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Application of Kaizen Principles, Methods, and Tools to a Large Cochlear Implant Program; A Continuous Quality Improvement Initiative

Douglas Sladen, Ph.D.

American Cochlear Implant Alliance July 2017

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Disclosures

I have no proprietary interest in any of the products or devices mentioned in this

presentation

This project was funded through a grant provided by the MED-EL Lean Initiative

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• Med EL Lean Initiative •  Improve access and remove barriers

• Why the Kaizen Lean Initiative? • Driven by the workers

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Kaizen Workshops •  Week 1 - Current state

•  Observations (n=23) •  Create value stream map (VSM) •  Plan for future state, develop a charter

•  Week 2 - 5S •  Sort, set in order, shine, standardize, sustain

•  Week 3 - Standard Work I •  First target area (scheduling work flow)

•  Week 4 - Standard Work II •  Second target area (audiology work flow)

•  90-day follow up •  Re-sample the new current state (n=18)

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Still building the Map: Value or not?

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Value Stream Map

Sequence of activities describing a process including waits in between the process steps.

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Current state – outcome measures

• Number of days from first contact through first appointment

• Number of days between surgery and activation of implant

• Number of minutes provider is out of the room to find ancillary equipment

• Number of hours to complete candidacy testing • Amount of inventory on site

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3) Standard Work - Scheduling •  Defects/Motion/Overproduction

•  Delay in triaging implant candidates •  Coordinating patient with several providers •  Multiple lists to track patient movement

•  Solutions •  Create mechanisms for electronic triage •  Eliminate duplication of testing, combine patient

appointments, create service sets to “hold” appts for candidacy and activation

•  Consolidate lists and create a single folder for patients moving through candidacy

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4) Standard Work - Audiology •  Defects/Motion/Overproduction

•  Patients have multiple different appointments to move through candidacy testing

•  Audiologists spend time doing activities that could be completed by an Audiology Assistant

•  Solutions •  Combine the first three appointments into one •  Assign the Audiology Assistants to complete some

activities (i.e., filling out order forms)

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0 10 20 30 40 50 60 70

Current State

90-day eval

Days from surgery to activation

Results – Wait time between surgery and activation

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0 0.5 1 1.5 2 2.5 3 3.5 4 4.5

Current State

90-day eval

Candidacy test times

Results – Candidacy test times

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0 10 20 30 40 50 60 70 80 90

Current State

90-day eval

% of visits in which the clinician leaves the room

Results – searching for equipment

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Results - Inventory

0 10 20 30 40 50 60 70 80 90 100

Current State

90-day eval

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Results – Wait time from 1st contact to 1st appointment

0 10 20 30 40 50 60 70

Current State

90-day eval

Days from 1st Contact to Candidacy Testing

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Patient Satisfaction Survey • Were your appointments scheduled within a

timeframe suited to your schedule? • Were you given all the necessary information

during your pre-operative appointments for you to make an informed decision

• 45 surveys were mailed to recently implanted patients in March 2017

• 30 surveys were returned (response rate 66.6%)

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Patient satisfaction survey

0

1

2

3

4

5

Preferred Time Understood content Made informed decisions Strongly disagree

n=30 Strongly agree

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"Quality is not an act. It is a habit." - Aristotle

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Summary • Application of Kaizen principles to this CI

program improved overall efficiency • Ongoing review and fine tuning is required • Quality improvement projects can enhance your

practice, though take considerable time to complete

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Contributors MED-EL Corporation Lean Initiative

Jordan Clawson

Mickey Matise

Rona Consulting Group

Erin Ressler

Ritsuko Travis

Mayo Clinic Cochlear Implant Program

Amy Olund, AuD

Matt Schmitt, BS

Barb Benson

Melissa DeJong, AuD

Alyce Breneman

Brittany Dowling, AuD

Lori Hubka

Sara Hollander

Matt Carlson, MD

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Questions & Discussion