CLIENT:
Lake Health CASE STUDY
Willoughby, OH
Break down what isn’t working and fix the processes in real time, so the team can get back to providing the best care. The team center, whether in an inpatient or outpatient environment, is the hub of clinician activity. To encourage collaboration, optimize workflow and footsteps, as well as increase staff and patient satisfaction, a team center needs to function well for many types of users.
CHALLENGE
EXECUTIVE SUMMARY
The client realized a staff flow issue and a
Our kaizen events are geared to help clients quickly assess their current condition,
need for a refreshed team center. Finding
map out patient flows impacted by the process, identify areas for improvement or
the root cause of the flow issue was a
streamlining, and then establish an ideal future work flow. This future work flow is the
priority so the newly designed station
critical first step in creating a viable and sustainable project.
would function optimally.
The kaizen event is a swift and targeted multidisciplinary workshop often consisting of two or three sessions. When appropriate, data is collected between sessions to better focus improvement activities. Implementation Methods : • Observation & Current State Mapping
SOLUTION
• Data Collection • Future State Mapping
Kaizen Events
• Develop the Road Map to Implementation
A brief and thorough analysis lead by lean healthcare architects and designers facilitated a consensus-driven outcome of a full scale mock-up that addressed ways to streamline staff flow, processes and enhance the patient experience.
PROJECT HIGHLIGHTS
6
Opportunities for improvement identified
2500
Square feet physical mock-up size
1
Prototype team station developed
CLIENT PROFILE Lake Health Medical Center Painesville, Ohio
Process Overview A kaizen event is a lean work session that seeks to harness a multidisciplinary team to make an improvement. This day-and-a-half kaizen involved staff interviews, visioning with senior leadership, observing the daily processes, interactions through
Lake Health is a private, not-for-profit
the team center and a design charrette. The outcome was consensus around a
leader in community health care in
full-scale mock-up space that resolved the key challenges from previous sessions.
Northeast Ohio. Offering the latest
Deliverables included a kaizen report, process map and full-scale space designed by
technology is a high priority at Lake Health,
the end users.
where you’ll find: • Comprehensive cardiac services,
Director-Level Visioning
including open-heart surgery in
This was the first of many sessions over the course of the event. Facilitated by Array’s
partnership with The Cleveland Clinic
Senior Continuous Improvement personnel, the team extracted challenges that a
• A progressive orthopedics and sports
traditional design process would not expose. Identifying current space restrictions
medicine program, including minimally
that were not originally thought of as an issue, and exploring staff communication
invasive techniques
and operational barriers were two primary obstacles the team exposed. The resulting
• Advanced surgical services • Up-to-date imaging and diagnostics equipment
knowledge provided the team with the insight to translate the directors’ visions into realistic goals for what this project truly needed. Important scope boundaries and limitations were also established during this initial activity.
/www.lakehealth.org
TOOL
KaIzen Event A kaizen event is a three- to five-day improvement event that brings together an interdisciplinary team to solve a problem and create a lasting change. We facilitate these events using consensus-based decision-making to ensure all voices are heard and each stakeholder supports the final decision.
Front Line Interviews Array conducted multiple interviews with a broad cross section of the department staff. During the interviews, Array team members asked questions to gain a full understanding of the state of the team center and the process clinicians have developed to overcome the obstacles the current environment presents. Following are the questions that were presented: • What activity do you do most in the space? • What is your greatest challenge in the space? • What do you use most in the space? • Do you work mostly alone or with others? • What is one thing you would change about the space? Reoccurring themes were uncovered in the interviews and later investigated at the field observation. Themes included poor staff flow around the team center, lack of counter space, knowledge sharing hub and people work alone at the team center.
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Observation The observation time was scheduled for the peak of department activity. This allowed for an enhanced understanding of some of the flow issues brought up in the previous interview sessions. After a tour of the team center, the kaizen team began observation of the shift change hour. During this time, the team observed many flow restrictions that went unnoticed by the staff. • Knowledge hub was outside of the team center, though it was directly in front of it. • Charting was a difficult task when physical charts were needed, as the counter space was not large enough for a chart and keyboard. • The middle of the team center was crowded and difficult to navigate through. • The medication room was not large enough to support the current workflow of using a workstation-on-wheels (WOW) for medication distribution.
TRANSFORMATION Our core mission is the same as that of our clients: improve the quality of our work, increase our efficiency, and motivate our staff to reach for success. At Array, we are establishing a culture of continuous improvement at all levels of our organization. We seek to empower team members to be agents for good change. We begin all endeavors by considering process before exploring solutions. Our team can guide your organization through pre-design, ensuring clear goal-setting;
• Staff relied heavily on the use of a workstation-on-wheels.
target outcomes; process analysis
Through these findings, the kaizen team developed a preliminary agenda for
and design; and decision support. Our
process and flow improvement in the space.
Lean-led approach to project definition provides a clear path to the right project before you begin to design.
How can we plan for future improvements? Developing a strategy for implementing future improvements can lead to great future successes. Our knowledgeable consultants can provide your organization with the experience necessary to create a plan for organizational transformation. Bringing all of the stakeholders to the table for a conversation about improvement strategy aligns all areas of the organization with your goals.
Department Analysis
Tools used:
The team center supported a 24-bed Monitored Care Unit on a single floor. It is
Consensus, Current State Assessment
centrally located on the floor but divided into two sides. Each side supports half of the department. The use of the WOW was prominent in the space but minimal charging areas were provided. This in turn had a WOW charging along the corridor outside every other patient room. • There is one meds room centrally located but in an area where the space is insufficient for easy access. • Currently the team center is distressed and in need of a face lift. • There is a small physician dictation room that is underutilized. • The overall path through the team center is indirect and tight to navigate. • Areas for “knowledge sharing” are located outside the team center due to space restraints and provide minimal area for face-to-face interaction. • The WOW is used in place of wall-mounted charting stations as the charting stations are not ideally located in the patient rooms.
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DESIGN CHARRETTE During this session the team presented their findings from the previous analyses to staff allocated for a half-day design charrette. Through multiple staff-centric design iterations of zoning diagrams and plan sketches, Array was able to facilitate consensus on the team center’s layout. This layout was then realized in a full-scale cardboard mock-up later that afternoon that the staff was able to test before completing the event. This was extremely helpful as it allowed the staff to translate the drawings to physical space and also perform mini mock operations. By testing the space, staff was able to find areas that needed adjustments from the original design. After the alterations to the design were made, the staff was able to reach consensus on the layout.
Summary Upon completion of the kaizen event, Array provided a report that described the event and the consensus-delivered outcome. This outcome recommended organizational improvement around staff flow, staff process and patient & family experience and we completed it in just two days. These recommendations were a direct result of Array interacting with the staff and leaders of the Department. Having this direct interaction provided Array with the insight to create a space that will facilitate the user’s ability to provide better care to patients and increase clinician satisfaction.
Final Remarks The kaizen event allowed Array to efficiently and accurately gather the necessary information needed to design a better space for the client. An original scope of work was presented and after analyses and observations, Array uncovered more areas for improvement. This led to a proposed outcome that was outside the originally intended scope of work. After the event, the team performed a +/delta on the effort and came away with the following points: • Users felt their opinions were heard and that each had an equal voice • The event was well organized and facilitated • The exercise helped the users ‘feel’ the space • There was dedicated participation by both clinicians and the kaizen team • The day-long event was not slow at any points; team stayed engaged
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DISCOVERING YOUR HEALTHCARE SOLUTIONS TOGETHER We are innovators who specialize in the areas your system seeks out to leverage its valuable operational and facility resources. Array Advisors has the expertise and skills to reach beyond your milestones and provide you the decision support you need.
OUR SOLUTIONS
OUR SERVICES
We are dedicated to improvement.
How can we assist you?
Problem-solving and forward-thinking
We are Array Advisors, your trusted partners in Strategy Development, Organizational
individuals lead our efforts, which focus on your unique place in the healthcare delivery spectrum. Our knowledgeable staff can help you solve strategic business problems and develop a method to improve efficiency and utilization.
Transformation, and Facility Informatics. The challenges you face are not unique, but your solutions should be. Through a partnership of Strategy and Transformation we help you achieve and sustain. Our process begins by understanding your current operations and clearly defining your system’s goals before generating options. We employ a variety of integrated methods tailored to your strategic challenges, such as process mapping; operational planning; and healthcare real estate portfolio optimization, to help position your organization for future success.
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Informatics Building Information Model management (BIM) is an enabler of most other technology trends in the Architecture, Engineering, Construction, Operations (AECO) industry, including but not limited to: sustainable design, offsite fabrication, LEAN construction, and energy efficient operations. Carefully considering how best to leverage virtual/digital representations of physical buildings can provide significant returns on innovation throughout the entire lifecycle of your facilities.
Strategy The need for healthcare real estate portfolio optimization has never been greater. With the acceleration in mergers and acquisitions, as well as the evolution of clinical models, healthcare organizations must continuously evaluate their physical assets and maximize the value they derive from them.
Transformation Transformation and lean methods are very useful when focusing on operational process improvement. By bringing all constituents together and giving them the tools to experiment and test new ideas, current state barriers can be identified and transcended.
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Published: FEBRUARY 2017