Robert White, MBA
Lean is a production process that considers the use of resources for any goal other than the creation of value for the end customer to be wasteful and a target for elimination (Wikipedia), and a kaizen event is a fast-acting process of implementing change. At Portsmouth Regional Hospital, a team that included members of the radiology department, centralized scheduling, a floor nurse, and the COO entered a room with the goal of improving customer satisfaction and emerged five days later with a plan to implement 8 different Kaizen events that resulted in savings of $350,000 and soaring customer and employee satisfaction scores. Robert White, MBA, and Elizabeth Vierra, Portsmouth Regional Hospital, Portsmouth, NH, described the process in the session “How LEAN Methodology Can Improve Customer and Employee Satisfaction.”
Contending with physicians, nurses, and patients that always seemed upset, the team began by observing the department processes using a stopwatch and writing down the number of steps it was taking to perform each one. Processes were categorized as direct care (taking care of patients), indirect care (prepping a room), regulatory (required by The Joint Commission), or one of 8 kinds of waste: defects, overproduction (preparing contrast for patients not on the schedule), waiting, not clear, transporting, inventory, motion.
The team made good use of the following LEAN tools:
• The 5 S Process: Sort, straighten, shine, standardize, and sustain.
• The 5 Whys: To find out why someone does something the way they do, ask why, then why, then why, then why, then why. “Sometimes you can find out in less than five, and sometimes it takes more,” White notes.
After making observations, such as the fact that the average technologist walked 7.5 miles each day, and collecting data, the team constructed pie charts for each modality to calculate how much of the process was categorized as waste and created a value stream map that identified problems in scheduling, transporting patients, availability of supplies, a name band that technologists had to scan repeatedly, and a confusing questionnaire.
Next followed a period of Idea Generation, and each person was asked to illustrate four ideas using crayons and paper. This process resulted in six action plans:
Action Plan #1
Problem: A confusing and lengthy questionnaire patients were required to complete upon entering.
Impact: It took 5 to 15 minutes to complete, seriously limiting the department’s ability to get patients into an exam room within 10 minutes of arrival.
Countermeasure: Condensed the questionnaire to two sides of one piece of paper. Rewrote the questions for clarity.
Action Plan #2
Problem: Scattered supplies, particularly in the CT area and specials.
Impact: Technologists (particularly per diems) were forced to rummage through cabinets looking for what they needed and patients lost confidence in the process.
Countermeasure: Management spent several hundred dollars (the only capital cost for the improvements) on replacing the cabinet doors with glass; labeled each shelf; gave each item a place; put someone in charge and made the staff accountable for order.
Action Plan #3
Problem: Multiple scanning of armbands in exam rooms.
Impact: Technologists were spending 30 minutes per month re-scanning arm bands; this was not just an imaging problem, but a house problem impacting the entire hospital.
Countermeasure: Brought in the vendor, who did house-wide training on how to use the armbands.
Action Plan #4
Problem: Inaccurate orders.
Impact: 70% of CT exam orders were inaccurate, resulting in excess processes. Impact on nursing was 10 minutes per defect.
Countermeasure: An Imaging Services Reference Guide was created and distributed to all referring physicians; the guide was also added to the internal web site; and “did you know” cards were created and distributed to the relevant departments.
Action Plan #5
Impact: Time loss.
Countermeasure: Under development.
Action Plan #6
Problem: Exams scheduled in clusters and resources for exams did not match appointment times
Impact: Referring physicians were sending patients to competitors.
Countermeasure: Reviewed and updated appointment templates and improved the number of patients that were delivered to an exam room within 10 minutes of arrival from 33% to 72%
The results have been impressive. Customer satisfaction, which began at an anemic 47%, soared to