Improvements through Lean @ NKS

Improvement and optimization of sterilization processes and flows

Camilla Lagerfors

Klas Rudbäck

2010/2011 the count council initiaded a change-program to adress

current challenges

Future health-care

• Upgrade hospital buildings

• Reconstruct health care

• Centralize highly specialized care

• Upgrade emergency care

• Focus on primary care

• A net-work integrated system with the patient at the center and high participation

• Increased productivity• Rapid population increase

• Ageing population

• Aged infrastructure

• Changed circumastances

• Increased cost that require increased efficiency

Care needs

Ability

to pay

Development in health care

Resources

A new organization, a new hospital

NKS –New Karolinska Hospital

• 35 operation-rooms

• The hospital is organized after ”Just in time”

• AGV

Value based health care

• Patient-centered care

• Super-specialization and optimizing

• Increased support to OR

20152015

A new misson for the CSSD:A full service partner to the OR-depts

20172017

Innovation Partnership

Innovation Partnership

• As a part of the CSSD-procurement/ender

• Started in 2014+5yrs

• Focus areas: -Workflow, -Equipment, -Patientsafety, -Work enviroment, -Service & Maintenance

• When CSSD started looking for KPI´s

• Find good and reliable index to measure effectivity within CSSD

• Preferred method was LEAN. Important not to invent the weel again!

By introducing Lean, we aim to build a platform to work from which we continuously can improve the operations.

Introduction to Lean

1. Define Customer Value- what is really important for the customer?

2. Establish KPIs- how do we measure the entire operations?

3. Introduce Teamwork- how do we work together towards set targets?

4. Map the Value Stream- in what steps is the work carried out (map waste)?

5. Implement Continuous Improvements- how do we work to always become better?

� What we’ll do, is a first introduction to how we can work with Lean and Continuous Improvements.

� The work with Lean must continue to develop and never stop. Lean has now first or last step, only a next one…

Customer Value

KPIs

Value Streams

Continuous

Improvements

Teamwork

The KPIs at CSSD reflects how safe our work environment is, how we fulfill customer expectations and how efficient we are.

Top KPIs

Priority Objective KPI

1. Safe Ensure a safe and healthy work environment. • Zero accidents or work related sick leave

2. RightProvide Operating dept’s with complete, sterile and punctual deliveries.

Not complete (pick errors in % of deliveries)

Not sterile (sterile errors in % of deliveries)

Not punctual (delays in % of deliveries)

• Right (100% - sum of the above)

3. EfficientCarry out the work with best possible efficiency and least possible waste

• Total work hours per delivery

Safe

Right

Efficient

Safe measures two aspects of how well the employees are protected from risks at work

Goal is always 100% safety!

Safe measures the number of safety incidents and the development over time.

1. Number of days since the last accident or work related sick leave.

- Presented as a number on the team board and updated daily.

- The value for ”all time high” is noted next to it, to compete against.

2. Weekly accidents or work related sick leave and the development over the last 12 months.

- Presented in a graph with weekly and 52 week values.

Safe days:

22 (34)

Efficient measures the amount of resources required to deliver an average order to the Operating dept’s.

Efficient measures the total worked hours versus the number of deliveries.

1. Since everyone at CSSD should deliver Customer-Value, all hours will be included.

- Presented in a graph with weekly bars and a 4 week moving average line.

-

• This can be drilled down in many different ways to analyze how the productivity is developing:

- per own department (cleaning, sterilization or packing)- per customer (child, thorax or intervention)

Efficient �Totalworkedhours

Totaldeliveries

Right measures CSSD´s perfect delivery ratio to the OR- dept’s, meaning complete, sterile and punctual deliveries.

Right is calculated from total errors compared to total deliveries.

1. A perfect delivery is the goal: complete, sterile and punctually delivered.

- Presented in a graph with weekly and 4 week values.

-

2. To react quickly, it is also important to follow the errors from the previous day:- Not complete- Not sterile- Not punctual

- This will also be measured per customer, in order to get a better feel for where the errors are occurring.

����� � ���% �� �!"#$$ $%

� �!"&#"�'#$�#%

Not Correct Not sterile

Errors yesterday

Not punctual

Complete PunctualSterile

The Customer Value describes clearly what is Right for our customers, meaning all departments receiving our deliveries.

Customer Value

• All aspects below must be fulfilled for the delivery to be considered Right by the receiving OP department.

Meaning:

• The deliveries contain all articles listed on the operations-card.

• The deliveries are clearly marked and correctly loaded.

Meaning:

• The deliveries arrive in time prior to the surgery.

• The deliveries arrive to the right place.

Meaning:

• All articles are sterile upon delivery.

• Date values are current

• Sterile packages are not damaged

• The sterile indicator is black.

• The cabins are correctly sealed.

Feedback from customers

• In order to get quick feedback, CSSD will daily collect ”quick remark forms” from the different OR- departments.

• There will also be regular customer meetings where the OR-departments are being involved in the Continuous Improvement work.

Discuss what teamwork means to CSSD and get started. Important to set as good structure as possible to avoid re-starts!

Teamwork

• Is about making all colleagues to work towards the Common Goals. - goals are understood from the Customer Value and the set KPIs - everyone at CSSD must have the same view of what Customer Value means

• The daily operations are reviewed at a Daily Team Meeting- 13:30 – 13:45 with a fixed agenda- only daily operations (including deviations) are discussed- key members are fixed but everyone is welcome

• There will be a Team Board in lunch room- inform clearly how the operations is running- shows the progress and actions around continuous improvements

• The work with Continuous Improvements is central- this is as natural a part of the daily work as the sterilization and deliveries - will be done systematically with focus on the largest potential

Continuous Improvements need to be run with good methodology and be a natural part of the daily operations.

Start using A3 for problem solving

A3 is

• A method for problem solving that builds on the classical Plan – Do – Check – Act cycle.

• A clear summary of problems and solutions.

• A communication tool between colleagues.

• A structure and discipline in the improvement work.

• A tool that can be used for all sorts of problems in most operations.

• It is important to have a structured method for defining theproblem and solution, to make sure it efficiently addresses actual problems.

Value-Streams – lessons learned and next steps

• Difficult to map value-streams efficiently if there are unclear routines in place. Instead an activity chart where routines are agreed should be made.

Key takeaways

• Value streams... Like a yarn

• Mapping the value streams was the most challenging task to fulfill

• This is due to non-established routines and workflows.

• A lot of Dependencies between OR and CSSD and Patient; Have to sort this out!

• Very difficult in NKS, a lot of resources has to been set.

SurgeryPost-

SurgerySurgery

Post-

Surgery

Patient Flow

Surgical Flow

Sterile Supply Flow

A journey through Integrated Workflow Solutions

This is a visualization of typical flows in a hospital for illustrative purposes only.

Each flow highlights points where IWS can add value to the workflow, and the intention is not to represent complete hospital flows.

A journey through Integrated Workflow Solutions

SurgerySurgerySurgeryPost-

Surgery

Post-

Surgery

Post-

SurgeryDischargeAdmission

Patient Flow

Surgical Flow

Sterile Supply Flow

This is a visualization of typical flows in a hospital for illustrative purposes only.

Each flow highlights points where IWS can add value to the workflow, and the intention is not to represent complete hospital flows.

Sterile Supply Flow/Surgical Flow/ Patient Flow

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IWS in the Surgical Workflow

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Admission

SurgerySurgerySurgery

Post-

Surgery

Post-

Surgery

Post-

Surgery

Discharge

IWS main IT Solutions

T-DOC TEGRIS INSIGHT

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Sterile Supply Management

OR IntegrationPatient Flow Management

Sterile Supply Flow

SurgicalFlow

PatientFlow

Integrated Workflow Solutions

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IWS is a suite of IT solutions that work together to ensure a safer, integrated and better utilized facility that supports greater consistency and efficiency, enabling healthcare professionals to focus on delivering the best possible care for patients.

Continuous Improvements – lessons learned and next steps

• Start measuring and pay attention to particularly good improvements. NKS

• Run a series of training session in how to work with A3 and other Lean tools in NKScontinuous improvements.

• Implement the warehouse module from T-Doc with screen and scanner picking features. NKS / Getinge

• Develop the flow through the autoclave-barrier, in order to reduce the number of physical lift. NKS / Getinge

Proposed further activities and improvements

• It is key in Lean that the employees have the responsibility for their own operations/tasks. If they don’t, the actions to improve will be significantly limited.

• It is difficult to measure, but continuous improvements will in the end be seen in the KPIs. A basic way of measuring is to simply calculate the number of completed and documented improvements.

• Critical that the Continuous Improvement work is seen as a part of the daily job, and that it has dedicated time during the day.

Key takeaways

Summary of recommended future activities

NKS

• Build value stream charts for the different departments in workshops with the teamsorder to establish a clear view of waste in the work.

• Start measuring continuous improvements and pay attention to particularly good improvements.

• Run a series of training session in how to work with A3 and other Lean tools in continuous improvements.

Getinge

• Establish documentation on good practices across the business.

• Establish a function that can support developing CSSD operations from a complete operational perspective.

• Implement the warehouse module from T-Doc with screen and scanner picking features.

• Develop the flow through the autoclave-barrier, in order to reduce the number of physical lift.

Jointly by NKS and Getinge

Saving lives is without question the greatest job in the world

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A safer, integrated and better utilized facility

that supports greater consistency and efficiency

Hospital control that

increases quality of care

while optimizing resource

utilization across

departments

Get back to

caring for patients by

reducing cumbersome

procedural tasks

Facilitate a care

environment that is calm,

safe, structured and

well-informed

Benefit from a

long-term, strategic

partnership

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