laguna honda hospital and rehabilitation center value ... 12/agend… · laguna honda hospital and...

June 12 – 16, 2017

Laguna Honda Hospital and Rehabilitation Center

Value Stream #1 – Admissions

Kaizen Workshop #3 – Room Readiness

Report out

<insert client logo>

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This is how the value stream mapping team envisioned the future room readiness process, after a bed/room becomes vacant.

Clinical AssessmentsApril Kaizen 2

Pre-AdmissionsFebruary Kaizen 1

Value Stream Future Map – Nov 2016

Room Readiness June Kaizen 3


Version 14 rev. 8/15/17

DUE DATE

Feb 10 2017 ©

Apr 21 2017 ©

Jun 12 2017 ©

Jun 30 2017 ©

May 1 2017 ©

Jul 31 2017 ©

Jun 5 2017©

Mar 1 2017 ©

JDI 1 : Admit Donna Dec 4 2016 ©

Feb 2 2017 ©

Completed!

Not Yet Done

PROJ 4 : Advance Directive Upload

PROJ 2 : Patient Arrival

KW 3 : Room Readiness

Sheri and Irin

John Grimes

PROJ 1 : RCT Notification Upon Resident Arrival/Admission Jennifer and Elizabeth

A3-TTEAM CHARTER Date: rev. 8/15/17 Reporting Unit: Laguna Honda Hospital & Rehab Ctr Theme: New Admissions Processes

TARGET STATEMENT IMPLEMENTATION PLAN

© 2014 rona consult ing group

PROBLEM STATEMENT PROPOSED ACTIONSBy 2020, the percent of seniors (>60 years old) in San Francisco will

increase to 21%. LHH has a 150 year history of providing underserved

adult with disabilities and seniors needing acute and skilled nursing

services. In FY 15- 16, LHH served 1,214 residents, with 65% over 60 years

of age, and admitted 483 new patients. As DPH and SFHN prepares for

value based care, it is important that LHH addresses patient experience,

fiscal stewardship and quality care. First impressions to a new care

setting for new patients and their families make a difference. Our current

admission process is flawed: increased redundancies, multiple

messaging, complaints from referral sources, increased wait list for

approved patients, chaotic workflows, breakdowns in communications,

staffing inconsistencies and problems with internal relocations. We have

the greatest opportunity to improve how we welcome and care for San

Franciscans needing post acute care at Laguna Honda.

The ideas w ere categorized into major themes. Key ideas and concepts w ithin these categories are listed below :

Improvements to Pre-Admissions

Clinician Workflow

Electronic Notif ication

EVS Terminal Cleaning

Food Services Operations Analysis

original date - 12/2/16

While we moved to the new hospital six years ago, the admissions and referrals

process and staff working on these processes have changed overtime. New

steps and processes have been added on top of existing systems and

documentation in place, thus increasing duplication burder for the Admissions &

Screening Committee and also referring agencies/organizations. In addition, we

have received feedback fhtat our admissions referrall process was cumbersome.

Within 18 months, Admissions at LHH will achieve the fo llowing targets (subject

to change based o n Kaizen team wo rksho p) :

M ATERIALS AND SUPPLIES

• Locations and Par Levels of supplies and materials are standardized.

DELIVERY

• Reduce Admission Lead Time by 50%

• Admit patients within 2 days of admission approval

• 75% of vacant beds are filled with new patients the next day

QUALITY

• Staff satisfaction

COST

• Reduce cost per patient bed by 10%

ACTION ITEM RESPONSIBILITY

KW 1 : Pre-Admit Process Donna

KW 2 : Team Clinical Assessments Dr. McShane

JDI 2 : Upload "follow me" forms Michelle

PROJ 3 : Timely Completion of Documents H & P for Coding Debra and Michael

Jennifer and Michelle

PROJ 5 : PASRR Upload Michelle and Elizabeth

ANALYSIS PROJ - Project Color Key:Our observations find the fo llowing issues contributing to the current state: JDI - Just Do It

© - plan has been completed

CHECK AND ACT1) Projects Status Checks: Monthly eview with Responsible Parties. As of 8/15/17, all Projects 1, 2, 4 & 5 are completed.

Project 3 has been started with monitoring in place.

2) Just Do Its Status Checks: Weekly review with Responsible Parties. As of 8/15/17, all Just Do Its are completed.

3) Kaizen Events: Monitor implementation of Kaizen improvements weekly and workshop targets with completion of 30, 60

and 90 day reports as well as audits of standard work. As of 8/15/17, the 3 Kaizens have been completed. Refer to specific

Kaizen documents.

4) Quarterly reviews with executive team. As of 8/15/17, updates were provided at Exec and/or Quality Council meetings.

5) Development of visual workplace and communication vehicles. As of 8/15/17, the visibility wall ouside A3219 is updated,

as well as the production board posted outside the Strategic and Performance Management Department's Office by

Administration.

Key:

KW - Kaizen

0.02.04.06.08.0

10.012.014.016.0

Lead Time

(Days)

Wait Time

-4.0

1.0

6.0

11.0

16.0

Lead Time (Days)

Wait Time

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A3

<insert client logo>Kaizen 3 Room Readiness A3

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Problem Statement: Vacant rooms are scheduled to be occupied by a new

admission within 24 hours of discharge. However, the process of cleaning and

repairing a room after a discharge can take several days, which often leaves

rooms unprepared and/or not presentable when new residents arrive.

During Kaizen week, there were 13

rooms/beds that were vacant for an average of 28 days.Of the 13, 69% of

the rooms were not ready.


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Initial Target Sheet

Three Targets:1) 100% Facility

Assessment when room is vacant

2) 100% Room Readiness Checklist completion by Facility Services, EVS and Nursing

3) 100% room is ready within 24 hours of vacancy

<insert client logo>Current State of Room Readiness

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Current Process Cleaning the Room

Utility worker changes curtains

Nurses (PCA) makes the bed Porter mops the floor


Genchi Genbutsu (Going To See)

In the Gemba (Real Place)

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Go see.Ask questions.Show respect.

-Taichi Ohno

We went to the gemba to understand how rooms are prepared for the new patient.

<insert client logo>Gemba Walk

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Resident Experience

<insert client logo>Waste Gathering

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Inventory

Low beds in vacant rooms

Motion

Porter kept leaving room to get supplies

Overproduction

Bed needed to be made twice due to stained linen

Defect

Broken shower head

Overprocessing

Multiple communication methods in vacant room

notification

Waiting

Work order entry incomplete, requiring

engineer to go find out the problem

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Wastes Observed from the Gemba

<insert client logo>Idea #1: Create Standard Workflow

<Insert 1-2 photo(s) of idea generation session here>

Pictures of groups, and ideas

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<insert client logo>Idea #2: Submit Work Order Timely

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Understanding Nursing and EVS roles

<insert client logo>Room Readiness Checklist

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Checklist Team in action


Running experiments –

define, run, evaluate results, improve

Simulation experiment

at the Gemba

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<insert client logo>Simulation – S3

• Facility Assessment

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Simulation – S3

• Nursing Assistant cleans bed

<insert client logo>Simulation – S3

• Porter cleans room

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<insert client logo>Standard Work Instructions: 6

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Interdepartmental Collaboration

Sequence Steps

Checklist

<insert client logo>Work Product #1: Low Bed Inventory

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Problem: Where are all our low beds?

Tools Needed: • Inventory Assessment • Fang created a data collection

tool to get a snapshot of where low beds are on the LHH neighborhoods

Experiment: Ed Guina coordinated and centralized the data collection. Data received within 3 hours of requesting to complete the spreadsheet.

Results: 2 low beds not in use were found. We can save money by returning the rental beds.


Work Product #4: Standard Work for Resident

Belongings

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Problem: Resident belongings were not packed after discharge and variation in how and where it is stored.

Tools Needed: • Standard work instructions• Packing boxes• Labels

Experiment: Test standard work instructions for packing resident belongings.

Results: Developed standard work instructions for nursing staff. Two new forms now on the Intranet forms• Resident belonging label• Notice of unclaimed property

<insert client logo>Work Product #3: Work Order New Feature

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Problem: Unclear work order entries

Tools Needed: Work order data field change

Experiment: Added a new field in the work order entry, requesting to enter the name of the person who found the problem/issue

Results: Without informing users, 78% entered a name in the newly created field. This will reduce the time wasted in locating the person who submitted the work order to get more details and/or the Facility Services staff can fix the problem quicker.

New entry field: First and Last

Name of who reported problem

<insert client logo>Improvement Summary Using Lean

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Focus Impact/Lean Principle

Agreement on definition of room readinessResidents are admitted to a room that has passed inspection from Nursing, EVS and Facility Services (respect for people)

Interdepartmental room readiness checklist and sequencing of steps by Facility Services, EVS and Nursing

Vacant room notification sets up sequence of room preparation steps for Facility Services, EVS and Nursing (achieving flow – benefits of pull production and signaling)

Standard work for completing discharged residents belongings, packed in boxes, labeled and moved to K5

Decreases excess motion, resources, and over-processing from duplication and repetitive work (eliminating wastes)

Creating a Low bed inventory process By ensuring availability of inventory, Residents have the right type of bed that meets their clinical care needs (appropriate care and mistake proofing)

Improve work order entry field

By identifying the person who reported the issue/problem in the vacant room, the Facility Services staff assigned to fix the reported problem will be able to receive more information (standard work instructions)

Questions and Comments

Thank you.

Room Readiness Kaizen Improvement Event

Executive Sponsor: John Grimes

Process Owners: Diana Kenyon, Jacky Spencer-Davies and

Maxwell Chikere

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