This document summarizes a project to improve the flow of patients through a hospital's surgery/procedure department. The project aims to reduce cancellations, negative patient comments, and incomplete charts while better aligning staff skills with tasks. Key stakeholders overseeing the project include the director of outpatient services, chief nursing officer, and COO. The value stream manager is Angie Anderson, RN, and team members represent central supply, patient access services, and central scheduling. The project manager is Amanda Rommell. Metrics include cancellation rates, patient satisfaction comments, and completeness of medical charts.

2.  Project: Any process that drives patient
movement through the surgery
department.
 Purpose: To improve the flow of value for
the patients of the Paul Oliver Memorial
Hospital Surgery/Procedure Department
 Targets: Fewer Cancellations, Fewer
negative comments about procedure
prep, fewer incomplete charts, better
alignment of skills to tasks.

3. Executive Sponsors: Donna Clarke, Debbie
Link, Peter Marinoff
Value Stream Manager: Angie Anderson, R.N.
Team Members: Carolyn Erickson (Cent.
Supply) Jamie Gillison (PAS), Karen Mabrey
(Cent. Sched.), Carolyn Feltes, RN (Pool)
Project Manager: Amanda Rommell

4. The processes that drive patient movement through the February 16, 2012
surgery department Initiation Date:
Project:
Donna Clarke – Director of Out Patient Services
Debbie Link – Chief Nursing Officer
Sponsor/ Leadership Panel: Peter Marinoff - COO
Angie Anderson, RN
Value Stream Manager (Person most directly
responsible for the project area):
Carolyn Erickson (CS), Jamie Gillison (PAS), Karen Mabrey (C. Sched.), Carolyn Feltes, RN (Pool),
Team Members:
To improve the flow of value for the Paul Oliver Memorial Hospital Surgery/Procedure Department.
Purpose of Project:
* Fewer Cancellations
* Fewer negative comments surrounding the Prep process
Metrics and Targets (What metrics do you * Less incomplete charts
anticipate changing after the project, what * Better aligned skills with processes
are your goal numbers?):
Scheduling of procedure through receipt of patient satisfaction survey.
Project Scope (Beginning and end points of
the project):
Parameters (Processes that must be followed,
constraints, etc.):
Current Value Stream Map
Future Value Stream Map
Demonstrable knowledge of LEAN processes & Tools
Deliverables (Tangible outputs of the project):
Complete current VSM within wk by date
Timeline, including target completion date:
Sponsors will be updated weekly through August, 2012 and then monthly through December 2012.
Updates (How often will leadership be
updated?):

6. We discussed the rules, the types of waste, and
our metrics… we were ready to go!

7. After we finished the class-room work of defining
each step of the Colonoscopy process, it was time to
go to where the work is done (The GEMBA) and see
how it all fits together. This is also where we collect our
data!
Central Scheduling OR Office Central Supply

8. There was major disconnect in the
Ordering of Stock Room Supplies for the
LTC
› Staff were requesting supplies to be ordered
that were already on order causing a lot of
over-ordering
› The stock was running out on the floor
causing low par levels
› Things were being stored in multiple places
throughout the store room and on the floor.

10.  We Sort, Set in order, Shined, Standardize
and Sustained…
› This included cleaning the supply room and
removing items that didn’t belong
› We organized things that were “like” in order
to make finding items easier
› We cleaned the floor and ordered new
storage items
› We labeled everything!!! We used item
names and numbers, par levels and
corresponding order forms.

11. Now staff can easily identify what products go where, what should be ordered
when it’s gone and how much of each supply we stock!

12.  We also needed a
way to let all shifts
know when items
were ordered and
when they would
arrive…

13.  We focused on two areas that had relatively low %
complete & accurate
› Information complete and correct from registration
 There were 4 hand-offs of patient material in the current
value stream. We reduced this to just 2 hand-offs with a
minor change.
› PAS being able to contact the RN when patient
arrives.
 The current state had the patient checking in at the front
desk, waiting in the lobby, being taken by a RN to another
waiting area, and then back to the Recovery Room.

14. PAS Schedules - Prints
PAS stickers Chart and
Itinerary x 2
files.
Or Picks up 1 copy of RN Picks up Chart on day
Itinerary & Makes Chart of surgery
BEFORE AFTER
RN Picks up packet and
creates/stickers chart &
returns to front desk
PAS Schedules, Prints
Itinerary (x1), stickers and Patient brings chart to OR
facesheets waiting area for RN

15. Before After

16.  Prior to our Improving the flow work…
patient charts lived incognito and
created large batches….
 Now they have a home
And it’s clear to see when there is work to
be done!

17. BEFORE AFTER

18.  This group was really well organized
already. Though it may have been
difficult for someone else to step in and
know where thing are or how to replenish
items…
ENTER 5’s and KANBAN

19. BEFORE

20. AFTER

21. Next we met as a group to discuss what we want the future of this
Value Stream to look like
THINGS WE NOTED
1) Many small changes had already improved some of the
steps, and added value to most of them.
2) We had to really focus on thinking about what we WANTED
the future to look like and look beyond the obstacles that
were present NOW

22. CURRENT
FUTURE

23. The A3