Angela Beck, RNSix Sigma Black Belt

Global Lean, Six Sigma & Business Improvement SummitOctober 16th, 2008Orlando, Florida

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LEAND.M.A.I.C.

Formed with the merger of Clarkson Hospital and UNMCs University Hospital in 1997

690 Beds Private Not-for-Profit Hospital Tertiary/Quaternary Academic Medical Center

$651 FY2007 Annual Revenues 26,404 inpatient discharges (including newborns) 143,070 patient days (FY2008) 456,678 outpatient visits (FY2008)

J.D. Power & Associates; 2007 DistinguishedHospital for Cardiovascular Excellence

J.D. Power & Associates; Three consecutive yearsOutstanding Patient Experience for Inpatient Services

Ranked nationally in U.S. News & World Reports Americas Best Hospitals 2008, 39th Cancer Care and 41st Neurology & Neurosurgery

First in the State: Named Blue Distinction Center for Complex and Rare Cancer by Blue Cross Blue Shield of Nebraska

Awarded the American Heart Association Gold Performance Achievement Award for performance in treating stroke patients using the Get With The Guidelines program.

The Three GoodsAchieve better clinical outcomes and service for our patients and their families

Make operations more efficient and effective for serving our customers and maintaining financial stability

Make jobs easier to do for our staff and physicians

Achieve better clinical outcomes and service for our patients and their families

Make operations more efficient and effective for serving our customers and maintaining financial stability

Make jobs easier to do for our staff and physicians

Glenn Fosdick, FACHEPresident and CEO

Radiology Department Completed 227,846 radiological studies* in FY 2008.

* includes Diagnostic Xray, Mammography, Interventional Radiology, CT, MRI, Ultrasound, Nuclear Medicine/PET

Twelve phase renovation plan. Planning and design for all project areas completed

up to 5 years ago. First department renovation completed August 2006.

Departments/Areas Designated for Lean Assessments1. Ultrasound2. Waiting Room3. Remote Reading Room4. Main Reading Room5. Diagnostic Radiology

Facilities Management & PlanningSenior Facility Analyst

Architect PartnerProject Architect

Construction PartnerProject Manager

Subject Matter Experts

Process experts withineach department

Music during the exam was the number one

patient request

Staff requested comfortable,

adequately sized work areas in the new space

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Tech Work RoomTech Work Room

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Exam RoomExam Room

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Reduce traffic in and outof tech work room

Centrally locate frequently used items for staff and

patients

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Wednesday waiting room

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Wednesday waiting room

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2004 numbers 2007 numbers 2012 numbers

Who is in the Waiting Room?

Patients56%

Adult Family Members

33%

Children7%

Wheel Chairs4%

Who is in the Waiting Room?

Patients56%

Adult Family Members

33%

Children7%

Wheel Chairs4%

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Entry

Coffee Bar

Child Area

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6Six Sigma

Centrally located frequently Centrally located frequently used itemsused items

Adjustable height desks/chairsAdjustable height desks/chairsStraight desk tops for optimal Straight desk tops for optimal

teaching purposesteaching purposesDoors/walls located to reduce Doors/walls located to reduce

light light Modular walls used between Modular walls used between

workstations for easier workstations for easier relocation relocation

Task lights controlled on desk Task lights controlled on desk to reduce repetitive tasksto reduce repetitive tasks

4 entrances 8 specialties 31 workstations No clear path thru dept

Under-utilized spaces

ChestPeds

UltrasoundN. Campus

Neuro

G.I.

Bone

Nuc MedN. Campus

Details

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1. Translated learnings from Remote Reading Room mock up

2. Translated recommendations from ergonomic assessment done during Remote Reading Room project

3. Provided virtual tour of proposed floor plan for Radiologists

4. Lean challenge of floor plan by Black Belts/Lean Process Consultant

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1. Reduction in Transportation

Relocated electrical closet and equipment alcove Located view boxes in/near each specialty

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1. Reduction in Transportation

Relocated electrical closet and equipment alcove

Located view boxes in/near each specialty

2. Reduction of Under-Utilized/Wasted Space

Relocation of work stations in each specialty

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1. Adjusting room locations: Move high-volume rooms to ideal locations Move lead office into work area

2. Standardizing work areas: Reorient Exam Rooms 3 and 4 Room interior (i.e. sinks, cupboards)

3. Adjusting room entry ways: Increase access to tech workroom Increase access to rooms 5 and 6

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1. Adjusting room locations: Move high-volume rooms to ideal locations Move lead office into work area

2. Standardizing work areas: Reorient Exam Rooms 3 and 4 Room interior (i.e. sinks, cupboards)

3. Adjusting room entry ways: Increase access to tech workroom Increase access to rooms 5 and 6DEXADEXA

CXRCXR

PACSPACS

OO

ExamExam

22

ExamExam

11

ExamExam

55

ExamExam

66Pt

Hold

Pt Pt

HoldHold

Outpatient Waiting Room

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1. Adjusting room locations: Move high-volume rooms to ideal locations Move lead office into work area

2. Standardizing work areas: Reorient Exam Rooms 3 and 4 Room interior (i.e. sinks, cupboards)

3. Adjusting room entry ways: Increase access to tech workroom Increase access to rooms 5 and 6

DEXADEXA

CXRCXR

OO

ExamExam

44

ExamExam

33ExamExam

22

ExamExam

11

ExamExam

55

ExamExam

66Pt

Hold

Pt Pt

HoldHold

ExamExam

44

ExamExam

33

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1. Adjusting room locations: Move high-volume rooms to ideal locations Move lead office into work area

2. Standardizing work areas: Reorient Exam Rooms 3 and 4 Room interior (i.e. sinks, cupboards)

3. Adjusting room entry ways: Increase access to tech workroom Increase access to rooms 5 and 6

DEXADEXA

CXRCXR

OO

ExamExam

22

ExamExam

11

ExamExam

55

ExamExam

66Pt

Hold

Pt Pt

HoldHold

ExamExam

44

ExamExam

33

Outpatient Waiting Room

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Avoidance for Techs:

1,245 mi/yr

Avoidance for Techs:

1,245 mi/yr

102 ft difference @ 5,369 trips/month102 ft difference @ 5,369 trips/month101 ft difference @ 484 trips/month101 ft difference @ 484 trips/month

Avoidance for Techs & Pts:

111 mi/yr

Avoidance for Techs & Pts:

111 mi/yrAvoidance for Techs & Pts:

41 mi/yr

Avoidance for Techs & Pts:

41 mi/yr

9 ft difference @ 2,110 trips/month9 ft difference @ 2,110 trips/month

Tech Total

Patient Total

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12 weeks$48,750Waiting Room

7 weeks$43,000Main Reading Room

69 weeks$378,750Totals

26 weeks$225,000Diagnostic Radiology

14 weeks$5,500Remote Reading Room

10 weeks$56,500Ultrasound

Construction Schedule Impact

Cost Avoidance

Project

Proactive Application of Lean & Six Sigma ToolsBlack Belt deployed full time in Facilities Management &

Planning department with responsibilities including:

Project leadership of renovation and new construction projects as well as participation in Master Plan Development. Mentoring of Facilities staff on facilitation/quality improvement tools and methods. Supporting Facilities department on internal process improvement.

Receiving project requests prior to departments making requests for more physical space.

Cardiac Rehabilitation Patient Flow & Capacity

D M A I C

Based on cardiology as a center of excellence, the outpatient

cardiac rehab department is not able to accommodate the

increased volume of patients due to broadening coverage of

diagnoses in the current space. Limited time and space leads to

patient, staff, physician and overall customer dissatisfaction and

patient safety concerns.

Based on cardiology as a center of excellence, the outpatient Based on cardiology as a center of excellence, the outpatient

cardiac rehab department is not able to accommodate the cardiac rehab department is not able to accommodate the

increased volume of patients due to broadening coverage of increased volume of patients due to broadening coverage of

diagnoses in the current space. Limited time and space leads todiagnoses in the current space. Limited time and space leads to

patient, staff, physician and overall customer dissatisfaction apatient, staff, physician and overall customer dissatisfaction and nd

patient safety concerns.patient safety concerns.

(Original)

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D M A I C

Attendance Policy: Class time to be released after 14 consecutive days of patient absences Equals 6 class sessions Reserved class time released

Data collection: Historical data Two 3 month time frames

Patients

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# of Absences When Class Time Was Released

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D M A I C

Class Sessions 7 class sessions offered Mondays, Wednesdays and Fridays Patients allowed each class is dependent on staffing max is 12

Data Collection:

Real time data Two week time frame historically, a high volume time period

# of Patients

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Max Pts Allowed Total Pts Scheduled Total Pts Attended

Class Session Info

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D M A I C

Goal Statement

Cardiac rehab wants to increase capacity of phase II patients to

80% (orientation and class attendance). This will be

accomplished by increasing patient and staff accountability, as

evidenced by increased patient attendance and consistent

implementation of department policies and procedures by staff.

Goal StatementGoal Statement

Cardiac rehab wants to increase capacity of phase II patients toCardiac rehab wants to increase capacity of phase II patients to

80% (orientation and class attendance). This will be 80% (orientation and class attendance). This will be

accomplished by increasing patient and staff accountability, as accomplished by increasing patient and staff accountability, as

evidenced by increased patient attendance and consistent evidenced by increased patient attendance and consistent

implementation of department policies and procedures by staff.implementation of department policies and procedures by staff.

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D M A I C

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80% Goal(total utilization)

The collaboration of Subject Matter Experts with

Facilities, Architecture and Construction partners

on the Radiology project resulted in significant

cost avoidance and construction delays.

The use of full scale mock ups, 3D imaging and

virtual tours have proved to be invaluable tools

during the design process.

The learning process has taught us that we need to

refine our processes and examine workflow to

before the construction process starts.

We are moving toward a culture of proactively

using Lean tools in areas who have spatial

challenges in order to examine opportunities to

increase operational efficiencies.

Angela Beck402.559.3631

abeck@nebraskamed.com