Executive Summary
Implementing LEAN methodology to the Laboratory, Emergency Department, Surgery Department and Housekeeping
Organizational Characteristics
Number of staffed beds: 490
Number of admissions: 18,773
Number of physicians on staff: 534
(includes medical residents)
Total operating expenses: $349,162
(in thousands)
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There was a need for additional space and performance improvement. The laboratory was between permanent directors.
Initial expectations: Improved workflow; improved space design; improved productivity.
The space savings in the Laboratory prompted administration to ask if patient flow could be improved in the emergency department to result in additional space savings, reducing the need for new construction of 24 Emergency Department rooms.
Initial expectations: Space savings in the Emergency Department would result in saving capital dollars.
Surgery
Success in the supply replenishment process in both the Laboratory and Emergency Department prompted a project in operative service which accounts for 60 percent of inventory.
Initial expectations: A robust supply replenishment system that would reduce inventory and result in savings for the organization.
Housekeeping
Patients needing to be admitted were waiting in the Emergency Department for bed placement since rooms had not been cleaned.
Initial expectations: Rooms would be cleaned in the first-in-first-out basis after patients were dismissed, increasing the availability of rooms.
Results
- Single piece flow for collection and transportation of specimens as well as reorganization and standardization of work in the laboratory leading to a total change in how work was collected, received and performed.
- Turnaround time dropped from an average of 62 minutes to 35 minutes from collection to verification (availability to the physician) for chemistry panels.
- Accuracy rate improved from 3.4 Sigma to 5.2 Sigma (86 DPMO) level over a 2-year period and continues to improve.
- Standardization of Emergency Department rooms; rooms become specialized with carts loaded with necessary supplies.
- Reduction in LOS and improved availability of inpatient rooms for admissions resulted in construction of 16 rooms instead of 24.
- Most patients see a physician within 20 minutes of arrival resulting in increased patient satisfaction scores from the 60th percentile to the above 90th percentile.
Surgery
- Patients receive uninterrupted preoperative care – patients are ready for surgery in 25 minutes
- Preoperative patients were moved closer to the surgical suites eliminating the need for a preop waiting area within surgery.
- Suture inventory savings of $108,000 annually
- Bar-coded inventory replenishment system was implemented
- Bar-coded inventory capabilities enable periodic cycle counts to monitor inventory levels
Housekeeping
- Patients are dismissed in the information system within 15 minutes of departure
- The information system generates an automatic page to Housekeeping notifying them of a room to clean
- Carts bring cleaning supplies directly to the point of use eliminating the need to enter and exit the room to access supplies in the hallway.
- Turnaround times for rooms is approaching 60 minutes.
Required Resources
- 4 to 5 FTEs for 10 to 15 week projects
- Misc, supplies
Advice for Colleagues
The application of LEAN processes provides for improved patient outcomes, improved bottom line and can be applied to a large variety of areas within a health care system. Along with improved productivity and financial performance, it helps to achieve improved patient satisfaction.
Contact Information
Name: Kathy Maass
Title: Director of Process Excellence
Email: kathy.maass@mckennan.org
