From East Tennessee Children’s Hospital

Before a Food and Nutrition employee would have to take a trip to the PICU just to take food inventory.  Now the PICU night shift Unit Secretary takes inventory and faxes an inventory request to the kitchen.  This also allows PICU staff to provide for special patient food request and preferences.  Once this change rolls out hospital wide this new process will free up over one hour of the Food and Nutrition employees time and allow them to provide much needed support to other operations in Food and Nutrition. The new process is also showing more than $1 in food expense per patient per day in the hospital.

Floor Stock Procedure

CI Board Explanation

This is the continuous improvement board we use in our PICU to help promote and progress daily kaizen.  We meet around it weekly for quick 15 minute meetings to discuss ideas, problem solving progress and to celebrate continuous improvements wins.  It is divided into four sections:

1) Front Line Walks:  This section is for key stakeholder and management to sign off that they have attended a quick stand up meeting or completed a gemba walk in the department.  It is a visual tool to help move our management style to a lean culture of “Go See, Ask Why, Show Respect”

2) Problems to Solve:  This is the visual idea board discussed in Mark’s book Healthcare Kaizen.  Staff members pin their idea cards onto the board.  We then discuss these ideas as group including all affected departments and talk about ideas “To Do”.  In addition, we have started taking the “To Do” ideas cards to the staff lounge and let the frontline staff vote on the next problem “To Do”.  This has helped staff that cannot attend the meeting have a voice in the process.  Once an idea card has been started we then move it to the “Doing” column.   Finally when the idea has been implemented we move it the “Complete” column.

3) A3:  This section is dedication to the problem solving of the idea cards.  We use the A3 problem solving process to help ensure that we are practicing “Second Order” problem solving and not creating more work around or short term fixes.  We want to get to the root cause of these problems so that they never occur again.

4) Kaizen Wall of Fame:  This area is used to celebrate completed idea cards and A3’s.  We post these both on the department continuous improvement board and on a bulletin board outside of our cafeteria.  Our hope is that we can share these solutions with other departments throughout the hospital and help them implement these improvements.

East Tennessee Children’s Hospital “CI Board”

A Kaizen from East Tennessee Children’s Hospital and their PICU. Here is an example that is good for patients and staff (less delay) and is good for the organization (better charge capture).

Before there were multiple methods of informing Central Supply of the need for cart refills.  Nursing could call down to Central Supply, fax a tick sheet or transport the cart to the bar code reorder workstation. The nurses were unsure of the “correct” method of ordering.  This caused confusions for both Central Supply staff and the PICU nurses.  Now the Central Supply and PICU nurses worked together to create one method that works for both departments. Patient charges are now captured on a charge sheet and entered into the reorder workstation without moving the cart.

CVL / Airway Cart Restocking for Patient Charge Items

A nurse voiced her concerns about the time it takes to access Ativan, a medicine used for seizures. PICU and Pharmacy worked together to get to the root cause of the problem and created a process to cut down the time and the number of steps in the process from eight steps to just four steps. This change has been implemented across the hospital to help all staff and patients.

Ativan Storage

Ativan Storage