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Industrial Engineering in an Unusual Healthcare Setting Richard Blackwell Project Director, Process Quality Cermak Health Services November, 2009.

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Presentation on theme: "Industrial Engineering in an Unusual Healthcare Setting Richard Blackwell Project Director, Process Quality Cermak Health Services November, 2009."— Presentation transcript:

1 Industrial Engineering in an Unusual Healthcare Setting Richard Blackwell Project Director, Process Quality Cermak Health Services November, 2009

2 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

3 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

4 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

5 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, …)

6 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

7 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

8 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

9 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

10 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

11 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

12 The Approach – Six Sigma  DMAIC process improvement  D efine the problem  M easure the scope of the problem  A nalyze process data to understand the root causes of the problem  I mprove the system performance  Implement C ontrol system to monitor performance and prevent re-occurrence of the problem

13 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

14 A Process (“Swimlane”) Map Dept Process Logic Sub-Process Operation

15 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”

16 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

17 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

18 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

19 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

20 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

21 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

22 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

23 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)

24 QualitySystem  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

25 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

26 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

27 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

28 Links and Resources  my slides and other materials  lots of ideas and resources re Lean methods and tools  starting point for Six Sigma and many other directions in Quality  IIE Society for Health Systems  ASQ Healthcare Division  professional certification for Project Managers and lots of tools

29 Questions?

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