During the week of January 27 – 31, 2014, a Lean replication event was held at Wascana Rehabilitation Centre on two long term care units (3-5 and 2-5) to address the storing, handling and bundling of linen and incontinence products. The purpose of the event was to standardize morning care routines on the two units that would eliminate unnecessary touches to the linen and ensure care givers have the supplies they need before they enter the resident rooms during the morning care routine.
The replication event builds on RPIWs (Rapid Process Improvement Events) that were held on these units in March, 2013. The original RPIW work used Lean techniques like spaghetti diagrams, value stream maps, and task timing to identify wasted steps and time carrying clean linen in and soiled linen out of rooms during a.m. care. The RPIW improvements included a new way of bundling the linen required for each room on a small cart. This solution saved time and steps and also eliminated multiple touches of the linen, which can compromise infection prevention and control standards.
Other outcomes of the RPIWs included 5S (sort, simplify, sweep, standardize, sustain) of the soiled linen room to eliminate infection prevention and control risks. The changes in the amount of linen on the carts will contribute to the larger project of managing linen inventory as the region transitions to the new provincial linen service.
The purpose of the replication event was to standardize the work that was accomplished at the RPIWs and to begin creating a model line that can be replicated on other units at Wascana and eventually throughout the province. Lean events like 5S and RPIW are valuable but are time consuming for front line staff, managers, and Kaizen (continuous improvement) specialists. The replication event will create a process that other units can implement without having to invest time in re-creating the standard work. The replication of this standard work can be adapted in small ways to suit the type of care provided on a unit as well as physical variations on different units.
Specific standard work that was created at the replication event included:
- Morning care routines that eliminate interruptions by ensuring care givers have all the linen they need before they go into the resident’s room
- Elimination of small carts of linen that sat in hallways obstructing movement of residents and caregivers and creating an infection prevention and control risk
- Standard work to eliminate the touching of clean and soiled items in the soiled linen service rooms
- Creation of Kanban cards in resident rooms for Tena products (Kanban is a visual cue for replacement of inventory)
- Standard work to replicate Tena storage and carts
- A card system to determine the quantity of linen for each patient so that staff know exactly what will be required on the cart in each unit
- Standard processes for the stocking and de-stocking of carts
Tammy Watson, a continuing care aide who participated in the replication event felt that the improvement will increase the amount of time she will be able to spend with the residents. “The time we save from walking back and forth to get linen and other supplies will make us less rushed, and allow us to spend more care time with each resident.”
Shauna Leonard, Unit Manager on 3-5 felt the process was beneficial for her staff.
“The project has been both exhilarating and productive. The discussions between the project team and staff were focused on improving care. The concerns of our staff were accepted, respected, and incorporated into the final working documents. This was truly a team effort.”
“This has been a good week,” said Ngaire Woodroffe-Brown, Director, Extended Care/Veterans Program Wascana Rehabilitation Centre. “The team has set the foundation for replicating in the future. The key pieces to this success are learning from others using the “pay it forward” approach, establishing clear audit processes, and most importantly, eliminating waste so that care providers can do what they truly want to do and care for people.”
“We learned a lot during this replication event and were able to make small improvements on the things we learned during the RPIWs,” says Jennifer Fetch, Kaizen Specialist for 3sHealth. “Before we roll out this standard work and begin replicating it, we will audit these improvements to ensure they are working.”
Featured photo – left to right: Willy Abuan, WRC; Tyler Chiddenton, Ministry of Health; Bob Parker, RQHR; Tammy Watson, WRC; Erica Church, WRC; Jennifer Fetch, 3sHealth.