The participating stakeholders brainstormed what they

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The participating stakeholders brainstormed what they wanted from a system and how they would evaluate the options. They narrowed the options to three systems for pilot testing. A Hierarchy Task Analysis (HTA) was used to specify all of the tasks performed in the surgical suites. The candidate surgical ISs were evaluated with respect to their ability to support these tasks. Then, the management engineers created a Space Relation Diagram that plots the movement of each person during an activity. This tool helps to identify the frequency with which a person doing a specific task within the process goes to a specified location and when and where there are crowds or traffic during the process. Changes to the physical layout or location of tools and technology can then be identified to reduce crowding. Once the new system was selected, the process improvement team began implementing a process transformation approach to identify key areas for change. The approach employed stakeholder meetings, 15 16 focus groups with diverse staff for brainstorming, failure mode effect analyses, prioritization of opportunities (based on the analyses), a focused assessment of processes, and finally, implementat ion of process improvement. Surgeons’ Preference Cards was one of eight key areas assessed. Many were not being used or were out of date because surgeons had left or new technology had replaced the specified equipment and supplies on the card. Of the other key activities assessed, several activities related to scheduling and preadmission testing were
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43 prioritized over and above supply and inventory management under which the Surgeons’ Preference Card project fell. Ultimately, this meant that the Surgeons’ Pr eference Cards project was not a focus of the staff because of the priorities for completing process improvements around scheduling and preadmission. In May 2010, a small group including process improvement staff, an assistant nurse manager, a system administrator, and a clerical coordinator (see Exhibit 1.15) gathered to develop a design. The purpose of the Design Kaizen was to define the standard process for managing surgeons’ preference cards through their life cycle to keep up with surgeons’ evolving preferences. Because staff were unable to test ideas and make in-time changes to the yet-unimplemented technology, a followup Kaizen implementing the planned process with the technology in place was the next step in the process. Barriers to the Lean project implementation (discussed in greater detail in the next section, Factors that Influence Success of Lean Implementation) were related to prioritization of other key issues, including scheduling, which were felt to yield greater, higher priority returns. As issues continued to come up with the surgeons’ preference cards, the management engineer on the project reported that the process would eventually be revisited, and a Kaizen would be done to implement the proposed process; however, the timeline for implementation was uncertain.
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