Childrens Hospital Of Michigan Its Not Just About The Bricks And - - PowerPoint PPT Presentation

Children’s Hospital Of Michigan

“Its Not Just About The Bricks And Mortar”

A New Way Of Doing Business

Objectives

• Understand the need for cultural transformation in healthcare
• Share learning from Integrated facility Design (IFD) and lean

processes

• Understand need for operational efficiencies in today's

healthcare settings

• Increase knowledge base of Daily Management Systems
• Share lessons learned from designing 2 hospitals at same

time.

Children’s Hospital Of Michigan- Troy

Children’s Hospital Of Michigan Main Campus

Detroit Medical Center

Yesterday, Today & Tomorrow

• Established 130 years ago
• Michigan’s first and oldest

hospital entirely for kids

• Opened the new outpatient

facility – Feb. 1, 2016

• Open New Hospital downtown

2017

Children’s Hospital of Michigan

Serving Children from Near & Far

• Destination for

Pediatric Specialty Care

• More than 250

International Patient Encounters Annually from 22 Countries

• More than 500

Encounters Annually from 39 States Outside of Michigan

• See Children from

73/83 Michigan Counties

Livonia

Plymouth

Pediatricians We Train Practice Throughout Michigan and Beyond

Children’s Hospital of Michigan

• Most Advanced Care

– PANDA One – Level IV NICU – Level 1 Pediatric Trauma Center – Pediatric Burn Center – Heart, Kidney, Liver & Bone Marrow Transplants – Michigan’s Poison Control Center

• Nationally Recognized

– US News & World Report Best Hospital Rankings – Parent Magazine: Best Emergency & Preemie Care – Top 25 NIH Pediatric Research Funding

Key Elements for Successful Healthcare

• Provide patients and families with best

known options to improve health

• Delivery clinical quality
• Provide patients and families an

exceptional service experience

Advanced lean in Healthcare: Albanese, Aarby & Platchek 2014

Children’s Hospital of Michigan Responded

• Challenges viewed as opportunities
• “Go see what good looks like”

– Study trips

• Lean transformation at infancy level
• Mile wide inch deep approach

Next Steps

• Take our Lean transformation to the next level
• Construct a building utilizing Lean principles
• Commitment to do things differently
• Executive leadership buy-in
• Project champions
• Gain synergies from Troy facility to Critical Care Tower
• Customer is “The Patient”

Why a Lean Operating System?

• Day to day issues take up time and resources- fire

fighting

• Inability to focus on growth, engagement, research,

joint ventures, education etc.

• Stabile operating system needs to support

managements long term and short term goals

• Need to support patient needs and improve their

experience

• Need to support and improve the workplace experience

Advanced lean in Healthcare: Albanese, Aarby & Platchek 2014

Children’s Hospital of Michigan Lean Journey

Integrated Facility Design (IFD)

• Design process
• Applies Lean Principles

– Guiding principles ( line of sight, flow, work cells, point of use)

• Concurrent integration of all experts/stakeholders
• Achieve breakthrough performance
• Includes:

– Workflow analysis using the seven flows of healthcare – Cycle time and Takt time analysis – 5S (workplace organization)

• optimal layout furniture, equipment, supplies-rooms/workspaces.

– Standardized work planning

• optimal work sequences/ timing for optimal use of space

– Visual management principles

• define locations/content for visibility
• essential for practicing Lean management

Traditional Build Process- Division of Specialists

Administration Design Engineering Production

Compromised Requirements Re-engineering Re-tooling Poor Yield Poor Quality

Poor Feedback

Excessive Documentation Excessive Design Change

Over the Wall Over the Wall

Case for IFD

• For 100 years we have built buildings the same way

– Silos: Architect, Engineers – Finger pointing when things went wrong

• New way

– Collaboration: Various groups of people designing the building; Front line staff - Nurses, Clerks, Patient Care Associates, and Doctors – Architects and general contractors in background assisting as needed – Patients and families are also part of the design process

• All based on “The Patient” and how they move through and

experience a “no wait” environment.

Case for IFD

• Build a facility that meets customer demand
• Occupies a smaller footprint
• Uses fewer RFI’s post construction
• Reduce cost
• Long term plans need to address 3 key factors:
• Methods: LDM, Standard work, Level loading
• Mindset: Continuous improvement
• Management System: Strategy Deployment, Visual

controls operational stability

Advanced lean in Healthcare: Albanese, Aarby & Platchek 2014

Investment Strategy Assumptions

V A NVA VA NVA VA

Typical Organization Traditional Improvement

With Traditional Investment Strategy

Lean Waste Reduction

NVA

Minor Improvement Original Lead Time Major Improvement

• Speed up value added steps
• Add capacity

Improving Functionality & Capability

Predesign Schematic Desgin Design Development Construction Documents Agency Permit / Biddding Construction Conceptualization Criteria Design Detailed Design Implementation Documents Agency Coord / Final Buyout Construction

Ability to Impact Cost and Functional Capabilities Cost of Design Changes Traditional Design Process IFD Process

Design Effort / Effect

JWA 2013

IFD Costs Traditional Costs

Stages of IFD

• Governance
• Charter/resource allocation/commitment
• Conceptual
• Education/paper dolls/flows of healthcare
• Building conceptually designed
• Schematic
• Life size mock up/flow
• Troy: 3 week long events/Tower: 5 week long events
• Detail
• Life size mock up/room specifics
• Troy: 3 week long events/Tower: 5 week long events
• Matching Capacity to Demand
• Level loading schedules: week long event
• Daily Management System
• Standard work/leader standard work
• Confirmation of standard work
• Hourly rounding

Lots of Work to Do

Model Line

T ro y A rchitect dates D u e D u e T o wer Architect dates D u e

June 9th 16-Jun 23-Ju 24-Mar 31-Mar 7-Apr 14-Apr 21-Apr 28-Apr 5-May 12-May 19-May

NICU Functional Design Event Floor 3 Functional Design Event Surgery Functional Design Event Floor 1 Functional Design Event

26-May June, 2

Imaging/ED Functional Design Event Floor2 Functional Design Event Core & Shell Floor 3 Support D Even Holiday Week Issue Set Easter Week Core & Shell IFD & Conceptual Design Event Conceptual Design Event Basic site, M RI, building

Model Line

Troy Architect dates Tower Architect dates

18-Aug 14-Jul 21-Jul

Floor 1 & Support Detail Event

25-Aug 1-Sep

Surgery Detail Event

28-Jul 4-Aug

ED/Imaging Detail Event PICU Functional Design Event Value Engineering- end

• f July

Floor 2 & Support Detail Event NICU Detail Event

11-Aug

Holiday Week

29-Sep 10-Oct 8-Sep 15-Sep 12-Dec

PICU Detail Event Interior Decision Foundational Sign Off Support Detail Event Owner Sign Off Interior Fit

22-Sep

Involvement & Commitment

• Medical

– Allergy – Cardiology – Diabetes – Emergency Services – Endocrine – Genetics/Metabolics – Hematology/Oncology- including infusions – Neonatal Intensive care- Includes PANDA – Nephrology – Neurology – Radiology – RIM- PT/OT/Speech – Pediatric Intensive care – Pediatrics overall – PM&R – Pulmonary – Rheumatology

• Surgical
• Anesthesia
• Cardiovascular
• General Surgery
• GI
• Neurosurgery
• Ophthalmology
• Orthopedics
• Otolaryngology
• Urology

Conceptual Events

• https://vimeo.com/106000857
• Lean training
• Guiding principles
• Current state/future state

mapping

• Out of box thinking exercises

Guiding Principles

• Start with the customer
• Too much space is an enemy
• Design based on flow optimization, not department optimization
• Use load leveling to reduce space requirements
• Reduce lead times to decrease space requirements
• Design to accommodate cellular layout
• Build tents, not castles - avoid monuments
• Create line of sight
• Prepare for point of use supplies
• Use the 7 Flows to test the design
• The source of teamwork is a common future: Engage everyone in Integrated Design Events
• Add natural light
• Design for acoustical environment
• Development of STD Work for every Process
• Flexible and Shared use of Space
• Perception & Reality of a “Safe Environment”
• Create on staging and off staging flows
• Bring resources to the patient

Patient/Family Is Our Customer

SURGERY DEPARTMENT CURRENT STATE

Patient Intake Wait Pre-Op Transfer to OR OR Transfer to PACU I PACU I Transfer to PACU II PACU II Discharge Lead time CT: 20 minutes CT:30 minutes CT: 40 minutes CT: 5 min CT: 80 minutes CT: 10 minutes CT: 64 minutes CT: 10 minutes CT: 60 min CT: 10 min. 324 minutes

SURGERY DEPARTMENT FUTURE STATE

Patient Intake Pause Pre-Op & Induction OR Transfer to PACU I PACU I Discharge Lead time CT: 5 minutes CT:30 minutes CT: 25minutes CT: 50 minutes CT: 5 minutes CT: 25 - 90 minutes CT: 5 minutes 165 minutes

Lead Time: 324 min. to 165 min. # Steps in process: 10 to 7

Mapping the Flows

Paper Doll Scorecards

NICU PAPER DOLL SCORECARD ROUNDS 1 2 3 4 5 6 7

• PT. DISTANCE

TRAVEL ED 109 102 92 94 85 105 105 PROVIDER TRAVEL 90 44 54 59 49 64 64 NURSE TRAVEL 297 67 36 56 22 50 50 FLOOR TOTAL

• SQ. FT.

30,000 24,006 23,384 25,340 25,340 23,300 23,300 PROGRAM TOTAL SQ FT 28,350 24,000 23,840 25,340 25,340 23,300 23,300 OTHER

2ND FLOOR PAPER DOLL SCORECARD (ED/RADIOLOGY/CLINIC ) ROUNDS 1 2 3 4 5 6 7

• PT. DISTANCE

TRAVEL ED 408 ↓54% 204 ↓77% 207 ↓76% 288 ↓67% 208 ↓76% 208 ↓76% PROVIDER TRAVEL 20 0% 20 0% 20 0% 20 0% 20 0% 20 0% NURSE TRAVEL 20 0% 20 0% 20 0% IFD GUIDING PRINCIPLES 18/18 20 0% 20 0% 20 0% FLOOR TOTAL

• SQ. FT.

25,000 21,960 ↓12% 18,900 ↓12% ↓25% 18,900 ↓12% 18,900 ↓12% 18,900 ↓12% OTHER: PROGRAM 19,300 SQ FT

Buildings Takes Shape

3rd floor conceptual design

Stacking the building

Schematic Event

http://www.clickondetroit.com/news/dmc-consults-young- patients-for-hospital-design/27374930

Schematic Week Agendas

• Review of drawings
• Review/walk through of layouts
• Mock up of rooms
• Scenario testing
• Routine/Emergency
• Health care flows
• Scorecard validation
• Changes to design
• Tour preparation/route/questionnaire
• Review of tour feedback
• Changes to design
• Finalization of event
• Needs for next event
• Tear down for next event

All About The Flow

LIKES PLEASE CONSIDER CSP same floor Making 1 big sterile supply room Pre-op induction rooms HCG testing & restroom location PACU rooms and windows for light PACU rooms in line of sight Like rooms and windows Soiled utility in PACU Removing hallway by case carts 2nd door on 2 bin room Sound proofing for induction rooms Move housekeeping Add door to anesthesia workroom Expand waiting room area Family flow for long cases Pyxis in fish bowl Linen room Flip flop PACU with nourishment & equipment

Test Move Test

Tours

Schematic Event Wrap Ups

SURGERY VALUE ADDED ANALYSIS

METRIC CURRENT FUTURE % OF CHANGE # STEPS 17 7 ↓62% LEAD TIME 324 MIN 165 MIN ↓51% %VA STEPS 1/17 = 6.1% 1/7 = 14% ↑8% % VA TIME .06 6.1% .12 12% ↑6% # CHECKING STEPS 5 2 ↓60% # HANDOFFS 5 2 ↓60% WORK IN PROGRESS 4 1 ↓75% DISTANCE TRAVELED 1,375 FT 150 FT ↓89.1%

Detail Events

• Layout each individual room
• Placement/number of plugs
• Placement of doors/tables/scales/sinks/clocks
• Height of registration desks/play areas/computers
• Furniture/IT/Clinical Transformation walkthroughs
• General Contractor/Electrical/Mechanical engineer walk

through

• Any changes to layout resulted in revalidation of

scorecard

• Equipment planning

It’s All About The Detail

LOBBY/REGISTRATION LIKES PLEASE CONSIDER Play area Interactive board games Tours Involving child life in interior design Plugs Pods of chairs for families Glass/natural light Keys for locker cabinets- survey says Lockers Family bathroom Hidden drinking fountain Lower desk to be more open Water feature if get Shorten privacy walls Process for step parents to see patient Tables by chairs for belongings Chair groupings INDUCTION Natural light in hallway Sky light Like TV Add music to TV stations Like chairs Keep IV pump with child thru process Family friendly design Child friendly decor Team design Chairs Sound proof walls 3 way light system Family presence in OR Nurse call on TV monitor Soundproof hallway doors

Detail Mock Ups

Detail Mock Ups

Survey Said!!

Troy OR Surgery

7 13 12 8 14 10 15 12 2 14 9 1 9 9 10 8 10 9 10 12 3 2 11 3 4 2 1 7 1 2 1 1 3 2 4 6 8 10 12 14 16 1 Y or N 2 Key or Combo 3 Group or Row 4 room or alcove 5 Y or N 6 Y or N 7 Y or N 8 like or not 9 like or not 10 Y or N 11 Y or N 12 tower or Boom 13 pos or neg 14 Y or N 15 Pos or neg 16 pos or neg 17 pos or neg 18 pos or neg 19 pos or neg 20 Y or N 21 pos or neg 22 Y or N 23 Y or N or Pos or Neg Frequency Y N

Results:

Reduced OR Lead-Time

by 51%

Reduced Clinic Lead-Time by 40%

30% decrease in RFI’s during construction

Designed two buildings (Ambulatory Specialty Center/Critical Care Tower) in less than 6 months. Reduced ER room requirements by 13% from business plan

14%Reduction in Ambulatory building requirements from business plan

0 Waiting Rooms- small Pause areas

Lean & Integrated Facility Design Results

Matching Capacity to Demand

Max. Min. Resources Required Patient Requests

Leveling Concept

• volume
• variety

Clarify wastes

Max. Min. OR Service Requirement

Hockey to Ballet

Typical OR Schedule After Level Loading Flex Slot for Add-On

Vision of Level Loaded Schedule

• A level loaded schedule:
• Smooth’s out the daily demand for the Clinic resources
• Provides dimensions and a blend of categories based on:

 Specialty  Appointment type  Provider  Room in Room out time  Volume

• Eliminates waste
• Incorporating level loading and flow improves patient and staff experience
• Appointments are arranged to best meet Takt time and reduce variation at the

pace of registration or recovery room

• The thresholds and boundaries that are identified will be upheld to maintain a

leveled schedule

• A system that provides safe, efficient care for add-ons (same day no delay)
• A system that incorporates no shows, cancellation rates

Benefits

• Better communication/teamwork
• Steady pace
• Efficient workflow
• Reduced space requirements
• Less frustration and pressure for staff
• Identifies quality problems upstream
• Assist in improving current specialty center
• Improved patient, family, physician and staff

satisfaction

Level Flow Makes Standard Work Possible

Example of Leveled OR Output

Each block represents 10 min Cadence Level Patient Flow (1 every 28 min) Nurse Standard Work (complete work in 20 min) Daily Management System (DMS) Maintain process capability through immediate andon response

OR Rooms and PACU

Inverted Leadership Triangle

PACU Beds

7 8 9 10 11 12 1 2 3 Room :30 :40 :50 :00 :10 :20 :30::50 :00 :10 :20::40 :40 :50 :00 :10 :20::40 :40 :50 :00 :10 :20::30 :40 :50 :00 :10 :20::30 :40 :50 :00 :10 :20::30 :40 :50 :00 :10 :20::30 :40 :50 :00 :10 :20::30 :40 Mon Rm 1 GI GI GI GI GI GI GI GI GI GI GI Mon Rm 2 ORT ORT ORT ORT ORT ORT ORT Mon M/H Mon PACU 1 Mon PACU 2 Mon PACU 3 Mon PACU 4 Mon PACU 5 Mon PACU 6 Troy OR level loading example JWA 2014

Core Element: Matching Capacity to Demand

Floor 1 SVC.

8:00 8:05 8:10 8:15 8:20 8:25 8:30 8:35 8:40 8:45 8:50 8:55 9:00 9:05 9:10 9:15 9:20 9:25 9:30 9:35 9:40 9:45 9:50 9:55 10:00 10:05 10:10 10:15 10:20 10:25 10:30 10:35 10:40 10:45 10:50 10:55 11:00 11:05 11:10 11:15 11:20 11:25 11:30 11:35 11:40 11:45 11:50

Rm 1 ORT

M AXray ProviderMA

MA Xray Provider MA

M AXray ProviderMA M AXray ProviderMA

Lunch Rm 2 ORT MA Xray Provider MA

M AXray ProviderMA

MA Xray Provider MA Lunch Rm 3 ORT

M AXray ProviderMA

MA Xray Provider MA

M AXray ProviderMA M AXray ProviderMA

Lunch Rm 4 ORT MA Xray Provider MA

M AXray ProviderMA

MA Xray Provider MA Lunch Rm 5 GEN

M a Provider

Labs

M a M a Provider

Labs Rm 6 GEN

M a Provider

Labs

M a M a Provider

Labs

M a

Rm 7 MA's 3 0 0 3 2 0 2 2 2 2 2 0 2 2 2 2 0 0 2 3 3 2 2 3 3 2 3 1 0 0 2 2 2 2 2 2 0 0 1 3 3 3 1 1 1 1 1 Takt Time 13 min 2 2 2 3 1 2 2 2 1 Reg 3 1 4 1 2 1 1 2 1 1 1 1 1 3 2 1 1 2 1

Clinic and Emergency Room

ED 1 C M R R P P R C C M R R P P P R P P R C ED 2 C M R R P P P R R R P P P P P R R R R P R C ED 3 CMRP RP RPRP RPRP C RPR P R M ED 4 C M R R P P P R R R P P P P P R R R R P R C Legend Treat & Street C M R R P P R C 41 min Low & Slow C M R R P P P R P P R C 134 min Mid C M R R P P P R R R P P P P P R R R R P R C 246 min High CMRP RP RPRP RPRP C RPR P R M 191 min Mental Health C M R P P P S S S P R M 269 min Takt Time Winter 64 min. Summer 96 min. Shift

15:00 15:05 15:10 15:15 15:20 15:25 15:30 15:35 15:40 15:45 15:50 15:55 16:00 16:05 16:10 16:15 16:20 16:25 16:30 16:35 16:40 16:45 16:50 16:55 17:00 17:05 17:10 17:15 17:20 17:25 17:30 17:35 17:40 17:45 17:50 17:55 18:00 18:05 18:10 18:15 18:20 18:25 18:30 18:35 18:40 18:45 18:50 18:55 19:00 19:05 19:10 19:15 19:20 19:25 19:30 19:35 19:40 19:45 19:50 19:55 20:00

Emergency Room Takt Board Ambulatory Clinic Schedule

Ensuring Flow: Air Traffic Controllers

Runway Unforeseen Variation X minutes X minutes

Airport level flow

Air traffic control compensates for non level flow in real time by moving resources where needed

Cultural Change: “Not Just a new Building”

33%

Designing a building

33%

Lean principles

• f matching

capacity to demand integral

33%

Creation of a daily management system to ensure building functions as intended by design

Daily Management System

Standardized Work Shift Readiness Schedule & Cadence Improvement Ideas Leader Standard Work, Coaching, Visual Systems & Accountability

Unit Targets

Principles

Core Elements

• Mindset/culture
• Visual management
• Patient access unimpaired
• Standard work
• Simple, direct & visible
• Materials staged at point-of-use
• Department right sized for maximum

utilization of space

• Equipment at point-of-use

Core Element: Mindset/Culture

• Focus on on-going process improvement
• Focus on flow
• Patient is the customer
• Managers/Directors: deep knowledge of

Lean principles – How do we continually improve? – How do we sustain results?

• GEMBA walks
• Teaching/coaching
• Real time problem solving

Core Element: Visual Metrics

Daily Management

• Operational metrics collected by

department staff

– Throughput metrics – Daily success metrics – Manage execution to plan

• Updated “real time” (hourly)

– Trend charts updated daily

Metrics: Identify issues & rapidly improve

• Team sees trending
• Ability to problem solve real time
• Ability to take trends and be part of

department improvement team

• Correlates with department strategies

Core Element: Visual Schedules

Visual Schedules

– Able to readily see where patients are at – Visible throughput

Core Element: Standard Work

• The one best way to provide

care to our patients and families – Done right the 1st time – Live documents

• Visual documents

– Show patient flow – Depicts steps of process – Standard operations sheets

• Defines steps

– Job Element sheets

• Defines details
• f each step
• Used for training
• Used to audit

Standardized Work - future state high level

Standard Operations Sheet Task Level

Job Element Sheet

Core Element: Leader Standard Work

• 1. Confirm name band with family/patient
• a. correct spelling of name
• b. correct date of birth
• 2. Allergies correct and documented on EMR
• a. confirm allergy status with patient/family
• b. documented in EMR correctly
• c. allergy band applied to patient
• 3. Take vital signs, weight and height
• a. log into computer to document all obtained information
• b. check for consent in chart under clin doc
• i. if consent is not signed, notify doctor
• d. check for History & Physical
• i. if no H&P, notify doctor

• 1. Confirm name band with family/patient
• a. correct spelling of name
• b. correct date of birth
• 2. Allergies correct and documented on EMR
• a. confirm allergy status with patient/family
• b. documented in EMR correctly
• c. allergy band applied to patient
• 3. Take vital signs, weight and height
• a. log into computer to document all obtained information
• b. check for consent in chart under clin doc
• i. if consent is not signed, notify doctor
• d. check for History & Physical
• i. if no H&P, notify doctor

Standard Work Audit Standard Work Audit

Standard Work Audit RED = All standard work measures not met upon completion of audit GREEN = All standard work measures met upon completion of audit

Surgical Suite - Pre Op RN Intake Surgical Suite - Pre Op RN Intake

• Leader Standard Work

– Hourly rounding – Go to the GEMBA – Quality Audits – Confirmation of Standard Work

• Are people doing what they

are suppose to be doing

• Front line leaders perform
• Higher level leaders

confirm/coach/support performance of these tasks

Key points:

• Leader Standard Work is the engine that drives DMS
• It is essential if backsliding is to be stopped

Date: _____________ Unit:____________ Leader: ______________________ Coach: ______________________ Time of Huddle: Reviewed (?) Entered into Midas (?) Shout outs Great Catches SSE - harm reached patient (Unexpected

Safety Events documented - near misses (falls, ADE…) Patient Complaints/Grievances PSMS scores Teamwork assessment: Fist or 5 Readiness Methods - processes for day Equipment - do I have what I need Supplies - do I have what I need Staffing - do I have what I need. Gaps not filled. 5S- everything in its place, clean, labeled Unit Metrics # On time starts % meeting Takt Time Additional metrics Additional metrics Review Issues log- open/closed- trends *Note issues on Leader standard work form for follow up Announcements

Core Element: Shift Readiness

Methods Checks

Check existing policies and work standards: Red = need to revise or training process issue

• Anticipate & execute roll out of new policies and work standards:

Red = behind, or plan (countermeasure) needed

• Check quality audits: Red = audits not performed, or not meeting

standards

Equipment Checks

Check designated equipment, red if abnormal quantity, location, ready-to- use, calibration

• Anticipate need for equipment (higher or lower than normal use); red if too

little or too much equipment for the need

• Check plans for maintenance or to roll out new equipment; red if unable to

support

Supply Checks

Check designated supplies, red if abnormal quantity, location, ready-to-go;

• r if expired or under recall
• Anticipate shortages; red if a shortage may occur
• Check plans to roll out new supplies or remove obsolete supplies; red if

unable to support or not meeting plan or need

Staffing Checks

Check staffing, red abnormal staffing to meet care or service needs; not fully trained for the standard work

• Anticipate changing needs during the shift and upcoming shifts, red if

anticipate being unable to match staffing to demand

• Anticipate risk for fatigue, red if unusually extended shifts or overtime

Environment

Is the environment clean, any repairs

Core Element: Improving Cadence

Clinical Coordinators

• Hourly rounding

– # of patients in department – # on time with cadence set for level of care – Issues that need immediate attention – Follow up on previous issues noted – Huddle to include: – ATC/Clinical Coordinator – Manager if in building – Physician if available – Unit staff if available – Communication with staff & providers – Adjust schedule to meet flow – No longer FIFO – Utilize schedule board to make adjustments

Core Element: Materials Management

2 Bin KanBan System

• Visual control of supplies
• Just in time supplies where they are

needed (Inventory control)

• Minimal storage in building

– No cupboards in exam rooms, OR – Cart replenishment system – Supplies ordered when bin is empty; not counting every supply every day

• Backed up by a Plan For Every Part

(PFEP)

Lessons Learned

• Go and see what good looks like
• Ensure value engineering does not impact design

flow

• Communicate more than you think you should!
• Solidify commitments

– Help ancillary staff see importance of participating in events

• Hospital representatives from design to be part of

construction meetings right from the start

• Relationship building with construction team

– Value of clinical input

• Same staff in subsequent events
• Trust the process and design

Credits

• Doug Dulin

– Joan Wellman & Associates

• Use of slides, presentation material approved by D. Dulin JWA

Questions