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Item # Category Pre-Kaizen Goal After Kaizen % Improvement 30 Day 60 Day 90 Day

TBD

Why are we doing this event?Reduce preventable readmissions and VTE to goal.

MEASURABLE GOALS

Support/Special Services/Materials Needed?Flip chart (easel & paper), butcher paper, 3x3 post it notes (in colors), pens, pads, sharpie markers, blue painters tape, LCD projector, scissors, calculator

Cindy Maynard

Team Co-Leader

Data Collected For Kaizen? Yes ResourceFinal Presentation Location TBD

Team Meeting Area TBD Unit Shift SupervisorTeam Leader Meeting Time 4:00

Member

Team Leader Meeting Loc Same as Meeting RoomResourceFinal Presentation Date TBD Pharmacy

Final Presentation Time TBD ResourceResource

Training Time

Value Steam Owner/Mgr.

Kaizen Facilitator/Trainer Steve MooreMemberTraining Required (Yes or No) Yes

Kaizen Dates 12/2-12/6MemberKaizen Tool (if you know it) VSM

2:00

Member

MemberTraining Location

RegistrationED

Med SurgCase Management

ADT Member

Basic Data Kaizen TeamKaizen Area or Process ReAdmissions and VTE Cindy Maynard

Executive Champion Susan Ellis

Team Leader

Preventable ReAdmissions & VTE Kaizen Objectives

Scope (Beginning point to ending point)Registration (ED) thru Post Discharge (to include (ED Triage, Patient Care (Med Surg, ICU), Case Mgmt

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VS Title Re-Admits/VTEVS Owner Susan Ellis

Team Leader Cindy MaynardDate Prepared 12/5/2013

# Action Where When Event Type

Potential Leader Expected Results

1Establish standard work to reduce wait time and length

of stay in the ED. ED TBD SW Rich Pinson

Increase capacity 2 hours per ED associate, increase revenue 50%, reduce patient wait time for admission, improve LOS by 50%

from 4 hours to 2 hours

2 Establish standard work to improve flow in Registration Registration TBD SW Jackie GenaIncrease capacity 1,300 hours per year, reduce waiting, eliminate error, improve

revenue cycle.

3Establish standard work to improve flow in patient care, eliminate waiting and interruptions, eliminate possibility

for errors causing readmissions and VTEs.Med Surg TBD SW Mari Lou Fraley

Reduce readmissions 40%, increase capacity by 3,500 hours per year, improve

med reconciliation, eliminate VTE's.

4Establish standard work to Improve discharge planning

and patient education Case Management TBD SW Cindy MaynardReduce readmissions 10%, reduce LOS

20%, improve bed availability

5 Implement active measurement to improve problem solving

ED/Med Surg/Phar/Cs

Mgmt/RegistrationTBD LDM Tim Vires Increase capacity, improve pt care, reduce

ReAdmissions, eliminate root causes of VTE.

6Establish standard work to provide for consistent

implemention of the VTE care set Pt Assessment TBD SW Deitra Hackworth Reduce VTEs

7Reduce inventory and improve efficiency in ED and

Med Surg through implementation of 5S ED/Med Surg TBD 5S/VM Maggie Banks Reduce inventory, increase efficiency

8 Establish standard work in Discharge and Transport Pt Care/Transport TBD SW Margo BaysReduce LOS, increase pt satisfaction,

reduce readmissions

Value Stream Roadmap

Rapid Improvement Events (Kaizen Events)

Impact to the HRMC would be $1,600,000

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Establish standard work to improve discharge planning and improve patient educationKaizen Objectives

Scope (Beginning point to ending point)Admission to Discharge

Why are we doing this event?Reduce readmissions, decrease LOS, improve bed availability

Focus on the root causes for readmission within 30 days of discharge via the Discharge Planning and Education Processes. Establish

Standard Work to ensure predictable outcome each time.

Section 3025 of the Affordable Care Act added section 1886(q) to the Social Security Act establishing the Hospital Readmissions Reduction Program, which requires CMS to reduce payments to IPPS hospitals with excess readmissions, effective for discharges beginning on October 1, 2012.

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Kaizen Processes Used Process Flow Mapping

Function Potential Failure

ModePotential Effects

of FailureSeverity 1-3

Potential Cause(s)/Mechanism(s) of Failure

Frequency 1-3D

etection 1-3

R.P.N.

Recommended Action(s) Responsibility & Target Completion Date

Case MgmtStop paying

attention to the criteria

Population discussed in the meeting grows

2 Time pressures 3 1 6 Poke Yoke the criteria process DD/End of week

Pt home needs may not be metCore Measures would not be discussed

Increase chance of being readmitted for same diaganosis

All

Pt needed services that was excluded from the meeting by the criteria

Pt did not get services that they needed

3 Oversight by team member 1 1 3 Follow up with a call to the patient Case Mgmt as needed

MD

Discharge pt classified as not

ready to be discharged

3 9Not part of the meeting so no one was aware of what they needed,

did not have ordersFollow up with a call to the patient Case Mgmt as needed1 3

FMEA

# Activity / Task Task Time Tools Required What it looks like

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Reconcile computer schedule to the magnetic board. Check for Add Ons, Cancelations, and any other changes. Start at 0630.

5 min

Printed Current Schedule / Physical Magnetic Board

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Instruct Schedulers to update SIS with any changes. Final schedule to be completed by 0645.

2 min SIS

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Scheduler to print new schedule and give to board runner.

2 min Printer

PURPOSE:To ensure accurate role definition of responsibilities of the Board Runner

SCOPE: Defining the expectations of the Board Runner

LOCATION:BJSP Operating Room EFFECTIVE DATE: 11.7.2011

SUBJECT: Board Runner REVISION DATE: New

AUTHORIZED BY:Rebecca Fall DOCUMENT NUMBER:

SOP

Brainstorming & Trystorming

Problem Solution Discharge Planning Meeting often has information missing or incomplete leading to multiple follow-up to create the discharge plan for the patient. The meeting also lacks focus on what is to be discussed, which patients should be discussed, how the discharge plan will be updated, and who will complete any follow up items.

Developed standard work to include: • Patient population for the mtg. • Prioritization • Agenda • Closure on Follow-up Items • Measure

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# Activity / Task Task Time Tools Required What it looks like

1 Review discharge planning tab for patients and sort list by room number

10 mins Cerner discharge planning tab

2 Review and prioritize patients for manual add to discharge planning list

10 mins

3 Call meeting to order and identify roles 2 mins

4 Identify patient and review identified content 3 mins

Discharge planning list and Cerner (PowerChart/ PharmNet)

5 Determine actions and assign responsibilities 2 mins

6 Document discharge plan and update patient chart 2 mins Cerner Dicharge planning form

7 Repeat steps 4-6 for next patient 7 mins

8 Summarize actions to be taken 2 mins Notes from record keeper

9 Assigned actions completed and documented on discharge planning form

5 mins Cerner Discharge planning form

PURPOSE: To ensure a smooth transition from hospital to home and making sure home needs are met to provide appropriate treatment

SCOPE: Patients identified to be reviewed in the discharge planning meeting

Standard Operating ProcedureLOCATION: New Basement Meeting Room A EFFECTIVE DATE: 1/22/2014

SUBJECT: Discharge Planning Meeting REVISION DATE: New

AUTHORIZED BY: Administration DATE OF DEVELOPMENT: 1/22/2014

All follow up items completed & on time

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Measure daily completion of follow up items at each discharge planning meeting and education given to pts.

Track readmissions monthly related to COPD and CHF

Track LOS monthly

Metric Before Kaizen After Kaizen Reduce Walking 10, 500 hours @

$30/hr 5,250 hours, $158k savings

Eliminate VTE 12 per year @ $5k ea 0, $60,000 savings Reduce ReAdmissions 8% per year 4% per year, $800k

savings Reduce Re-Work 20,000 hours @$30/hr 0 hours, $600,000

savings

$1,617,500 annualized

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You learn a lot by visiting other departments and experiencing what they do

The cost of rework! How much walking we do How everything is connected I can understand why patients get so mad because we are constantly

showing up without what we need We can do better with time management We can accomplish a lot if everyone is together in one room for the

week We increased patient education Everyone has been open to the changes the team made Surprised at how quickly we were able to make changes When you involve the people who are going to be working with the

changes it makes it easier and quicker

Thanks for you for allowing me to present our organizational experience with LEAN PROJECT!!!

Questions?

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