ASP SUMMIT 2023 Webinar 2 "Applying Lean principles at the OR to improve MD reprocessing efficiency"

[00:00:00]foreign [Music] [Music] welcome [Music] back [Music] foreign [Music] welcome everybody to our second ASP Summit 2023 webinar series for as you know my name is I'm awesome I'm the senior education manager for the ASP me region it's my big pleasure to continue today with these um for series program featuring six webinars so today um it's my pleasure to to continue these efficiency in medical device processing the road they had series topic and we'll cover today how applying the lean principles that you are can improve the medical device reprocessing so before we go on and and start to to be introduced to our moderator and us for today I would like to share with you some housekeeping tips and rules with you for a great webinar experience first please make sure you switch off any non-essential applications on your device that maybe will be taking from you the internet bandwidth like the Outlook or other browse windows for example if by taking if by any chance during the webinar you experience any sound or video disturbance please refresh your browser window or close it and log in again today webinar will start with a 40-minute presentation followed by 10 minutes q a session we'll continue to webinar uh with the key takeaways as always and we will introduce you to our next webinar topic and speaker this will be now will be finished in one hour to respect everybody agenda if you have any questions for the presenter which are not addressed during his presentation please make sure you type them on the chat box on your right of the screen or if you are with a mobile device you'll find it on the bottom part of your screen in order to make the presentation part of this webinar more interactive we will have several live pools during the webinar where you can answer presenters questions please use the few seconds provided to vote in order to engage yourself during the presentation one last point this webinar will be recorded So the link and the replay will be sent to all the resistance shortly after this webinar will be over so now it's my pleasure to to present our moderator for today Dr Carlos Palos who is also our scientific director for ASP Summit CME webinars series 4. for those that have joined previous webinars you maybe already know him so um Dr Carlos welcome again to ASP Summit CME webinar series 4 and thanks for joining today I'll end over now to you thank you very much I'm uh hello everyone so it's a pleasure to be here again and uh after uh we are the missing uh one month's uh session but uh we are the uh something that was not possible to to change so we will move on now and so today uh we have um uh the characterization of our participants uh most of you are from Europe but we have about um of from uh the Emirates and Saudi Arabia and other Middle East countries and uh Also regarding the characterization of the attendees uh we can see that as usual most of the participants are nurses we have some Physicians and um most of you work also on the the contamination and Lead manager and the central civilization services and also in the infection prevention and control so that's what we are and most of uh you work in acute hospitals and have more than 20 years of experience so with this characterization of attendees so it's my pleasure to announce our our speaker for today uh Manuel Valiente which is a registered nurse is a medical and surgical nurse specialist he works at NHS in Portugal uh is the quality the department nurse director uh of the University Center Hospital of San Antonio in Porto and besides these tasks is also a motivational speaker on linear Oscar that's why he's here and he's also the iasop vice president and is also a treasurer of the yearna uh as a executive committee member and so Manuel Valente is someone which is very important and is very inspiring and I I'm sure that we are going to attend uh very interesting session so so I uh the station is yours brilliant thank you very much for being with us thank you good afternoon um thank you for your invitation um I hope that the image is good um it's a pleasure to me to be here trying to share our experience in the use of Flynn principles and lean management around the operating room area and I will try to be how to say in a clean way like clean [Music] um focus on our idea of lean and the use and I I try to to to share some examples of use of win in the contest of the medical device type procession efficiency our agenda for today is based on the general principles of the management and then I try to to show you that how we could operationalize the concept in the our trying to [Music] improve deficiency of medical device the efficiency we we keep some minutes in the end to to to to to people uh send uh and answer some questions commentaries or clarifications and I hope that uh in the end of this webinar uh we could um I would say give some insights to improve the process indoor well we try to to to start this webinar with the quiz about the concept and um when the the the the pop-up window opens I I ask you to try to put it in your left part of the the screen in a way that you could see all the the questions and the questions are what is lean management and the first possibility is it is a management metal methodology whose main objective is to get costs and reduce stuff or the second one it is a set of management tools used to solve problems of inefficiency the third possibility is it is a management philosophy that promotes The Continuous Improvement of process based on the value of our clients with the contribution of all professionals involved and the fourth and last it is a work methodology promoting the Improvement of efficiency processes used on the in the resolution of the day-to-day problems please give your answers okay I feel it is almost God then we will share the results and now I think it's time to go on talking about the General in principles uh is somewhat curious and the main reason is because we have how to say a crisis in the sector of healthcare for different reasons but most of them as Solutions and we could start with problems of Adverse Events and special delivery events associated with the health care and despite the great efforts made in the last 10 years it has not reduced as much as expected as expected with all the associated consequences we have also problems about skyrocketing cause poor quality nurse and physician shortages or employees abstractions but Healthcare Providers um are realizing the imperative of improving quality and safety and eliminating waste as strategy and we talk a lot of ways when we used to manage With The Lean Concepts and we a little later explain what is the concept of ways applying principles in healthcare in my personal opinion is a way to transform your inquire entire organization into a safe and high quality High performing Healthcare delivery system but um Healthcare is the how to of managing change and creating a continuous Improvement why we consider that clean work in healthcare what are the benefits of playing lean thinking embeds quality at the source into every process with big implications for outcomes and we talk about outcomes we talk about mortality morbidity safety in general lean freeze app the latent capacity in the current system without require any new capital and this is very important because we release more time and to spend to solving complex and difficult case as you improve career in process you see new opportunities for Designing alternative ways to live your care with different working practice and the right equipment there is no lean best way but several but we have to elect to do something Lynn elsecat doesn't happen unless someone is responsible for rethinking the whole process it's not a individual process from Individual unities it is supported by all those involving involved in the in the running of the process no one is out of the process and finally the organization with in the starting moment with the expert help develops a future state line that shows where to conduct breakthrough Improvement events and where to use Link tools I say we need a coordination team to be successful lean manufacturing principles were developed by Toyota in the 50s and applied for a long time till the 80s when they talk about lean and his concept and you say how it is possible to use something that starts useful on automotive industry and it's useful also in healthcare lean application link management is not is an application of the the concept of manufacturing lean and the principles to the practice of department or or a project management the goal of lean management is to maximize value while minimizing waste one more time to waste to be lean is to provide what is needed when it is needed with the minimum amount of materials equipment labor or space as a theoretical concept when we talk about lean we talk in the reduction of constraints in the original Japanese they talk about muda mura and muri and what is this mother refers to the activities that can some resources without providing additional value it's it's what we say it's a low efficient process mura it's operational and events which decrease efficiency and voltage productivity in the long term it's a mix of low efficiency and effectivity and Murray refers to the overuse of equipment or employers and in the median and long term it's a low effective process because people feel um exhausted lean project management aims to reduce the three types of constraints the three amps we did the the the the the process this kind of solution starts on the automotive industry is very common on the distribution industry for today and also we start 10 years ago in our hospital but when we start in healthcare it's not common and some people feel how to say not confident to use something that came from the industry what are the basic values of linelscape the concept is always the same make the less is more the way of do things what is this is one more time talking about waste in the process and we are talking a little later about race then it's the more important put the the customer the patient as fast all the improvements are made on the best interests of patient and family then we have to Define value in terms of the user and the customer and in this contest what we want is to improve the quality of patient care better outcomes improve safety the process don't give problems for the for or that provoke Adverse Events eliminate delays and reduce the length the lens of stay in the the the the in the area and all these without using more resources in some literature we we see two or three uh questions that are repeated a lot one is the question of spy is specify what is value values any activity which improves the patients else well-being or experience as example not having to wait for a consultation missing a procedure because laboratory tests are not available don't have Healthcare associate infection done in the the process that we use to to to to to [Music] use on on the the the activity we have to identify what is value and it is what we say about identify value stream and uh try to understand what is not necessary and inefficiency or ineffective on the objective that we are focused trying to to to make the process always flowing is redesign it in a way that gives one more time vowel for the patient and we could use a lot of different kinds of wind tools for for this context and one example could be 5S the concept of reorganize reorganization of the the the the places where things happen the concept of pool is also how to say in a normal way uh inverse process when we talk about um pull the the the the the system instead of pushing we said that we must try not to wait for something that will happen but on the other end go in the proactive way to the the necessities of the clients an example could be why we have to wait and for patients to go to the words and not on the other side people on the watch try to discharge earlier patients and whoosh push sorry pull the the patient from the emergency and accidents department for the world and in the end what we try to do is to pursue perfection develop and the main process continuously continuously inefficacy in the pursuit of ideal process I think it's a moment to to talk a little about waste and the in the concept of lean management waste is the base of inefficiency so that I try to to to ask you what you know about waste in this process the first solution could be regularly wasted waste clinical waste Urban waste chemical waste and cardioactive waste the second possibility could be defects overproduction waiting transport inventory stock motion and Extra Protection the sad possibility could be biological waste Urban waste waste chemical West and hydroctive waste and the last enforce clinical waste Urban waste and the Industrial Waste almost are voting okay no more 102 okay I feel that the majority of people knows a little about lean management the concept of waste it's somewhat intuitive but sometimes when is translated from General Industry for healthcare it's difficult to understand classical we talk about seven types of ways but on the I feel the last 10 years we we talk a little about one more and we talk about eight first one is artifacts and defects are things that not happen like we like if we operate the patient and the result is the surgical site infection we have a defect the other cons the other type of waste is overproduction and sometimes it's it happens on operating rooms when we operate more patients then the number of uh beds that we have on recover room we have a moment of overproductions that is not absorbed by the recovery the other one is very common not only in healthcare but any in any place is waiting waiting for something that not happens and the the the the classical example is the team working when someone from a team is not on his position on the time that is defined and the others are waiting and that waiting is totally inefficient it's a not using the the potential that we have in this concept Transportation it's not so simple to to to introduce in the concept but imagine that a patient to to be operated came to a place in the for example the world in the in the hospital then has to be transported from the world to uh waiting room near the the operating room then is transport to the operating room and inside operating room is transported to inside the the over these process it's not necessary objectively to do a surgery and a good example could be the Ambulatory Surgery the amount of transportation is so lower in in the in this contest that are more efficient another example is the inventory or or stock for a long time and we we have experienced we reduce our inventory inside of operating room for more than 60 percent of course we need a new logistic system in a way that all the days we have the white medical device and and drugs to do the surgeries another one is the excess the motion to to move around without the giving value to the process and the the best example is a process that is has bad ergonomics and for that reason people has to move a lot to do the process and for the seven classical the the concept of extra processing I think it's the the the best example in the healthcare is practice clinical practice not evidence-based it's something that we do without any benefit for the patient and last one dates that the the new one could be what we describe as not utila utilize Talent it's the the the [Music] that's not includes all the people inside the process and because of that some people couldn't give [Music] quality inside for for them when production has been successfully adopted in the in the service in healthcare sector because its supplementation improves process efficiency and better resource management additionally a culture of continuous Improvement search is created in the organization a cultural focus on client passion that creates valve for client this implied a change of the paradigmund from others to the patient the patient is the center of our work and where we could apply the lean in healthcare any place nowadays in any place in the hospital we have experience in the use of lean Healthcare to optimize the conditions of the process now I try only to show you how we could operationalize this in the context of reprocessing medical advisory processing efficiency what we do in here is an example the first thing that we do and for some people this could be strange considering that all the solutions are simple and most of them very intuitive to me this difficult and for Latin people is to do it all the days all the deer all the uh in same way and the process starts before any survey the first activity that we Implement in the our operating room is to made a standard surgical planning when we start this project 10 years ago each team its special surgery team has a different way to inform and sometimes not informed operating room about what are what are they want to do in the in the the time that they use inside the the operating room and Sometimes they used to send it on the same day that we are doing the the process so that we have to say I.T tools we Define what are the minimum information that we need to uh manage the process of the surgical procedure all that information in the case of surgical procedure are coded with the international classification of this is 10 and they could share the special needs that they consider for this process then we have all the information but sometimes we have the information not on the right time sometimes too late and for that reason we decide that we need that information standard information 24 hours earlier and nowadays there are Specialties that work in a weekly schedule in that situation what we could do we could validate 24 hours before the the process that we have all the things we need to do the process but sometimes we don't have because people different surgical teams wants to use the same install capacity for different procedures in different places and for that the reason sometimes we have to reorganize the schedule in a way that we could use all our potential all our equipment but in different moments in the in the day after seven and all these only could be done with a process that that is measure that we could as information to take decisions imagine that someone wants to do a procedure a surgical procedure that the today is planned for 10 minutes but on the last 100 procedures it lasts a minimum of one hour it's impossible to do it in that situation and for that reason we could show that there's a narrow in the plan or something it's not right then we try to reduce the amount of waste associated with management of surgical medical device and the first thing is but we not start on Day Zero we start on day plus years done so that we have to use what we have and try to understand what we are doing today what they are doing in the future and what we have to do this in a way that we could use our invested investment in surgical medical device in the best way in some moments we have constraints because we don't have plan for the future but in some other moments we understand that we could improve the process and a good example is the normalization of surgical sets parts are different we are we have a lot of surgical sets but for some reason they are not equal and sometimes we have too much too much instruments inside of surgical sets because we have the normal type of surgical instruments and have a lot of more for strange situations abnormal situation and then one of things that we use in this 10 years ago is to split in two sets the normal and textured extraordinary or emergency say and with this Simple Solution we reduce the amount of medical device that Central civilization serves as to reprocess each time that we open this so big sense we also do something that it's important and I I only talk about tech time and cycle time if we need to manage 10 sets of laparos laparoscopy in one day the amount of time that we have to do it it's the amount of time that Central civilization is open imagine that the the centralization is open for 10 hours we have one hour to reprocess each of these set but the cycle to repossess this instruments are one hour and hour what happened we have a problem to do it on the day that we have the day work we have with this and for that reason we have to balance the quantity of sets and our capacity to reprocess it and not ask Central civilization the service to do it in the time that is lower than it is possible because the result could be very dangerous also we defined policies to use single use and multiple use the medical device because sometimes the Temptation is to use only single use the cost effectiveness of multiple used medical devices higher and we we are not talking only in money but the the environment impact of the single-use device is something that is absolutely necessary to to take in account and on the other end we try to use as well as possible the time of operating room utilization all our work was focused on reduce the time that the operating room is not doing surgical procedures and that work was done improving ergonomics externalizing things that in the past we do between the surgical procedures in the way that the time that the the the operating room is open and is clean for one more per Shader we use it as as possible to improve the process of reprocessing it starts inside the the the operating room and this starts also when we purchase the medical device we couldn't use a medical device inside an organization that don't have all the technology to represent and ask Central civilization service to do it in a way that is not safe of course we have to have reprocessing protocols and this process starts in the operating room when we use to maintain all the surgical instruments how to say clean during the operating procedure we are trying to optimize the process of reprocessing that happens like also we have to assist systematization systematicize the practice today Manuel is in the central civilization service and all the things happens slowly because it is through the I'll say um the focus on the quality and safety on the other day someone is there and things happens so rapidly but the result in the process are so much different and this is not possible in the lean management process okay trying to optimize the positive contamination condition is another example if the instruments arrive in the centralization service that's also [Music] um in a condition that is more difficult to clean his work will be slower and more challenging and and finally one more time we must try to reorganize the process of the turnover in a way that we not wait too much time because we are doing things inside operating room that could be done outside all these only Goods be acceptable in a contests where all the equipment all the facilities all the best instruments and old medical device and the best professionals could manage it in the best way if we have all that but our results are sub-automa what happens in this process we need to improve and the the concept of continuous Improvement is the concept of lead management all the days we must pursue the result and the best results and this is not possible without team work and Leadership I feel that sometimes people could [Music] how to say imagine that something could happens only first chance but nothing happens because of chance it happens based on a strong leadership and a a very good teamwork to manage this operational we organize on the beginning of each day uh little 10 minutes meeting that where people share what's what we want to pursue as objective today uh special objectives and share what was not good the past day and what we do to try to not repeat the problem today also we have measure all our performance indicators and examples of performance indicates is how much time we have to to do the turnover yesterday the median time is 10 minutes but for some reason one of our operating rooms are stopped for one hour and we try to understand what's happened in this situation try not to to repeat we have I would say some type of lean tools that help this process and one of the the one that I like very much is the gamble walls game but the concept of gimba is the concept of the the the the the local where things happen in the industry is the factory in the operating room is near the the operating table and the concept of gimbal walks is oh the management team and [Music] General team is mainly one time a week I would say a walk around the the the facilities trying to understand where are the wastes and seeing the doers when we train these things happen and all the days we could improve the process now I try to to make the last quiz and I ask you trying to answer how can we change the actual operational management practice my first proposal is with the strong leadership external expert advisors and the complex off-the-shelf I.T toolkit with the new second possibilities with a new work philosophy approach integrating the contributions of the employers apprehending a management model oriented to develop for the customer reducing known procedures waste or reducing the number of employers Outsourcing service with the view to increasing earnings and last but not least waiting for a new artificial intelligence technology which can replace as in the action of defining new and better action action strategies 102 more okay I agree with you I feel that the result only could be different if we use a new way of working in the set um sorry oh yeah it's good okay the concept is something it's strange What's Happening Here okay good well my take your message will be okay we here in as a Vox properly that lean is a button-up movement but it's got to have top down endorsement without leadership without top management support it's very very difficult to to implement clean when we start we feel that we are trying to use some tools but after one or two years we understand that we change our mindset and Lin is a strategy to improve quality and efficiency or process as I say performance never results from a chance but from a daily and systematic organization of the plant activities someone said insanity is doing the same thing over and over and expected different results doing the same thing over and over and expect different results it's sick and for that we have to look at reality with an alternative Matrix lead us to a new reality with the ACT potential for improvement the Strategic Simplicity of lean philosophy cannot be confused with ease of implementation and normalizing is not intended to constrain professionalism or a Visionary strike it's fulfilled just to ensure that the expected result happens at first time of course the awareness of results and yes the awareness of results investment is the level and the foreground of continuous Improvement if you don't have better results it's very difficult to fit the team in a way that they work in a different and for the the first I think five years out of the box and sometimes in comfortable in comfortable way of doing things anyone that wants to start clean and lean management as to understand that it's an investment and long-time investment I feel that the first five years are the the main effort but all the days 10 years after we need to to fit the the the the the process and show people how we how the the results happens if we do it in a different way thank you for your presence and I will be available for any questions commentaries or any other thing that we you you you want thank you Valiant for your excellent presentation and just in time so we are now we have seven minutes to go and we have here some questions of the uh audience uh and um uh I I will start with this one so um um what changes do you plan to promote or Implement at your facility as a result at uh with what was shared in terms of future for example uh you talked about artificial intelligence and uh what do you think that it would be uh possible to to to to improve to to give more gains to these strategies of mean and others I think do you hear me please Carlos yes yes okay perfect yeah sorry one or two examples of uh things that we are part we are developing and I I have some results but we are starting and we don't have results the question of artificial intelligence it's a good example for scheduling surgeries we start to understand our data in a way that we could show people that something that they want to do it's impossible with the data that we have but nowadays with intelligence official intelligence we could design different types of scheduling in a way that we could answer the needs for waiting lists for NHS as you know in Portugal we have to comply four times to answer for a surgical prostrator and and if we don't answer in this time we have penalties and penalties is they reduce the amount of money they send to us to pay our bills and for this reason we try now and we have a little of experience to use artificial intelligence to optimize the scheduling of operating rooms another example we are starting the use of robotic surgery and we will we must change our [Music] architectural concept of operating rooms and we are starting this so that I don't have so much information to share with you but what our six months experience said we have to change the flow of patients in this type of surgery because we want to use more efficient the time that we use for this type of sorry it's two example different examples yeah yeah yes and uh I think that uh the next month is we will will bring us uh a new world of uh uh usability and um and the benefits and also the limitations and the cost rates of artificial intelligence in in every field and in the management and in healthcare yes it is also uh very important and I think that um this will this will bring us um so many opportunities uh to improve that we as humans and that way we treat the data is not is not possible to to to do to achieve and um well uh I I have here also one one question um um what did you find most valuable to your current role uh in in in in in in in the in the hospital so in in the quality because you are now in the quality department so when I when I I I'll just say uh came to the the quality Department what I feel is uh my vision about the hospital goes white but on the other hand I see things that in the past when I work a lot in the operating room that I don't understand why things not happen in the best interest of patients inside operating room and nowadays and this is one of the reasons that I say it's not possible to implement the continuous Improvement in the unity alone in the hospital if old hospital is not in the same pace of process because we improve something inside but something outside of our control good good on delay what we are trying to do so that when I'm I change from operating room to the Quality Department what I try to do today is put oil in the mechanism in a way that all the processes all around the hospital could be better for all our patients yes it's a it's a good it's a good definition putting on to increase the efficiency well thank you very much we need to go uh I will pass to jam so uh for the rest of the attendees and everyone so uh we'll see you in a month thank you thank you very much thank you so thank you so much um I'd like to thanks again to Mr Valente for his insights for presentation on Lynn and I hope it was really beneficial for our audience thanks also to Dr Palos from moderating this webinar before I leave you with the next webinar just want to tell you that I want to remind you that our webinar today have been recorded and you will receive email with the reply Link in few hours um in the email you have a short um feedback survey so please invest two minutes of your time to help us to improve even better our webinar sessions um the second thing I want to tell you about it's regarding our um certificate so on the same email you will have a link to get your certificate for attending this session as well and more important maybe you will find the webinar fact sheet with the key takeaways and and from this session from Mr valent um last but not the least I want to lead you and left you with the last uh news about our next webinar so in our next webinar will be pleased to have uh on September 27 at same time a presentation on ISO one three four nine eight five sorry one three four eight five and as a reception certification on the iso one three four five uh certification is smarter to improve the medical device for processing efficiency so stay tuned it's uh really a good one and we're gonna count with Mr waltermart um is a process project manager a cssd manager also an ad instrument management at the uzi leuven in leuven City a part of Belgium so you will share that how easy how easy one three four eight five will purpose and and as a martyr to improve our reprocessing efficiency so thanks once again um for your time um it's uh I wish you all a lovely vacation period we're gonna stop um next month and also August so we will see again in September and I hope to see you all in our next webinar on September 27th with Mr Walter merch have a nice day [Music] [Music] foreign [Music] foreign