HOSPITAL EXCELLENCE OPERATION MODELMiguel Angel Moreno, Abraham

Mendoza IIE Annual Conference and Expo 2014

Applied Solutions SessionsMontreal, Canada

May 31 – June 3, 2014

Importance

Certification requirements that guarantee the competence of doctors and hospitals

1993, first effort: Mexico, Canada and United States.

2007, Proposed as national standard of quality in health.

2009, first version approved for certification of hospitals.

2012, latest version which integrates the requirements of the Joint Commission International.

Equipment, Materials & Medicine

Manufacturers

Distributors Hospitals Patient

Goods and services

Information / Money

Health Sector Supply Chain (HSSC)A supply chain in the Health Sector includes a number of different parties, including manufacturers, distributors, third party logistics (3PL) providers, transportations companies, hospital receiving and materials management departments, nursing, and finally, the patient. Langabeer (2008)

HCSC in Mexico

HOSPITALOperation Management

Key Performance IndicatorsManagement Processes

Processes ControlFocused Improvement

Resources Optimization

Manufacturer

Distributors

Health Sector

Certification

Medication & care Safety Methods

Resources Optimization (materials, personnel, facilities)

New Services & methods

Inventory Level Optimization

Medication & TI's

Goods & services flow

Opportunities for OM & SCM

Satisfaction Level

Resources Scheduling

Inventory Level Optimization

HCSC Key ProcesesInventory Management Facilities Management

Procurement Process Purchasing Scheduling Forecast Optimum level definition Economic Order Quantity Warehousing

Network and complexity Localization and number of

facilities Size and localization of

warehouses Layout design Materials management

equipment Sistema de almacenamiento

Distribution Patient Service Route and personnel

scheduling Re-abastecimiento System selection Equipment Expedite

Availability of service Service Level perception Response time (lead time) Key Information availability Total cost of service

Minimize unproductive inventories.

Increase the perception of value.Ensure the application and delivery of medical services in time and correctly.

Build strategic alliances with suppliers.

Define the service levels expected for suppliers and service providers.

Use of information technologies in the communication of requirements.

Constant review of methods and business processes to reduce response times.

Strategies

Great DilemmaHospitals in Mexico

How did they do the continuous improvement process?Step by step taking at least 8-12 years to achieve Lean (best hospital in Jalisco)1st Quality System definition and implementation (2004, started in 2002)2nd CGS certification (2005) & ISO (2007)3rd “H” Award (2009)4th JCI certification (2010)5th Quality Award & ISO 14001 (2011)6th Start Lean Healthcare (2012)

CERTIFICATION

LEAN HEALTHCAR

E

6 SIGMA

Continuous

Improvement

Culture

Strategies for achieving operational excellence

6 Sigma

Lean Healthcare

Certification / ISO

Waste sources

elimination

Processes critical sources of variation

elimination

Processes continuous

improvement standardization and auditing

Business Process Management (BPM)

SynergyStrategy

Structure Capabilities

1Patient focus 2 Leadership

3Struc ture and Organization

4Partnership

5Information Tecnologies

9 Integration

8 Team Management

7 Continuous Flow of patients

6Continuous

Improvement Culture

C ERTIFIC AC IÓN

• Managing the expected outcome• Customer orientation• Individual proces in a systematic

manner• Processes interrelationship• Results vs. Capacity and

effectiveness• Focus on the resources and methods• Bases for continuous improvement

culture

•Interrelationship betweenen processes•Impact of processes on the overall result•Reduction on cost operation•Documentation of improvements•Standardization of the efforts•Ready for certification

• A systematic process• Standardization and deployment• Customer satisfaction improvement• Cost reduction, service level

improvement and processes variability reduction

• Organization becomes an Industry reference

• Improvement as decision-making

Process Diagnosis (Phase 1)

Lean Introduction

(Phase 2)

Lean philosophy deployment

throughout the organization

(Phase 3)

Continuous improvement

culture as decision-

making process (Phase 4)

Hospital Excellence Operation Model

Phase 1

Diag

nosis

Key Processes Mapping

Processes InterrelationshipKey Performance

Indicators

Lean Maturity

Phase 1 (Implementation)

Diagnosis

Key Processes

Current Status Which one (pilot)?

Future Status How should be?

What tools?

Identify Training

Applicability Data analysis

Improvement Standardization Deployment

How we propose to solve it? Creating Synergies

BPM

LEAN HEALTHCARE 6 SIGMA

MISP.1

PRF

AOP

MISP.4

MISP.5

MISP.6

ACC

COP PFE

MISP.2

MISP.3

QPS

SAD

PCI

ASC

GLD

MMU

FMS

SQE

MCI

INTERNATIONAL PATIENT SAFETY GOALS(MISP.1). Identify Patients Correctly(MISP.2). Improve effective communication(MISP.3). Improve the Safety of High-Alert Medications(MISP.4). Ensure Correct-Site, Correct-Procedure, Correct-

Patient Surgery(MISP.5). Reduce the Risk of Health Care–Associated

Infections(MISP.6). Reduce the Risk of Patient Harm Resulting from

Falls

CGS & JCI Standard vs HEOM

How we propose to solve it? Creating Synergies

BPM

LEAN HEALTHCARE 6 SIGMA

MISP.1

PRF

AOP

MISP.4

MISP.5

MISP.6

ACC

COP PFE

MISP.2

MISP.3

QPS

SAD

PCI

ASC

GLD

MMU

FMS

SQE

MCI

PATIENT CENTERED STANDARS(ACC). Access to care and continuity of care(PRF). Patient and family rights(AOP). Assessment of patients(SAD). Diagnosis Services(COP). Care of patients(ASC). Anesthesia and surgical care(MMU). Medication management and use(PFE). Patient and family education

CGS & JCI Standard vs HEOM

How we propose to solve it?Creating Synergies

BPM

LEAN HEALTHCARE 6 SIGMA

MISP.1

PRF

AOP

MISP.4

MISP.5

MISP.6

ACC

COP PFE

MISP.2

MISP.3

QPS

SAD

PCI

ASC

GLD

MMU

FMS

SQE

MCI

MANAGEMENT CENTERED STANDARS(QPS). Quality Improvement and patient safety (PCI). Prevention and control of infections(GLD). Governance, leadership and direction(FMS). Facility management and safety(SQE). Staff qualification and education(MCI). Management of communication and information

CGS & JCI Standard vs HEOM

Implementation (Public Hospital)

Implementation (Public Hospital)

Implementation (Public Hospital)

Implementation (Public Hospital)

Implementation (Public Hospital) After 3

months with the hospital

Quality System designedKey and support procceses definedKey proceses mapping (2 of 5)Basic documents ready

Pending documents

Key proceses mapping (3 of 5)Support proceses MappingGeneral policies (care and Safety)Validate compliance with the standard

Conclusions1. Key business processes (PCN) are similar in any

hospital: admission, triage, outpatient treatment, hospital treatment and discharge.

2. The Support process (PS) are similar in any hospital: financial, supply, maintenance and safety, social work and technology information.

3. The HEOM proposed shows clear, simple and flexible methodology to be developed in a short time.

4. By integrating the BPM, Leanhealthcare and Six Sigma it is possible to establish in a same effort everything you need for certification and process improvement.

Conclusions5. Identify key business processes that give value to the

patient.6. Minimizing the number of documents needed to comply

with the certification standard. 7. You can set the levels of service expected for suppliers

and service providers.8. Automation or information technology implementation

processes are identified.