1. To add a picture background: 1.From the Design tab, Background group, select Background Styles > Format Background 2.In the Format Background dialog box, select Fill > Picture or texture fill > Insert from file 3.Choose a picture from your files and press Insert 4.Close the Format Background dialog box OUR EMERGENCY DEPARTMENT AT HRINGBRAUT Kleppur - 14-18. september 2015

2. WHERE ARE WE COMING FROM….

3. ……WHERE ARE WE HEADING

4. A POINT OF NO RETURN…

5. Thank you: Thank you all for being here this whole week Opportunity: Once in a lifetime opportunity to organize the ED and the whole hospital. Organize and standardaize and maintain standardized work from the opening day Continous improvement: Requires continous learning. How can a building foster continous improvement. How can we design it to be flexible and useful in the future ? Not plug and play: Increase patient safety, eliminating waste, reducing travel and waiting, lowering cost. Creating a culture: Not build a new hospital that imports the old systems. THIS IS THE APPLE OF OUR LIFE 5

6. What is Lean ? It is management philosophy based on two tenets: Continious process improvement og respect for people. What are we going to do this week ? : Work with the overall layout of the Emergency Department in our new hospital building at Hringbraut using the 3P model What is 3P : Product, Process, Preparation Patient: Always first, patient centered care, respect THIS WEEK WILL BE CREATIVE 6

7. New spaces are needed New products or services New processes or providers WHICH IMPROVEMENT NEEDS ARE CANDIDATES FOR A 3P? 7

8. LEAN-LED HOSPITAL DESIGN 1.Look at the ways work is currently done 2.Determine how work could be done better, more safely and more efficiently in future we can even adapt right now 3.Design for that future target

9. LEAN-LED DESIGN PRINCIPLES Think systems, not silos – share spaces between services Standardize Create a visual workplace Waiting is waste Pathways should be direct – smooth flow Form must follow function Understand and improve processes and then determine space.

10. EXCAMPLE FROM THE BOOK – SOUNDS FAMILIAR ! WE HAVE TO UNDERSTAND THE PROCESSES “The ED could not understand why discharge took so long, staff on the floor were unhappy with the incomplete documentation that sometimes arrived from the ED and The Case Management was frustrated with its attempts for control the process” “ Because nurses couldn´t rely on always having linens where and when they needed them, they hoarded and that resulted in over- ordering “ 10

11. VISION FOR THE ED.. Second to none – Patient always first Highest levels of quality, safety and efficiency - Our services should be Safe Timely Effective Efficient Equitable Patient centered

12. – Real-time indicators provide valuable information on various operational and safety factors – Are used both independently and with huddles REAL-TIME INDICATORS

13. REALTIME INDICATOR DASHBOARD AT LSH ED Array of indicators displayed as a dashboard website, 3 pages Displayed on 2 monitors, 1 main monitor in staff main work area, another out on hall visible to staff, patients and guests. Dashboard also accessable at each staff members computer station

14. REAL-TIME QUALITY INDICATORS PAGE 1 Guðlaug Rakel Guðjónsdóttir Number of pts. at ED major track Number of pt. in waiting area Number of pts. un- triaged Number of pts. at ED minor and major track Average time from arrival until seen by doctor Number of available ED beds Average LOS, pts. discharged home Average LOS, admitted pts. Number of pts. visits last 24 hrs.

15. PAGE 2 Guðlaug Rakel Guðjónsdóttir Number of pts. admitted to hosp. last 24 hrs. Number of pts. that left without being seen NEDOCS Number of Hemolysed blood samples last 24 hrs.

16. PAGE 3 Number of pts. admitted to hosp. last within 6 hrs. last 24hrs number of pts. vs. percentage Number of pts. discharged within 4 hrs. last 24hrs number of pts. vs. percentage Number of pts. visits during the last 10 days Number of pts. admitted to hospital during the last 10 days

17. MEASUREMENTS – WHAT IS IMPORTANT TO MEASURE ? Number of adverse events Patient satisfaction LOS Emploee satisfaction Finances …………… …………….. …………..

19. THINK OUTSIDE THE BOX AND HAVE FUN !! Patient first Great opportunity Responsibility, affects the future health care services in Iceland Creating a culture THIS WILL BE A BUISY WEEK 19

20. To add a picture background: 1.From the Design tab, Background group, select Background Styles > Format Background 2.In the Format Background dialog box, select Fill > Picture or texture fill > Insert from file 3.Choose a picture from your files and press Insert 4.Close the Format Background dialog box THANK YOU