Summary of Lean Activities 2004 - 09

Education

• Basic Education / Lean Thinking - System Management ... April 2004
• Lean Thinking Education to Lead Coordinator ... August 2004
• Boot Camp for Potential Kaizen Facilitators ... May 2005
• Educational Series (Six one-hour modules) ... Fall 2006
• Demo Projects ... October, 2006
• Trainer Lab (training resources across the system) ... November 2006
• Appreciative Inquiry ... November 2008
• Value Stream Mapping ... December 2008
• Poster Series ... 2008

Learning Labs

1. Homecare / Intake Department (December 2004 - November 2005)
Goal set to have all referrals scheduled/coded/insured by 5pm. Other goals included: implementing simpler, efficient processes, improving nurse and referral source customer service, and adapting the department to the computer system.

2. Samaritan Hospital / Pre-Admission Testing ( September 2005 - December 2006).
Goals set to have all charts complete 16 hours prior to surgery, decrease the # of delayed surgeries because of lack of information, decrease duplication of manual writing, H&P available, streamline the patient / physician point of entry and physicians using consistent forms.

3. Eddy Ford Nursing Home (December 2005 - January 2007)
Goals set to ensure staff communication of the plan of care / continuity of care for all residents on Unit 3, reinforcement of standards of care and communication of morning meeting points, and ensure all proper supplies, resources and equipment are available for caregivers when needed. First lab focused on a nursing unit.

4. Northeast Home Medical Equipment (May 2006 - June 2007).
Goals set to improve the delivery of service to the customer through Intake, Warehouse and Distribution departments and eliminate rework. First lab focused on management.

5. Trainer Lab (November 2006 - October 2007)
Representatives from across the system (Patient Care, Community Services, Housing and Residential Services Divisions) being trained in Lean thinking and tools with goal of having "Lean knowledge workers" across the system, who can teach Taste of Lean, help with day-to-day problems and spread the culture of Lean thinking across their divisions.

6. Primary Care Billing (June 2007 - August 2008)
Ensure accurate and timely billing on the first submission. Focuses on full Primary Care Network.

7. Heritage House Nursing Home / Nursing 3 Unit (June 2007 - September 2008)
Goals set to ensure staff involvement and communication of the plan of care for residents and patients on Unit 3, as well as communication on processes and procedures across all three shifts. Improve the dining room atmosphere and process. Ensure all proper resources, equipment, materials/supplies are readily available and functioning properly.

8. Empire Home Infusion Services (December 2007 - February 2009)
Goals set to ensure timely deliveries, decrease OT, assess processes in light of growth, increase communication, and standardize across processes to eliminate inconsistencies.

9. Patient Care (SH & AMH) Medical Records (November 2007 - June 2009)
Goal set to identify day-to-day issues, streamline current processes and empower front-line staff. Focus on coding, transcription and clerical processes.

10. AMH 5th Floor Nursing Unit (January 2008 - August 2009)
Goal set to maintain and/or increase patient and employee satisfaction, eliminate waste and standardize processes. Focus on all processes occurring on 5th floor (especially infection control).

11. Housing & NEH Finance (April 2008 - August 2009)
Goal set to standardize across the division and eliminate wasteful steps, where possible. Focus on payroll, budget, intercompany, payment, bill and financial statement related processes.

12. Eddy Senior Care Day Center (July 2008 - November 2009)
Goal set to improve communication across departments, improve satisfaction of staff, participants and families, ensure a smooth flow for potential participants visiting and for new participants' first day, and to meet the participants' needs by ensuring all scheduled activities in the Day Center are completed as planned.

13. Patient Care Purchasing / AP / Materiel Handling (August 2009 - Present)
Goal set to understand how each departments' work impacts the other departments and improve communication between departments. Also, decrease supply costs, increase electronic ordering, timely ordering and delivery, streamline processes and issues related to accruals and receiving.

14. Sunnyview/Heritage House Rehabilitation Services Intake (September 2009 - Present)

Demonstration Projects (October 2006 - December 2007)

1. Patient Care (Albany Memorial Hospital & Samaritan Hospital) Information continues to be printed which is available via the electronic medical record. Utilizing Lean thinking and the tools of Lean toward our goal of going paper less in the EDs (and eventually across the hospitals). Move to a "hybrid" chart (mix of paper and electronic) from a legal medical record standpoint. This team continues to meet (2008 & 2009)

2. Long Term Care (Residential Services Division & Eddy SeniorCare/PACE) High voluntary turnover of aides exist in our Residential Services Division and at Eddy Senior Care. Utilizing Lean thinking and the tools of Lean to decrease aide turnover.

Value Stream Mapping

1. Patient Care/Samaritan Hospital (December 2008)
Patient flow from the Emergency Department to inpatient to discharge. Goals include improving ED arrival to discharge time and time for admitting patients from the ED to floor to discharge, by decreasing wait times, non-value added activities and increasing communication.

2. Residential Services Division (July 2009)
Information flow across the resident's stay from referral to discharge, including all quality aspects. Goals include improving the information flow within all facilities to enhance workflow and meet the needs of our customers (defined outcomes for residents, staff, management and external entities). As a secondary goal, opportunities will be identified to improve operational processes across the division as well.

Kaizen Events

1. July 2004 - Homecare / Eddy VNA Commercial Payor Authorization Process

2. September 2004- Patient Care/AMH OR Patient Prep Process

3. October 2004 Patient Care / SH OR Turnaround Time

4. November 2004 - Residential Services / Eddy Cohoes Rehab Center Admissions Process

5. January 2005 - Residential Services / All 4 nursing homes & hospital lab - Physician-ordered lab process and reporting

6. March 2005 - Homecare / NEHME Equipment Pickup Process

7. March 2005 - Patient Care /Forms Revision Process

8. April 2005 - Housing / Beverwyck Refurbishment Process

9. May 2005 - Patient Care / AMH Patient Flow from ER to Inpatient and OR to Inpatient

10. June 2005 - Patient Care /Antibiotic timing for pneumonia patients in the ER

11. July 2005 - Patient Care / Samaritan Hospital Missed Medication Acquisition Pprocess

12. August 2005 - Homecare / Catskill VNA Agency Discharge Process

13. September 2005 - Residential Services / Hospitals Referral Discharge Process for Nursing Home Placement

14. October 2005 - Primary Care / Prescription Renewal Process for Chronic Medication at Routine Visit

15. November 2005 - Eddy Senior Care Pharmacy Ordering & Delivery Process

16. January 2006 - Homecare / Eddy VNA Nurse Scheduling Process

17. February 2006 - Housing / Assistive Living Facilities ALU Admissions Process

18. March 2006 - Patient Care / Medical Records Transcribed Reports Distribution Process

19. April 2006 Residential Services Division / All 4 Nursing Homes -Worker's Comp

20. May 2006 - Patient Care / AMH Infusion Pumps

21. June 2006 - System / Finance Monthly Intercompany Billing Process

22. September 2006 - Patient Care / OR Charge Process / High-cost Implants

23. October 2006 Patient Care / Samaritan Hospital Behavioral Health / Outpatient Clinic Registration & Scheduling Process

24. January 2007 - Eddy Senior Care Participant Scheduling Process

25. February 2007 - Housing / Glen Eddy Food Temperature

26. March 2007 - Residential Services Division / Nursing Homes & Outside Vendor Pharmacy Process

27. January - March 2007 - Primary Care Network Medication Renewal Process with Electronic Medical Record

28. May 2007 - Residential Services Division / All 4 Nursing Homes Computerized ADL documentation

29. June 2007 - Patient Care / Samaritan Hospital Flow of Patient from ED to Behavioral Health Crisis Unit.

30. September 2007 - Patient Care / Albany Memorial Hospital and Samaritan Hospital

31. October 2007 - Patient Care / Albany Memorial Hospital and Samaritan Hospital Coding Process for ED Outpatients

32. January 2008 - Sunnyview Rehabililtation Hospital Discharged Medical Record Completion Process

33. February 2008 - Patient Care / Samaritan Hospital Radiology Professional Billing & Collection Process

34. March 2008 Eddy SeniorCare/ PACE Service Requests

35. May 2008 - Patient Care / Samaritan Hospital Case Management Process / Length of Stay

36. May 2008 - Northeast Health/MIS Roll-out of New Technology

37. June 2008 - Northeast Health/Foundation & Finance Fund Balance Report

38. June 2008 - Patient Care / Assigning Appropriate Status - Surgical Patients & ED Patients

39. October 2008 - Patient Care Infectious Disease Case Review

40. November 2008 - Hawthorne Ridge Assisted Living/Alzheimer's Admission Process

41. February 2009 - Sunnyview Admitting Process

42. March 2009 - NEH Interoffice Mail / Courier Service

43. March 2009 - Sunnyview Outpatient Therapy Insurance Authorization

44. April 2009 - NEH / HR Performance Review Process

45. May 2009 - Patient Care OR Inventory Control Process

46. June 2009 - NEH Purchasing / AP Process / Maintenance

47. September 2009 - NEH User Access

48. October 2009 - Patient Care OR/Endo Specimen Labeling/ Distribution Process

Mini - Kaizen Events (2-day)

(Initiated as a way to address smaller-scoped projects but still adhering to the steps of the Kaizen process.)

1. November 2007 - Residential Services Division/ EMGC Resident - Personal Clothing Laundry Process

2. January 2008 - Community Services Division (Homecare)/HR - Personnel File Hire Process

3. April 2008 - Residential Services Division/Eddy Ford Dining

4. April 2008 - Housing / Hawthorne Ridge Independent Living Refurbishment Process

5. April 2008, July 2008, January 2009 - Rehabilitation / Sunnyview Block Scheduling

6. April 2008 - Housing / The Glen at Hiland Meadows Assisted Living Medication Re-ordering Process

7. April - June 2008 - Community Services Divison/Eddy VNA Intake Referral Mapping

8. June - July 2008 - Northeast Health Managment Information Systems/Problem Solving Approach

9. September 2008 - Residential Services Division Access

10. January 2009 - Rehab/Sunnyview Audiology Charging

11. January 2009 Rehab/Sunnyview Nurse Scheduling

12. February 2009 - AMH Cardiac Patient Flow

13. March 2009 - Residential Services Division/Eddy Village Green Orientation

14. March 2009 - Samaritan Hospital Healthy Families / Screening and Assessment Process

15. May 2009 - Beverwyck Trash Runs

16. May 2009 - Residential Services Division / Sunnyview Handling Alternate Levels of Care (Process mapping & ideal state)

17. June 2009 - Eddy SeniorCare/PACE Intake Process

19. July - October 2009 - Samaritan Coding INO Process (process mapping)