How Organizing Linen and Supplies Turned Morning Care from Frantic to Meaningful
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How Organizing Linen & Supplies Turned Morning Care from Frantic to Meaningful Ngaire Woodroffe Brown, RQHR and Jill Forrester, 3sHealth www.qualitysummit.ca #QS14
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Morning care is, for many long-term care residents, one of the only times they get dedicated one-on-one time with a care giver. Before this transformation, however, if you visited the unit, what you saw was care givers scurrying up and down the halls looking for linen and supplies. Now the halls are empty and silent, because the care givers are where they need to be – delivering uninterrupted one-on-one care to residents with all the supplies they need just where and when they need them and in the right amount.
Transcript of How Organizing Linen and Supplies Turned Morning Care from Frantic to Meaningful
How Organizing Linen & Supplies Turned Morning Care from Frantic to Meaningful
Ngaire Woodroffe Brown, RQHR and Jill Forrester, 3sHealth
www.qualitysummit.ca
#QS14
Faculty/Presenter DisclosureFaculty: [Ngaire Woodroffe Brown & Jill Forrester]
Relationships with commercial interest: • [Grants/Research Support: none]• [Speakers Bureau/Honorarium: none• [Consulting Fees: none]• [Other: none]• No relationships to disclose? Not Applicable
Disclosure of Commercial Support• This program has received financial support from [n/a] in the form of [n/at]
• This program has received in-kind support from [n/a] in the form of [n/a]
Potential for Conflict(s) of Interest: • [N/a] has received [n/a] from [n/a]• [n/a ][developed/licenses/distributes/benefits from the sale of, etc.] a product
that will be discussed in this program: [n/a]
Mitigating Potential Bias• [Explain how potential sources of bias identified in slides 1 and 2 have been
mitigated – n/a]
Before We Begin… Linen & other supplies have a huge impact
Standard work is a powerful tool
Use strong processes, replicate thoughtfully
Communication is vital
The enormity of the improvement to care through something so simple!
The importance of thinking and acting as one
Context: 2 RPIWs March 2013 Potential BiasLinen Infection Prevention & Control throughout its trip through the facility
Housekeeping + Unit 3-5 (Joint Process Owners)
AM Care Routines & Supplies: Unit 2-5 (Process Owner)
Sponsors: Ngaire Woodroffe Brown, Director, Extended Care/Veterans ProgramJim Crawford, Director, Provincial Linen Services, 3sHealthSteve Adkins, Director, Support Services, RQHR
SuccessesDefects Eliminated
Soiled Room 5S• Touches of soiled linen to clean linen bags in soiled room and clean care givers
New Process for Gathering Supplies for AM Care • Touches to linen prior to use • Pre-kaizen - only 16% of linen tracked used in less than 48 hours after exposure
Number of times care givers left the room to get supplies during am care • Pre-kaizen – care givers left rooms 27 times in 2.5 hour time span for 10 residents
But We Weren’t Happy…
Audit Results
9 months had passed
Daily visual management in place
Sponsor had long term replication plan
Commitment from process owners and team members
Replication at Wascana RehabUnit M-5 M-6 2-5 2-6 3-5 3-6
5S Chart Room (as part of RPIW) 5S
5S Clean Supplies 5S 5S 5S 5S 5S 5S
5S Soiled Room RPIW (Joint Start)
RPIW (Joint Start)
AM Care Infection Control RPIW
AM Care Supplies RPIW
Tena Kanban Kanban
Bento Kanban Kanban
Clean Supplies Kanban Kanban Kanban
Replication #1 March 2013
Replication #2May 2014
Replication #4June 2014
Stage 1 Replication: January 2014gating Potential Bias
Care Aides : Willy Aubon, Erica Church and Tammy WatsonKaizen Support: Tyler Chiddenton (MoH), Bob Parker (RQHR) and Jennifer Fetch (3sHealth) Sponsor : Ngaire Woodroffe Brown, Director, Extended Care/Veterans Program, WRC (absent)
Soiled Room 5S
Pre 5S
You Know They Were Keen….
Soiled Room
Replication attempt
Pre-Kaizen Linen Carts• Linen sits exposed and
touched for days/weeks
Cart sits in hall 24 hours/dayOnly 16% of linen used within 48 hours
Care givers going in and out of room 27 times in 2.5 hour period looking for supplies
New AM Care StandardRounding cart prepared each morning then cleaned and put away Defects eliminated:
Linen exposed for minutes/hours Linen touched once prior to resident use Care givers do not leave room during
care
Variation Unit can decide whether to bundle or stack
linen
Tena Kanban
AfterRight amount, right time in right
location. Residents & families aware.
Before Cluttered. Right amount?
At right time? In right location?
Tena Kanban – Our Tena Cupboard
Insert photo of regular products in cupboard Special OrderProducts
Stock / Regular Order Products
Principles for Replication Plan
Use JBA tools and processes
Keep it as simple as possible
Engage team members from original RPIW (“pay it forward”)
Learn from workers on the gemba – update standard work where needed.
Build partnerships – “think and act as one”
Replication Event Agenda
What Happens - Preparation Week1. Kick Off Meeting
Sponsor comments
High level Lean review; Source team talks about wastes removed with new
processes
Fear & expectations with group
Preparation Week cont’d2. Current State at Source & Receiving Sites
Observe new standard work in action
Can’t simply replicate – need to integrate learnings and update standard work
3. Start Data Gathering
Identify 2-3 targets from RPIW target sheet
Gather the data in Receiving site to get baseline
Preparation Week cont’d4. Document Implementation Steps
Build detailed implementation plan for event week• Standard work for implementation• Photos, posters, communications• Measurement tools
5. Communicate
Share plans and results through daily visual management
Tour teams through source gemba
And Then Event WeekMonday
• Reaffirm standard work and prepare for implementation
• Communicate with team
Tuesday and Wednesday
• Implement the new standard work
• Communicate, train, begin post-kaizen data gathering
• Plan audit
Event Week con’tdThursday
Team members go back to work
KPO and TL document, troubleshoot, build report out
Daily check ins with team, sponsors and process owners
Friday: Report Out 1 p.m.
Replication Components
RPIW Stage 1 rep
Stage 2 rep
Build Package for Each Process• Standard work • Standard steps for implementation• Photos, signage and communication tools• Data gathering tools
Stage 2 rep
Stage 2 repReadiness Assessments
Cascading Replication Plan
Reporting and Tracking Audits
Lean Foundation:DVM, VSM
Communication of Plans by Sponsor
Learnings Liked the prep week, event week and report out; add 5S
3 day prep event worked; give at least 3 days for event week (ie. extra day)
Need Team Lead and and Sub Team Lead – KPO can’t do it all
Review current state – there will be changes….
Used waste wheel as starting point for discussion
Engage original team members in replication ( use the “pay it forward” approach)
Invite future replication partners to RPIWs and replication events
Clarify partnership arrangements & roles
Replication Wall
Lastly, keep your “eye on the prize”….
Questions?
Contact Us:Ngaire Woodroffe Brown, Director, Extended Care/Veterans Program, WRC or
Jill Forrester, Director, KPO, [email protected] ; [email protected]
www.qualitysummit.ca#QS14
