Jahanna Ray and Lisa Williams don’t get as much exercise as they used to, at least not while they’re working as registered nurses and clinical coordinators at St. Francis Hospital in Columbus, Ga. Before implementing lean management principles, nurses were losing approximately 750 minutes each day by walking 50,000 feet – or nine and a half miles – to retrieve IV pumps from the hospital’s Sterile Processing Department (SPD).
“The Sterile Processing Department used to be somewhat centrally located, but when they built new operating rooms, they appropriately located the department underneath the OR,” recalled Ray. “But what that did to the nurses was it required them to walk 15 minutes to get a pump. That’s with no interruptions and no multi-tasking.”
With so much nursing downtime, hospital management had real concerns about delay in patient treatment, potential for error and decreased nurse and physician satisfaction. According to Ray, nurses traveling to retrieve pumps were in a so-called electronic “dead zone,” where they could not be reached should their patients need emergency assistance.
It was then that Bob Gilson, chair of the St. Francis Board of Trustees, suggested that the hospital consider applying lean management principles: a set of tools derived mostly from the Toyota Production System widely used in manufacturing to help identify and steadily eliminate waste from an organization’s operations. As a member of the Industry Services Board of the Georgia Institute of Technology’s Enterprise Innovation Institute, he was already familiar with the organization’s efforts in lean health care through its Lean Healthcare Performance Group.
“Bob Gilson had contact with Georgia Tech and suggested to our CEO that we become involved with the Chamber of Commerce’s lean initiative for Columbus. What we’re trying to do is create a lean community in Columbus with lean services in health care and city government, as an innovative way of recruiting industries that might want to locate here,” noted Jill Hiers, director of operations improvement for St. Francis. “We decided to try it here and see what we could do as a project.”
Senior leadership and directors at St. Francis met to develop a list of all the issues that needed to be addressed, and then narrowed that list down to five possible projects. According to Hiers, the project that would have the greatest impact on the nursing staff was the intravenous (IV) pump project, dubbed the “Having the Right Equipment in the Right Place and at the Right Time” initiative.
Over a one-week period in November of 2007, Frank Mewborn, Jennifer Trapp-Lingenfelter and Derek Woodham, lean specialists with the Enterprise Innovation Institute, trained St. Francis staff on lean principles, assisted with data analysis, brainstormed and prioritized ideas, updated management on the new process and implemented the lean plan. Now, a certain number of IV pumps are kept on each floor and each floor has clean, sterile space for an overflow or staging area. Pumps are cleaned by nurses within three to five minutes of use, as opposed to the previous turnaround time of 12 to 24 hours.
“We developed inventory levels for each floor, and there are visual cues to signal when the pumps get down to a certain level. A tag should be taken to the clinical coordinator to let them know the pumps are potentially running low and to locate additional pumps,” said Trapp-Lingenfelter. “Basically, in manufacturing terms, they developed a kanban system.”
As expected, there was also a dramatic impact on the Sterile Processing Department staff time, since it no longer had to retrieve pumps from the floor, return them to the holding area and sterilize them. According to Williams, it took more than 45 minutes for one staff member to retrieve the pumps and take them back to Sterile Processing, let alone clean the pumps and distribute them back to each floor.
“There was a lot of elimination of non-value added activities in Sterile Processing because now they’re freed up to spend their time on other equipment that needs to be cleaned,” Williams explained. “We no longer have to manually log the pumps because each floor has its own stock. If there’s a floor that’s short, and one floor has excess pumps, they can just borrow between the floors.”
Those saved footsteps also correlate to the bottom line: before the lean implementation, nurses’ trips to the Sterile Processing Department equated to $7,500 a month, or $90,000 a year. The estimated cost of time wasted by SPD to retrieve pumps was nearly $600 a month, or more than $7,000 a year. Nurse satisfaction has also increased tremendously.
“The comment that stuck out to me the most from the nurses was, ‘You mean we can actually design the process and put it into practice? We have the autonomy to take the process and fix it?’” recalled Hiers. “For every problem we’ve encountered since the implementation, we’ve come up with a solution. We are continually growing improvements.”
In fact, the clinical coordinators at St. Francis are participating in the Center for Frontline Leadership, the hospital’s commitment to provide professional development for employees. This semester, each unit is working together to identify some process that needs to be improved and then implement the new process. Future lean projects will focus on the delivery of medication, the discharge process and improving wait times in the emergency room.
Julia Downey, the team coordinator for customer quality initiatives at St. Francis, said she was especially impressed with how much the team was able to accomplish with Georgia Tech’s assistance in such a short time.
“I really was amazed at how quickly we were able to work through the process and implement something by the end of the week,” she said. “Sometimes you lose people and sometimes the dynamics change, but just being able to work through the process and have something implemented by the weekend was wonderful.”
St. Francis is a faith-based, not-for-profit community hospital founded in 1950 in Columbus, Ga. The 376-bed facility specializes in cardiac care, stroke and chest pain, and employs more than 1,800 people, including 275 board-certified physicians.
For more information on lean health care services offered by Georgia Tech’s Enterprise Innovation Institute, contact Jennifer Trapp-Lingenfelter (404-386-7472); E-mail: (email@example.com).
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Writer: Nancy Fullbright