Treasure Valley businesses beef up by paring down

St. Luke's nurse Rebecca Schattin enters patient information into the Omnicell dispenser to access a patient's pain medication at the Boise medical center. The machine saves nurses' time in handling medications. JOE JASZEWSKI — Joe Jaszewski / Idaho Statesman

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On-time starts in the O.R.

You may know the surgery drill: Don’t eat anything the night before an operation. Show up early the next morning.

Then sit, sometimes for hours. Almost from the first operation performed, scheduling falls behind.

It’s a problem at St. Luke’s in Twin Falls, where physicians perform about 50 surgeries a day.

The hospital is attacking the problem on a number of fronts. One deals with operating-room turnover.

By videotaping workers, the hospital found it took about 26 minutes, and as long as 35 minutes, for a team to clean an operating room and set it up for the next surgery.

Everybody cleaned a room differently, says Mike Reno, interim CEO at St. Luke’s Twin Falls hospital, who will take charge of the entire St. Luke’s system’s lean program.

“With all that variation, how on earth can we stick to a schedule?” Reno says.

Team members came together to watch the video of themselves doing the cleaning and then talked about it.

The result: a uniform, 22-step process for cleaning an operating room.

Step 1: Remove the soiled linens. Step 2: Remove biological materials, such as body fluids.

Having a streamlined process knocked the time down to an average 18 minutes, Reno says. That’s about a 30 percent decline.

Along with other modifications, establishing a cleaning routine helped the hospital improve its on-time starts for surgical procedures from about 75 percent to 97 percent. Patients are no longer asked to come to the hospital early in the day and wait for hours, Reno says.

Going lean helps Best Bath weather tough economic times

Seventy-nine production employees at Best Bath Systems in Caldwell walk about a mile less a day than they used to.

Trimming steps, while keeping the company production of fiberglass showers and walk-in tubs moving, is one of the benefits the company got from five years of pulling waste out of its operation.

Best Bath sells its products nationwide, mostly for assisted living, student housing and hospitals.

In 2007, it was running out of room at its Boise plant off Broadway Avenue near the Boise Airport. The company began mapping out its production line, looking for ways to consolidate tasks and become more efficient. Managers sought to move items fewer times, to avoid backups of products waiting to be assembled and to reduce inventory backlogs.

The company went lean.

Last July, when it moved most of its business to a new, 106,000-square-foot building in Caldwell, some of the lean ideas came with them, while others were developed at the new site.

A quick look around the plant shows the work they’ve done:

* Showers and tubs awaiting a treatment of gel coat (a white plastic that people see in their showers) used to be lined up about 10 deep in a single line awaiting the treatment. Now, they are divided into two lines of five, which reduces the number of steps employees have to take to retrieve the pieces.

* Tools in the room where excess fiberglass is trimmed off products used to be in a fixed location, so workers had to walk to them. Now they are on rollers, suspended from the ceiling, and move with the workers.

* Enhanced labeling tells the workers everything they need to know about products they are making, saving time by removing many questions workers had doing a certain job.

At the station where a reinforcing fiberglass application is applied, the line was readjusted to make maximum use of the “chop gun” that sprays on the fiberglass.

“If the spray gun is not spraying, we are not building product,” owner Gary Multanen says.

Many improvements were suggested by employees — a key element in turning a production facility lean.

Workers suggested the rolling tool board. Another worker suggested putting a compressed air hose on a retractable reel to keep it out of the way and make it easier to reach.

At Best Bath, leanness required investment. The company spent about $2 million on changes to cut waste from production. It expects to recoup that in about three years.

But leanness also has allowed Best Bath to maintain production with a smaller workforce. The company sold $23 million in products in 2007, its biggest year ever, with a payroll of 147 employees. This year — after the crumbling construction industry forced the company to downsize through attrition and layoffs — Best Bath expects to have $20 million in sales with 96 employees.

Lean manufacturing didn’t cost people their jobs, but it contributed significantly to the company continuing to show a profit through the downturn, Multanen says. Profit margins ranged from 11 percent to 13.4 percent between 2008 and 2010.

Bill Roberts

Draining inventory

At a warehouse on 11th and Miller streets in Boise, not far from St. Luke’s Regional Medical Center, sits a warehouse that once housed $1.5 million of inventory supplies for the hospital. It held everything from toilet paper to syringes. Too much of some things. Not enough of others.

Inside the hospital, different people had the responsibility for ordering supplies. Nurses ordered things nurses needed. Respiratory professionals ordered products they required.

The hospital needed to trim its inventory, says Vince Chodor, St. Luke’s lean-team leader.

First, St. Luke’s set out simply to reduce the inventory. Since January 2010, the hospital has worked down its $1.5 million of material to about $400,000. The hospital intends to eliminate the rest of it, Chodor says. The goal is to put supplies where they are needed: on unit floors and in supply rooms.

Next, nurses and other staff decided on the supplies they needed and put a supply person on each unit in charge of ordering.

Step 3: St. Luke’s is working with its distributor to avoid buying in case lots. The hospital won’t buy a dozen items if it needs only two or three.

The hospital also is stabilizing its orders. The hospital and its distributor know about how many of a certain item the hospital may need. The distributor stocks for that demand, say hospital representatives.

One of the greatest time- wasters for nurses on the fifth-floor orthopedic and neurological surgery unit at St. Luke’s Regional Medical Center was the medication drawer.

Every day, the hospital pharmacy would send up medications for new patients and new medications for patients already in the hospital to the unit, where they would be sorted into a drawer with three dividers, each holding meds for several patient rooms.

When it came time to dispense the meds, nurses would hunt through a jumble of plastic bags. They might miss one of the baggies and have to call down to the pharmacy for a reorder, costing time and money, and slowing patient service.

So St. Luke’s employees brainstormed ideas and came up with solutions:

* Create a cabinet of cubbies at the nurse’s station to hold medications for each room and place the meds behind clear doors so nurses can see them.

* Have the pharmacy preload a dispensing machine with typical kinds of meds patients take on an as-needed basis.

The result: Time spent handling some patient medications was cut sharply.

“We saved 72 hours a year for a nurse,” says Keyana Osthed, a registered nurse and a unit clinical supervisor.

Since the system started in January, it has been rolled out to three other units and notched a time savings equal to about $58,000.

What’s happening on the unit is expected to spread throughout the entire St. Luke’s Health System, which stretches from Twin Falls to McCall, as part of a plan to eliminate waste, which St. Luke’s defines as everything from unnecessary movement to unused inventory loading up a warehouse.

St. Luke’s is one of the latest converts to lean production, a philosophy that originated with Toyota Corp. Sometimes simply called “lean,” the approach holds that anything not adding value to customers is waste.

St. Luke’s launched its lean plan in January 2010 as a way to lower costs and improve patient care.

For now, the Boise- and Meridian-based hospitals are starting with inventory reduction and patient flow, and the Twin Falls center is focused on improving operating room efficiency and workflow at its new hospital.

For St Luke’s, going lean is part detailed analysis of work’s minutiae — running stopwatches to see how long it takes for employees to complete a task or filming people at work to see how their jobs might be done more efficiently.

It is also part common sense — the sort of advice your mother probably gave you as a child, time-honored phrases like, “A place for everything, and everything in its place.”

Bill Roberts: 377-6408

Straightening out supplies

Nowhere is the effect of the lean movement more evident at St. Luke’s than in supply rooms. In the typical supply room, different items are stacked in front of each other. It’s like the family refrigerator, where a container of food may get pushed to the back and not seen by the next hungry person opening the door.

The rooms lack uniformity. Things aren’t necessarily in the same place in different supply rooms, says Vince Chodor, the team leader who’s working with the staff to put lean programs in place.

St. Luke’s staff focused on supply rooms as one place they might do better. So they timed how long it took to retrieve items.

Registered nurses were asked to retrieve 10 items. They took an average of 23.7 seconds per item. They retrieved the correct item 89 percent of the time.

Then rooms were reorganized. Items were color-coded: yellow bins for urology supplies, green for respiratory supplies. Different types of items weren’t stacked in front of each other, meaning people didn’t have to dig to the back to get something.

The nurses were timed again. They averaged 8 seconds per item. Accuracy hit 100 percent.

“That is a big change,” says Keyana Osthed, a registered nurse and a unit clinical supervisor.

Reorganizing supply rooms, and modifying the hospital’s inventory and ordering systems are expected to save St. Luke’s the equivalent of about $500,000 a year in employee costs in the Treasure Valley.

HOW YOU CAN TAKE ON A LEAN TRANSFORMATION

How can you tell if your company is a candidate for going lean?

If your company is having challenges with quality, costs, delivery or safety, you might benefit from boosting efficiency.

What will it cost to go lean?

A small company using a consultant could expect to pay about $5,000 for some training and coaching, and to start some small projects, said Steve Hatten, executive director of TechHelp, a government-funded organization on the Boise State University campus that helps businesses become more competitive. Midsized businesses can expect to pay from $40,000 to $50,000.

Companies can expect to achieve increased efficiencies that may help them pay to expand the program in their businesses.

Is going lean primarily for the manufacturing side of a company?

No. Best Bath Systems, for example, is leaning its entire operation. One example: its warranty department. The company eliminated unnecessary paper backup systems and made other changes. The result: One person used to handle warranty problems. Now the employee also does other jobs.

What am I facing if I take on a project to become more lean?

Becoming lean can cause a fundamental shift in a company culture. It is a process that never ends. Lean means embarking on a path of continuous improvement, of constantly looking for new ideas and ways of doing things.

What role do employees play?

Employees are fundamental to the success of lean operations. Managers may set the vision, but it is employees who often come up with many of the ideas about how to do things in fewer steps.

Leaders in lean businesses routinely meet with employees — some departments meet daily — to discuss how things are going and what can be done to improve them.

A company with a top-down management system could discover it has to change many of its management strategies.

What is involved in learning how to streamline your operation?

Companies drill down to the nitty-gritty of work tasks. They measure time spent, distances walked, how things move through a plant, what machinery sits idle and why. That information is typically mapped out. With the help of employees, those processes are refined to eliminate anything unnecessary.

So if you make your company leaner and find you don’t need all the employees. Then what?

Using leanness as a way to lay off people likely won’t work.

You may not get the cooperation you need if employees think they are “leaning” themselves out of a job. Some companies plow the time back into other work projects.

At St. Luke’s in Boise, for example, the nurses who gained nearly two weeks a year by changing their handling of medications used the recovered time to change how they pass on instruction to nurses coming on duty.

Part of that now involves patients, who are invited to be part of the conversation.

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