Park Nicollet Health Services

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Park Nicollet Health Services

• 5S 3P Lean Case Study in a Healthcare
  Environment - Facilities

Duane Spiegle, Vice President, Real Estate
Support Services IFMA February 7, 2006
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Park Nicollet Vision
Creating with the Individuals We Serve Optimal
Health and Greater Value
Everyone Caring
Everyday
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Our Core Strategy

• Passionate about best possible outcomes
• A world-class continuum of care
• Broad base of primary care
• Value-added seamless handoffs with excellent
  specialty programs
• New value (and revenue) streams by medical
  condition

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Health Care - A Crisis of Value
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The crisis in value is recognized globally as a
business opportunity

• Global market for health care
• Health care is growing as a percent of the
  worlds economy
• The World Is Flat dynamics include
  the digitization of services
• Entrepreneurial opportunities
• Massive investment lining up
• GE
• AOL
• Target
• Microsoft
• Private capital

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World is Flat global competition coming to
health care

• Nighthawk radiology
• Apollo Hospitals - India
• Cleveland Clinic E-consults
• NHS Admissions to the US
• e-mobile medical records still to come

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Park Nicollet Health Improvement System
Just In Time
Jidoka
Produce to takt time
Standard Work
People
One-by-one confirmation to detect
abnormalities. Stop and respond to every
abnormality. Separate equipment work from human
work. Enable equipment to detect abnormalities
and stop autonomously
Operate with the minimum resource required to
consistently deliver Just what is needed In just
the required amount Just where it is needed Just
when it is needed
One piece flow
Standard Work In Process
Supplies
Equipment
Pull system production
Visible Operational Availability
Leveled production (Heijunka)
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Why Toyota?

• Most advanced management system in the world
• Effective in removing all 7 forms of waste
• motion
• time (Waiting)
• inventory
• over-production
• transportation
• defects
• processing
• It is a system of productivity Quality
• It keeps on ticking 40 year history at Toyota

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LEAN the 7 sees

• See for yourself (go to the gemba)
• See what people do (standard work)
• See how people spend their time (stopwatch, time
  observation sheet)
• See where people go (spaghetti chart)
• See what really happens to your patients (value
  stream maps)
• See who your teammates really are (value stream
  maps)
• See the wasted effort (muda)

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Our Commitment

• Kaizen Promotion Office (KPO) staffed (11)
• Kaizen Operation Teams (KOT) staffed (25)
• 135 leaders pursuing Certification
• (This includes experiences on factory floor at
  Genie and Japan gemba kaizen)
• 100 leaders pursuing Certification Maintenance
• Intern program in place 5 /W 12 completed

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Our Commitment (cont.)

• 250 RPIWs completed
• Over 1200 staff members have participated
• 9 3P workshops completed
• (TRIA, Chanhassen, HVC, Endoscopy, Chronic
  Disease, OB, Cancer Center, EDI, Methodist
  Hospital)
• Visibility Room operational
• 5S Campaigns - 10 projects per month

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3 Main Methods for implementing Lean

• 5S making our workspaces clean, organized and
  visual
• RPIWs Rapid Process Improvement Workshop
  weekly workshops aimed at eliminating waste, in
  its many forms
• 3P Production Preparation Process used to
  create a new process or totally redesign an
  existing process PDCA

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5S 3P Integrated Timeline
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5S Creating a physical environment in support
of Lean

• 5S is a strategy for organizing the workplace
  to minimize waste of time. Having everything
  clean, neat, and in the proper location enhances
  quality and productivity because it helps make
  things easier to find and problems more visible.
• A place for everything, and everything in its
  place, clean and ready for use

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5S Workplace Organization

• Sorting - Remove excess or unused products,
  furniture and equipment. Keep only what is
  needed.
• Simplifying - Make the workplace easy to
  understand where products and equipment can be
  found. Place products used to do the work close
  to the worker to avoid steps.
• Sweeping - Visual checks will help indicate that
  everything is in its place and in sufficient
  quantity. Establish simple signals to assure
  inventories are replenished in small quantities.
• Standardizing - Make the workplace the same in
  layout and products used in the work.
• Self-discipline - Adopt the habit of making
  regular visual checks to maintain the
  improvement.

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Bio-Med Before 5S
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Bio-Med After 5S
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Mechanical Room Before 5S
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Mechanical Room After 5S
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Mechanical Room Before 5S
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Mechanical Room After 5S
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5S Results for 2006

• 94 teams
• Involving 397 employees
• A total of 14,414 red tagged items were sent to
  the 5S warehouse. Items re-deployed, sold,
  donated or thrown away
• Items valued at 1.2 million

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3P Production Preparation Process

• Model process for designing quality service
• Used when demand dictates increased capacity
  required or new product introduced
• Process design or service delivery changes

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3P Production Preparation Process (cont.)

• Patient (customer) the focal point
• Programming and Space Planning condensed into one
  week.
• 15-20 Participants (stakeholders, decision
  makers, customers, lean experts, patients,
  architect)
• Outcome sets project scope no work around
  (stick to the plan)

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Approach to Construction

• Traditional Lean
• Progress from 3P, Cost Estimate 5d 5d
• Schematic Design 35d 20d
• Design Development 40d 30d
• Contract Documents 50d 30d
• Bid and Award 15d 15d
• Construction 100d 90d
• Move-in 5d 5d
• 250d 195d

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3P Tools

• Patient Quantity Analysis (PQA)
• 7 flows (Yarn measurements)
• 7 ways (think like 12 year old)
• Simulation/Modeling (post-it notes Lego's)
• Mock-ups
• Layouts

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7 Flows

• Flow of Patients
• Flow of Providers
• Flow of Medications
• Flow of Supplies
• Flow of Information
• Flow of Equipment
• Flow of Instruments/Processes

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Steps

• Define scope and team membership
• Fishbone current process
• Create preferred process flow examine
  alternatives (from nature)
• Develop and evaluate 7 options
• Narrow selection and present results
• Complete equipment design and layouts

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Involving Patients

• 3P patient participation
• Patient Provider Council

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3P Intelligent Design of our workspaces
(mockup, try, practice)
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3P Tools (fishbone diagram)
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3P Tools (string model)
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3P Tools (string model)
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3P Tools (string model)
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3P Tools (simulation)
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3P Tools (mockup/layout)
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3P Results - Chanhassen

• Decrease walking
• For patient reduced 27
• For nurse reduced 27
• For clinician reduced 42
• Reduce inventory
• Reduced 21 exam rooms
• Reduced 1 procedure room
• Reduced construction cost 196,200
• Total project reduction 357,300
• 20 reduction of square footage
• Created flexibility, team work among disciplines
  lean concept of 'open room' less steps for
  patient and staff improved flow and visual
  control.

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3P Results - HVC

• Patient walking distance decreased 73 in
  nuclear, interventional and chest x-ray
• Staff walking distance decreased 30
• Estimated cost of changed 400,000 including
  design, change orders, materials/equip
• Cost avoidance of 140,000 in staffing
  assumptions
• Capacity gains result in opportunity for
  additional 2.5 million in gross charges

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3P Results - TRIA

• We could have institutionalized poor processes in
  the facility design customers (external
  internal) would not always be served well.
• Good data is essential.
• Next room available increases capacity.
• "Expert" opinions are often wrong. Data and
  modeling proved this.
• By using 3P, movement could be cut by 50,
  patient time in facility by 30, labor costs by
  20 and time to patient payment by 30

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Summary of 3Ps Lessons Learned

• Have defined scope/goal from the start
• Clearly articulate/communicate your scope/goal to
  team
• Measurement and good data are critical to the
  process
• Participation from patients is essential
• Standard work is necessary for efficiency
• Flexibility is achieved by breaking down
  department barriers
• Interdisciplinary groups should always design
  facilities
• Visualization is a key to understanding flow and
  processes
• Simulation is enlightening, it changes peoples
  views on flow

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Lessons LearnedDavid Wessner, CEO

• its humbling that I have to admit were
  relearning how to get everyone involved in taking
  the waste out of work. The more you learn about
  waste, the more you see it.

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Lessons LearnedSam Carlson, MD Chief Medical
Officer

• Standard work and reducing variation in
  processes are key components of safe and
  productive work practices and conflict with
  professional autonomy.
• Accept the challenge!"

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Lean Resources
Publications Lean Thinking by Womack and Jones
The Toyota Way by Jeffrey K. Liker Toyota
Production System by Taiichi Ohno A World Class
Production System by John R. Black Web
sites www.lean.org www.gemba.com www.parknicolle
t.com
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Thank You