laguna honda hospital and rehabilitation center value ... 14... · proj 4 : timely completion of...

Laguna Honda Hospital and Rehabilitation Center

Value Stream #1 – Admissions Process (December 2016)Kaizen Workshop #1 – Pre-Admissions process (February 2017)

Value Stream Map & Workshop• A value stream map is a sequence of activities describing a

process including wait time in between the process steps• 5- day workshop that studies a current process and identifies

opportunities to eliminate waste and inefficiencies• Apply lean concepts and create a future state vision and

implementation plan through – Kaizen (rapid improvement events) – Projects – Just do it activities

Understanding the Admission Flow

Administration

Scheduling

Assessments

Care and Treatment

Gemba Walk

Observation Summary

# Observations Time

Patients 22 (5 patients) 31 hours

Operators 62 60 hours

Interviews 24 N/A

Current State

Current State Observation Themes

• Unclear Work Roles• Long Waits• Rework• Redundant Communications• Work-Arounds• No Backup / Lack of Prep• Lack of Notification• Lack of Engaging Patient / Resident

Future State Idea Generation

Future State

• Patient centered– Respect & dignity

• Standardize – Workflow– Roles & responsibilities– Layout & supplies

• Streamline processes

• Prepare in advance & anticipate

• Timely & complete• Communication &

notifications• Full use of technology• Leveling the work• Teamwork

Version 6.0

DUE DATFeb 10 2017 Apr 21 2017Jun 23 201

Mar 31 201Dec 31 201Jun 30 201Jun 30 201Mar 31 201Mar 1 2017

Dec 4 2016 Feb 2 2017

CompletedNot Yet Don

PROJ 6 : PASRR Upload Michelle

PROJ 4 : Timely Completion of Documents H & P for Coding

PROJ 2 : Food Service Streamlining

KW 3 : Room Readiness

Elvis, Quoc and Chia

Maxwell

PROJ 1 : e-Notification to and e-Acknowledgement from All Services/Disciplines Rosana, Jo and Jennifer

A3-T CHARTER Date: rev. 1/9/17 Reporting Unit: Laguna Honda Hospital & Rehab Ctr Theme: New Admissions Processes

TARGET STATEMENT IMPLEMENTATION PLAN

© 2014 rona consulting

PROBLEM STATEMENT PROPOSED ACTIONS he percent of seniors (>60 years old) in San Francisco will

21%. LHH has a 150 year history of providing underserved disabilities and seniors needing acute and skilled nursing

n FY 15-16, LHH served 1,214 residents, with 65% over 60 years d admitted 483 new patients. As DPH and SFHN prepares for

d care, it is important that LHH addresses patient experience, ardship and quality care. First impressions to a new care

new patients and their families make a difference. Our current process is flawed: increased redundancies, multiple , complaints from referral sources, increased wait list for

patients, chaotic workflows, breakdowns in communications, onsistencies and problems with internal relocations. We have

st opportunity to improve how we welcome and care for San s needing post acute care at Laguna Honda.

The ideas w ere categorized into major themes. Key ideas and concepts w ithin these categories are listed below :

Improvements to Pre-AdmissionsClinician WorkflowElectronic Notif icationEVS Terminal CleaningFood ServiceLanguage

original date - 12/2/16

oved to the new hospital six years ago, the 26 nursing stations (2 per od) are set up differently and have veered off from the original set up

LHH implements the Lean Management System, it is timely that we locations of supplies and equipment to meet the current needs of the od staff and residents. Within 18 months, Admissions at LHH will

following targets (subject to change based on Kaizen team :

S AND SUPPLIES s and Par Levels of supplies and materials are standardized. plemented and sustainable.

Admission Lead Time by 50% tients within 2 days of admission approval ents filling beds next day

sfaction

cost per patient bed by 10%

ACTION ITEM RESPONSIBILITYKW 1 : Pre-Admit Process DonnaKW 2 : Team Clinical Assessments Dr. McShane

JDI 1 : Admit Email List Donna

PROJ 3 : Patient Arrival Sheri and IrinDebra and Michael

PROJ 5 : Advance Directive Upload Jennifer and Michelle

ANALYSIS PROJ - Project Color Key: ations find the following issues contributing to the current state: JDI - Just Do It

© - plan has been completed

JDI 2 : Upload "follow me" forms Michelle

Projects Status Checks: Monthly eview with Responsible Parties.Just Do Its Status Checks: Weekly review with Responsible Parties.Kaizen Events: Monitor implementation of Kaizen improvements weekly and workshop targets with completion of 30, 60 90 day reports as well as daily audits of standard work. Weekly review with executive team. Development of visual workp and communication vehicles.

KW - Kaizen

CHECK AND ACT

0.02.04.06.08.0

10.012.014.016.0

Lead Time(Days)

Wait Time

0.02.04.06.08.0

10.012.014.016.0

Lead Time (Days)

Wait Time

Problem StatementBy 2030, the percent of seniors in San Francisco will increase to 16%. Our current admission process is flawed: increased redundancies, multiple messaging, complaints from referral sources, increased wait list for approved patients, chaotic workflows, breakdowns in communications, staffing inconsistencies and problems with internal relocations.

Target StatementWithin 18 months, Admissions at LHH will achieve the following targets:

MATERIALS AND SUPPLIES• Locations and Par Levels of supplies and materials are

standardized. 5S is implemented and sustainable.DELIVERY

• Reduce Admission Lead Time by 50% (est. to )• Admit patients within 2 days of admission approval• % of patients filling beds next day(measure method TBD)

QUALITY• Staff satisfaction

COST• Reduce cost per patient bed by 10%

Kaizen Workshops

DUE DATEFeb 10 2017 ©Apr 21 2017Jun 23 2017

Mar 31 2017Dec 31 2017Jun 30 2017Jun 30 2017Mar 31 2017Mar 1 2017 ©

Dec 4 2016 ©Feb 2 2017 ©

Completed!Not Yet Done






Maxwell


IMPLEMENTATION PLANACTION ITEM RESPONSIBILITY

KW 1 : Pre-Admit Process DonnaKW 2 : Team Clinical Assessments Dr. McShane




PROJ - Project Color Key:JDI - Just Do It© - plan has been completed


KW - Kaizen

• 5- day rapid improvement workshop taking a deep dive into a portion of the Value Stream Map

• Develop and test experiments to implement a future state

Kaizen #1 A3: Pre Admission Process

Problem Statement: Referral sources have concerns about the lengthy process and we know there are too many defects in, the referral review and acceptance process.

Pre Admission Process

Current State Map: 14 process steps from “Application received” to “Decision made”

Gemba Walk

Gemba locations:Departments: Admissions and Eligibility and Patient Flow Coordinator’s Office, Rehab

Neighborhoods: South 2, South 3, Pavilion Mezzanine

Fishbone Gap Analysis

Supplies and equipment

Problem: Advocates and referents

complain that it takes too long, and we know there are

too many defects in, the referral review

and acceptance process.

People

Duplicate entry

InformationInformation Systems

Printer

Application Form

Work flow

Education

Process

Location/layoutDelayed decisions

Multiple reviews

Job Scope

Communication

AccessInappropriate applications

Transparency

GuidelinesMissing Info

Delayed infoIncorrect info

Duplicated applications

5 Whys For Root Cause Analysis

• Referents do not know what skilled nursing needs are

Why? • Skilled nursing criteria is not on the application

Why? • As a hospital we have not clearly defined skilled nursing criteria

Why? • We have not sat down as a group to define it

Why? • Because we have not devoted time to this

Solution • Define skilled nursing with a interdisciplinary team of stake holders

Why are we getting applications for patients who do NOT have skilled nursing needs?

Because:

Improvement Work

• Generated 32 ideas for improvement• Prioritized our focus• Ran 12 experiments • Test our solutions• Track results • Iterated toward

improvement

Outcomes Using Lean Solutions

• Simplified and standardized the admission application• Defined admission criteria guidelines for skilled nursing• Agreed to only accept complete applications (set up reduction)

Admission Application

• Developed standard work for how applications are screened (work cell)• Decreased the time a decision is made - screener reviews applications sooner

Screening Process

• All A&E tasks are conducted without leaving the area (work cell)• Developed standard response for referents with the status of the application

Admission and Eligibility Process

• Electronic notification when an application is ready for review• Shared protected electronic folder for hosting applications (mistake proof)

Communication

Pre Admission Process

A&E work cell

Screening Committee work cell

Future State Map: 6 process steps and 2 work cells

Target Sheet

Baseline Target KW Results 30-60-90

days trackingPercentchange

35 35 30

69 mins 34 mins (> 50%) 51% better

126- 12,960 mins (9 dys)

120 mins - 4.5 days (> 50%) 0

5-82-4

(> 50%) 0 100% better!.25 mile and 2 elevator rides 0/0 7

9 7 22% better22 18 (> 20%)

0Numerator (# defects) 31 23 (>25%) 26% betterDenominator (sample size) 35 n/aPercentage 89% 0 #DIV/0!Numerator (# defects) 50% 10%Denominator (sample size) n/aPercentage #DIV/0! 0 #DIV/0!

Number of times it gets to A&E and missing

Number of times it gets to screening

Measures

Cycle time from reciept of Admission Application to screenerLead time (includes wait time) from reciept of Admission Application to screening committeeNumber of times the Admission Application is handed off (physical or email)

Number of pages Admission Application

Quality (% Defects)

Number of Admission Applications

Amount of feet the referral packet travels

Number of packets review by screening

Kaizen Action Bulletin

Up Coming Kaizen Workshops

DUE DATEFeb 10 2017 ©Apr 21 2017Jun 23 2017

Mar 31 2017Dec 31 2017Jun 30 2017Jun 30 2017Mar 31 2017Mar 1 2017 ©

Dec 4 2016 ©Feb 2 2017 ©

Completed!Not Yet Done






Maxwell


IMPLEMENTATION PLANACTION ITEM RESPONSIBILITY

KW 1 : Pre-Admit Process DonnaKW 2 : Team Clinical Assessments Dr. McShane




PROJ - Project Color Key:JDI - Just Do It© - plan has been completed


KW - Kaizen

Laguna Honda Team Effort