Hospital borrows ideas from manufacturing

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Photo credit: FKP Architects
Children chose the colors and designs for Alfred I. duPont Hospital for Children’s bright blue exterior as well as its comfy room furniture. FKP Architects worked with patients and families to make the new building more family-friendly.

AI duPont reinvents efficiency in new hospital wing

By Kathy Canavan
Senior Staff Writer

When you treat small humans instead of small cars, you can’t use all Toyota’s timesaving techniques, but the new wing at Alfred I. duPont Hospital for Children comes close.

The wing is actually a 450,000-square-foot solution.

Using just-in-time delivery systems and value stream mapping, the hospital has already been able to shave its emergency room wait time and the new wing will likely reduce it further.

When they examined every single step they take, staffers realized most admission backups had their roots in their double-room system. They couldn’t put a newborn in with a 15-year-old. They couldn’t put a girl in a boy’s room. On top of that, some children had to be in isolation.

Because eight out of 10 admitted patients enter through the emergency department, staffers suggested a radical redo. Every room in the bright blue new wing is private.  It’s not an expansion; it’s a do-over.

“It’s not about saving money. It’s about improved care for our families,” said hospital spokesman Chris Manning. “We know that, in the end, efficiencies with time shift to the patient. There is a return on investment that we may not be able to quantify.”

At a hospital that has a “value stream manager” and a “continuous improvement office” the rethink doesn’t stop there. Staffers looked outside to Toyota and California hospitals for ideas they could use, but they also looked inside. They asked for suggestions form nurses and housekeepers who see all the moving parts close up.

“People closest to the work generally know what the problems are and how to solve them,” said nurse Susan Scheidegg of the continuous improvement office.  “This all comes from Toyota processes and how they’ve evolved. They have a system they look to but they also look to their people to be problem solvers.”

The new wing will use a just-in-time supply chain – a system that’s already been tested in the old hospital’s Emergency Department.

That department orders only enough supplies to last the maximum time it takes to get more from a supplier. No more warehouses. No more expired stock. No more nurses in the supply chain.

Hundreds of blue plastic bins are filled with supplies. Behind them: hundreds of lookalike bins filled with identical supplies.

The old method: If a nurse took a pair of slipper socks, which turned out to be too large for her patient, they’d live in her pockets until she put them back, took them home or emptied her pockets at the nurses’ station.

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Photo by Kathy Canavan
Susan Scheidegg, a nurse and continuous improvement specialist, explains the blue bin system, the hospital’s just-in-time delivery system that saves nurses’ time, allowing them to spend more time with their patients.

The new grab-and-go method: A nurse takes the supplies she needs until the bin is empty. A supply technician scans the barcode on the side of that empty bin, and a supply order is created. Every order is tracked on a computer dashboard. If a nurse finds extra products in her pockets at day’s end, she places them in a returns bin, and the supply tech files them correctly.

“We designed this from the ground up, modeled after things done in manufacturing,” said hospital spokesman Chris Manning. “This makes it possible to take our nurses out of supply-chain management and lets them use that time to improve service to the patients.”

Analyzing every step turned up another time waster. Nurses often hunted around a patient room for a roll of tape or left the room to fetch one. Now a mini supply closet stands in the same place in every room.  “We’re trying to make them pretty much the same across the hospital,” Scheidegg said. “We want to make it easy so nurses can get back to the bedside taking care of patients.”

Joanne Skahill, the Emergency Department’s flow supervisor, said 147 things that happen between the second a doctor signs discharge papers and the moment the patient leaves the hospital. Her team analyzed each one. Their take: By bringing a team to the patient instead of bringing the patient to a nurse, a respiratory therapist and a registration clerk, they could save time. Discharge time dropped from 31 minutes to 12.

Staffers asked children and parents what would make their stay easier, and their ideas were incorporated into the new wing right down to furniture design and fabric choice. One major change: All nurses will wear royal blue and doctors will don white lab coats so it’s easy for families to find one when they need one.

Nurses stations were redesigned to make it easier to communicate. Huddle boards were erected. Skahill’s team erected huddle boards throughout the Emergency Department so the night staff could relay messages about events that might affect the daytime operation. When shifts changed, the morning staffers meet around the board and conjure up solutions to any problems.

Some of the fixes the teams thought up didn’t exist 10 years ago – apps, texting and iPads. Others have been used in hospitals and manufacturing for years, such as the concept of a standard work, the most efficient method to perform a service and achieve a desired output.

The hospital has taken advantage of manufacturing’s innovations, but Skahill said there’s a limit to the number of business solutions that can be recycled for a children’s hospital.

“Toyota is dealing with nuts and bolts and we’re dealing with humans. Here, the patients just arrive. We can’t tell them when to arrive. If six of them arrive together, we need to flex to take care of them,” she said. “It would be great if they came in maybe every six minutes, but they don’t. And they don’t have the same needs, parents or resources. We’re still trying to make it a standard work as much as possible by figuring out what works best and then doing it over and over, while being flexible to each child’s needs.”

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