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What Providers Need To Prosper The Next 50 Years: Planning
Meets Operations
October 4, 2012
8:00 – 9:00 AM
Craig L. Miller, CCMSenior Project Manager
JacobsNYC and Long Island Office
Craig.Miller@Jacobs.com
Safety Minute
CPR/AED or 1st Aid Classes are available at your local American Red Cross or hospital.
According to the American Red Cross:
• Sudden cardiac arrest, leading cause of death in adults, accounts for 325,000 deaths per year.
• Treatment delay of 4-5 minutes decreases survival rate as much as 40%; 10 minutes or longer results in 95% chance death.
• More information can be found at: www.redcross.org/
Learning Objectives
1) Strategize, plan, integrate, and design logistics and operational needs to
deliver over the long term a high performance healthcare facility.
2) Measure and evaluate the results, value, and performance received from
various solutions.
3) Explore how new trends, best practices, and approaches can be used to plan a high performance hospital, and how they differ from traditional practices.
4) Asses, build, and balance goals with available resources.
2
Understanding Your Roles and Challenges
• Typically involved early with planning
• From a logistics/operations perspective, your asked to:
– Optimize performance / improve efficiency
– Reduce waste
– Incorporate flexibility, provisions/infrastructure
– Create system wide logistics vision, leverage standardization
– Investigate off-site service/support center options
• Tight budgets
• Space restrictions / constrained sites
• Other?
Industry Wide Challenges• 32-million newly insured Americans as a result
of health care reform (Modern Healthcare magazine)
• Cuts in Medicare and Medicaid funding
• Aging workforce
• Over-crowded ED’s, and Trauma Centers
• Cutting edge clinical technology, and
procedures
• Mergers, acquisitions, and private entities
• Lower operating budgets; a “do more with less”
approach
• The list goes on……..
Typical Hospital Org. Structure
Human
ResourcesFinance Information
Technology
LegalSecuritySafety
MCE /
Facilities
Leadership
3
Developing the Plan and Paving the Way
� What do Providers Need To Prosper The Next 50 Years?
� How will Planning Meet Operations?
Strategy
• C-Suite (CEO, CFO, COO) and stakeholders
• Imperatives/Drivers
• Logistics and operational vision
• Interoperability
• Goals and objectives
• Guiding Principles
• Key Performance Indicator's (KPI's)
• Service Levels
• Identify measures
• Sustainability
• Flexibility
Integrated Planning
• Master Planning
• High level ROI Analysis
• Develop Basis of Design for Logistics and Operations
• Application of Process, Distribution, Storage/Retrieval, IT, and Purchasing
• Identify systems
• Integrate industry best practices
• Develop road map
• Dashboards
Execution
• All phases of design including Concept, Schematic, Development, and Construction
• Develop detailed business cases for systems considered
• Link/network systems for interoperability
• Commissioning/ Activation
• Measure performance
• Make adjustments
• Existing Hospitals• Newly Planned
• Mergers and Acquisitions• Individual Buildings and
Departments
• Systems with multiple Hospitals and Clinics
Medical
Supplies
Medications
Linen
F&N Supplies
Administrative
Supplies
Lab Testing
Lab Samples
Soiled Food
Trays
Trash
Bio-Waste
Returns
Expired
Medication
Recalls
Soiled Linen
Housekeeping
Supplies
Food Trays
Blood
Minor Medical
Equipment
Mail & Parcels
Medical
Records
Medical
Records
Minor Medical
Equipment
Staff
Patients
Med – Surg Floor
Logistics can be defined as “resource” management.Stated another way, logistics strategy is applying the 5 rights:� Right resources (drug)� Right time (frequency)� Right quantity (dose)� Right location (patient)� Right path (route)
4
Trends in Logistics / Resource Management
• Automation
– Robotics
– Integrated Software Systems
– Pneumatic Transport
• Service Center vs. Off-
Site Warehouse
• Simulation
• GS1 Data
Standardization
• Interoperability
– Connects Clinical, Support Services, Operations
– Includes EMR and Compliance
– Process Efficiency (e.g. Lean) with a view to the outside
Automation• Robotics
• Pneumatic Transport – Moving away from
elevators, less FTE’s, more efficient, less touch
points
• Integrated Systems
• Examples: Supply Chain / Materials
Management, Pharmacy, EVS, Dietary, Labs,
SPD
6
Automated Waste Collection
Fan Room
Central Collection Plant
Central Processing
and Monitoring
Air Intake
Air Exhaust
Trash in
Trash out
Velocity monitoring
� Trash� Soiled Linen� Recycle
Simulation
Optimize, While Balancing Resources & Goals / Objectives
ResourcesGoals /
Objectives
Current & Future
Schedule
Utilization
Volumes
Supplies
Staff
Equipment
Rooms
8
Automated Guided Vehicle Example
Pharmacy
•Resources?
•Goals?
Sterile Processing
•Resources?
•Goals?
Dietary
•Resources?
•Goals?
EVS
•Resources?
•Goals?
Mail and Parcels
•Resources?
•Goals?
RespatoryTherapy
•Resources?
•Goals?
Materials Management
•Resources?
•Goals?
GS1
12
Distribution
Store /
Retrieve
&
Enter / Exit
Store /
Retrieve
&
Enter / Exit
Purchasing
Process Flow
Information Technology
Distribution
Store /
Retrieve
&
Enter / Exit
Store /
Retrieve
&
Enter / Exit
Purchasing
Process Flow
Information Technology
Simulation
Optimization and
Improvement Strategies
Process and Value
Stream Mapping
Just In Time Delivery
Handoff
Infection Control
13
AGVS
ATL&Recyc
P-Tube
Automated, Semi Auto,
Manual
Gravity Chutes
Vertical Transport
Point-Of-Use
Systems
Carousel Systems
Mini-Load AS/RS
Low Unit Of
Measure
Product Slotting, Storage, Retrieval
Vertical Lift
Modules
Integration
IT Management
Data Standard-
ization
Data Synchron-
izationData Mining
RFID
Data Cleansing
PPI
Standardization
Software & Hardware
Value Analysis
Assessments
Product Selection
14
Ancillary ServicesPlanLayoutDesignOrganizeEquip
Operationalize
Clinical ServicesIntegrate
TailorOrganize
EquipOperationalize
Ancillary ServicesPlanLayoutDesignOrganizeEquip
Operationalize
Clinical ServicesIntegrate
TailorOrganize
EquipOperationalize
Operating Efficiency Patient Safety
Expenses and Waste
Case Studies & Value Propositions
Clinical Modeling CasesDiagnostics Platform
$4.5M Value Added Highlights
Reduced original program by:
1 MRI
1 PET-CT
Identified early in the process the need to add:
12 centrally located Prep / Hold /
Recovery Bays
1 Echo
1 ECG / Holter
1 Stress Lab
Additional value opportunities were identified
early in the process for spaces which could be
deferred:
2 Neuro-diagnostic room
1 Device Clinic room
2 Ultrasound
2 Nuclear Med
More than $4.5 Million worth of opportunities was
realized by Rush in the form of optimized patient
throughput, space reductions, staff, equipment,
construction, and resources which could either be
eliminated or reallocated to other programs.
Emergency Department$1.5M Value Added Highlights
Validated patient throughput for initial move-in and
future volumes
Confirmed optimum distribution of room types in
order to achieve waiting room times of less then
30 minutes
Quantitative results which supported optimizing
the number of Critical Care rooms to 9
Identified early in the process an opportunity to
defer outfitting or utilize for back-up / surge the
following rooms:
Acute
Isolation
Confirmed department could integrate pediatric
with adult care, thus eliminating the need for a
separate pediatric pod. Modeling assisted in ROI
analysis of a pediatric pod.
Over $1.5 Million worth of strategic decision-
making capabilities and opportunities was realized
by Rush in the form of space allocation,
equipment, and resources which could be
deferred, eliminated, or reallocated to other
programs.
“Simulation modeling was very
beneficial for planning our new ED. It really added great value by
helping us understand the
appropriate balance of rooms while achieving our level of service goals. This tool will serve us well for future
operational plans whether related to expansions, financial opportunities,
or expanding surge capabilities ”
Dr. Dino Rumoro
Chairperson
Associate Professor
Department of Emergency Medicine
“Simulation is a very effective
way to test and vet operational assumptions
before committing capital or
resources. I found it to be invaluable in creating an
efficient operational model”
Bernard F. Peculis, MS, MBA
Administrative Director
Department of Diagnostic
Radiology and Nuclear
Medicine
15
Out Of Control Returns = WasteOut Of Control Returns = Waste
Eliminate Annual Write-Offs: >$650K/Year
Some of the Issues
• No Reverse Logistics plans– Hiring and Resigning
– Expiration
– Return processing
– Recalls
• Limited IT integration
• Limited schedule alignment with Clinical needs
• Loss of trust and confidence between clinical and support
• Rogue purchasing, and limited procurement process
Solutions
• Develop and Implement Reverse Logistics Program
• Integrate IT with RFID, GS1 Data Standardization, and Systems (Finance, HR, Supply Chain, Clinical, etc)
• Service agreements, schedules, and procurement procedures
Results
• Reduced write-offs by ~$425K/Year; still improving
• Developed and Implemented system wide logistics program
• Rolled-out 1st phase GS1
• Re-established trust and confidence
AutomationSome of the Issues
• Tight budget - Expand & Build New Hospital while Reducing Expenses
• Long horizontal travel distances
• Aging work force
• Infection Control
• Safety
• Limited funds to add FTE’s
• Maximum 20 Minute delivery of Food Trays
Solutions
• Develop and determine if there is a favorable business case
• Explore available systems
• Develop Simulation Model to optimize systems
• Design systems, and issue RFP to vendors
Results
• Reduced Annual Operating Expenses by over $2.5Million
• 2-4 Year payback
• Improved Patient & Staff Safety
• Used to distribute almost all resources across campus
• Re-established trust and confidence
Instrument LossesEliminate Annual Re-Purchasing Surgical Instruments: >$750K/Year
Some of the Issues
• Instruments, accessories missing after surgery
• Limited IT integration
• Rogue purchasing, and limited procurement process
• No reverse logistics in place
Solutions
• Develop and Implement Reverse Logistics Program
• Integrate IT with RFID, GS1 Data Standardization, and Systems
• Develop new equipment
• Other
Results
• Reduced write-offs by ~$675K/Year; still improving
• Developed and Implemented system wide logistics program
• Rolled-out 1st phase GS1
• Deployed new equipment
16
Strategy
• C-Suite (CEO, CFO, COO) and stakeholders
• Imperatives/Drivers
• Logistics and operational vision
• Interoperability
• Goals and objectives
• Guiding Principles
• Key Performance Indicator's (KPI's)
• Service Levels
• Identify measures
• Sustainability
• Flexibility
Integrated Planning
• Master Planning
• High level ROI Analysis
• Develop Basis of Design for Logistics and Operations
• Application of Process, Distribution, Storage/Retrieval, IT, and Purchasing
• Identify systems
• Integrate industry best practices
• Develop road map
• Dashboards
Execution
• All phases of design including Concept, Schematic, Development, and Construction
• Develop detailed business cases for systems considered
• Link/network systems for interoperability
• Commissioning/ Activation
• Measure performance
• Make adjustments
Thank You and Get Home Safe
Craig.Miller@Jacobs.com
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