Quality Update
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The AHA Quality Center is a resource of the American Hospital Association designed to help hospitals accelerate their quality improvement processes to achieve better outcomes for patients and improve organizational performance.
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Improvement Strategies and Methodologies is one of the AHA Quality Center’s “Eight Dimensions of Quality.” Further information and tools to help you understand the Improvement Strategies and Methodologies dimension can be found at www.ahaqualitycenter.org.
Abaker needs an oven to bake a cake, but not just an oven. He or she needs a variety of utensils—measuring cups, spoons, whisks, cooling racks, etc. In fact, every professional needs a variety of tools to produce quality products that consumers will demand.
Health care organizations are no different. Six Sigma, ISO, the Baldrige criteria or another methodology might work for some processes, but not all of them. There’s no silver bullet. Today’s workers demand an assortment of tools to improve and maintain quality health care delivery in their organizations.
In early 2006, Virtua Health, Marlton, N.J., already had several tools in its quality cookbook. For six years, the four-hospital health system relied on the Six Sigma methodology to achieve organizational goals of excellent service, a caring culture, clinical quality and safety, best people employment and resource stewardship.
Along with that, Virtua implemented two GE Healthcare processes—the Change Acceleration Process (CAP) to help employees and management deal with organizational change; and Workout, which focuses on brainstorming and action plans in town hall type meetings.
However, it became clear to President and CEO Richard Miller and his team that they needed to do more. They needed something that would bring about quality changes faster than Six Sigma, something that employees could embrace as their own and that would offer a structured methodology for implementing quick fixes. Virtua turned to the Lean Methodology, which Miller calls “a perfect tool for health care. It’s complementary to Six Sigma and allows for quick turnaround.”
Lean Methodology is derived from the Toyota Production System. The basic premise is to keep production continuously flowing; anything that interferes with the flow is considered waste. It is designed to improve profitability, customer satisfaction, throughput time and employee morale by eliminating such things as defects, overproduction, waiting, excess inventory, overprocessing and underutilization.
One of the biggest hurdles for any organization attempting to implement change is staff buy-in. Workers may either resist the change entirely or figure that any new process is just a fad and won’t be around long enough for them to take notice.
To succeed, senior management must be fully on board and drive the initiative. Such steps as tying senior leader compensation to results usually produce results and get people’s attention. “Drive the initiative from the mountaintop,” says Michael Kay, enterprise general manager, northeast zone, GE Healthcare.
At Virtua, Miller and his senior staff explained to employees what to expect and what was expected from them. Since the organization had already implemented several other methodologies, overcoming resistance was not a big challenge.
“We tried to get the wisdom of the group,” says Tejas Gandhi, director of management engineering and Lean leader, Virtua Health. “Lean makes them feel responsible and empowered. It’s their ideas, their work and their processes.”
Lean changes are implemented quickly compared with other methodologies—three days versus six months or more—and employees see immediate results. Moreover, Lean Methodology is designed to streamline processes, eliminating extra steps. Once staff members map the entire process and remove unnecessary steps, they realize that their work life and patient care will improve, Miller says.
Leaders also need to give staff the right—and ample—resources (called “picking the right tool,” in Lean terminology). This is one of the reasons that Virtua added Lean to its toolkit. While Six Sigma is excellent for accomplishing major changes, the organization needed something else to fix the small stuff. “Six Sigma cleared the forest,” Gandhi says. “We need to clear the bushes now.”
Leaders must pick the right tools carefully. Throwing too many at employees will create a “flavor of the month” effect and they’ll be dismissed by employees. “[Lean Methodology] is not the tool of the month,” Miller says. “Keep it as simple as possible, keep people focused, and don’t change it. Repeating yourself is important.”
This past spring, Virtua held its first Lean Kaizen event. (Kaizen is Japanese for “change for the better” or “improvement.”)
The first step in any Kaizen event is to figure out what activities are valuable. This is done by looking at the entire process through the eyes of the consumer. Based on this analysis and advice from GE consultants, the Virtua team decided to streamline supply ordering, distribution and payment processes; put storage areas closer to where supplies are needed instead of having a centralized location; and label and color-code supplies to make them easier to find.
The next step was to develop a Value Stream Map. This phase illustrates each step in the supply chain and determines the value. Team members put sticky notes all over a wall, labeling each step in the process from purchase order through accounts payable.
A “spaghetti” map was then created to show the movement of each product or service through the entire process. Next, the team implemented “just in time” fulfillment—calculating the time from when a supply is needed to when the order is filled.
In the Kaizen final phase, the entire process is reviewed to make sure it is sustainable and that the team didn’t miss identifying any extraneous steps.
Based on this process, the team decided to reorganize storage by sorting and eliminating items that weren’t used or needed. They removed items from central storage and placed them in the departments where they were used. And they standardized pain management and other case carts.
Something as simple as removing eye-surgery supplies from central storage and placing them near the operating room dedicated to eye/lenses surgeries created additional space, eliminated the need for a nurse to prepare a special cart to take the supplies to the operating room and preserved the sterile integrity of the supplies.
These steps eliminated duplicate work, made it easier to find items, improved safety by ensuring that only the people who needed to handle something did, and generally made the supply process easier on staff.
The improved process also shortened the supply chain, cutting the time it took to fill an order by 24 minutes and reducing the number of staff involved in stocking an item from 11 to six people. It eased congestion of the storeroom and delays in getting supplies. And, the number of steps it took to stock an item dropped from 25 to 17.
The Virtua team found the Lean Methodology a valuable problem-solving tool. While it isn’t applicable to every process, Lean has the capability to quickly streamline a particular process, empower staff members and ultimately, enhance the quality of care—Jennifer Towne is the director of content and knowledge management for the AHA Quality Center. Visit the AHA Quality Center at www.ahaqualitycenter.org to explore these and other topics.
| Central Sterile Room | ||
| Before | Lean Activity Employed | After |
| Congestions-18 minutes on nonvalue-added activities | 5Ss (sort, set in order, shine, standardize and sustain) | 0 minutes on nonvalue-added activities |
| Delays: 20 minutes per central storage cart | Point of use: Flow | No delays: 2 minutes per cart |
| AP Cycle Time | ||
| Before | Lean Activity Employed | After |
| 25 process steps, 10-day lead time, 98 minutes of work | Flow | 17 process steps, 4-day lead time, 62 minutes of work |
This article 1st appeared in the October 2006 issue of HHN Magazine.
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