u of i slides 11 09
DESCRIPTION
Slides presented on Nov 12 to undergraduate IEs at the University of Illinois.TRANSCRIPT
Industrial Engineering in an Unusual Healthcare Setting
Richard BlackwellProject Director, Process Quality
Cermak Health ServicesNovember, 2009
Summary
Brief history of IE and Quality Background on Cermak Clinic Describe the problem: distribution and
administration of medications to CCJ detainees Discuss the approach taken, results to date, and
expected outcomes Outline other IE projects being considered at
Cermak Discuss the potential impact of IE in healthcare
and other service industry applications
Goals
Discuss and demonstrate use of several IE techniques in an unusual healthcare setting Value Stream Analysis and process mapping Six Sigma process improvement (DMAIC) Quality Management System support of
accreditation audits Suggest possible career directions for IE
students
Who I Am
Graduated from U of I with MSIE in 1978 Career trajectory
Manufacturing and distribution applications of OR/MS techniques
Owned my own consulting and software development company
Telecommunications from 1997 to 2009; Project and Product Management; Marketing; Quality
Currently Project Director for Process Improvement at the Cermak Clinic of Cook County Jail
After 30+ years in Industry, I still consider myself an IE; everything else is just what I
happen to be working on
Quality Management Systems - Quick Background Industrial Engineers (as Scientific Managers) basically invented
the Quality discipline – Walter Shewhart, Joseph Juran, W. Edwards Deming
Starting in the 1970s, traditional Quality Control shifted to more comprehensive Systems approaches Good Manufacturing Practice (GMP) driven by the FDA International Standards Organization (ISO) Certification Malcolm Baldridge Award (Motorola the first winner in 1988) Motorola’s Six Sigma methodology
During the 1990s, an expansion of formal QMS Certification into new areas Software Engineering Institute’s Capability Maturity Model ->
CMMI ISO “Variants” (TL 9000, QS 9000, AS 9000, …)
Our Approach
Starts with Six Sigma as a structured problem-solving approach Methods (e.g. DMAIC) Tools: statistical and process/problem
analysis Uses Quality Management System
certification as a goal and a club to drive organizational change
Cermak Health Services
Part of the Cook County, Illinois Health & Hospitals System Located in the Cook County Jail The largest single-site correctional healthcare facility in the US
Provides comprehensive care for ~10,000 detainees 150,000 sq ft in 129 bed infirmary plus satellite facilities within the jail Responding to Department of Justice findings from 2008, Cermak is currently upgrading service delivery
capacity and methods
Industrial Engineering in Healthcare IEs (as Management Engineers) and other
healthcare professionals have often used IE/OR/MS techniques Process simplification and re-engineering Process automation Patient safety
Both IIE and ASQ have divisions that focus on healthcare
Opportunities will expand as healthcare cost containment efforts ramp up
Case Study - Medications Administration 20% of detainees receive medication, with
many receiving more than 1 Patients are dispersed
129-bed Infirmary for acute care 3 step-down intermediate care units General population is in 247 small living units
(~50 per unit) in 17 stand-alone Divisions A court has determined that detainees are
to receive all prescribed meds within 24 hours of prescription
Complications
Detainees move around Transferred at short notice, or may be in Court
or school at meds admin time Meds distribution methods vary
Dose by dose administration of TB, HIV, psychotropics, and controlled substances
7-day self-packs when appropriate Dispensed from central pharmacy and
also from meds rooms in some units
The Project
Develop a single, documented process that will be followed for all detainees in the system Eliminate non-Value Add steps Shorten the fulfillment cycle to 24 hours or less Reduce/eliminate missed or incorrect meds Institute control of drug inventory Reduce returns
New process is the basis for the implementation of a new campus-wide computer system
The Approach – Six Sigma
DMAIC process improvement Define the problem Measure the scope of the problem Analyze process data to understand the root
causes of the problem Improve the system performance Implement Control system to monitor
performance and prevent re-occurrence of the problem
Define Stage
Form project team(s) and develop project charter
Map & document current processes With groups of stakeholders By direct observation
Develop a measurement plan Anecdotal data from stakeholders not usually sufficient Six Sigma requires independent data to ensure
objectivity Measurement allows you to develop and pre-test the
metrics employed in the Control plan
A Process (“Swimlane”) Map
Dept
Process Logic
Sub-Process
Operation
Value Stream Analysis
A more elaborate form of process mapping used in Lean Any step that does not add customer value is
a candidate for elimination Rich vocabulary of symbols for process steps
Moves Delays Etc.
Guides the development of a desired “Future State” from the “Current State”
Measure Stage
Based on Define stage results, Mean Prescription Flow Time and Delivery Errors per Encounter selected as targets In order to meet 24-hour requirement, need to
know current state Analysis of Flow Time will support
determination of root causes for delays Delivery Errors cause rework, increase mean
flow time, and affect patient safety
Unfortunately…
No data is available in current computer systems
Current paperwork inconsistently filled out, results not tabulated
Measurement plan – limited sampling Observe meds pass and note results Work backwards through pharmacy records to
determine what was prescribed and when Analyze monthly nursing records for actual
delivery
Analyze & Improve
DMAIC is not strictly linear; phases often overlap
In this case, some of the required improvements are known We can use the data analysis to validate
required process improvements after we start them
“Surprises” can be leveraged as they occur
Process Results to Date
Pharmacy capacity is limited by several bottlenecks Manual entry of Prescriptions Label printing & manual sort Staging of meds for delivery to Divisions
Administration in the Divisions contains significant non-Value Added steps Redundant manual data transcription “Unnecessary” validation of delivered meds against patient’s
medical profile Impossible with current processes to verify that correct meds
have been administered Improvement approach is to document and implement one
standard process
An Implementation Plan
Present plan to Senior staff Form Working Group – CQI, Pharmacy, Nursing, Medical
Draft Context document, review with staff and Software Vendor for accuracy
Combine existing documents and process flows and adapt Eliminate non-value adding steps Leverage Software capabilities Define and implement metrics support elements in Software
Review and revise with Senior staff Pilot
Review with Dept of Corrections and revise as required Final approvals Develop training materials Train Monitor & mentor
Why Is Implementation So Hard? Most Process Improvement Efforts Fail
One study shows that 60% of Six Sigma projects end in partial or complete failure
The reasons are not surprising People don’t like to change Organizations change all the time, making
long-term committed efforts difficult Management commitment is hard to get
and keep Some projects just don’t make sense
Improving the Odds
Techniques exist to improve the odds Stakeholder & Force Field analysis:
understand the management setting and risks before starting a project
Scope Management: Avoid over-commitment and “creep” by clearly
documenting realistic objectives and goals Avoid projects lasting > 6 months
Change Management: a toolkit for overcoming resistance to change
The Control Phase
Implemented using standards-compliant process documentation Must be supported by senior AND line management Will face scrutiny by employee unions
Includes key elements of a standard Quality Management System A performance measurement system Internal Audit (Self-monitoring) Management Review; Corrective/Preventive Actions
Verified by an independent accreditation body (NCCHC)
CustomerFocus
DocumentedManagement
System
ManagementInvolvement
ImprovementProcesses
InternalAudit
QualityQualitySystemSystem
Management Involvement Management commitment to all aspects
of the Quality System
Customer Focus Management is focused on Customer
satisfaction, relationship development and communication
Documented Management System Documentation is available that provides
policy, responsibilities and records in accordance with the Quality System
Internal Audit Periodically conducted to verify
effectiveness of Quality System Document / communicate audit plan and
ensure independence of auditors Reviewed by Management
Improvement Processes Monitor, measure and analyze processes
for conformity and improvement to products
Corrective/Preventive Actions
Continual Management Dynamics
Other IE Projects
Map & Streamline the sick call process Map & Streamline the Mental Health care
delivery processes Design meds administration automation
processes Analyze and optimize layout and
throughput of a proposed detainee admitting facility
Common IE Skills Used
Process analysis Statistical analysis of process data Process design, documentation &
implementation Design of management metrics systems Support of certification/accreditation Design & implementation of process
automation Cross-disciplinary team leadership
Career Ideas for New IEs
Healthcare – it’s exploding Public Sector – Lord knows they can use us… Software/Consulting – draw on IE training, &
gets you into the game Project Management – a natural step up from
entry-level, and there are never enough PMs Six Sigma – a natural for IEs; you already
know most of this stuff Lean – IE with a different name
Links and Resources
www.punshui.com: my slides and other materials www.lean.org: lots of ideas and resources re Lean
methods and tools www.asq.org: starting point for Six Sigma and many
other directions in Quality http://www.iienet2.org/SHS/Community/
Default.aspx: IIE Society for Health Systems http://www.asq.org/healthcare-use/why-quality/
overview.html: ASQ Healthcare Division www.pmi.org: professional certification for Project
Managers and lots of tools
Questions?