Spencer Hospital - Spencer Success Story
Lean Processing at Spencer Hospital, February 2008
SPENCER HOSPITAL: A 99-bed acute care hospital located in the northwest corner of Iowa
Lean Processing at work in Spencer Hospital is known as SHAPE: Spencer Hospital Achieving
Performance Excellence
Background:
Our Lean journey began in October 2005; strong leadership and support from the CEO, the Executive
Team, & the Board of Trustees plus the dedication of front line managers and staff make the process
work. The focus is always on eliminating waste and achieving results in quality, service, operations and
employee engagement. As of this month:
 40% of @ 500 staff have participated on rapid improvement teams
 Plus, “Voice of the Customer,” patients, families and physicians are involved at key times
The customer, ultimately patients and families define "value". And we value internal and external
customers. We use Lean principles: 1. Value; 2. Value stream; 3. Flow; 4. Pull; 5. Ideal; and,
fundamentals: 1. On-Demand; 2. Defect-Free; 3. One-by-One; 4. Lowest Cost
We make use of an abundance of Lean tools: process mapping, spaghetti diagrams, communication
circles, 5S-ing, standard work, A-3 problem solving, visual controls, and appreciation for the worker, and
full review of the existing work process. At the foundation of all the work is measurement; metrics
provide the understanding of where we are and where we need to be and if, in our changes, we are
getting there.
We are dedicated to being "people-oriented, process-focused and results-driven". SHAPE is not a quick
fix; it is a commitment to excellence through open-mindedly having the courage to see the waste and to
call it that…. and then doing something about it. SHAPE is not just a process; it is a way of doing
business. We have just scratched the surface and look forward to long term success.
Success Stories – Results: Quality Improvements and Cultural Impact:
1. Topic: Surgery – Central Sterilization Assembly & Work Flow
Scope: Review Central Sterilization Cell assembly flow; i.e. items coming out of the washer and
continuing through placement of items on sterilization racks after coming from the autoclaves;
motion from decontamination process to placement in storage racks, then prepared for surgery
use.
Before:
Initial state review:
 Layout was spread out, revealed waste in steps and excess space allocation; table set up
perpendicular to work flow and material not lined up for ease and efficiency
 Data: 4.6 miles traveled/person/day
During:
Mapped current flow, ideal, and future flow;
 Try-stormed (trialed) 6 rapid improvement experiments to shorten distance traveled and
optimize ease of assemble of sterile packs
Results:
Developed continuous flow in the direction of the work by:
 Moving configuration to line up with flow
 Freeing up space to move sterile supplies closer to assembly
 Relocating autoclave rack, battery charger, biological test tubes
 Rearranging materials– point-of-use supplies and holders
 Marked "parking" areas for case carts to be returned and maintained
Data: Saved 181 miles/person/year –or .7mile/person/day
Freed up 200 square feet of space
After:
Central Sterilization staff continued to work to free up the remaining 66 sq feet of space needed to allow
the movement of sterile supplies into the Central Sterilization area, saving them from having to travel to
the lower level of the hospital each time they needed these items.
Lessons Learned:
 This 4-day event enabled a team to focus, study and make significant changes – all within a
week.
 We need to test new ideas, break paradigms.
 The solution to a problem is not through more space or more resources, "creativity before
capital".
 Lean principles do apply to healthcare.
Another Success Story:
2. Topic: Mental Health Intake Process
Scope: Review and streamline Mental Health process of admitting patients
Before:
Initial State Review:
 Disconnect of communication, cumbersome process with excessive tasks/steps, and lack of
standardization
 Data: Average cycle time = 2 hrs 38 minutes
During:
Mapped the flow of the patient from Emergency Department (ED) to Inpatient room; also, ideal state
map


Current total process steps = 53; significantly non-value added steps
Performed 14 rapid experiments and measured results
Results:
Streamlined the admission process
 Established admission path from ED to patient floor, more direct via elevator across from intake
room
 Set up a new, secure admission room
 Stocked supplies at point-of-use
 Created standard work, processing orders etc. in the computer medical record; created standard
screens and maximized use of the EMR (electronic medical record)
 Resolved the wireless computer issues – installed new WAPs (wireless access points)
 Data: Average cycle time reduced to 2 hrs, a 24% savings
Lessons Learned:
 Lean really works.
 This is hard work----but achieves results quickly.
 Doing experiments during the week really helps.
 It is often difficult to move people's cheese, i.e. change their world.
 We have a new appreciation of the complexity of processes.
Teams in action:
We involve the staff from the areas "where the work happens" – putting up an Issues and Ideas poster
for them to contribute before the Kaizen event; we also have the process owner bring staff to the SHAPE
work room to review the information on poster paper "covering the walls" so they are in the loop and
engaged to accept the changes as best as possible.
This process has helped staff and leaders work together on real engagement and results, promoting
further drill down and stressing the need to hold the gains. This is a great opportunity and investment
for the staff and community. The driving force for all our work is "What is in the best interest of the
patient"!