Applying Lean principles to ES operations

AHE membership offers access to environmental service (ES) experts through an annual conference, webinars and online education. As a new member to AHE, I eagerly signed up for a Lean management system class and the instruction revolutionized my approach to problem solving.

Lean efforts can result in reduced inventory costs, lead and cycle time and physical work space; improved efficiency and communication; and increased process flexibility.

For instance, emergency rooms are too often a holding space for admitted patients. Emergency rooms lack inpatient comforts so customers are often dissatisfied. HCAHPS scores will reflect this and influence reimbursements.

The Lean tools are the perfect approach to uncover more effective ways to function. Here are four key Lean concepts:

• Value. Value is defined by the customer and how well the process or service meets his or her needs.

• Value stream. Value stream provides a map of all steps of a process that produces a final product with value. It helps to identify waste.

• Pull. Pull results in producing items or services demanded by the patient versus pushed by the supplier.

• Perfection. This concept aims for constant improvement.

While my administration supported me as a Green Belt project participant, I wrote, "Patients experience delays in admission due to the lack of available beds. This is known to occur when isolation rooms need cleaning, as these rooms require a different, lengthier process. The typical turnaround time for cleaning a non-isolation room is 20 minutes. The turnaround time for cleaning an isolation room is 45 minutes, an extra 25 minutes that leads to patient dissatisfaction and delays an appropriate level of care on the destination unit."

The Lean team mapped the terminal cleaning process to identify opportunities to improve turnaround time. The Lean tool helped me to identify waste in the system by flagging otherwise unnoticeable inefficiencies.

For example, isolation terminal cleaning requires the removal of the cubicle curtain. The clean curtains are centrally stored, requiring staff to leave the floor to obtain this resource. Additionally, the curtain room was disorganized.

Waste identified through the value-stream analysis included:

• Transport. The unnecessary movement of goods, materials or information (i.e., curtain location).

• Motion. The unnecessary motion by participants (i.e., going to get the curtains and ladder).

After identifying the waste steps in the value-stream mapping process, the team began to plan for the future state. It applied the 5S process (e.g., sort, straighten, shine, standardize and sustain) to the curtain room. Team members organized the room and worked with the curtain vendor to label the laundered curtains as a short-term solution.

The team also is working on long-term process improvement, which involves improving efficiency through curtain standardization and curtain room decentralization and improving the curtain cleaning process.

As a result of the online learning guiding this Greenbelt project, we are on target to meet our goals.

By Noel Clinton Feik, director of guest services at Bassett Healthcare, Cooperstown, N.Y., and a member of AHE's recognition committee.

Valuable resources available

AHE represents, defines and advances the professionals responsible for care of the health care environment to ensure high-quality outcomes and healthy communities. Following are a few of the resources that AHE offers.

• Recommended Practice Series: Environmental Services Equipment and Supplies. The equipment and supplies covered in this booklet are essential, discrete components of safe, efficient and productive environmental services (ES) operations. For more information, go to www.ahe.org/ahe/learn/tools_and_resources/publications.shtml.

• Benchmarks and other Metrics for Effective Linen Management. This webinar looks at metrics such as processing and replacement costs, pounds per adjusted patient day, total cost per pound and labor-distribution cost per pound to help you assess and evaluate the cost-effectiveness of your program. To access it, log on to www.ahe.org/education.

• AHE Environmental Sustainability Certificate Program. AHE has launched a new certificate program to acknowledge the ongoing and outstanding environmental and ecological sustainability efforts of ES departments. For more information on the program, go to www.ahe.org/ahe/lead/environmental_sustainability_certificate_program.shtml.