency.
Sustain
Hold the gains & improve.
Pre-RPI SDS Case Cart Process
PL
Q
MSC
Supplies
Packs, Supplies
Q
(65k)
(136k)
Suture Board
SDS
Core
Suture
Supplies, Equip,
Instruments
Rx
Room
Q
Q
Q
OR
Suite
Instruments, Packs,
Soft Goods
Window (10)
Q
SPD
Pick Tickets
Medications
PDC
Q
2 WKS PLs = $90k
Core (30%) = $30k
4 Turns
3+ months
40 Different Inventory
Locations
New Case Cart Building Process
Inventory Supply
Room
PDC
Pull soft goods for
1st case next day
– Andrew
(day before)
DOS
PDC pull items; put
on cart; place in
inventory room for
Andrew
DOS
Pull clean cart into
inventory room.
Put on soft goods
and PDC items.
PDC Items
Soft Goods
Packs, Solutions,
Canisters
Instrument Set
Put on instrument
set, solutions,
custom pack,
canisters, linens
and bags
Facilitator gets
equipment and
positioning
devices
MSC
MSC restock soft
goods, custom
pack, solutions,
canisters –
daily
Back Hallway
Take cart to
back hallway
Core
SPD
SPD pulls
instrument set for
next day.
Take to SDS, w/
PL’s, to Kanban
spot
Laundry
Linen
Linen
exchange cart daily
Facilitator pulls
meds, saturns
and MD sterile
specials
Meds, Suture,
Equipment
OR Suite
Push cart into OR
for 1st case – TF
cases, push into
kanban square
Case Cart Building
Process Flow
DOS
Day Before DOS
Inventory Supply
Room
§ Case cart builder
pulls soft goods
for 1st case of
next day
§ Places soft good
in tote
designated for
specific OR
§ Stages for next
day
§ PDC pulls items
needed for entire
day and places
on cart
§ Cart is moved to
back hallway of
Core to
designated spot
At 6am
Before 6am
§ SPD brings up
cart with
instrument sets
for 1st unit (4 hrs)
to designated
spot in clean side
of decontam with
a list of what
goes where
§ Specialty
instrument (nonstored) for each
procedure are
combined with
the instrument
set by SPD
§ Case Cart
Builder (CCB)
gets clean cart
from back
hallway
designated spot
and takes to
clean decontam
§ CCB puts
instrument set,
peel pack and
un-sterile
specials; and
pushes to
inventory storage
room
§ Add designated
tote
§ Push cart to back
hallway
§ In back hallway,
CCB adds
solutions,
canisters, linens,
PDC items and
custom packs
§ Case cart
pushed into
designated OR
§ 1st case only
§ Facilitator pulls
sutures, meds,
and sterile MD
specials and peel
pack items
§ Facilitator gets
equipment and
positioning
devices
§ Pushes cart into
OR when
complete
§ Repeat steps 4-6
for next case
§ CCB places TF
case cart in
designated spot
in back hallway
or outside OR
Data Summary
# Steps
# VA Steps
# NVA Steps
# Queues
# Handoffs
# Feet Traveled
# In Queue (WIP)
Lead Time
Cycle Time
Space
111
6
105
4
23
10,234
Hundreds
58 Hrs
8 Hrs
C Floor
B Floor
A Floor
45
6
39
3
3
378
↓ 59%
↓ 63%
↓ 25%
↓ 87%
↓ 96%
17 Hrs ↓71%
15 min ↓ 97%
Inventory Reduction
Patient Chargeables
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SDS Core
SPD
Before
7,944
5,394
$ 13,338
Future
7,378
0
$ 7,378
19,498
2,169
$21,667
2,765
0
$ 2,765
Change
$ 5,960
Non-Chargeables
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SDS Core & Inventory
Room
SPD
Returns to MSC
$18,902
$ 2,000
Suture
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SDS Core
Total
$ 65,119
Marked boxes
$ 9,896
$36,758
JULY – DECEMBER 2005
PERCENT OF SDS AVERAGE WEEKLY STOCKOUTS
Percent of SDS Average Weekly Stockouts
1.22%
1.08%
1.01%
0.72%
0.58%
0.81%
0.58% 0.58%
0.65%
0.72%
0.60%
0.45%
0.45%
0.29%
0.58%
0.14%
0.27%
0.22%
0.00%
0.00%
0.00%
0.36%
0.36%
0.22%
JULY – DECEMBER 2005
PERCENT OF MSC AVERAGE WEEKLY STOCKOUTS
Percent of MSC Average Weekly Stockouts
3.57%
3.21%
3.03%
3.08%
3.17%
3.07%
2.99%
2.94% 2.95%
2.64%
2.65%
2.57%
3.29%
3.19%
2.90%
2.97%
2.71%
2.50%
2.64%
2.39%
2.57%
2.15%
1.85%
2.39%
1.89%
Communications & Instrument Delivery Protocol
2nd Shift prints pick tickets
after 5p
2nd Shift
Sort pick
tickets into
two piles
1st Shift
7:30a – 12:30p
1st run pick tickets
No front sheet
SPD calls SDS for Missing
Instrument Needs #66042 at
6:00a
Pick instruments and record
missing instruments
(Blue Sheet)
12:31p – 5:31p
1st Shift
Copy Missing Instrument
Sheet
Pick instruments and record
missing instruments
(Blue Sheet)
Send copy w/instruments
Place original w/1st shift pick
tickets
Copy Missing Instrument
Sheet
Send copy w/instruments
Deliver instruments for the
day to SDS by 11:30p
Deliver instruments to SDS
10:00a
Dispose used PL’s
Dispose used PL’s
Call SDS for Missing
Instruments #66042 by 11a
Rapid Instrument Turnover Flow SDS
Circulating RN calls for
instruments to be picked up in
OR
Instrument suitable
for auto wash?
No
Hand wash
Deliver back
to room
Sterilize
Hand wash
Deliver back
to room
Sterilize
Yes
Time available to
auto wash
Yes
Initial cleaning by hand
Run in washer
Deliver to room
Sterilize
No
Forms “System”
Someone wants to generate or
revise clinical protocol, careplan,
clinical guideline or other clinical
form
Form
content is
developed
NO
Track form
Forms Committee
and Standards
Committee
Approval
Processes
Approved
?
Track form
Stakeholder
Approval
Process for
Implementati
on
YES
Track form
Swedish Online forms
and orders
Track form
Print
Process
Track form
Track form
Printed Forms
To Departments
Va
ri a
tion
V
ar
ia
tio
n
To Inventory/Storage
Department/
Unit
tion
n
tio
V
ar
Va
ri a
Sort & Purge
Old Forms
ia
Sort & Purge
Storage/Inventory
Old Forms (Merrill, MSC, 1 SE)
Management and Storage of Forms and Forms Inventory
In The Units and In All Storage Locations
Printed Forms
Storage/Inventory
Department/Unit
atio
n
V
ar
ia
tio
n
Va
ri
Department/Unit
Sort & Purge
Old Forms
Storage/Inventory
(Merrill, MSC, 1 SE)
atio
n
V
ar
ia
tio
n
Va
ri
Sort & Purge
Old Forms
Goals:
Ø Reduce staff “search time” for forms
Ø Identify and inventory most current forms
Ø Find opportunities for standardizing forms process on units
Ø Eliminate forms that are problematic for patient safety
Ø Reduce forms inventory on units, MSC, Merrill
Ø Identify responsible person to manage forms inventory on unit
Ø Design staff education format for new/improved forms process in units
Ø Design process so that nursing units are aware of when a new or revised form is in house
and how to obtain it on the unit
Ø Design process so that prior to distribution of new or revised forms, staff have received
notification and or education as appropriate
Ø Identify who pays for purged/discarded forms
Ø Standardize process to notify MSC and Merrill when form has been discontinued
Ø Standardize process to notify MSC and Merrill for just-in-time delivery of forms to unit
Forms Development Process
Someone wants to generate or revise clinical
protocol, careplan, clinical guideline or other
clinical form
Form content is
developed
NO
PDSA
Team meetings
Stakeholder input
Evidence-based research
Pilot/Test in daily work
Make recommended revisions
Put into standardized format
Begin form education plan
Prepare to submit to Forms and Standards Committees
Track through Committees’ processes
Revise as Committees require
Resubmit to Committees for approval
Track form
Forms Committee and
Standards Committee
Approval Processes
Approved?
Track form
Stakeholder
Approval Process
for Implementation
YES
Submit to key stakeholder committees and councils
Make revisions if necessary
Resubmit to project team for rework if necessary
Resubmit to Forms and Standards if necessary
Submit to Print process when final
Track form
·
·
·
·
·
·
·
·
GOALS
Reduce lead time for forms development and
printing
Streamline and standardize forms development
process
Design staff education format for new/revised
forms
Reduce cost of forms development and printing
Link Forms and Standards committees to the
Forms Development Process
Identify single point accountability for Forms
Development Process
User can track forms development process
Prepare for the transition of forms to CIS
Track form
Swedish On-line
forms and orders
Print Process
Track form
To Management After Printing Process
Forms have
been printed
Track form
Becoming Partners

The week-long Rapid Improvement Process
Workshop helped to break down longstanding barriers between departments…

Surgery was unaware of the services Supply
Chain could provide to them…

Communications opened up during the
workshop with many opportunities
Becoming Partners

The RPI was a strong success…85%
reduction in “Go-Gets” by moving
supplies closer to point of use and case
cart accuracy improved to 99% because
cases picked within core and on a just-intime basis.

Right people, doing right job, at the right
time
Summary
•
HOW HAVE OUR ROLES CHANGED?
Better partners between Supply Chain and
clinicians
•
Supply Chain viewed as professionals in supply
management and leaders of sustained process
improvement
•
Supply problems eased in the OR with better
supply management process (fewer stock outs
and “go-gets” from the rooms)
•
Nurses can be nurses – focusing on patient care
HOW HAVE OUR ROLES CHANGED?
•
Supply chain professionals manage
the process with data and continued
“Roundings” with clinicians, OR
managers, and physicians
•
Supply chain professionals are now
relied upon to solve other problems in
the OR