Tag: Arnold Palmer Hospital

OM in the News: Pink Slime and Lean Hospitals

The public is continually subjected to health-related scares, from food packaging to water bottles that contain BPA, a chemical that has been linked to cancer. The media also highlights food additives that are not really harmful, but just sound unappetizing, such as “pink slime” in ground beef and the use of dried insects to color beverages at Starbucks. Yet, according to The Reporter (May 10, 2012), our nation’s hospitals are the one place where people actually have the most reasons to be scared and to demand change.

Studies estimate that 100,000 Americans die each year from preventable medical errors and another 100,000 die as the result of hospital-acquired infections. This health-care safety problem can be tackled with the OM tools of lean and TQM. We see this in one of our text’s most popular video case studies, “The Culture of Quality at Arnold Palmer Hospital”– worth showing when teaching Chapter 6.

The good news is that a growing number of hospitals are dramatically reducing different types of preventable errors, including patient falls, bedsores, wrong-site surgeries and medication mistakes, using the principles of lean (Chapter 16).  Dr. Richard Shannon helped his Pittsburgh hospital achieve, in just 90 days, a 95 percent reduction in deaths caused by central-line-associated blood-stream infections–through improved teamwork and making sure the correct supplies are always readily available.  Because these improvements do not rely on expensive technology or years of specialized training, they can be replicated in any hospital.

A 2010 survey, however, shows the bad news–that most hospitals are not devoting time or resources to prevent central-line infections, which claim 30,000 lives annually. And these hospital-acquired infections cost the U.S. about $30 billion a year in unnecessary medical expenses.

Discussion questions:

1. What  OM tools in Chapter 6 can be applied to help prevent infections in hospitals?

2. After watching the video, what does Arnold Palmer Hospital do to maintain quality?

Video Tip: Project Management at Arnold Palmer Hospital

From talking to OM professors around the country, I have found that the 7 video case studies dealing with Arnold Palmer Hospital for Women and Children are probably the most popular in the video series we created for you to show in class. The other videos cover Hard Rock, Frito-Lay, Wheeled Coach Ambulance, Regal Marine, and Darden Restaurants. (But wait till you see what we have in store for the next edition of our OM texts: an inside look at OM in an NBA team!)

If you teach Project Management (Ch.3) in your course, here is a great 8.5 minute video to show– with a case full of real data to assign. Some of the points to make with the building of  the new 11 story Arnold Palmer Hospital addition are: (1) planning took place for over a year before the first dirt was shoveled; (2) there were a thousand plus meetings  to allow doctors, nurses, patients, staff, and others have a say in what the new facility should look like; (3) a warehouse a mile away was turned into a mock floor of the hospital so visitors could walk in and evaluate the placement of beds, bathrooms, windows, and even electrical outlets; and (4) MS Project was used to manage the whole project.

This latter point is important. In today’s weak job market, I encourage students to take advantage of the copies of MS Project (full-blown, but time-limited) that Pearson-Prentice Hall  provides with our book. Included is a self-paced tutorial , which together with the printouts at the end of Ch.3, can help students master this useful software–and beef up their resumes at the same time. You might even give extra credit to a student who solves the case study using MS Project, as opposed to using Excel OM or POM for Windows, the other free programs that come with the text.

Video Tip: Supply Chain Management at Arnold Palmer Hospital

We think our video case studies on the Arnold  Palmer Hospital for Children and Women have been very popular for 2 reasons. First, they cover seven different OM topics–from quality to layout to process design to JIT to capacity to project management to  SCM–which means you can follow one organization from start to finish during the semester. And second, hospitals are a great example of a service application of OM that students can relate to. So if you are looking for a video to spice up your supply chain (Chapter 11) lecture, this is a good choice.

Arnold Palmer Hospital (APH) used to belong to a 900 member national group purchasing organization (GPO), through which it saved money on virtually every staple it needed.  But not everyone was pleased. Doctors, for example, were given only limited brand choices of certain surgical implants, like pacemakers, through the GPO. And it was difficult to take advantage of local vendors who might provide better service and prices. By creating its own, much smaller GPO, with only 7 local hospital members, APH realized it could save 7%, around $7 million annually, on its $100 million in purchases. This savings came despite the increased overhead of starting one’s own purchasing department.

In this 8-minute video, you will see the power of an interesting group, a Medical Economics Evaluation Committee. The committee allowed hospital staff to have  input into the approved products list, picking the medical tools they preferred, but only after agreeing to stick with a few choices at the best prices–truly a combination of medicine and economics.

The video also shows the 3 tiers of suppliers and how they are effectively integrated into the supply chain to drive down costs, reduce inventory, and improve quality.

Video Tip: Layout of the New Arnold Palmer Hospital

Jay and I  have created two videos to accompany Ch.9 (Layout Strategies) : the first an assembly line analysis at Wheeled Coach (the ambulance manufacturer) and the second the design of a radical new building  for the Arnold Palmer Hospital.  The hospital layout was really exciting because we became involved in the project and filmed it from start to finish.

Instead of the traditional “racetrack” design (long hallways with a central nursing station on each floor), when the hospital  added the  new building  a circular “pod” system was designed. The whole idea was to cut down the walking time of the hospital’s most precious scarce resource: nurses. The average nurse (about 45 years old) was hiking 2.7 miles a day up and down the hallways to the central station.

The layout design process lasted over a year. Over  1,000 meetings of doctors, nurses, and patients turned into drawings and then into “test” layouts. The hospital rented a warehouse a mile away and created full-sized mockups of every type of room. When we toured, we were encouraged to comment on every aspect of the layout, from placement of electrical outlets, to pictures on the walls, to Murphy beds for guests, to bathrooms.

The result was  a roundish building with  central nursing pods for each cluster of 34 rooms (this is shown in Figure 9.22 in the book). What a change in walking time for nurses: a 20% drop with the new layout!

Nothing is perfect, though. Despite all the thoughtful planning, analysis, and mockups, the last time I visited the new building I found nurses still unhappy about the “local station” pods. They  had to go back and forth to the “central station” too frequently because everything needed was not at the local pods near the patient rooms. Layout is indeed part art, part science.

Video Tip: Capacity Planning at Arnold Palmer Hospital

This is the 3rd  blog I am making about the series of 7 Arnold Palmer Hospital  video cases we filmed a few years ago. The 1st two were: The Quality of Culture (10/13/10) and Flowcharting Processes (11/2/10). If you plan to teach either Supp. 7, Capacity and Constraint Management, or Chapter 4, Forecasting, you may want to show this third  film (8.5 min.) and assign the accompanying case study.

I like this video because there just aren’t many videos available on the subject and  because this is such an interesting scenario. When the hospital decided to expand some years ago, it had already far exceeded its capacity. It had tried everything to increase throughput, including moving certain surgical procedures to a sister facility a mile away, having staff drive patients home as soon as they were ready for discharge….anything to free up a bed in a more timely manner.

When all else failed, the new building plan was put in place, but the issue of capacity planning continued. This time it was whether to build for forecast demand,  or actual demand. Using  Figure S7.6, the hospital used a lead stategy which allowed for major portions of the new building to be left in concrete shell form until a build-out was needed.

Although annual births had been on a constant increase for 15 some years, this turned out to be a good choice for capacity planning. As you may know, the economy in Central Florida (Orlando) has absolutely tanked, with less newcomers, and less births, in the area than was ever expected.

I usually present this video case when I teach Forecasting, as it presents an excellent integration of the topics of trend projection/regression analysis and capacity.

Video Tip: Flowcharting at Arnold Palmer Hospital

Many of our colleagues think flowcharting is an invaluable tools we should be teaching in OM. I agree, and every semester I show the video Process Analysis at Arnold Palmer Hospital (7 min.).

APH believes that if a process takes place more than one time, it should be documented and flowcharted. There is even a staffer shown in the film, Diane Bowles, with the job title “Clinical Practice Improvement Consultant”, whose full-time work is charting scores of processes.

After I show the video in class, I assign small teams to flowchart the process of maternity patients moving through the hospital (see the video case at the end of Chapter 7). The Solutions Manual shows one possible chart. When you show the video, ask the students about the pre-registration function, how it can be used to streamline the operation, and why pregnant women benefit from it.

The key is that continuous improvement helps both patient and hospital function/efficiency.

Video Tip: Arnold Palmer Hospital’s Culture of Quality

A few weeks ago, I visited my neighbor Artie while he was in the hospital. It was a typical large facility, with long hallways, nice private rooms…some of which had great views of the lake. But when I entered his room, the first thing I noticed was that the trash can was not only filled, it was overflowing!  As I left, I stopped at the nurses’ station to report this “defect”. The response: “Maybe you should call management to let them know”.

I can say that at Arnold Palmer Hospital for Women and Children (APH) this would never have happened. When you show this 10 minute video in class, you will see why. The culture of quality is ingrained deep at APH.

Let me give you a little off-the -record background about our filming experience, which was a fantastic learning exercise that resulted in 7 APH video cases in the text. I first sat through the  new employee orientation period. One of the 1st cultures I learned was that hospital employees always keep a positive face in all public spaces. No one may be heard talking about how bad their day is, problems at home, or troubling patients. The hospital has private staff corridors that parallel the public ones. Only there can staff speak openly. Second, all top administrators at APH are former nurses, who worked their way up. Kathy Swanson, the director, has an MBA, and others also have business training. I believe they have a culture of caring about patients above all else. Note in the film how they each take calls from patients 24/7.

We have 2 videos dealing with service TQM in Ch.6, the other being Quality at the Ritz-Carlton Hotel (7.5 min.). I prefer to show the APH film because the hospital incorporates several Ritz concepts, including empowering any staff member (even janitors) to hand up to $200 in gift cards to any patient with a complaint. My friend Artie could have gotten rich if his hospital had such an attitude!

Jay and I are especially proud of this APH video as it took 1st place in the annual Addy video competition in 2005. Out of 13,000 entries, it won the highest award, the Silver Telly.