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 (firstname.lastname@example.org).
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Writer: Nancy Fullbright