HOSPITAL EXCELLENCE
OPERATION MODEL
Miguel Angel Moreno, Abraham Mendoza
IIE Annual Conference and Expo 2014
Applied Solutions Sessions
Montreal, Canada
May 31 – June 3, 2014
Certification requirements
that guarantee the
competence of doctors
and hospitals
Importance
1993, first effort: Mexico, Canada and United
States.
2007, Proposed as national standard of quality in
health.
2009, first version approved for certification of
hospitals.
2012, latest version which integrates the
requirements of the Joint Commission International.
Health Sector Supply Chain (HSSC)
A supply chain in the Health Sector includes a number of different parties, including
manufacturers, distributors, third party logistics (3PL) providers, transportations companies,
hospital receiving and materials management departments, nursing, and finally, the patient.
Langabeer (2008)
Goods and services
Equipment,
Materials &
Medicine
Manufacturers
Distributors
Information / Money
Hospitals
Patient
HCSC in Mexico
Medication & TI's
New Services & methods
Medication & care Safety Methods
Manufacturer
HOSPITAL
Satisfaction
Level
Operation Management
Key Performance Indicators
Management Processes
Processes Control
Focused Improvement
Resources Optimization
Certification
Distributors
Resources Scheduling
Inventory Level Optimization
Inventory Level Optimization
Goods &
services flow
Resources Optimization (materials, personnel,
facilities)
Opportunities
for OM & SCM
Health
Sector
HCSC Key Proceses
Inventory Management
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
Procurement Process
Purchasing Scheduling
Forecast
Optimum level definition
Economic Order Quantity
Warehousing
Facilities Management

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Distribution

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Route
and
scheduling
Re-abastecimiento
System selection
Equipment
Expedite
Network and complexity
Localization and number of
facilities
Size and localization of
warehouses
Layout design
Materials
management
equipment
Sistema de almacenamiento
Patient Service
personnel 




Availability of service
Service Level perception
Response time (lead time)
Key Information availability
Total cost of service
Strategies
Minimize unproductive inventories.
Increase the perception of value.
Ensure the application and delivery of
medical services in time and correctly.
Build strategic alliances with suppliers.
Define the service levels expected for
suppliers and service providers.
Use of information technologies in the
communication of requirements.
Constant review of methods and
business processes to reduce response
times.
Great Dilemma
CERTIFICATION
Hospitals in Mexico
How did they do the continuous
improvement process?
Step by step taking at least 8-12 years
to achieve Lean (best hospital in
Jalisco)
1st
Quality System definition and
implementation (2004, started in
2002)
LEAN
HEALTHCARE
2nd CGS certification (2005) & ISO
(2007)
3rd “H” Award (2009)
4th JCI certification (2010)
5th Quality Award & ISO 14001 (2011)
6th Start Lean Healthcare (2012)
6 SIGMA
Continuous
Improvement
Culture
Strategies for achieving operational excellence
Processes critical
sources of variation
elimination
6 Sigma
Waste
sources
elimination
Processes
continuous
improvement
standardization
and auditing
Certification
/ ISO
Lean
Healthcare
Business Process Management (BPM)
Patient focus
Synergy
1
2
Leadership
Strategy
CERTIFICACIÓN
Continuous
Improvement
Culture
6
Structure and
Organization
3
7
Partnership
Structure
4
Capabilities
8
Information
Tecnologies
Continuous Flow
of patients
Team
Management
5
9
Integration
Hospital Excellence Operation Model
• Managing the expected
outcome
• Customer orientation
• Individual proces in a
systematic manner
• Processes
interrelationship
• Results vs. Capacity
and effectiveness
• Focus on the resources
and methods
• Bases for continuous
improvement culture
• Organization
becomes an Industry
reference
• Improvement as
decision-making
Process
Diagnosis
(Phase 1)
Lean
Introduction
(Phase 2)
Continuous
improvement
culture as
decisionmaking process
(Phase 4)
Lean
philosophy
deployment
throughout the
organization
(Phase 3)
•Interrelationship
betweenen processes
•Impact of processes
on the overall result
•Reduction on cost
operation
•Documentation of
improvements
•Standardization of
the efforts
•Ready for
certification
• A systematic process
• Standardization and
deployment
• Customer satisfaction
improvement
• Cost reduction, service
level improvement and
processes variability
reduction
Phase 1
Diagnosis
Key Processes Mapping
Processes Interrelationship
Key Performance Indicators
Lean Maturity
Phase 1 (Implementation)
Current Status
Which one
(pilot)?
Future Status
How should be?
Identify
Training
Applicability
Data analysis
Improvement
Standardization
Deployment
Key Processes
Diagnosis
What tools?
How we propose to solve it?
Creating Synergies
BPM
INTERNATIONAL PATIENT SAFETY GOALS
(MISP.1). Identify Patients Correctly
(MISP.2). Improve effective communication
(MISP.3). Improve the Safety of High-Alert Medications
(MISP.4). Ensure Correct-Site, Correct-Procedure, CorrectPatient Surgery
(MISP.5). Reduce the Risk of Health Care–Associated
Infections
(MISP.6). Reduce the Risk of Patient Harm Resulting from
Falls
COP
PFE
SAD
AOP
PRF
ACC
SQE
PCI
MCI
FMS
QPS
GLD
MISP.6
MISP.2
MISP.4
MISP.1
MMU
CGS & JCI Standard vs HEOM
ASC
MISP.3
LEAN
HEALTHCARE
6 SIGMA
MISP.5
How we propose to solve it?
Creating Synergies
BPM
PATIENT CENTERED STANDARS
(ACC). Access to care and continuity of care
(PRF). Patient and family rights
(AOP). Assessment of patients
(SAD). Diagnosis Services
(COP). Care of patients
(ASC). Anesthesia and surgical care
(MMU). Medication management and use
(PFE). Patient and family education
COP
PFE
SAD
AOP
PRF
ACC
SQE
PCI
MCI
FMS
QPS
GLD
MISP.6
MISP.2
MISP.4
MISP.1
MMU
CGS & JCI Standard vs HEOM
ASC
MISP.3
LEAN
HEALTHCARE
6 SIGMA
MISP.5
How we propose to solve it?
Creating Synergies
BPM
MANAGEMENT CENTERED STANDARS
(QPS). Quality Improvement and patient safety
(PCI). Prevention and control of infections
(GLD). Governance, leadership and direction
(FMS). Facility management and safety
(SQE). Staff qualification and education
(MCI). Management of communication and information
COP
PFE
SAD
AOP
PRF
ACC
SQE
PCI
MCI
FMS
QPS
GLD
MISP.6
MISP.2
MISP.4
MISP.1
MMU
CGS & JCI Standard vs HEOM
ASC
MISP.3
LEAN
HEALTHCARE
6 SIGMA
MISP.5
Regreso a
casa
Implementation
Egreso
Caja
Valoración
Referida
(Public Hospital)
Medico
Admisión
Decisión
Información
egreso
Valoración
Comite
S
I
Decisión
Administración
Alta?
NO
Mantenimiento
Labor
Trabajo Social
Quirófano
Abastecimientos
Proceso
de atención
Hospitalaria
Seguridad
Estudios
Tecnologías
Información
Decisión
Tratamiento
Médico
UCIN
Medicación
Implementation (Public Hospital)
Objetivo:
Supervisar
el área.
Trabajo Social
Objetivo:
Mantener
funcional
las áreas.
Objetivo:
Mantener
limpias las
áreas.
Mantenimiento
Limpieza
TRIAGE
Voluntaria
Archivo clínico
Decision
Admisión
Objetivo:
Controlar el
acceso a las
áreas.
Seguridad
Objetivo:
Proveer
información
y registros.
Trabajo Social
Implementation
(Public Hospital)
Mantenimiento
Limpieza
TRIAGE
Voluntaria
INDICADORES DE DESEMPEÑO
Registro de pacientes
Todos los pacientes serán registrados
para determinar:
- Tiempo de espera
- Número de pacientes atendidos por
periodo
Archivo clínico
Decision
Admisión
Seguridad
Diagrama de
Flujo
Interacción
de procesos
Lista de
responsabilidades
Indicadores de
desempeño
Registro de Incidencias
Registro de situaciones fuera de
control y que implican fallas en la
seguridad o salud de los pacientes:
- Indice de incidencias por periodo
ADMISION
Implementation
(Public Hospital)
Diagrama
Flujo
TRIAGE
Diagrama
Interacción
AMBULATORIO
EGRESO
Listado de
Responsabilidades
Indicadores de
Desempeño
Procedimientos
específicos
Regreso a
casa
Valora
ción
Medico
Admisión
POLÍTICAS
GENERALES
Egreso
Caja
Referida
Deci
sión
Com
ite
Administr
ación
Mantenim
iento
Trabajo
Social
HOSPITALARIO
SI
Deci
sión
Alta?
Quirófano
Proceso
de
atención
Hospitala
ria
Abastecimie
ntos
ías
Informac
ión
NO
Labor
Espir
itual
Segurid
ad
Tecnolog
Información
egreso
Valoración
Tratamiento
Médico
Estudios
Deci
sión
UCIN
Medicación
Implementation
(Public Hospital)
After 3
months
with the
hospital
Quality System designed
Key and support procceses defined
Key proceses mapping (2 of 5)
Basic documents ready
Pending
documents
Key proceses mapping (3 of 5)
Support proceses Mapping
General policies (care and Safety)
Validate compliance with the standard
Conclusions
1. Key business processes (PCN) are similar in any hospital: admission,
triage, outpatient treatment, hospital treatment and discharge.
2. The Support process (PS) are similar in any hospital: financial, supply,
maintenance and safety, social work and technology information.
3. The HEOM proposed shows clear, simple and flexible methodology to
be developed in a short time.
4. By integrating the BPM, Leanhealthcare and Six Sigma it is possible to
establish in a same effort everything you need for certification and
process improvement.
Conclusions
5. Identify key business processes that give value to the patient.
6. Minimizing the number of documents needed to comply with the
certification standard.
7. You can set the levels of service expected for suppliers and service
providers.
8. Automation or information technology implementation processes are
identified.