WHA Improvement ForumFor December

“Removing Waste and Improving Efficiencies”

Tom Kaster

Courtesy Reminders: •Please place your phones on MUTE unless you are speaking (or use *6 on your keypad) •Please do not take calls and place the phone on HOLD during the presentation. 1

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Today’s Agenda The Value Equation What is Improving Efficiencies? What is Removing Waste? Gaining Staff Engagement in Waste Reduction

and Efficiency Improvement

The Value Equation

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Increase Quality = Increase ValueDecrease Cost = Increase Value

Increase Quality and Decrease Cost = Accelerated Increase in Value

Improving Efficiencies • Which School of Thought?

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Efficiency Improvement Fewer FTE’s

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Excess or Wasted Inventory

Inefficient care

Over / Underuse HACs

Poor Communication

FTE Savings

Wasted Energy

Poor Scheduling

Poor Service

Non-valued Activities

Unnecessary Delays

FTE Savings through Attrition

Back to Deming: 14 Points for Management

#8: Drive out fear, so that everyone may work effectively for the company.

Improvements in efficiencies and waste cannot be made when people are afraid that the project is a veiled excuse to cut FTE’s.

If the culture is of fear, your project will do more harm than good.

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Back to Deming: 14 Points for Management

#9: Break down barriers between departments.

Large improvements in efficiencies and waste reduction cannot be made at the micro level. You need knowledge from members of the whole process to improve the system.

Without a systems team approach, you could improve in one area but cause more harm than saved in another.

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The 8 Wastes

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Removing Non-Value Activities

ExampleWaste Example Direction

Waiting•Waiting for medical records•Waiting for medical staff•Waiting for test results •Patients waiting for medical staff

•"Right now" scheduling •Fewer meetings; work done in small focus groups•Matching capabilities to demand for services, supplies

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Waste Example Direction

Over-Processing •Clarifying orders •Redundant information gathering/charting •Missing medications •Multiple blood draws for different tests

•Clear interpretation of regulations •System (electronic or paper)of information traveling with patient that eliminates redundancy

ExampleWaste Example Direction

Defects•Medication errors •Rework •Variation in outcomes •Incorrect charges/billing •Surgical errors •Incorrect diagnosis •Harm caused

•System redesigns that support workers in doing their good work by clear specification of activities of work, clear expectations of outcomes and safe environment for problem solving in the course of work •Clear definition/ understanding of what is "defect free" •Single, clearly understood method of addressing "defect free" right now

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Example

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Waste Example Direction

Motion •Looking for information •Looking for materials and people •Materials, tools located far from the work

•IT systems that match the demand of work •Reliable communication systems •Fluid materials availability that meet the current demand •Consistent scheduling that meets the demand

Example

Waste Example Direction

Transportation •Delivery of medication from central pharmacy •Staff travel to a remote storage room to retrieve supplies •Delivery of surgical pack to OR•Unnecessary / untimely delivery of meals

•Conduct 5-S workplace organization to standardize location of supplies near the point of work

•Examine staff location as related to commonly used supply storage locations

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Example

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Waste Example Direction

Over-Production

•Duplicate charting •Multiple forms with same information• Unneeded Copies of reports sent automatically •Unnecessary labs ordered•Multiple / duplicate labs ordered

•Clear interpretation of regulations •System (electronic or paper)of information traveling with patient that eliminates redundancy •Bring departments together to map processes and find solutions

Example

Waste Example Direction

Inventory•Overstocked medications on units •Overstocked supplies on units and in warehouses •Duplicate supplies based only on preference•Inadequate inventory management process•Build up of outdated inventory

•Supply exactly what is needed; no more, no less •Keep supply availability current •Understand personal preferences and orchestrate "like" items use

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Example

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Waste Example Direction

Confusion

•Same activities being performed in different ways by different people •Unclear MD orders •Unclear route for medicine administration •Unclear system for indicating charges for billing •Patients not understanding discharge instructions •Poor shift change hand off•Lack of daily patient goals

•All activities of work clearly specified •Clear signals that trigger activities of work uniformly

• Better use of existing resources• Less patient waiting time• Less time waiting for orders• Savings from using less inventory / energy • Improved customer service• Improved communication• Decreased OT or Less Agency Service Costs• Improved employee satisfaction

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Efficiency Improvement More Value Added Work

Project Ideas

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Where to Start• Develop a portfolio of improvement projects• Align them with the primary and secondary

drivers• Set an aim of cost savings for each project• Develop a cross-functional team which focuses

on each project which includes frontline staff• Research potential solutions • PDSA PDSA PDSA

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Takeaways

• If you develop a culture that defines efficiency improvement as cutting FTE’s you are going to fail in your improvement projects / initiatives

• Your staff is you best resource for improvement • Understand that waste comes in multiple forms• Develop your improvement portfolio • Always strive to increase value added activities and

decrease non-value activities

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In Closing

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“It is better to protect investment by working continually toward improvement of processes and of product and service that will bring the customer back again.”

Resources• Institute for health improvement– Increasing

Efficiency and Enhancing Value in Health Care

• Institute of Medicine: Overuse, Underuse and Misuse of Medical Care

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Thank You!Questions

Please complete 3 question survey when closing webinar window.

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