The Description Of The Cleveland Clinic In The Usa

Introduction

Founded in 1921, Cleveland Clinic is one of the most respected health care institutions in the US, primarily known for its cardiovascular (heart) care but not limited to it. It also ranks amongst the top institutions for kidney, neurology/neurosurgery and respiratory diseases. To help with the smooth running of the day to day support functions at the hospital and improving them, a performance and service improvement (PSI) department was established there in early 2000s. The team consisted of proven process improvement leaders from different industries including consumer products, aerospace and even automotive.

Surgical Processing Department (SPD)

The surgical processing department (SPD) located in E building catered to approximately 60% of all surgeries carried out at the Cleveland Clinic. The department was staffed by 25 people who worked around the clock to serve routine as well as emergency cases. They were responsible for the disassembly and cleaning, inspection for checking defects, reassembly, sterilizing, preparation of case carts (assembling required instruments for each surgical case) and the delivery of these case carts in the operating rooms.

Challenges in the SPD

In recent years, the physicians and nurses had started complaining about the accuracy of the instruments provided by the SPD as well as the speed of the delivery. Most of the times, instruments went missing which was a major cause of concern. Jim Stanicki, the manager of SPD realized in 2006 that the department was in dire need for change. He partnered with Jim Leonard, a senior member of the PSI team to analyze current practices and look for ways to improve them. They found the following inefficiencies:

• Difficulties in sorting large number of instruments
• Workers in each process were isolated from each other resulting in coverage problems and lack of versatility
• Inefficiencies in the floor layout Lean Approach & Kaizen (Improvement)

The team created a current state value stream map to determine the processes and the time taken to complete them. The four sub-processes which were identified were: Decontamination, Prep and Pack, Sterilization and Case Cart Assembly and Delivery. The team held Kaizen events with the staff to analyse the four subprocesses and find ways to improve them. Some of the major changes carried out in each of the subprocess included:

Decontamination

The team redesigned the process layout (floor design) of decontamination area which reduced walking time and cart break down time.

Prep & Pack

Instead of each staff member going through the decontaminated equipment to prep and pack, one person was given the task to do so. This removed confusion amongst the staff and improved efficiency and communications.

Sterilization

The team moved the loading station closer to prep & pack drop off to reduce walking time and added a printer in the room to decrease the time taken for print outs.

Cart Assembly and Delivery/Storage

The supply room was reorganized, aisles were widened, and tape was placed on the floor to outline lanes for the carts. This reduced the cart assembly time and walking time as well. The results showed that the team was able to address the two key issues, not to mention the other improvements as well in the subprocesses thus reducing delaysMissing Instrument count: Reduced by 26% Instrument set processing time: Reduced by 24%.

Additional Improvements

The PSI team expanded its role in late 2007 and became the Strategic Planning and Continuous Improvement Group (SPCI). It was involved in various other projects including:

Magnetic Resonance Imaging (MRI) delays

The MRI process was being stopped midway by the technicians to cater to each patient’s specific needs. The SPCI team identified this as the source of delay. The team also identified opportunities to utilize other equipment. Lead time was reduced from 21 to 11.5 days.

Surgery preparation time

The preparation time was slow and inefficient as patients had to undergo various tests and wait for test results for one particular service. The SPCI team put in a system which identified the types of tests being ordered for patients and which were overlapping and whether there was need for more tests after or not. This reduced the pre-surgery waiting time from 7 to 6 days.