During the summer of 2001, the project looked at the Cardiology department of Community Medical Center (CMC). A month was spent observing the system to understand the current condition of the department. During that time, tools such as a value-stream map were set up to interpret the flow of patients through the system. The system currently in place was documented in terms of content, sequence, timing and outcome. Toyota Production System (TPS) principles were introduced to the employees as they began writing A3 problem-solving reports (a tool used in TPS). Reactions to these principles, as well as applications of them, were documented as well.
We developed a seven-week, introductory training course and offered it to CMC employees. The purpose of the course is to train a person in the principles of the Toyota Production System (TPS) so that he or she can return to his or her working department to begin implementing such concepts. Students meet once a week to review what they learned the previous week, discuss how they have applied the learning goals within their departments, and to introduce a new TPS subject. This course was later offered at St. James hospital in Butte, MT.
During the summer of 2002, the project focused on the Pharmacy of Community Medical Center (CMC). An undergraduate research assistant helped the pharmacy staff create a current state value stream map for pharmacy orders. During the observation needed to create the VSM, we discovered that a major reason for delays in getting orders filled was the high number of interruptions to the pharmacists work. A major contributor was a catch-all problem they called "missing medications." We began attacking the "missing med" issue one problem at a time using A3 reports. By summers end, the number of missing meds reports per day dropped a dramatic 40% and order filling time dropped 30%. Unfortunately, due to a management change, our efforts in the Pharmacy have been suspended.
Cindy Jimmerson wrote a workbook to accompany the course developed the prior year. We continued to offer the training course to CMC employees and gave one-on-one coaching in value stream mapping and A3 reports. We hired on a graduate student, and spent some time training him and getting him up to speed on the project.
Our graduate student, Manimay Ghosh, conducted field work at CMC. He spent approximately six months on-site, coaching the Fiscal Services group in problem-solving focused on the billing cycle at CMC. Much of the effort was directed at reducing Accounts Receivable Days (number of days from delivery of service to collection of payment for that service). The team developed a current state value stream map, and created numerous A3 reports addressing specific problems related to delays in the billing cycle.
We are also worked to transition CMC from dependence on the support of this grant to a self-sustaining system of continuous improvement.
We are writing up approximately 18 case studies of TPS-style problem-solving, and are preparing to analyze the data. We also are preparing to analyze the survey data. We expect to publish this work in next year, as well as complete Manimay Ghosh's dissertation.