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.

1. How Organizing Linen & Supplies Turned
Morning Care from Frantic to Meaningful
Ngaire Woodroffe Brown, RQHR and Jill Forrester, 3sHealth
www.qualitysummit.ca
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2. Faculty/Presenter Disclosure
Faculty: [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

3. 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]

4. Mitigating Potential Bias
• [Explain how potential sources of bias identified in slides 1 and 2 have been
mitigated – n/a]

5. 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

6. 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 Program
Jim Crawford, Director, Provincial Linen Services, 3sHealth
Steve Adkins, Director, Support Services, RQHR

7. Successes
Defects 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

8. 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

9. Replication at Wascana Rehab
Unit 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 #2
May 2014
Replication #4
June 2014

10. Stage 1 Replication: January 2014
gating Potential Bias
Care Aides : Willy Aubon, Erica Church and Tammy Watson
Kaizen Support: Tyler Chiddenton (MoH), Bob Parker (RQHR) and Jennifer Fetch (3sHealth)
Sponsor : Ngaire Woodroffe Brown, Director, Extended Care/Veterans Program, WRC (absent)

11. Soiled Room 5S
Pre 5S

12. You Know They Were Keen….
Soiled Room
Replication attempt

13. Pre-Kaizen Linen Carts
• Linen sits exposed and touched for
days/weeks
Cart sits in hall 24 hours/day
Only 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

14. New AM Care Standard
Rounding 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

15. Tena Kanban
After
Right amount, right time in right
location. Residents & families aware.
Before
Cluttered. Right amount?
At right time?
In right location?

16. Tena Kanban – Our Tena Cupboard
Insert photo of regular products in cupboard Special
Order
Products
Stock /
Regular
Order
Products

17. 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”

18. Replication Event Agenda

19. What Happens - Preparation Week
1. Kick Off Meeting
 Sponsor comments
 High level Lean review; Source team talks about wastes removed with new
processes
 Fear & expectations with group

20. Preparation Week cont’d
2. 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

21. Preparation Week cont’d
4. 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

22. And Then Event Week
Monday
• 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

23. Event Week con’td
Thursday
 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.

24. 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

25. 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

26. Replication Wall
Lastly,
keep your “eye on the prize”….

27. Questions?
Contact Us:
Ngaire Woodroffe Brown, Director, Extended Care/Veterans Program, WRC or
Jill Forrester, Director, KPO, 3sHealth
Ngaire.Woodroffebrown@rqhealth.ca ; Jill.Forrester@3sHealth.ca
www.qualitysummit.ca
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