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HOSPITAL EXCELLENCE OPERATION MODELMiguel Angel Moreno, Abraham
Mendoza IIE Annual Conference and Expo 2014
Applied Solutions SessionsMontreal, Canada
May 31 – June 3, 2014
ImportanceC
ert
ifica
tion
re
qu
irem
en
ts t
hat
gu
ara
nte
e t
he
com
pete
nce
of
doct
ors
an
d
hosp
itals
1993, first effort: Mexico, Canada and United States.
2007, Proposed as national standard of quality in health.
2009, first version approved for certification of hospitals.
2012, latest version which integrates the requirements of the Joint Commission International.
Equipment, Materials & Medicine
Manufacturers
Distributors Hospitals Patient
Goods and services
Information / Money
Health Sector Supply Chain (HSSC)A supply chain in the Health Sector includes a number of different parties, including manufacturers, distributors, third party logistics (3PL) providers, transportations companies, hospital receiving and materials management departments, nursing, and finally, the patient. Langabeer (2008)
HCSC in Mexico
HOSPITALOperation Management
Key Performance IndicatorsManagement Processes
Processes ControlFocused Improvement
Resources Optimization
Manufacturer
Distributors
Health Sector
Certification
Medication & care Safety Methods
Resources Optimization (materials, personnel, facilities)
New Services & methods
Inventory Level Optimization
Medication & TI's
Goods & services flow
Opportunities for OM & SCM
Satisfaction Level
Resources Scheduling
Inventory Level Optimization
HCSC Key ProcesesInventory Management Facilities Management
Procurement Process Purchasing Scheduling Forecast Optimum level definition Economic Order Quantity Warehousing
Network and complexity Localization and number of
facilities Size and localization of
warehouses Layout design Materials management
equipment Sistema de almacenamiento
Distribution Patient Service Route and personnel
scheduling Re-abastecimiento System selection Equipment Expedite
Availability of service Service Level perception Response time (lead time) Key Information availability Total cost of service
Minimize unproductive inventories.
Increase the perception of value.
Ensure the application and delivery of medical services in time and correctly.
Build strategic alliances with suppliers.
Define the service levels expected for suppliers and service providers.
Use of information technologies in the communication of requirements.
Constant review of methods and business processes to reduce response times.
Strategies
Great Dilemma
Hospitals in Mexico
How did they do the continuous improvement process?
Step by step taking at least 8-12 years to achieve Lean (best hospital in Jalisco)
1st Quality System definition and implementation (2004, started in 2002)
2nd CGS certification (2005) & ISO (2007)
3rd “H” Award (2009)
4th JCI certification (2010)
5th Quality Award & ISO 14001 (2011)
6th Start Lean Healthcare (2012)
CERTIFICATION
LEAN HEALTHCAR
E
6 SIGMA
Continuous
Improvement
Culture
Strategies for achieving operational excellence
6 Sigma
Lean Healthcar
e
Certification / ISO
Waste sources
elimination
Processes critical sources of variation
elimination
Processes continuous
improvement standardization and auditing
Business Process Management (BPM)
SynergyStrategy
Structure Capabilities
1Patient focus 2 Leadership
3Struc ture and Organization
4Partnership
5Information Tecnologies
9 Integration
8Team
Management
7Continuous Flow
of patients
6
Continuous Improvement
Culture
C ERTIFIC AC IÓN
• Managing the expected outcome• Customer orientation• Individual proces in a systematic
manner• Processes interrelationship• Results vs. Capacity and
effectiveness• Focus on the resources and methods• Bases for continuous improvement
culture
•Interrelationship betweenen processes•Impact of processes on the overall result•Reduction on cost operation•Documentation of improvements•Standardization of the efforts•Ready for certification
• A systematic process• Standardization and deployment• Customer satisfaction improvement• Cost reduction, service level
improvement and processes variability reduction
• Organization becomes an Industry reference
• Improvement as decision-making
Process Diagnosis (Phase 1)
Lean Introduction
(Phase 2)
Lean philosophy deployment
throughout the organization
(Phase 3)
Continuous improvement
culture as decision-
making process (Phase 4)
Hospital Excellence Operation Model
Phase 1
Dia
gnosi
s Key Processes Mapping
Processes Interrelationship
Key Performance Indicators
Lean Maturity
Phase 1 (Implementation)
Diagnosis
Key Processes
Current Status Which one (pilot)?
Future Status How should be?
What tools?
Identify Training
Applicability Data analysis
Improvement Standardization Deployment
How we propose to solve it? Creating Synergies
BPM
LEAN HEALTHCARE 6 SIGMA
MISP.1
PRF
AOP
MISP.4
MISP.5
MISP.6
ACC
COP PFE
MISP.2
MISP.3
QPS
SAD
PCI
ASC
GLD
MMU
FMS
SQE
MCI
INTERNATIONAL PATIENT SAFETY GOALS(MISP.1). Identify Patients Correctly(MISP.2). Improve effective communication(MISP.3). Improve the Safety of High-Alert Medications(MISP.4). Ensure Correct-Site, Correct-Procedure, Correct-
Patient Surgery(MISP.5). Reduce the Risk of Health Care–Associated
Infections(MISP.6). Reduce the Risk of Patient Harm Resulting from
Falls
CGS & JCI Standard vs HEOM
How we propose to solve it? Creating Synergies
BPM
LEAN HEALTHCARE 6 SIGMA
MISP.1
PRF
AOP
MISP.4
MISP.5
MISP.6
ACC
COP PFE
MISP.2
MISP.3
QPS
SAD
PCI
ASC
GLD
MMU
FMS
SQE
MCI
PATIENT CENTERED STANDARS(ACC). Access to care and continuity of care(PRF). Patient and family rights(AOP). Assessment of patients(SAD). Diagnosis Services(COP). Care of patients(ASC). Anesthesia and surgical care(MMU). Medication management and use(PFE). Patient and family education
CGS & JCI Standard vs HEOM
How we propose to solve it?Creating Synergies
BPM
LEAN HEALTHCARE 6 SIGMA
MISP.1
PRF
AOP
MISP.4
MISP.5
MISP.6
ACC
COP PFE
MISP.2
MISP.3
QPS
SAD
PCI
ASC
GLD
MMU
FMS
SQE
MCI
MANAGEMENT CENTERED STANDARS(QPS). Quality Improvement and patient safety (PCI). Prevention and control of infections(GLD). Governance, leadership and direction(FMS). Facility management and safety(SQE). Staff qualification and education(MCI). Management of communication and information
CGS & JCI Standard vs HEOM
Implementation
(Public Hospital)
Implementation (Public Hospital)
Implementation (Public Hospital)
Implementation (Public Hospital)
Implementation (Public Hospital) After 3
months with the hospital
Quality System designed
Key and support procceses definedKey proceses mapping (2 of 5)
Basic documents ready
Pending documents
Key proceses mapping (3 of 5)
Support proceses Mapping
General policies (care and Safety)Validate compliance with the standard
Conclusions
1. Key business processes (PCN) are similar in any hospital: admission, triage, outpatient treatment, hospital treatment and discharge.
2. The Support process (PS) are similar in any hospital: financial, supply, maintenance and safety, social work and technology information.
3. The HEOM proposed shows clear, simple and flexible methodology to be developed in a short time.
4. By integrating the BPM, Leanhealthcare and Six Sigma it is possible to establish in a same effort everything you need for certification and process improvement.
Conclusions
5. Identify key business processes that give value to the patient.
6. Minimizing the number of documents needed to comply with the certification standard.
7. You can set the levels of service expected for suppliers and service providers.
8. Automation or information technology implementation processes are identified.