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July 5, 2013

Lean update from Kelsey Trail

The Kelvington Integrated Facility 3P process continued with a Rapid Process Improvement Workshop (RPIW)#1 May 13th – 17th

An RPIW is a week-long process involving a team of patients and family members, staff, and clinicians.  The team focuses on one problem, identifies the root causes, creates and test solutions and, by the end of the week,implements the solution. The team checks the solution at 30, 60, and 90 days to see if the results and new procedures have been sustained.

RPIW #1 focused on the flow of patients in the medical clinic.  The team trialed a schedule for three practitioners that allowed space for same day access and a lighter schedule for the practitioner on-call.  The team also trialed the use of a Medical Office Assistant to room patients, take blood pressure and weight.  Recognizing that true demand for the medical clinic includes patients considered non-urgent being seen at the outpatient department in the Kelvington Hospital, the team developed a script for the registration and nursing staff at the hospital to use to re-route these patients to the clinic.  The RPIW also utilized 5S, a lean tool used to create efficiencies in equipment and supply storage and inventory.

During the trial, the team increased the capacity in the clinic to meet demand and reduced the lead time for a patient visit by 45 percent.  They decreased travel for the RN by 71 percent and increased the capacity at the clinic by 46 percent. 

In May and June, the original 3P Acute Care, Emergency, Primary Health Care and Support Services teams took the opportunity to review the square footage of the original 3P facility design to identify further opportunities to improve using the 7 flows of medicine and the7 wastes to guide their conversations.  The 7 flows are: the flow of patients, clinicians, medications,supplies, equipment, information, and process engineering (synchronizing the other flows).  The 7 wastes are:overproduction, inventory, waiting, movement, transportation, defects and overprocessing.  In response to concerns raised by the community with regard to the cost of a circular versus a square or rectangular shaped clinic, the Primary Health Care team redesigned the clinic space and compared the 7 flows from the circular shape to those in the square shape.  The 7 flow meetings held to date have resulted in a significant reduction in the footprint of the facility as a whole and the reorganization of some of the spaces within the facility. 

The architects will now incorporate the changes into a new blueprint and will provide analysis of the resulting square footage and cost savings.  All savings generated through the 7 flow meetings and redesign of the original 3P design will be reinvested into the renovation of the long term care facility.  

From June 10th – 15th,a second 5S was held at Kelvington Hospital which was focused on the Kelvington Hospital Nursing station.  5S is a week-long strategy for organizing the workplace to minimize waste of time. Having everything clean, neat and in the proper location enhances quality and productivity by making things easier to find and problems more visible.  

The 5S’s are:  Sort (separating the necessary from the unnecessary); Simplify (creates a place for everything & everything in its place); Sweep (defines how to maintain a clean, safe, organized working environment); Standardize (involves developing standard work to ensure consistency); and Self-discipline (striving to maintain the 5s gains, adhere to standards and agreements).

The goal of the 5S was to decrease the inventory of items in the nursing station and to create a more efficient workplace that is standardized. The result of the 5S saw disposal of a number of outdated forms and patient resources located in the nursing station and an 80 percent improvement in the time spent looking for appropriate forms.  The form inventory was reduced by 31 percent.

RPIW #2, which was originally scheduled for July 22nd – 26th, has been rescheduled for later this fall. (Source: Progress Report, Kelsey Trail Health Region)