How to use Lean principles to accelerate patient flow and reduce turnaround times in a hospital lab.

1. A Faster Hospital
In Five Days
Lean Six Sigma for Hospitals!
Jay Arthur (888) 468-1537
Webinar:
www.qimacros.com/training/qi-macros-webinar/#healthcare
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2. A Faster Hospital in Five Days
The Economies of Speed
Rule #1: To accelerate your speed, eliminate delay.
•The 3-57 Rule – Employees only work with
the patient for 3 minutes out of every hour.
The other 57 minutes are delay.
•The 15-2-20 Rule – 15 minute/hr reduction in
delay will double productivity and increase
profits 20%
$ •The 3X2 Rule - grow three times faster than
average and double your profit margins
Source: Competing Against Time
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3. A Faster Hospital Using Lean
Simplify with 5S

Sort, Straighten, Shine, Standardize, Sustain
Streamline with Lean
 Value Stream Mapping
 Spaghetti Diagramming

Inventory Reduction
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4. Simplify Your Business
with 5S
Sort Organizing, separating the needed from
the unneeded
Straighten A place for everything and everything in
its place.
Make it visual and self-explanatory.
Shine Cleaning and looking for ways to keep it
clean
Standardize Maintain and monitor the first 3 S’s
Sustain Discipline, stick to the rules /
continuous improvement of all
principles
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5. 5S Team
Lab Before Lab After
Clutter
5S Team removed two dumpsters
of clutter
Other items were red tagged and
moved out of the lab.
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6. Remove the Speed Bumps
of Lean
•Delay
•Overproduction
•Waste and Rework (Defects)
•Non-Value Added processing
•Transportation
•Inventory
•Motion
•Employees Unused Creativity
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7. Redesigning the Work Flow
What is the current flow?
 Value Stream Mapping (time)
 Spaghetti Diagrams (space)
What flow would reduce the speed bumps?
Tools for Lean:
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8. Value Stream Mapping
To Eliminate the Delays
Log Evaluate Get
25 days 120 days 60 Min
Request Request Backup
10 Min 45 Min
Valid? Cancel
Varies 45 Min
Treat 1 day Diagnose 7 days Schedule 10 Min
Hint: Most of the Delay is in the arrows
Most of the Defects and Deviation are in the boxes
Hint: Make Your Product Faster, Not Your People.
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9. A Faster ED in Five Days
Press Ganey:
ED TAT Times 4+ hours (Press Ganey)
38 Min Discharged
RWJ 2005:
90 Minutes
Admitted
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10. A Faster OR in Five Days
Copenhagen University Hospital
investigating if the patient got required information from the
surgeon (10 minutes),
unpacking individual sterile disposables (30 minutes),
waiting for missing devices (5 trips per surgery),
waiting for the patient to regain consciousness (20 minutes)
waiting for transport to recovery (10 minutes)
Countermeasures to save 60 minutes:
Surgeon draws an “X” on patient’s wristband when patient
informed
Prepackaged sterile disposables saved two nurses and 30
minutes.
Standard checklists ensure that all materials available before
start.
Anesthetic depth was adjusted to wake patient when finished.
60
Hospital orderlies move patients to recovery immediately.
Minutes
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11. Faster Medical Imaging in Five Days
North Shore University Hospital
Average turnaround time (TAT) was 20.7 hours and varied from 8-to-34
hours
CT tech travel to requisition printer (6,480 feet per day)
Countermeasures to save 14 hours:
Relocate printer saving over 6,000 feet per day of unnecessary travel.
Dedicated CT transporter
Excel-based schedule maintained and viewable by all nursing units.
“Pull system” adjusted patient transport to handle STAT scans.
Contrast preparation was reassigned to the evening shift
One CT dedicated to complex procedures to optimize patient flow.
Staffing was adjusted to demand.
Results:
Average TAT fell from 20.7 hours to 6.45 hours
200 additional inpatient scans per month
14 60 additional outpatient scans per month
Hours $375,000 in additional revenue
Cancellations due to improper prep dropped from 30.6% to 22.7%.
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12. You Already Understand Lean
“Cell” Design for Kitchens
SINK REFRIGERATOR
Rule #2:
Walking is Waste!
You already
understand Lean!
STOVE
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13. My Kitchen
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14. Spaghetti Diagram
to Reduce Movement
Purpose: To understand
the current process.
1. Layout the existing
processing stations
2. Become the product
3. Show the flow of the
product through the
process.
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15. Lab Redesign
Lab Before Lab In Process
Reagent Refrigerator
Walking
Is
Waste!
Trash
Reagent Refrigerator
Spaghetti Diagram of too much travel
was here.
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16. Original Lab Design
CHEM COAG
500/day 80/day
UA
100/day HEMO
500/day
MICRO
100/day
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17. Lab Redesign
Auto
CHEM UA
HEMO
COAG
CHEM
HEMO
Micro
COAG
Manual
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18. Lean Lab Results
Reduced
• Floor Space 17% (Goal 10%)
• Staff Movement 54% (Goal 30%)
• Phlebotomist Travel 55% (4 miles ~ 1.5 FTE)
• Tech Travel 40% (2,304 feet 0.15 FTE)
• Sample Travel 55% 23,400 feet
7 hours of delay per 24 hours
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19. Use Lean For Faster, Better
Healthcare
Lean Simplify
Streamline
Faster = Better
Lean reduces mistakes by 50%
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20. Free Resources and Contact Info
Lean Six Sigma Money Belt Training: www.lssmb.com
Lean Six Sigma for Hospitals Linkedin Group
30 Day Eval Copy of the QI Macros –qimacros.com/freestuff.html
Action Plan: qimacros.com/pdf/six-sigma-action-plan.pdf
Lean Six Sigma Reference Card: qimacros.com/JobAid.pdf
Dirty 30 Process for Six Sigma Software: qimacros.com/pdf/dirty30.pdf
Handout: qimacros.com/pdf/faster-better-cheaper-healthcare.pdf
Jay Arthur
KnowWare® International
2253 S. Oneida St. Ste 3D
Denver, CO 80224
(888) 468-1537
jay@qimacros.com
www.qimacros.com
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