Newnan Manufacturers Use Lean Consortium as Springboard for Continuous Improvement

Sean Leroux, plant manager for Kason Industries in Newnan, Ga., believes in learning by doing. When he and Skipper Schofield, continuous improvement manager for Kason, had the opportunity to get involved with the Georgia Tech Lean Consortium – a forum for organizations to advance their knowledge and effective use of lean principles – they didn’t merely sit in on meetings and take notes. They took the ball and ran with it.

“In going through different factories and facilities, we were able to learn new ideas and then try to expand on them within our own facility,” said Schofield. “If we can bring back one good idea from each event, then we’ve been successful.”

As part of the Consortium, member company representatives rotate hosting the group at their facilities, where they present their vision for lean and the challenges and successes to date. After a plant tour, the group provides feedback to identify areas of success, as well as opportunities for further improvement. Members are also offered exclusive training classes in areas that they help to select.

Leroux and Schofield learned about reducing die changeover time inventory control from Newnan-based Bonnell, an aluminum extrusion manufacturer. They were particularly impressed with the 6S program of E.G.O., a local manufacturer of heating elements, as well as the way the company’s equipment was color-coded and labeled. The 6S program derives from 5S, the method of workplace organizations and visual controls developed by Hiroyuki Hirano, which translates into sort, stabilize, shine, standardize and sustain. Many companies add a sixth S, safety, to eliminate hazards and embed safe conditions into all work environments.

“E.G.O. had a great training program in 6S, and Earl Smith and Dave Perry, both E.G.O. engineers, led a group of 16 people here at Kason, most of them managers,” Leroux recalled. “We did a spin-off of that and then trained our entire factory in that methodology.”

Schofield also received invaluable assistance from Bonnell when it came to learning about implementing ISO 9001, a set of standards for quality management systems. Bill Tucker, quality and process manager for Bonnell, invited Schofield into the company’s facility to see how it approached the standard.

“The nice thing about Bonnell is we have similar processes, so there’s no sense in recreating the wheel,” observed Schofield. “I was actually able to tag along with the quality auditor at Bonnell during their six-month audit and ask whatever questions I wanted. It was a unique experience to see things from the auditor’s perspective.”

According to Larry Alford, director of the Georgia Tech Lean Consortium, the working relationship between Kason, E.G.O. and Bonnell demonstrates the best of what the Consortium can offer.

“What these guys have done is really special. They’ve taken it beyond just seeing each other at the meetings and translated it into how they can genuinely help each other,” he said. “I am overwhelmed by one company’s willingness to come to another company and teach a course.”

Organizations from any economic sector – including manufacturing, service, government or health care – are welcome in the Georgia Tech Lean Consortium if they have a vision for lean within their organizations, a strategy and commitment to its implementation and successful experiences to share with the consortium.

Lean principles are a set of tools widely used in manufacturing to help identify and steadily eliminate waste from an organization’s operations. Already, 11 south metro Atlanta companies, six Augusta area companies and seven northwest Georgia companies are participating in the Lean Consortium through shared training and peer-to-peer relationships.

To learn more about the Georgia Tech Lean Consortium, please contact Larry Alford (404-895-5237); E-mail (ude.hcetag.etavonninull@drofla.yrral) or visit www.gtlean.org.

Photo caption: Earl Smith of E.G.O., Sean Leroux of Kason, Bill Tucker of Bonnell, Larry Alford of Georgia Tech EI2, Skipper Schofield of Kason, and Dave Perry of E.G.O., all shared continuous improvement ideas as part of Georgia Tech’s Lean Consortium.

About Enterprise Innovation Institute:

The Georgia Tech Enterprise Innovation Institute helps companies, entrepreneurs, economic developers and communities improve their competitiveness through the application of science, technology and innovation. It is one of the most comprehensive university-based programs of business and industry assistance, technology commercialization and economic development in the nation.

Research News & Publications Office

Enterprise Innovation Institute

Georgia Institute of Technology

75 Fifth Street, N.W., Suite 314

Atlanta, Georgia 30308 USA

Media Relations Contact: John Toon (404-894-6986); E-mail (ude.hcetag.etavonninull@noot.nhoj).

Writer: Nancy Fullbright

Georgia Tech Helps Piedmont Newnan Improve Accuracy, Decrease Turnaround Times

The cross-functional team at Piedmont Newnan was made up of employees that deal with the process daily. For this project, they focused on case carts, which are used for pulling together all supplies needed for surgical procedures.

Pam Murphy, a registered nurse and director of surgical services at Piedmont Newnan Hospital, has seen it all in her 23 years of employment at the hospital.

In 2007, when the hospital was chosen as a pilot site for a lean implementation for the Piedmont Healthcare System, she knew that participation from the hospital’s staff would be critical. She also knew there would be a concern that lean – a methodology that aims to eliminate waste – would mean doing more with less.

“A lot of staff members first thought that we were just trying to get efficient so we could eliminate positions. We had to assure them that this was not the case; we just wanted to be as efficient as we could be so we could build the business,” she recalled. “The hard part for an organization is committing the resources, something especially difficult in healthcare. Once you do that, however, you can attack the issue in one week and come up with solutions.”

The focus of Piedmont Newnan’s process improvement project was the six operating rooms on its main campus. Jennifer Trapp-Lingenfelter and Kelley Hundt of Georgia Tech’s Enterprise Innovation Institute helped train Piedmont staff in lean principles, an operational strategy that focuses on eliminating waste while increasing value-added work. Lean techniques improve profitability, customer satisfaction, throughput time and employee morale.

“We knew that the turnaround time on the operating rooms was our biggest issue, but when we did the value stream map that outlined the entire process, we decided to tackle something we knew could make a big difference,” said Murphy. “We decided to focus on the case carts, which are used for pulling together everything that we need for a surgical procedure.”

The case cart project began in December 2007 with an introduction to lean principles. According to Trapp-Lingenfelter, at least 90 percent of the OR staff had received basic lean training by the end of the project, a critical component of the success. A cross-functional team composed of nurses, surgical technologists and central service personnel went to the OR and the central sterilization department to observe the case cart process and note which steps were value-added and which ones involved waste.

Prior to the lean implementation, the case cart accuracy at Piedmont Newnan was approximately 50 percent. The team observed that there was no formal scheduling process for the central sterilization department, no designated person to pull together case carts, no standard process to pull the case carts and a lack of labeling and organization. These issues led to a significant amount of re-work.

After the team analyzed the process, it identified solutions that could be implemented that same week – such as 5S, a method for organizing the workplace. The team developed a new standard case cart design, labeled cabinets and carts, established parking spots for case carts, defined the path for picking items that go in the carts, alphabetized instruments, designated a return bin for unused supplies, centralized the case cart picking tools and set a minimum inventory level for all instruments. Now all case carts are pulled the day of a procedure, with the exception of 7:30 a.m. surgeries pulled the afternoon before. In addition, missing items are highlighted in yellow, the standard picking procedure is posted and one person is assigned the responsibility of picking the case carts.

“Before the lean process, whenever we had down time we would tell staff to pull case carts for the next day. They would begin to look down the list and see items that were currently in use or needed to be in use that afternoon, so we would end up with case carts that were missing instruments,” Murphy noted. “As a result of this project, we realized that our computer system would allow us to see where equipment was, so we built a location into everything. Now, if I gave you a card with a list of items that needed to be pulled for a surgery tomorrow, you could go pull everything even if you had never been in my OR before.”

As a result of the lean implementation, case carts can now be pulled in five minutes versus 20 minutes before and the overall case cart accuracy has risen from 50 percent to 98 percent. Supply items that need to be available on case carts but which may not be used with all procedures are only opened if needed, reducing waste. The bins have yielded a projected savings of $118,000 annually.

“The success of the case cart project was a win-win, so when we decided to tackle turnaround times, we had buy-in from the staff and they had already been educated on the process,” said Murphy.

In this project, the team developed a process that defined roles, responsibilities and visual controls to reduce the time required to clean and prepare an operating room for a new procedure. Prior to the implementation, the average turnaround time for patient out to patient in was 19 minutes; it now averages 14 minutes. Physician turnaround time went from 51 minutes to 40 minutes. Piedmont Newnan has also been able to increase its percentage of on-time procedure starts and decrease after-hours cases and resulting overtime pay. Moving forward, the team will set goals specific to each specialty.

The projects at Piedmont Newnan were so successful that they were recognized by VHA Georgia, part of the national healthcare alliance, VHA Inc. Last year, 10 Georgia hospitals were recognized for improving their supply chain performance, clinical care, operational efficiency and community benefit performance. Piedmont Newnan Hospital was selected as a winner of the 2008 VHA Inc. Georgia Regional Leadership Awards in the Operational Excellence category for improvements in the operating room that increased patient care and improved patient and physician satisfaction.

“Sustainability is probably the hardest part because you have to be willing to commit to it. If you conduct a 5S procedure on an area and then let it go, it’s going to end up looking like your junky kitchen drawer again,” Murphy observed. “Having someone come in from the outside gets you to think about how things can be done differently. Having another set of eyes that aren’t familiar with your process helps you open your eyes and see ways to make improvements.”

Through its Healthcare Performance Group, Georgia Tech project leaders work with healthcare professionals to conduct lean assessments, teach basic lean concepts, develop value stream maps to analyze the flow of materials and information, create quality systems and implement rapid process improvement projects. For more information on healthcare performance improvement services offered by Georgia Tech’s Enterprise Innovation Institute, contact Jennifer Trapp-Lingenfelter (404-386-7472) or (ude.hcetag.etavonninull@retlefnegnil.nnej).

About Enterprise Innovation Institute:
The Georgia Tech Enterprise Innovation Institute helps companies, entrepreneurs, economic developers and communities improve their competitiveness through the application of science, technology and innovation. It is one of the most comprehensive university-based programs of business and industry assistance, technology commercialization and economic development in the nation.

Research News & Publications Office
Enterprise Innovation Institute
Georgia Institute of Technology
75 Fifth Street, N.W., Suite 314
Atlanta, Georgia 30308 USA

Media Relations Contact: John Toon (404-894-6986); E-mail (ude.hcetag.etavonninull@noot.nhoj).

Writer: Nancy Fullbright

Georgia Tech Helps North Georgia Metal Fabricator Increase Production and Sales

Lee Adams, president of Fabritex, shows EI2 project manager Karen Fite how the company implemented lean principles throughout its facility in Hartwell, Ga.

Lee Adams, president of Fabritex Inc., remembers exactly how his family-owned business started. His entrepreneurial father had purchased a trampoline and realized he could make the metal frame as well as anybody else.

“We started 20 years ago in 1989, and since then, we’ve grown into a 55-employee, 110,000-square-foot facility with an emphasis on tube fabrication and sheet and plate fabrication,” Adams said. “We manufacture everything from tubular wire carriers to stem baskets to annealing process materials. Just because we haven’t built something before doesn’t mean we’re not going to quote on it. We try to think outside the box and sell ourselves as a one-stop shop.”

It was precisely this innovative mindset that brought both opportunity and challenges to Fabritex, based in Hartwell, Ga. In 2007, a customer asked Adams about producing a new product line within a specific timeframe and gradually ramping up production to cut cost. To determine the most efficient way to do so, Adams called on Georgia Tech’s Enterprise Innovation Institute.

Tara Barrett, Danny Duggar and Karen Fite, all project managers with the Enterprise Innovation Institute, led a project in value stream mapping, a technique used to analyze the flow of materials and information required to bring a product or service to a consumer. As part of a value stream mapping project, the team developed a value stream map that identified all the value-added and non-value-added steps then in use, assessed the current state to create product flow by eliminating waste, and drew and implemented a map showing what the future state could be.

“Fabritex needed to increase throughput and reduce cost. The results were that they were able to increase their production to a capacity of 500 units per month and meet their customer’s requirements,” noted Fite. “Our goal is to have Fabritex learn the concepts and continue to implement them after we’re gone.”

According to Adams, the process is now streamlined and more efficient. The company has made nearly $300,000 in capital investments, saved $100,000 and increased sales by more than $1 million. The company also created eight jobs and doubled production.

“Georgia Tech was really able to get the creative juices flowing. It gave the guys working on the floor the encouragement to make improvements and make suggestions where normally they wouldn’t have spoken up,” Adams observed. “Now there’s a craftsmanship to what they do; they’re not just here punching a clock.”

The value stream mapping project proved so successful that the company has continued to partner with Georgia Tech. Dan Trier, sales and marketing manager, has already taken several classes offered through the Georgia Tech Procurement Assistance Center (GTPAC), an organization based at the Enterprise Innovation Institute that helps Georgia businesses identify, compete for and win government contracts.

“We’ve had a Corps of Engineers project for more than 10 years, but this is an area we would like to explore more. I’ve attended classes on how to read and speak government procurement language, which is not easy, as well as learning where to find government contracts, how to read them and how to fill them out,” Trier said. “Joe Beaulieu, Steve Bettner and Chuck Schadl will answer any question we have and have really been helpful in terms of where to find the contract opportunities.”

In addition to classes, GTPAC provides its clients with coaching, mentoring and a set of tools to research and identify government contracting opportunities. Services are available at no cost to any Georgia business, large or small, that possesses the interest and potential to perform work, as a prime contractor or a subcontractor, for federal, state or local government agencies.

According to Fite, Fabritex has all the ingredients for success, especially in these challenging economic times.

“Fabritex had the right culture to accept and tackle this type of project – a strong culture that adapts to change, employees who will create solutions to unique problems, and, most importantly, leadership that promotes continuous improvement through the motivation, guidance and support of employees,” she said.

 

 

About Enterprise Innovation Institute:
The Georgia Tech Enterprise Innovation Institute helps companies, entrepreneurs, economic developers and communities improve their competitiveness through the application of science, technology and innovation. It is one of the most comprehensive university-based programs of business and industry assistance, technology commercialization and economic development in the nation.

Research News & Publications Office
Enterprise Innovation Institute
Georgia Institute of Technology
75 Fifth Street, N.W., Suite 314
Atlanta, Georgia 30308 USA

Media Relations Contact: John Toon (404-894-6986); E-mail (ude.hcetag.etavonninull@noot.nhoj).

Writer: Nancy Fullbright

Piedmont Newnan Hospital and Georgia Tech Present at National Conference

Pam Murphy, director of surgical services at Piedmont Newnan Hospital, and Jennifer Trapp-Lingenfelter, a project manager for Enterprise Innovation Institute, talked to surgical leaders about how to facilitate lean projects and sustain improvements.

More than 75 surgical services leaders across the country recently heard about how Piedmont Newnan Hospital was able to decrease its turnaround times by 30 percent and increase case cart accuracy to 100 percent with a little assistance from Georgia Tech. Pam Murphy, director of surgical services at Piedmont Newnan Hospital, and Jennifer Trapp-Lingenfelter, a project manager for Georgia Tech’s Enterprise Innovation Institute EI2, presented at a workshop at the OR Manager conference in Las Vegas, Oct. 7. The six-hour workshop, “Implementing Lean in the OR,” explained how operating rooms can facilitate lean projects and, more importantly, how to sustain the improvements.

Lean is the practice of evaluating the steps of a process to determine the cost-value added to a final product or service. It seeks to minimize the resources required for production by eliminating waste that inflates cost and turnaround times, and decreases efficiency.

Piedmont Newnan began working with Georgia Tech in December 2007 with an introduction to lean principles. According to Trapp-Lingenfelter, at least 90 percent of the operating room staff had basic lean training by the end of the project, a critical component of their success. The cross-functional team comprised of nurses, surgical technologists and central service personnel who went to the OR and the central sterilization department to observe the case cart process and note which steps were value-added and which ones involved waste.

“A lot of staff first thought that we were just trying to get efficient so we could eliminate positions. We had to assure them that this was not the case; we just wanted to be as efficient as we can be so we can build the business,” recalled Murphy. “The hard part for an organization is committing the resources, something especially difficult in health care. Once you do that, however, you can attack the issue in one week and come up with solutions.”

As a result of the lean implementation, case carts can now be pulled in five minutes versus 20 minutes and the overall case cart accuracy has risen from 50 percent to as high as 100 percent. Whereas staff would open all supplies prior to this project, they now refer to “do not open” bins, items that may be used in a case but do not need to be opened until that time. The bins have yielded a projected savings of $118,000 annually. Piedmont Newnan has also been able to increase its percentage of on-time procedure starts and decrease after-hours cases.

Through EI2’s Healthcare Performance Group, project leaders work with healthcare professionals to conduct lean assessments, teach basic lean concepts, develop value stream maps to analyze the flow of materials and information, develop quality systems and implement rapid process improvement projects. For more information on healthcare performance improvement services offered by Georgia Tech’s Enterprise Innovation Institute, contact Jennifer Trapp-Lingenfelter, Healthcare Performance Group (404-386-7472); E-mail: (ude.hcetag.etavonninull@retlefnegnil.nnej).

About Piedmont Newnan Hospital:

Piedmont Newnan Hospital (PNH) is a 143-bed, acute-care hospital in Newnan, Georgia, offering 24-hour emergency services, women’s services and general medical/surgical services. Diagnostic services include CT, nuclear medicine, MRI, PET, ultrasound and fluoroscopy. A complete range of medical/surgical services includes laparoscopic surgery, physical therapy, respiratory therapy, sleep studies and cardiac catheterization and rehabilitation. With approximately 856 employees and a medical staff of over 150 physicians, PNH is a member of Piedmont Healthcare (PHC), a not-for-profit organization that also includes Piedmont Hospital, a 481-bed acute tertiary care facility offering all major medical, surgical and diagnostic services located on 26 acres in the north Atlanta community of Buckhead; Piedmont Fayette Hospital, a 143-bed, acute-care community hospital located on Highway 54 in Fayetteville; and Piedmont Mountainside Hospital, a 42-bed community hospital in Jasper. Piedmont Healthcare also is the parent company of the Piedmont Heart Institute (PHI), which combines more than 75 cardiovascular specialists in Piedmont Heart Institute Physicians with over 30 locations across north Georgia, and the Fuqua Heart Center of Atlanta at Piedmont Hospital; Piedmont Philanthropy, the philanthropic entity for private fundraising initiatives; the Piedmont Physicians Group, with more than 100 primary care physicians in over 30 offices throughout metro Atlanta; and the Piedmont Clinic, a 600-member physician network. For more information, visit piedmontnewnan.org.

About Enterprise Innovation Institute:

The Georgia Tech Enterprise Innovation Institute helps companies, entrepreneurs, economic developers and communities improve their competitiveness through the application of science, technology and innovation. It is one of the most comprehensive university-based programs of business and industry assistance, technology commercialization and economic development in the nation.

Research News & Publications Office
Enterprise Innovation Institute
Georgia Institute of Technology
75 Fifth Street, N.W., Suite 314
Atlanta, Georgia 30308 USA

Media Relations Contact: John Toon (404-894-6986); E-mail (ude.hcetag.etavonninull@noot.nhoj).

Writer: Nancy Fullbright



Athens Hospital Improves Processes by Implementing Lean in Laboratory

As part of the lean implementation, team members removed sliding doors from shelving and doors from storage cabinets to easily identify supplies.

Debbie Guzman, laboratory director at Athens Regional Medical Center, says that implementing lean principles in a health care setting is especially challenging. Traditionally used in manufacturing, lean refers to an operational strategy derived from the Toyota Production System that focuses on eliminating waste while increasing value-added work to improve profitability, customer satisfaction, throughput time and employee morale.

“People involved in health care are about hands-on care-giving, comforting and healing,” she said. “We needed someone to help us who understood our language.”

Fortunately, Guzman found an excellent translator in Georgia Tech’s Enterprise Innovation Institute. Through its Healthcare Performance Group, project leaders work with health care professionals to conduct lean assessments, teach basic lean concepts, develop value stream maps to analyze the flow of materials and information, develop quality systems and implement rapid process improvement projects.

“We wanted the Healthcare Performance Group to provide the training, the structure and the facilitation for a period of time to do a 5S project in the lab. By using the 5S system – sort, straighten, shine, standardize and sustain – we thought we could significantly improve the efficiency and effectiveness of the laboratory,” explained Jim Pirkle, Athens Regional’s associate director of quality services. “Originally we were going to begin the project in one area, but we wanted each of the section supervisors to be involved so it could be a whole lab culture change.”

After years of inventory accrual and process adaptation, the five sections of the lab – pathology, chemistry, hematology, microbiology and blood bank – were in a physically dysfunctional environment. As the hospital expanded, team members had the opportunity to design a new lab that had the right supplies next to the right instruments, the appropriate amount of storage and counter space, equipment set up to facilitate testing processes and work processes arranged to minimize excess steps.

“We wanted to address inventory control – having the right inventory in the right place and at the right time,” said Frank Mewborn, leader of the Healthcare Performance Group. “An example that everyone could understand and relate to was gloves. We had the team estimate the glove inventory and then we actually counted it. We found open boxes and unopened boxes all around the lab. The inventory was three times higher than the team predicted. It was an eye-opening exercise.”

While the overall goal was to help design a highly-functional lab, the immediate project goals included making workspace more efficient, reducing inventory and supply costs, decreasing process steps and complexity and creating efficiencies in a timely manner. Participants included the lab director and supervisors, lab staff and quality support staff from Athens Regional, as well as Mewborn, Tara Barrett and Kelley Hundt from Georgia Tech. Five teams of 21 people learned about lean and 5S methodologies, participated in brainstorming and planning exercises and completed an “eye-opening” walk-through of the entire laboratory.

“Typically when we do a project like this, we do it in a series. We’ll pick one small area of the lab and get it really ship-shape and then use it as a model for the next area,” Mewborn recalled. “But Debbie wanted this to be a culture change in addition to a procedural change so we did all five areas simultaneously.”

In the first phase of the project, team members sorted the useful from the unnecessary. They evaluated the necessity of all supplies and equipment, cleared away trash and outdated equipment from the area and removed sliding doors from shelving and doors from storage cabinets to easily identify supplies. Most importantly, each department developed a systematic and collaborative process for sorting obviously misplaced items from useful ones.

Team members also relocated supplies, acquired supply bins and consolidated storage areas; set up a standard visual inventory system with red and green tape and developed kanban cards to display the name of the supply, the name of the supplier, the desired number of units and the item’s reorder point; and cleared trash away from the work area, thoroughly cleaned countertops, drawers and cabinets and removed redundant and unnecessary signage. Moving forward, Athens Regional has established a committee to focus on sustaining these improvements.

“Employees say this is now a much better place to work, and there is not as much clutter or confusion. In regards to patient safety, that’s a significant benefit,” Pirkle said. “As a result, we’ll have better patient outcomes as we become more accurate and timely.”

In particular, the 5S project increased the lab’s storage capacity by 64 percent, freed up counter space by 30 percent and reduced body fluid processing times from 12 to four minutes. Other results include reduced inventory and supply costs, decreased stock on hand, and greater clarity in the lab environment. Projected savings from reduced steps and time to complete work total more than $15,000.

“When the process is really lean, when you walk through the lab things are in their place. Everything is in the front and one person can go through the lines and know what needs to be ordered,” Guzman noted. “The biggest benefit of the project is that we now have some real lean champions in the lab.”

For more information on health care performance improvement services offered by Georgia Tech’s Enterprise Innovation Institute, contact Jennifer Trapp-Lingenfelter (404-386-7472); E-mail: (ude.hcetag.etavonninull@retlefnegnil.nnej).

About Enterprise Innovation Institute:
The Georgia Tech Enterprise Innovation Institute helps companies, entrepreneurs, economic developers and communities improve their competitiveness through the application of science, technology and innovation. It is one of the most comprehensive university-based programs of business and industry assistance, technology commercialization and economic development in the nation.

Research News & Publications Office
Enterprise Innovation Institute
Georgia Institute of Technology
75 Fifth Street, N.W., Suite 314
Atlanta, Georgia 30308 USA

Media Relations Contact: John Toon (404-894-6986); E-mail (ude.hcetag.etavonninull@noot.nhoj).

Writer: Nancy Fullbright

Newnan Hospital Partners with Georgia Tech to Implement Lean

This article is reprinted from OR Manager, Vol. 25, No. 5, May 2009.

When Pam Murphy, RN, director of surgical services at 144-bed Piedmont Newnan Hospital in Newnan, Georgia, first heard a Lean presentation, she says, “It made sense, because we are so process driven. The whole focus is, ‘What is touching the patient, and what is value added?’”

Piedmont Newnan’s ORs were the pilot site for a Lean project for the Piedmont Healthcare system. The hospital has 8 ORs on 2 campuses. Piedmont was aided by Georgia Tech’s Enterprise Innovation Institute in Atlanta.

Developed by Toyota, Lean in health care brings clinicians and other staff together to improve processes that waste time and resources.

Involving the staff

Murphy knew the staff’s participation would be critical. She also knew they would have a concern: Does Lean mean doing more with less? Would people lose their jobs?

Backed by the administration, Murphy assured them no one would lose their jobs because of Lean.

Another concern—with staffing tight, how do you get staff off to participate in a project? How might that affect productivity numbers?

Again, Murphy had top-level support. A Lean account was set up for charging employees’ time so managers wouldn’t be penalized for lower productivity.

“That was a key decision by the executive team,” says Jenn Lingenfelter, project manager for Georgia Tech’s Health Care Performance Group, who worked with Piedmont Newnan.

Getting started

Since the Lean project started in December 2007, the ORs have conducted two 5-day Lean rapid process improvement (RPI) projects (also called kaizen events), one on case carts and the other on turnover time.

The hospital wanted to start with turnover time, but Lingenfelter urged the team to step back and take a wider view of the surgical process. In doing so, they realized one issue affecting turnover time was that case carts weren’t available and supplied correctly, which meant rework before cases.

Murphy recognized that if she and the staff could improve the case cart process, they would attract buy-in from other staff and physicians and build momentum for other projects.

These are the steps they took.

Training for staff

In Lean, improvement initiatives bubble up from the front lines, so the staff is critical to Lean. Lingenfelter began by introducing managers and an initial group of staff to Lean. By the end of her involvement, 90% to 100% of the OR staff had basic Lean training.

Selecting a team

For the case cart RPI, a cross-functional team of front-line OR staff was selected, including nurses, surgical technologists (STs), and central service (CS) personnel.
Murphy had planned for coverage 6 weeks ahead by arranging for per diem staff and having other staff report earlier in the day.

‘Going to the gemba’

After an introduction to Lean, the RPI team went to the OR and CS departments to observe the case cart process. In Lean, this is called “going to the gemba”—going to where the actual work is done. Getting the team out of their daily routine helps them to spot activities that waste time and energy.

The team split up to observe the instrument flow in the CS department, case-cart picking, and the opening of case carts and setup in the OR. They gathered baseline data by timing how long it took to pick a case and assemble a case cart.
The observers helped pique interest of the rest of the staff.

“The team would say, ‘This is what we’re looking at. What do you think?’ That helped to spread the excitement,” Murphy notes.

Mapping the process

After the observations, the team met in a conference room to map out the process on the wall. They noted which steps were value added and which involved waste.

Themes emerged:
• The preference lists were in reasonable shape but needed tweaking. The lists are computerized but didn’t include locations where supplies were stored.
• There was not a formal way of picking a case.
• The staff didn’t trust one another to pull cases accurately because everyone did it in a different way.
• Items were not placed in standardized locations on the case carts.
• In the OR, many items were opened “just in case” instead of held in reserve, as indicated on the preference list. That caused a lot of waste.

Whirlwind of improvements

The team divided into smaller teams to tackle each issue.

“We prioritized ideas and focused on those we could do that week. It was like a whirlwind,” Lingenfelter says.

One focus was a standardized case-picking method.

“In manufacturing, a distribution center is arranged so you go down Aisle 1 and pick items, then you go to Aisle 2, and so forth. With the case carts, staff were zig-zagging and backtracking,” she says.

The team worked with the IT department to develop a systematic pick path.

The preference lists were standardized to mirror the layout of the supply room so the person pulling a case would always start in the same location. Another breakthrough was to eliminate pulling all of the cases the day before. That had caused some case carts to be incomplete, meaning rework to look for supplies before a case and “stealing” from case carts already pulled.

Instead, the team decided that the only cases pulled the day before would be the first cases of the day. That reduced the space needed for case carts and eliminated incomplete case carts. The staff’s biggest concern was that case carts would not be ready, but Murphy says that has not been an issue.

A standard arrangement

The team also developed a standard arrangement of items on the cart so items needed first are on the top shelf and so forth. Other changes were:
• entering supply locations on the preference cards
• labeling shelves and bins in the automated supply cabinets
• cautioning staff not to pull cases from memory but to use the preference cards—even if they had been there for 20 years.

Updating preference cards

The team also fine-tuned the process for updating preference cards:
• The person picking the case prints out the preference card and highlights any missing items, such as an instrument set still in CS.
• The preference card goes with the case cart to the OR.
• In the OR, the OR staff write any missing items on the preference card.
• After the case, the preference card is taken to a designated location. The cards are tallied for missing items to determine an accuracy rate.
• Preference cards needing changes are transferred to another box where one person does the updates, typically within 2 or 3 days.

An ‘aha moment’

The RPI’s biggest win and greatest savings came from an “aha moment” during the observations.

“We found people had gotten into the habit of opening everything for a case,” Murphy says, even items labeled on the preference card as “do not open unless needed.”

In an easy fix, a “do not open” bin was added to the case carts. All such supplies for a case are placed in the bin when a case is picked. After the case, the bin with any unopened supplies goes back to CS with the case cart, and the supplies are restocked.

The savings—$118,000 over a year.

After the RPI, the overall case cart accuracy rate rose from 50% to 98% accuracy to 100% accuracy in November and December 2008, Murphy says.

Keeping up the momentum

Lean is meant to be a cultural change, not a short-term project. How do you keep it going?

“You have to continue to monitor and measure. Otherwise, the staff loses sight of where they are,” Murphy says. She reports the preference card accuracy rate to the staff regularly.

The spirit of Lean needs to become part of everyone’s thinking, Murphy notes.

Many of the staff have been involved in Lean projects.

“The only reason we succeeded was because of the staff,” Murphy says. “The staff were the ones who came up with the ideas.”

If a process slips, they will say, “Wait a minute. That’s not part of our Lean process.”

When performance drops off, the staff who were on the RPI teams “will sit back down and look at what’s going on. They’re the ones who own it and drive it,” Murphy says.

Success can be infectious.

“This project was so much fun,” Lingenfelter says. “You feel like you’ve made a difference. You see a difference not only in the bottom line but in the culture.”
—Pat Patterson

©OR Manager, Inc. 2009. All rights reserved. 800/442-9918. www.ormanager.com

About the Enterprise Innovation Institute:
The Georgia Tech Enterprise Innovation Institute helps companies, entrepreneurs, economic developers and communities improve their competitiveness through the application of science, technology and innovation. It is one of the most comprehensive university-based programs of business and industry assistance, technology commercialization and economic development in the nation.

Research News & Publications Office
Enterprise Innovation Institute
Georgia Institute of Technology
75 Fifth Street, N.W., Suite 314
Atlanta, Georgia 30308 USA

Media Relations Contact: John Toon (404-894-6986); E-mail (ude.hcetag.etavonninull@noot.nhoj).

Helping Georgia’s Rural Hospitals

With support from the Healthcare Georgia Foundation, the Enterprise Innovation Institute is helping Georgia’s rural hospitals learn lean techniques that improve patient care and reduce costs. Shown is Nancy Peed, CEO of Peach Regional Medical Center in Fort Valley.

To improve customer satisfaction, enhance the quality of services and reduce costs, Peach Regional Medical Center has worked with the Georgia Institute of Technology to adopt process improvement techniques traditionally used by the manufacturing industry. Already, Peach Regional Medical Center’s Emergency Department has noted a 20 percent decrease in average length of stay for its patients.

“The bulk of our patients come through the emergency room, and people judge the care by how quickly they are seen and treated,” said Nancy Peed, CEO of Peach Regional Medical Center. “Peach Regional Medical Center provides care for 15,000 patients each year in our emergency department, and this volume continues to increase. That demand, coupled with an undersized and aging emergency department facility, means of course that we have throughput issues, and we are working diligently to manage and improve these issues.”

Earlier this year, Peed became aware of an initiative led by Georgia Tech’s Enterprise Innovation Institute to help train rural hospital staff in lean principles that identify waste in processes and find ways to eliminate it, while improving customer and staff satisfaction. The project is funded by a $349,000 grant from Healthcare Georgia Foundation. Georgia Tech has successfully used the approach with hospitals in Athens, Atlanta, Columbus, Newnan and Vidalia, and its training programs have been licensed for use nationwide by the American Hospital Association.

Matt Haynes, a Georgia Tech lean specialist, began the project by leading Peach Regional staff in lean overview training. Teams of six people from the medical center then developed value stream maps – diagrams of the entire patient admitting and discharge process – for both the medical surgical nursing and emergency departments.

“We identified 30-day quick fixes and also began implementing 5S, a method for organizing the workplace,” recalled Chance McGough, medical surgical nurse manager and lean coordinator for Peach Regional. “We organized the ER and utility rooms, labeled everything in the supply closets and color-coded materials so they are easier to find. That has helped facilitate flow through the ER because we spend less time looking for things and more time taking care of patients.”

In addition to the lean implementation, senior management at Peach Regional attended a Disney Institute workshop in Atlanta titled “Common Sense to Common Practice: Lessons for Healthcare.” Topics included how to improve the patient experience and motivate health care staff while delivering top-notch health care service, an imperative in a state where approximately 85 percent of hospitals are operating at a loss, Peed said. This training was also funded by the Healthcare Georgia Foundation grant.

“If we can come up with ways from within of doing things quicker, more efficiently and with less duplication, we’re ahead of the game and we can be even more successful and provide even better care to our patients,” noted Peed. “It’s not good enough to meet customer needs; you have to exceed them every time.”

Rural hospitals in Georgia face a financial crisis because their patients are less likely than those of metropolitan hospitals to have health insurance. At the same time, hospitals in underserved areas face other competitive disadvantages as they confront rising costs.

“The current recession has impacted the rural hospitals more so than those in metro Atlanta,” Haynes noted. “Improving the process of how patients are seen is having a positive impact on both patient treatment and the hospital’s profit.”

Such facilities need to find sustainable ways to become more efficient, which is why Healthcare Georgia Foundation provided the grant to Georgia Tech. In addition to Peach Regional Medical Center, hospitals participating in the program include Upson Regional Medical Center in Thomaston, Monroe County Hospital in Forsyth, Morgan Memorial Hospital in Madison, Banks-Jackson-Commerce Hospital in Commerce, West Georgia Medical Center in LaGrange, and Hutcheson Medical Center in Fort Oglethorpe.

The projects are expected to be completed by June 2010.

About Healthcare Georgia Foundation: Healthcare Georgia Foundation is a statewide, private independent foundation. The Foundation’s mission is to advance the health of all Georgians and to expand access to affordable, quality healthcare for underserved individuals and communities. Through its strategic grant-making, Healthcare Georgia Foundation supports organizations that drive positive change, promotes programs that improve health and healthcare among underserved individuals and communities, and connects people, partners and resources across Georgia. For more information, please visit the Foundation online at (www.healthcaregeorgia.org).

About the Enterprise Innovation Institute: The Georgia Tech Enterprise Innovation Institute helps companies, entrepreneurs, economic developers and communities improve their competitiveness through the application of science, technology and innovation. It is one of the most comprehensive university-based programs of business and industry assistance, technology commercialization and economic development in the nation. For more information, visit (www.innovate.gatech.edu).

Enterprise Innovation Institute

Georgia Institute of Technology

75 Fifth Street, N.W., Suite 314

Atlanta, Georgia 30308 USA

Media Relations Contact: John Toon (404-894-6986); E-mail: (ude.hcetag.etavonninull@noot.nhoj).

Writer: Nancy Fullbright

Lean Consortium Expands to North Georgia

The Georgia Tech Lean Consortium, a forum for organizations to advance their knowledge and effective use of lean principles, is expanding into northeast and northwest Georgia. Organizations from any economic sector – including manufacturing, service, government or health care – are welcome if they have a vision for lean within their organization, a strategy and commitment to its implementation and successful experiences to share with the consortium.

Lean principles are a set of tools widely used in manufacturing to help identify and steadily eliminate waste from an organization’s operations. Already, 11 south metro Atlanta companies and 17 Augusta area companies are participating in the Lean Consortium through shared training and peer-to-peer relationships.

Member companies rotate hosting the group at their facility, where they present their vision for lean and the challenges and successes to date. After a plant tour, the group provides feedback to identify areas of success, as well as opportunities for further improvement. Members are also offered exclusive training classes in areas that they help to select.

“The Lean Consortium here in Augusta has provided an excellent opportunity for me to exchange ideas and learn about best practices at other manufacturing facilities in my local area,” said Chuck Sabo, quality and safety manager at Purification Cellutions in Waynesboro, Ga. “The consortium allows this to be done without the need to invest in costly travel and I have found my colleagues at other companies to be very open with both their successes and failures.”

To learn more about the Georgia Tech Lean Consortium, please contact Larry Alford (404-895-5237); E-mail (ude.hcetag.etavonninull@drofla.yrral) or visit www.gtlean.org.

About Enterprise Innovation Institute:

The Georgia Tech Enterprise Innovation Institute helps companies, entrepreneurs, economic developers and communities improve their competitiveness through the application of science, technology and innovation. It is one of the most comprehensive university-based programs of business and industry assistance, technology commercialization and economic development in the nation.

Research News & Publications Office

Enterprise Innovation Institute

Georgia Institute of Technology

75 Fifth Street, N.W., Suite 314

Atlanta, Georgia 30308 USA

Media Relations Contact: John Toon (404-894-6986); E-mail (ude.hcetag.etavonninull@noot.nhoj).

Writer: Nancy Fullbright

Children’s Healthcare Reduces Length of Stay, Increases Patient Satisfaction with Georgia Tech Assistance

In 2008, Children’s Healthcare of Atlanta saw more than 170,000 patients across three of its three emergency departments. That kind of volume demands an effective and efficient process, and staff spent the past three years developing a master facility plan to do just that. However, moving into a larger space did not yield the expected results.

“We increased the size of our departments thinking capacity would resolve turnaround time issues,” said Marianne Hatfield, director of Children’s emergency services. “But what we found was we didn’t really get any better once we moved into the bigger space; we got slower. We really had not examined whether or not our process needed to change.”

A visit to Seattle Children’s Hospital convinced Hatfield that CHOA’s processes had to change to truly improve performance. Seattle Children’s Hospital is a leader in lean management principles – a set of tools derived mostly from the Toyota Production System and widely used in manufacturing – that helps identify and steadily eliminate waste from an organization’s operations. In April of 2008, Children’s contacted Georgia Tech’s Enterprise Innovation Institute for assistance in implementing lean principles in its emergency department.

“We knew we had to do something for turnaround time in our emergency department and we began interviewing people to teach lean. We thought Georgia Tech was the best fit. They were nearby and we could see what they had done with some other hospitals,” Hatfield recalled. “The week they spent with us changed the lives of the physicians and the frontline staff; they all think differently now. There was so much impact to that week together, where everyone really started to examine waste in our system. I don’t think we would have been able to do that on our own.”

Kelley Hundt and Matt Haynes, lean specialists with Georgia Tech’s Healthcare Performance Group, led a team of Children’s physicians, nurses, technicians and administrators to analyze and streamline flow processes from the moment a patient arrives in the emergency department until he or she is discharged. The team, which implemented lean principles primarily on Children’s Scottish Rite campus, identified both value-added and non-value-added activities and made a number of observations.

“By studying the processes, we learned that time was being wasted because of searching, re-work, travel and variation in processes,” observed Jeff Rehberg, manager of clinical process improvement at Children’s and a 1996 industrial engineering graduate of Georgia Tech. “Our goal was to reduce the length of time children who did not need to be admitted waited in the emergency department. Using lean principles, the team developed a model for pulling rather than pushing the patients through the emergency department.”

In a push system, the emergency department tries to push a patient through triage regardless of whether or not the physician is available. The new system, dubbed TAPP (Team Assessment Pull Process), anticipates emergency department demand and has both a physician and a nurse ready before the patient is called back.

“A lot of times when you hear people talk about emergency department flow, you hear them say ‘pull ‘til full,’ and we completely changed that. Before, as soon as we had an empty room, we would put patients in it – regardless of whether we had enough staff or physicians – because we thought people were happier if they weren’t in the waiting room and in an exam room,” Hatfield said. “Now we match the two resources before the patient comes back. When the patient comes into the exam room, both the physician and nurse are there and the work starts immediately.”

The new process noticeably reduced the time patients spent waiting for a physician assessment, enhanced physician and nurse partnering, eliminated order confusion and allowed discharge from the first room if no other treatment was needed. Most importantly, it improved the patient family experience by providing a more timely initial interaction with a physician.

“I am always trying to be more efficient and take out the waste in my own practice and patient care interactions without sacrificing quality,” said Dr. Michael Shaffner, a physician who helped develop the new process and a 1987 industrial engineering graduate of Georgia Tech. “There were no new concepts, but the implementation was fresh and greatly appreciated.”

From September 2007 to January 2008, the median length of stay in Children’s main emergency department was 190 minutes. A year later, length of stay had decreased to 163 minutes during the same season. In addition, the median time patients wait between being greeted and being seen by a provider has decreased by 37 percent.

“We did a one-month trial from mid-June to mid-July 2008, and we saw some frustration because physicians had to leave some rooms in search of supplies,” Hatfield recalled. “So we took a separate 5S team another four to six weeks to standardize all the rooms so the physicians have everything they need.”

5S refers to improving organization of the workspace in five steps: sort, set in order, shine, standardize and sustain. As a result of the 5S project, hospital carts are labeled and stocked in the same way, blood pressure cuffs are organized by size and small items frequently used by physicians are easy to grab and keep clean. Visual cues signify when it is time to re-stock a certain supply. The cumulative effects have been good for both hospital staff and patients, according to Hatfield.

“The way customer service scores normally work is when there is high volume, the score drops, but with low volume, customer satisfaction goes way up,” she observed. “September through January we were at the 99th percentile and this has been maintained month after month. We have to believe it’s the process because we’ve not really done anything different.”

Hundt says that a critical component of Children’s success was the support and involvement of top management.

“Management would not let the team fail; they stuck with it. They followed the model of plan, do, study and adjust and have seen tremendous benefits,” she said. “Before there was a lot of wasted time with interruptions and now they are working in an uninterrupted fashion. They developed a process that allows them to eliminate interruptions.”

To continually improve the lean process, Children’s is also implementing a lean education program that focuses on transforming all employees into problem solvers that can identify and eliminate waste. Ultimately, says Rehberg, lean principles will be applied to other areas of patient care, such as operating room, inpatient units and radiology.

“After other staff members heard about the great things going on in the emergency department, they started banging down our doors,” Rehberg said. “The more people that understand the concept, the better the process flows.”

For more information on lean health care services offered by Georgia Tech’s Enterprise Innovation Institute, contact Frank Mewborn, director of the Healthcare Performance Group (706-338-0072); E-mail: (ude.hcetag.etavonninull@nrobwem.knarf).

About Enterprise Innovation Institute:
The Georgia Tech Enterprise Innovation Institute helps companies, entrepreneurs, economic developers and communities improve their competitiveness through the application of science, technology and innovation. It is one of the most comprehensive university-based programs of business and industry assistance, technology commercialization and economic development in the nation.

Research News & Publications Office
Enterprise Innovation Institute
Georgia Institute of Technology
75 Fifth Street, N.W., Suite 314
Atlanta, Georgia 30308 USA

Media Relations Contact: John Toon (404-894-6986); E-mail (ude.hcetag.etavonninull@noot.nhoj).

Writer: Nancy Fullbright

Athens Manufacturer Goes Lean, Green with Georgia Tech Assistance

When entrepreneurs Sherrie Ford and Steve Hollis purchased an Athens manufacturing facility previously owned by the Swiss conglomerate ABB six years ago, one of their first items of business was to realign the company’s mission. Founded in 1958 by Westinghouse, the 400-employee company now known as Power Partners continues to manufacture the pole-type distribution transformers that help bring electric power to homes and businesses throughout the world, but with an innovative business angle.

“Our mission is no longer just to make the best transformers on the market, but also to not be put out of work ever. We can make anything as long as we’re able to keep the employment base,” stated Ford, chairman and executive vice president of culture. “Adding a breakthrough technology product that addresses global warming fulfills our ‘reinventing manufacturing’ promise to the work culture, a step toward securing at least these 400 manufacturing jobs, and creating a role model for others to consider.”

In 2007, Power Partners expanded its product line to manufacture solar water heater systems, which use solar energy to heat water and can provide up to 85 percent of the energy needed to produce domestic hot water. Systems are composed of solar thermal collectors, a fluid system that moves heat from the collector to the point of usage. According to commercial operations manager Scott Childs, Power Partners is initially marketing the systems to utility companies and dealers.

“The solar water heater system is going to provide hot water mainly in the summer, when electricity is most valuable to a utility, and the system will use more electricity in the winter when there is plenty of electrical capacity,” he noted. “We think that situation will marry well with our product, in addition to the utilities’ increased focus on green.”

In addition to the distribution transformers and the solar water heater systems, Power Partners has the exclusive North American rights to begin manufacturing adsorption chillers, a product that can substantially reduce operating costs by converting waste heat into cool air. Ford says she is excited about the new product’s potential.

“When combined with other technologies, adsorption chillers create about as low an impact on the environment as you can get. This is really going to revolutionize the way architects and construction firms think about their designs,” Ford said.

With all of the focus on manufacturing environmentally responsible products, it made sense for Power Partners to examine its own manufacturing processes. After working on projects in lean manufacturing and quality standards with Georgia Tech’s Enterprise Innovation Institute, Ford contacted the organization again to conduct an energy assessment.

In July 2008, Bob Hitch, a project manager with the Enterprise Innovation Institute, evaluated Power Partners’ process heating systems – annealing, welding, drying and painting – for potential energy-saving opportunities, an estimated energy savings of 30 percent. As a result of the recommendations, Power Partners is replacing its water-cooled bearings with high-temperature graphite bearings. Earlier assessment of the general facility energy usage by Hitch and the Power Partners engineers led to the update of lighting in the plant to T5 and T8 high-efficiency units, and replacement of outdated air compressors.

“By changing the bearings and the lighting and the compressors, we have saved an estimated $600,000 easily,” said Mike Stonecipher, vice president for technical services. “Those are realized savings and we now have a whole philosophy and set of tools to move us forward.”

Power Partners also participated in a November 2008 project for the Green Supplier Network, a partnership between the Environmental Protection Agency and the National Institute for Standards and Technology’s Manufacturing Extension Partnership. In addition to Hitch, the project was facilitated by Bill Ritsch of the Enterprise Innovation Institute and Dan Loudermilk of the Georgia Department of Natural Resources’ Pollution Prevention Assistance Division. The work was sponsored by Power Partners’ customer, Pepco Holdings, Inc.

“The primary objective of this three-day project was to identify opportunities for reductions of waste energy, material and inventories by creating a value stream map, which is a diagram used to analyze the flow of materials and information required to bring a product to a consumer,” recalled Hitch. “A team of key players was chosen, and this group was effective in seeing beyond the current processes by proposing a future state map that included some impressive gains in productivity, material usage and environmental reductions.”

The improvement ideas included operating the paint line during one shift only, creating a single point of contact for ordering tanks, rearranging the tank wall inventory to minimize travel, reconfiguring conveyors to improve material flow, minimizing repair stations by combining repairs where possible, and re-using the waste water from the paint area. However, Stonecipher says that the most significant improvement was completing a “green” value stream map for all plant processes.

“As part of lean manufacturing, we were familiar with the value process map. But what we had not done was look at it in terms of the environment. That was the first time we had taken a process map of a section of the factory and done it in accordance to our waste streams,” he said. “Now when we do a process map, that’s a standard part of it. From a lean and practice standpoint, lean green is a new tool that’s been brought to the equation.”

Power Partners realized other benefits as a result of the Green Supplier Network Project. Tank inventory was reduced by 34 percent, total supply chain lead time for tanks went from more than 17 days to less than a week, water usage was reduced by 10,000 gallons per day, quality improved and productivity increased. Stonecipher notes that while not all of the results were measurable, they were all beneficial.

Power Partners, which was recognized in 2007 as the seventh largest woman-owned business in America as certified by the Washington, D.C.-based Women’s Enterprise Business National Council, plans to use Georgia Tech’s assistance in the future to focus on pumps and motors, as well as ways to capture waste heat and re-use it so it can install its own adsorption chiller.

“We are people who are continually looking for creativity and innovation, and doing things that are not business as usual,” said Ford.

About Enterprise Innovation Institute:
The Georgia Tech Enterprise Innovation Institute helps companies, entrepreneurs, economic developers and communities improve their competitiveness through the application of science, technology and innovation. It is one of the most comprehensive university-based programs of business and industry assistance, technology commercialization and economic development in the nation.

Research News & Publications Office
Enterprise Innovation Institute
Georgia Institute of Technology
75 Fifth Street, N.W., Suite 314
Atlanta, Georgia 30308 USA

Media Relations Contact: John Toon (404-894-6986); E-mail (ude.hcetag.etavonninull@noot.nhoj).

Writer: Nancy Fullbright