Kaizen Event Report-Out Presentation “Right Sizing Linen” New England Rehab Hospital November 14-15, 2011 Jeanine’s Green Belt! 1
Kaizen Event Report-Out Presentation“Right Sizing Linen”
New England Rehab Hospital
November 14-15, 2011
Jeanine’s
Green Belt!
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Kaizen – Definition
The word “Kaizen” is a
Japanese word that simply
means “Change for the
Good”!
Most importantly, Kaizen is about making change happen with continuous incremental
improvement with empowered teams!
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Kaizen Process
Nov 14 (8-noon):
Training, Discovery
& Analysis
November:
Preparation
3
Nov 14 (noon-4pm):
Solution Brainstorming
Nov 15 (8-noon):
Idea Validation &
Implementation
Nov 16 +:
Result Follow Up
• Floor Staff
– Surveying rooms
• Housekeeping
– Jim, Tom
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• Kaizen participant managers
– Nurse Manager, EVS, Linen Services
Special Thanks!
• Other
– Pam Cline, Scott (Marketing), Richard (MMC Engineering)
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• James Mangini, Linen Services
• Clyde Ramsdell, Linen Services
• Petronilo Rodriguez (Pete), EVS Lead Associate
• Jesse Gage, RNT II
• Hannah Maltby , RNT I
• Aline Schultz, RNT II
• Debora Mambuca, Inf Control Practitioner
• Courtney Webb, Physical Therapist
• Wendy Dibrigida, Occupational Therapist
Team Members…
Our Team’s Goal:
• Problem Statement– The proper amount of clean linen is not always available
– Linen is being used for non-linen uses
– Linen inventory levels have never been "right sized“ causing excess
cost for storage or excess complaints for lack of linen
– Patient use area linen storage has never been standardized to
maximize efficiencies and reduce searching/obtaining linen
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Improve linen costs & implement sustainable systems
Kaizen Overview
• Scope– Clean Linen with NERHP
– “Dock to stock”
– Departments involved are Environmental Services, Nursing and Therapy
• Metrics– Reduce inventory levels from 26,000 lb/month and $14,000/month
– Reduce the # of retrievals thus allowing Nurses to do other things
– Reduce the # of complaints from 50 per week
– Increase patient and staff satisfaction from complaining to proclaiming7
Kaizen Overview
• 3 Teams. 2 hours in the GEMBA.
1. Data & Process (Clyde, Aline,
Courtney)
2. Patient Rooms (James, Wendy,
Hannah “Vanna”)
3. Linen Rooms/Closets (Pete, Jesse,
Debora)
4. Kaizen discovery coordination
(Jeanine, Matt)
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DiscoveryWhat did we observe?
Wrong size for the job
(opportunity for soiling
more linen$$)
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Inadequate
quantity,
“stock-out”,
in wrong
place, clutter
Throwing away
excess & not using
the best linen for
the job
DiscoveryWhat did we observe?
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1. Excess motion: 30 retrievals in
one hour. Etimated 300
retrievals per day * 2 minutes
per retrieval = 10 hours per day.
5 of those hours are waste.
2. Excess delivery time that
inhibits proper response time,
causes complaints, increases
the cart’s “safety hazard” time
and may result in “stock-out’s”
18 delivery
locations
serviced 3
times daily and
6 days per
week
DiscoveryWhat did we observe?
Gym: 2 spots
PT: 2 spots
1st floor: 4 spots
2nd floor: 10 spots
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Rod is less than
18” below ceiling
(fire hazard)Shower rooms:
DiscoveryWhat did we observe?
No shelving for staging (avoid
infection/soiled linen)
Not every room had a trash
or sharps container (no
standardization)
Mopping with linen
(increasing soiled linen cost)
Inadequate drainage &
curtain containment (causing
a lot of linen to be used on
floor)
Room is too small (causing
staff to bring in a large batch
of linen – waste!)
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No standard
location to store
linen in each room
Patient rooms:
DiscoveryWhat did we observe?
Used under chairs to
move (preventing floor
scratches, but increasing
soiled linen cost)
No consistency on how much
linen per new patient (2
pillows, 2 pads, warm
blanket in cold season)
Excess is “automatically”
givento each new patient
(and typically stored on
window sill)
13
Crash
Cart
liner/
cover
Spill & condensation
prevention
Under chairs to
move across floors &
prevent scratching
DiscoveryWhat did we observe?
Non-linen uses:
Foot, Ankle,
Knee, Back,
Neck
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1. Ambulatory
2. Ripped johnny’s
3. Bed bugs
4. Preventing “stock-out’s”
5. Preventing linen from falling off carts
6. Setting up a new patient’s room
7. Changing linen during stay
8. Cleaning a shower room
9. Stocking the 9 2nd floor linen closets
10. Getting “stocked-out linen” (call, page, email
housekeeping, go to another room or floor or area)
No adequate policy or procedure or adherence to a consistent process:
Ambulatory taking linen
DiscoveryWhat did we observe?
• Process mapping
• Waste identification
• Standard Work training
• Affinity diagram
• Priority – Payoff matrix
• Time/Motion study
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AnalysisWhat tools did we use?
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AnalysisWhat did our data tell us?
• 30 key issues
• Tools, methods, habits & policies
• 2 Parking Lot ideas
• Linen color & larger bath towels
• 2 future kaizen ideas
• Linen cart swapping, Pin Notebook
• More than $16,000 in annualized inventory cost savings
• Reducing PAR levels, “right sizing” par levels
SolutionsWhat did we validate?
We validated many ideas with staff
• Right number of linen for a new patient & caring for a
patient (under-pad, blankets)
• New process for distributing linen
• New process for managing soiled, heavily soiled & ripped
linen
• Patient related process changes, for example, unoccupied
beds, room transfers, positioning, shower room
SolutionsWhat did we implement?
Training aids:
• Laminated placards:• Window sill
• On bathroom wall
• On patient bulleting board
• Inside each PIN (patient
information notebook)
Door
On window sill
PIN
Pt Bulletin Board
SolutionsWhat did we implement?
Training aids:• Communication flyer’s:
• Upstream to hospital
liaisons
• Staff handout “What’s
changed” (to each shift,
RN manager & signed)
• On staff bulletin board
“Linen tip of the month”
Bulletin Board
PIN
SolutionsWhat did we implement?
Adjust inventory:• Updated Par Levels in the computer system
• Maine Med will supply only the PAR level and sorted
• “Right Sized” each
linen storage area
• Labeled shelves in
linen closets/cabinets
with item name and
PAR quantity (not to
exceed #)
• Straightened and
labeled nurse unit
linen carts
BEFORE
AFTER
SolutionsWhat did we implement?
Linen solutions for non-linen use:• Paper clothing protectors
• Sternal Pillows
• Spill clean up
• Cart Covers
• No personal use of linen
• Water pitcher coasters
• Patient positioning
• Shower & spill clean up
• Teen Johnny’s instead of cutting them
SolutionsWhat did we implement?
Process changes:• No distributing to patient rooms (except new
patient setup)
• New patient setup with standard linen
• Nurses stock 9 R2 linen closets only to PAR levels
• No using tape on linen
• Use a moist hot pack to avoid burn and excess linen
use
• Heavily soiled & damaged linen have a new bag
• Sorting linen in basement (distributing time will be shorter)
SolutionsWhat did we implement?
New patient care tools:• Propping/positioning will be done with blanket in a pillow
case
• “Project pads” for mopping floors after patient showers &
general spill clean up
• Bath mat’s for shower floors
• Cart covers for linen carts
• Paper towel use for water pitcher coasters
• Project pad bag for soiled “project pad’s”
• Clean, damaged Navy blue bag
• Future “Alex” machine for ambulatory dispensing
• Towel bars in shower rooms for staging [less] linen
• Teen johnny pants will be in circulation in January
• Linen picture & spec glossary at Nurse station