© 2014 2 4. jicas approach clean hospital program a part of the contents of this chapter reprints...
TRANSCRIPT
5S-KAIZEN-TQM Approach
in HospitalsWorld Business Associates Co. Ltd., Japan
Director & Senior Consultant
Jun SUGIURA
2 WBA©WBA 2014
4. JICA’s Approach “Clean Hospital Program”
A part of the contents of this chapter reprints them from the following report of JICA.Thematic Evaluation "Analysis of the Outcome Generating Process of 5S-KAIZEN-TQM Approach in Hospitals" (Final Report): http://www.jica.go.jp/english/our_work/evaluation/tech_and_grant/program/thematic/
3 WBA©WBA 2014
4. “Clean Hospital Program” in Africa
The Japan International Cooperation Agency (JICA) has conducted the “Program of TQM for Better Hospital Services” since 2007 in 15 African countries and promoted enhanced hospital management and improved hospital service quality by adopting “5S-KAIZEN-TQM Approach” .
(Eritrea, Uganda, Kenya, the Democratic Republic of the Congo, Senegal, Tanzania, Nigeria, Niger, Burkina Faso, Burundi, Benin, Madagascar, Malawi, Mali, and Morocco)
Manufacturers
in Japan
Hospitals in Japan
5S-KAIZEN
Manufacturers in the U. S. A.
TQMHospitals in the U. S. A.
Manufacturers in Sri Lanka
Hospitals in Sri Lanka
Hospitals in Africa
Asia/ Africa Knowledge Co-creation Program (JICA)
4 WBA©WBA 2014
4. “Clean Hospital Program” in Africa
This program consists of;1. The African hospital persons and Ministry of Health executives are invited to Japan, or Sri Lanka to have training with an idea of the five S's-KAIZEN-TQM, and to visit the factories and hospitals which five S's-KAIZEN-TQM are applied.2. The participants devise the Action Plan for making organization and an enforcement schedule to carry it out in the pilot Hospital in their own country through the training.3. After going back to their country, the trainees enforce the pilot project and deploy five S's-KAIZEN-TQM in the country.4. Japanese and Sri Lanka’s lecturers will go around each African country to enhance pilot Hospital activity and the quality of health care services through five S's-KAIZEN-TQM, and to deploy the approach more extensive in the future.
5 WBA©WBA 2014
5. JICA’s Approach Logic model of “The 5S-KAIZEN-TQM” approach
A part of the contents of this chapter reprints them from the following report of JICA.Thematic Evaluation "Analysis of the Outcome Generating Process of 5S-KAIZEN-TQM Approach in Hospitals" (Final Report): http://www.jica.go.jp/english/our_work/evaluation/tech_and_grant/program/thematic/
6 WBA©WBA 2014
5. Logic Model of “the 5S-KAIZEN-TQM” approach
Logic tree for manufacturing companies
5S Activity
Sort Set in order StandardizeShine Sustain
DiscardUnnecessary
items
LabelNecessary
itemsEliminate
contaminationContinue
3SImprovement
education
Cleanwork place
Reduce timefor searching
Raise awareness of staff
Reduce waste of goods
Reduce wasteof facilities
ImproveCost(C)
Improve Productivity
(P)
Improve Quality
(Q)
ImproveDelivery
(D)
ImproveSafety
(S)
Improvement in organizational capacity (team work, capacity for improvement, staff satisfaction)
Increase in profit Increase in customersatisfaction
Continuous developmentof company
ActivitiesD
irect outcomes
Project purposes
Impact
Improve company managementOverallgoals Increase in sales
7 WBA©WBA 2014
5. Logic Model of “the 5S-KAIZEN-TQM” approach
5S Activity
Sort Set in order StandardizeShine Sustain
DiscardUnnecessary
items
LabelNecessary
itemsEliminate
contaminationContinue
3SImprovement
education
Cleanwork place
Reduce timefor searching
Raise awareness of staff
Reduce waste of goods
Reduce wasteof facilities
Improve management of
drugs/equipment
Improve labor
efficiency
Improve “job”
quality
Prevent hospital
infection
Eradicate medical
accidents
Improvement in organizational capacity (team work, capacity for improvement, staff satisfaction)
Cost reduction Increase in staffsatisfaction
Continuous provisionof public medical service
ActivitiesD
irect outcomes
Project purposes
Impact
Improve hospital managementOverallgoals Increase in patient
satisfaction
Logic tree for hospitals in Africa
8 WBA©WBA 2014
5. Logic Model of “the 5S-KAIZEN-TQM” approach
On-site project purposes in African hospitals
Overall goal
Continuous provision of public medical service ●Survey on patient satisfactionImpact
Improvement in hospital management
● Survey on patient satisfaction ● Survey on staff satisfaction● Management data● Medical treatment data
(1)Eradicatemedical
accidents
(2)Preventhospital infection
(3)ImproveManagement of
drugs/ equipment
(4) Improve “job” efficiency
(6)Improve organizational
capacity
Continuous reduction of
medical accidents
Continuous reduction of
hospital infection
Continuous improvement in efficiency of inventory and order management
• Continuous reduction of patients’ waiting hours• Continuous reduction of working hours
Continuous improvement in capacity of
voluntary activities
On-site
Projectpurpose
Outcom
e
Continuous improvement in “job” quality
(5)Improve “job” quality
Key Performance Indicators
WBA©WBA 20149
5. Logic Model of “the 5S-KAIZEN-TQM” approach
On-site project purpose in African hospitals
Project purpose in manufacturing
1 Eradicate medical accident Improve safety
2 Prevent hospital infection Improve safety
3 Improve management of drugs and equipment
Improve productivityImprove cost
4 Improve “job” efficiency Improve productivityImprove cost
5 Improve “job” quality Improve quality
6 Improve organizational capacity
Comparison of the project purpose in between African hospitals and manufacturing
10 WBA©WBA 2014
5. Logic Model of “the 5S-KAIZEN-TQM” approach
ImpactCauseDirect
outcome 1OutputActivityDirect
outcome 2Intermediate
outcome
Prerequisite that 5S-KAIZEN cannot
deal with
5S activity KAIZEN activity TQM
Improve “job” quality
Improve organizational
capacity
Basic structure of the logic model
11 WBA©WBA 2014
5. Logic Model of “the 5S-KAIZEN-TQM” approach
Improvement in hospital
management Survey on
patient satisfaction with
treatment
Impact
Medical accidents (safety)
Continuous reduction of
medical accidents Ratio of
medical accidents
(No. of cases)
Number of in-hospital accidents
Fewer errors in patients’
information
Easily retrieve proper medical records.Sort patients’ records (S1) and store them according to rules (S2)
Cause OutcomeOutputActivities
Post patients’ information in a place easily seen (e.g. bedside) (S2)
Errors in patient
information
Errors in drugs/
medical device
handling
Sort (discard) unnecessary drugs/ medical devices (S1)
Label on drugs/ medical devices (S2).
Place drugs/ medical devices in predetermined locations (S2).
Deficiency in work
environment
Sort unnecessary items in hospital (S1).
Secure safe passageway and indicate them (S2).
Shine hospital (S3).
Set a rule on sharing patients’ information and follow it (S4).
Set a rule on sharing/ handling drugs/ medical devices and follow it (S4).
Deficiency in medical skills/
knowledge
Education/ training for medical skil ls/ knowledge
Deficiency in equipment
maintenance
Deficiency in drugs/
medical devices
Invest in drugs/ devices; Improve infrastructure
including water/ electricity (fund procurement)
Shine devices (S3).
Set a rule for regular inspection (S4).
Identify patients properly.
Reduce errors in sharing patients’ information.
Less time to retrieve patients’
information
Continuous improvement in
method to identify patients’
information
Easily find necessary drugs/ medical devices
Easily identify proper drugs/ medical devices.
Easily find proper drugs/ medical devices for use.
Reduce errors in sharing/ handling drugs/ medical devices.
Fewer errors in drugs/ medical
devices
Less time to retrieve drugs/
medical devices
Continuous improvement in method to store drugs/ medical
devices
Continuous improvement in
method to handle drugs/
medical devices
Secure more space for easy move.
Reduce touching, catching, and tripping.
Reduce slippery floors.
Fewer accidents in
traveling
Less time for traveling
Continuous improvement in method to travel
in hospital
Continuous improvement in
layout
Easily find abnormalities.
Prevent accident due to abnormality before it happens.
Early detection of abnormal
devices
Continuous improvement in
method to maintain devices
Fields that 5S-KAIZEN cannot deal with
(Direct Outcome 1) (Direct Outcome 2)(IntermediateOutcome )
Improving “job” quality
Improving organizational
capacity
5S activity KAIZEN activity TQM
Example of logic model for eradicate medical accidents
12 WBA©WBA 2014
5. Logic Model of “the 5S-KAIZEN-TQM” approach
Example of indicators to eradicate medical accidents
Cause Sample indicator for output Sample indicator for direct outcome Sample indicator for intermediateoutcome
Sample indicator for impact
●Organized files and medical records S1( )● Medical records stored according to rule S2)(
● Patient information posted near the patient S2( )
● Established rules on sharing patient information S4)(●Work performed according to rule S5)(
● Discard of unnecessary drugs/ medical equipmentS1)(
● Labeled drugs/ medical equipment S2( )
●Drugs/ medical equipment stored at designatedplaces S2)(
● Established rules to discard/ store/ handle drugs/medical equipment S4)(
●Discard of unnecessary items in hospital S1)(
● Pathways with safety ensured and directions postedS2)(
● Regular cleaning in hospital S3)(●Predetermined frequency, content, and assignmentof hospital cleaning S4)(
● Regular cleaning/ maintenance of equipment S3)(
● Established rules to inspect equipment S4)(
● Number of close calls●Number of patients falling/ hurting● Number of claims from patients●Frequency of cleaning hospital
Defectivemaintenance of
devices
●Frequency of cleaning/ inspection ofdevices●Number of detected defects inequipment
Error inpatients'
information
●Number of mistaken retrievals ofpatient information●Number of lost information on patients●Average time required to confirmpatient information☆Number of claims from patients●Degree of understanding of staff onhandling rules
Project purpose"Continuous reduction of medicalaccidents"
●Number of medical accidents(per year)●Number of deaths due to medicalaccidents(per year)●Number of malpractices/ medicalnegligences (per year)●Number of implementations of safetymeasures (per year)
Impact"Improvement of hospitalmanagement"
☆Degree of improvement insurvey on patient satisfaction hospital facilities/ medical(treatment)☆Number of patients (per year)☆Occupancy rate of hospitalbeds (per year) (Number of inpatients/total number of beds)●Number of patientsreferred from other hospitals(per year)●Number of medicaltreatments (per year) operations, checkups,(deliveries)
Error in drugs/medical devices
●Number of times disposal was made ofunnecessary drugs/ equipment●Number of mistaken retrievals ofdrugs/ medical equipment☆Average time required to retrievedrugs/ medical equipment●Degree of understanding of staff onhandling rules
Defective workenvironment
WBA©WBA 2014
6. Quality Improvement of
Medical Devices
WBA©WBA 2014
Human FactorOrganization for Management Education & Training Management of Operation Management of Moral
Technology/SkillMaintenance Technology Building (Facility) Medical DeviceOperation TechnologyQuality Evaluation Technology
6. Quality Improvement of Medical Devices
KAIZEN/5S
5S:Create spaceCreate timeExpose problemsStandardize operationFollow rulesEducate people
A PDC
Continuous PDCA
WBA©WBA 2014
Cause Activities Output Outcome
6. Quality Improvement of Medical Devices
Deficiency inWork
environment
Deficiency indevice
maintenance
Deficiency intechnology
/skill
Sort unnecessary items (S1)
Secure safe passageway (S2)
Shine devices (S3)
Set rules for regular inspection (S4)
Bundle and fix cables (S2)
Make habit to follow rules (S5)
Education/Training for technology/skill
Deficiency inSpare parts Invest in spare parts
Secure more space for easy move
Reduce touching, catching and tripping
Reduce cutting cables
Easily find abnormalities
Clarify inspection rules
Rules are followed
Regular inspection is
done
Reduce device troubles
Capable to introduce new
devices
Early repairing is possible
Continuous quality
improvement of
medical devices
Fields that KAIZEN/5S can not deal with
(Logic model)
Improving “job”
quality
Improving organizational
capacity
WBA©WBA 2014
6. Quality Improvement of Medical Devices(Indicators)
Cause Activities Output Outcome 1 Outcome 2
Deficiency inWork
environment
Sort unnecessary
items (S1)
Number of discarded devices
Number of newly introduced devices
Operation rate of medical devices
Secure safe passageway (S2)
Number of accidents with devices
Bundle and fix cables (S2)
Number of troubles with cables
Number of device troubles
Deficiency indevice
maintenance
Shine devices (S3)
Frequency of cleaning Number of early repair
Set rules for regular inspection (S4)
Number of new rules and revised rules
Implementation rate of the periodic inspection
Make habit to follow rules (S5)
Frequency of regular inspections
17 WBA©WBA 2014
7. Conclusion
18 WBA©WBA 2014
7. Conclusion
1. KAIZEN is;1) Voluntary bottom up activity by work groups2) Continuous PDCA spiral3) One of tools to improve quality4) Not independent from managers, but depending on manager’s direction5) Easy to begin but difficult to continue active
2. Hospitals in Japan and in the US;1) Should reduce medical cost 2) Should decrease medical accidents 3) Should improve patient satisfaction
3. Key factors of success to introduce KAIZEN are;1) Top manager’s leadership and initiative2) Developing people3) Successful experiences4) Setting measurable indicators
19 WBA©WBA 2014
7. Conclusion
4. Japanese hospitals are active on improving;1) Productivity2) Quality
5. The US hospitals are active on improving;1) Quality2) Safety
6. JICA’s “Clean hospital program” in Africa was introduced;1) Example of logic model of “5S-KAIZEN-TQM” was explained2) Table of Indicators for each step of logic model was shown3) It was explained how to use the logic model
7. Logic model for quality improvement of medical devices is proposed.
Thank you for participating in the seminar till the last.