GoalGive to patients;
Exactly what they need;When they need it;
Every time;Defect free;
In a safe environment;At the lowest cost;Without waste.
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Objectives
Understand how the tenants of LEAN technology can help with
improving patient care and patient outcomes
Appreciate the role of workload in LEAN simulation modeling
Identify 3 sources of information for potential study using LEAN and
workload
Understand how LEAN and workload were able to predict error
reductions using medical bar coding technology
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“Lean” Methodology (TPS)
Started from need
Absolute elimination of waste
Support needed
Flow process
Automation Human Touch( )
The Criticals“ ” Information
Team work
Individual Skill
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A bit more about “Lean”
Analysis of Waste“ ” Time on hand waiting( ) Transportation Patient and Staff Delay( ) Processing Materials workflow( – ) Movement
“Do overs”
Understand the work
Ask Why 5 times
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Why Hospitals are moving to TPS
Improve Patient Outcomes( )
Decrease Cost
Respond to Increase Demand
Enhance Patients dealing with chronic disease
Address technology implementation processes and applications
Address specialization and fragmentation of hospital care
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Where to begin?
Troublesome processes
Bottle necks
Complaints Patients and Staff( )
Suggestions from Staff
Suggestion from Patients
Observations
Outcome data
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Nursing Practice Time
Patient Care Activities
81 min
Assessment Vital Signs( )31 min
Care Coordination 86 min
Documentation
148 min
Medication Administration 72 min
Source: JONA Vol 39, No 6, June 2009
Notes: 36 Hospital Medical-Surgical Units in 17 health care systems and 15 states
Waste Non Clinical
Walking Personal Time
LookingRetrieving/ PatientFamily Care/Delivering AdministrationTeaching/
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Processing Information
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Human information processing deals with how people receive,
store, integrate , retrieve and use information
Capacity is about 5-7 chunks of discrete information
Bottle necks occur and storage is an issue
The human capacity to interpret accurately the structure and
dynamics of complex systems is grossly overestimated
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Complexity(Multiple States)
Example: Medication Administration
Complex Systems are multi-dimensional!From : Driving Improvement in Patient Care.“ ”
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Enablers
What Assists in representing essential aspects of an existing
system
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Another Enabler is Workload Data
For Example in Process Improvement
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Challenges in Data Acquisition
What is the distribution of times that it takes to perform the individual
tasks in a process?
Time and motion studies
Standardized times
Electronic health record digital data
Expert opinion
Theoretical time distribution curves
Workload Time Standards
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So from the “Lean” with IT Perspective in Performance Improvement Activities we:
Combine duplicate activities
Eliminate multiple reviews and approvals
Automate repetitive tasks
Simplify complex activities
Reduce batch sizes
Reduce amount of handling
Process in parallel
Error-proof activities
Implement demand pull build to orders( )
Outsource inefficient activities
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So the Question is…
Is there a significant difference
in nursing hours
cycle time for medication administration
cost
&
of course medication errors
after implementation of Bar Code Medication Administration
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Where to look for Workload
Analytical Phase
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What do we want to occur?
Improvement in medication error per intervention
Decrease in cycle time per intervention than the paper process
Increase in productivity decrease in time i. e. , nursing labor hours ( )per intervention
Decrease in total cost per intervention medication error savings( )
What is the difference between the cost of the investment and the
return?
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Lets examine the steps’
The intervention
The steps that are part of the intervention
Check medication administration record
Prepare medication
Administer medication as per protocol
Document
Total time for the process is 38. 8 minutes Included is fatigue and (delay and adjustment for things we havent accounted for’ )
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A word about simulation
We can test our hypothesis without actually implementing it
We can examine the steps to determine where the bar coding fits
Delineate the steps with bar coding
What is the return on investment?
Actually determine amount of time saved
Actually determine amount saved by decreasing error rate by 50%
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Check the Actual Results
Bar Code Administration does not take longer than the paper
process
Labor not significantly different
There is a learning curve
The medication error rate is being evaluated
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Another Place to Look!Non-Service Recipient Care
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A word about the Power of GROUPS or
the Wisdom of Crowds
Workload Groups are also Enablers( ! )
People who do the work are the best people to find the needed
improvements
Smart Groups
Diverse
Independent
Decentralized
Need a structured format
Have Basic Ground Rules
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Using Simulation
Benefits
Decrease up front investment
Test new protocols and procedures before implementation
Awareness of benefits and drawbacks before implementation
surprises( ) Better awareness of cost benefit savings
Drawbacks
In house expertise - if you have it
If you dont have in house expertise long learning curve’ –
Partnerships
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Way Forward
Can LEAN utilizing workload data assist in achieving the goal initially “ ”stated?
Goal
Give to patients;Exactly what they need;
When they need it;Every time;Defect free;
In a safe environment;At the lowest cost;Without waste.
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Bibliography
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