Spencer Hospital - Spencer Success Story

Lean Processing at Spencer Hospital, February 2008

SPENCER HOSPITAL: A 99-bed acute care hospital located in the northwest corner of Iowa Lean Processing at work in Spencer Hospital is known as SHAPE: Spencer Hospital Achieving Performance Excellence

Background: Our Lean journey began in October 2005; strong leadership and support from the CEO, the Executive Team, & the Board of Trustees plus the dedication of front line managers and staff make the process work. The focus is always on eliminating waste and achieving results in quality, service, operations and employee engagement. As of this month:  40% of @ 500 staff have participated on rapid improvement teams  Plus, “Voice of the Customer,” patients, families and physicians are involved at key times

The customer, ultimately patients and families define "value". And we value internal and external customers. We use Lean principles: 1. Value; 2. Value stream; 3. Flow; 4. Pull; 5. Ideal; and, fundamentals: 1. On-Demand; 2. Defect-Free; 3. One-by-One; 4. Lowest Cost

We make use of an abundance of Lean tools: process mapping, spaghetti diagrams, communication circles, 5S-ing, standard work, A-3 problem solving, visual controls, and appreciation for the worker, and full review of the existing work process. At the foundation of all the work is measurement; metrics provide the understanding of where we are and where we need to be and if, in our changes, we are getting there.

We are dedicated to being "people-oriented, process-focused and results-driven". SHAPE is not a quick fix; it is a commitment to excellence through open-mindedly having the courage to see the waste and to call it that…. and then doing something about it. SHAPE is not just a process; it is a way of doing business. We have just scratched the surface and look forward to long term success.

Success Stories – Results: Quality Improvements and Cultural Impact:

1. Topic: Surgery – Central Sterilization Assembly & Work Flow Scope: Review Central Sterilization Cell assembly flow; i.e. items coming out of the washer and continuing through placement of items on sterilization racks after coming from the autoclaves; motion from decontamination process to placement in storage racks, then prepared for surgery use. Before: Initial state review:  Layout was spread out, revealed waste in steps and excess space allocation; table set up perpendicular to work flow and material not lined up for ease and efficiency  Data: 4.6 miles traveled/person/day

During: Mapped current flow, ideal, and future flow;  Try-stormed (trialed) 6 rapid improvement experiments to shorten distance traveled and optimize ease of assemble of sterile packs

Results: Developed continuous flow in the direction of the work by:  Moving configuration to line up with flow  Freeing up space to move sterile supplies closer to assembly  Relocating autoclave rack, battery charger, biological test tubes  Rearranging materials– point-of-use supplies and holders  Marked "parking" areas for case carts to be returned and maintained

Data: Saved 181 miles/person/year –or .7mile/person/day Freed up 200 square feet of space

After: Central Sterilization staff continued to work to free up the remaining 66 sq feet of space needed to allow the movement of sterile supplies into the Central Sterilization area, saving them from having to travel to the lower level of the hospital each time they needed these items. Lessons Learned:  This 4-day event enabled a team to focus, study and make significant changes – all within a week.  We need to test new ideas, break paradigms.  The solution to a problem is not through more space or more resources, "creativity before capital".  Lean principles do apply to healthcare.

Another Success Story:

2. Topic: Mental Health Intake Process Scope: Review and streamline Mental Health process of admitting patients

Before: Initial State Review:  Disconnect of communication, cumbersome process with excessive tasks/steps, and lack of standardization  Data: Average cycle time = 2 hrs 38 minutes During: Mapped the flow of the patient from Emergency Department (ED) to Inpatient room; also, ideal state map

 Current total process steps = 53; significantly non-value added steps  Performed 14 rapid experiments and measured results

Results: Streamlined the admission process  Established admission path from ED to patient floor, more direct via elevator across from intake room  Set up a new, secure admission room  Stocked supplies at point-of-use  Created standard work, processing orders etc. in the computer medical record; created standard screens and maximized use of the EMR (electronic medical record)  Resolved the wireless computer issues – installed new WAPs (wireless access points)  Data: Average cycle time reduced to 2 hrs, a 24% savings

Lessons Learned:  Lean really works.  This is hard work----but achieves results quickly.  Doing experiments during the week really helps.  It is often difficult to move people's cheese, i.e. change their world.  We have a new appreciation of the complexity of processes.

Teams in action:

We involve the staff from the areas "where the work happens" – putting up an Issues and Ideas poster for them to contribute before the Kaizen event; we also have the process owner bring staff to the SHAPE work room to review the information on poster paper "covering the walls" so they are in the loop and engaged to accept the changes as best as possible.

This process has helped staff and leaders work together on real engagement and results, promoting further drill down and stressing the need to hold the gains. This is a great opportunity and investment for the staff and community. The driving force for all our work is "What is in the best interest of the patient"!