Results two years after

Lean Management in the Jura Hospital Scheßlitz

„The development of internal process optimization competence

has really paid off for us. In cooperation with Stryker Healthcare
Services our Lean Management team has realized significant
primary projects since 2007 which enabled us to identify additi-
onal revenue potential of about $ 1,5 million. We already mana-
ged to realize 70 % in the first two years. This exceeded our
expectations by far. Now our next step is the optimization of our
occupational health and safety processes by using the Stryker
ViMotion Software.“
Brigitte Angermann
Brigitte Angermann, Assistant General Manager, Jura Hospital Scheßlitz

Customer Benefits at a Glance
• every single US$ invested in „Lean“
made more than a US$ 5 yield
• realized additional earnings of
about US$ 1,1m within two years
• increase of over 12 % more cases
• cost savings of about US$ 300,000
annually
• increase of case mix by 7 %
• reduction of inventory from
17,000 to 1,000 parts
• reduction of labor utilization and
overtime
• considerable optimization of ability
to plan human and financial
resources
• implementing internal „Lean“
projects reduces cost-intensive
external consultancy
• superior results as competition
• long-term steady patient flow
• decreased patient flow times
• increased patient and staff
satisfaction
The Jura Hospital has been managed
under the sponsorship of the non-
profit hospital organization of the
county of Bamberg mbH according
to private enterprise principle since
1995. The hospital has a capacity of
about 120 beds and is equipped with
modern medical infrastructure.
Qualified care combined with
excellent accommodation and
catering performance standards
provide a friendly atmosphere and
ease the patients‘ hospital stay.
„Although the hospital took internal
measures to maintain and further
improve the standard, the central
outpatient department and the OR
turned out to be bottlenecks and the
Jura Hospital‘s main concern by the
end of 2007“, states Brigitte Anger-
mann, Assistant General Manager of
Jura Hospital Scheßlitz. Whereas the
performance of the central outpatient
department suffered in particular
from unplanned overtime with
decreasing employee motivation,
there were also above-average
change-over times, major deviations
in the scheduling of the OR as well as
delays in performance due to instru-
ment and material supplies.
Lean Management
with a Strong Partner
Striving for solutions, the Jura
Hospital Scheßlitz decided to imple-
ment the small and fast optimization
steps of Lean Management. Lean
Management, developed by Toyota in
the middle of the 20th century to
optimize processes in the automotive
industry, offers various advantages.
A major advantage: The employees
initiate and support the changes in
the hospital. In addition value-added
process steps are encouraged from the
patient‘s point of view as non-value-
added activities are reduced. In other
words: Lean Management creates the
scope for the stakeholders within a
hospital to increase the quality and
quantity of treatment.
It was necessary to decide on a
suitable partner for the implementati-
on. The Stryker Team Healthcare
Services was selected due to its Lean
Management and knowledge transfer
expertise.
Stryker, in cooperation with the
University of Tennessee, trained 8
Jura Hospital Scheßlitz employees as
project leaders In Lean Management
in the autumn of 2007. Subsequently,
process optimization for the central
outpatient department and in the OR
was implemented with the approaches
of Lean Management.

• shorter response and waiting times

Stabilization and Optimization Furthermore anaesthesia is started in Performance development
of Processes parallels to finishing the previous INDEX VALUE

procedure. Ten minutes before the

200
To initially reduce variation and end of the procedure the surgeon +USD 1,1m
stabilize processes, our employees and informs the nurse which then can 175
the Stryker project coaches reduced prepare the material for the next 150
our stock from about 17,000 to 1,000 operation and inform the cleaning
125
units creating new free space while crew.
abolishing interim storage facilities 100
located in various places. To guaran- Measurable Success 75
tee material availability despite 100
50
reduced inventory levels the hospital Significant improvements were made
introduced a so-called Kanban in performance development. „Due to 25
system. This system indicates with newly obtained OR capacities the
2007 2008 2009
simple visual signals when and how calculated additional revenue potenti-
much of a certain article must be al of about USD 1,5 million has now
ordered. Parking lots indicate where a already been realized by more than Number of cases
certain object must be located in the 70 %.
OR, the prep and post operation
120 %
rooms.
115 %

110 %

105 % +12 %
Material and objects that belong to a We do not only profit from an
+2,5 %
certain room were color-coded and increase in our case numbers of more 100 %
hence clearly allocated. New storage than 12 %, which certainly means an 95 %
space was created by small installation improvement on our capacity“, the 100 %
90 %
and reconstruction measures in the Assistant General Manager sums up.
instruments storage area. Relevant 85 %
objects are now faster readily availab-
2007 2008 2009
le. Due to the newly created space, „Our case mix has also increased by
one room was defined as the new nearly 7 % due to the optimization.“
main stock location which can now be In addition, the hospital was able to Case mix
replenished, in contrast to the increase its staff ‘s motivation as well
previous situation, without crossing as satisfaction significantly which also
130 %
the OR. Furthermore carts for resulted in happy patients: they have
anesthesia were equipped with all the shorter waiting and operating times 120 %
essential devices and are ready for use experiencing higher satisfaction. In a 110 %
at any time. Not only distances for the nutshell; everybody wins. „The Jura +7 %
100 %
employees were considerably shor- Klinik Hospital saves approximately
tened by these measures which led to USD 300,000 in costs by reducing 90 %
significant time savings. The dramatic labor utilization, overtime and 80 %
reduction of material and element inventory“, says Angermann. 100 % -3 %
70 %
searching and changing times
moreover resulted in noticeably less The Next Step 60 %
disturbances in the operating process.
2007 2008 2009
This is a circumstance that capitalized „We were able to detect and benefit
soon. The initial stabilization phase from further optimization potentials
was followed by the optimization following the tremendous success of Working hours
phase. the primary projects. The next step is
The Jura Hospital compiled a new OR to implement Lean Management to
110 %
statute which was signed by all improve occupational health and
physicians and employees and which safety together with Stryker Health- 105 %
includes, among other things, the care Services. Using the video-based 100 %
following: The first patient and all analysis tool ViMotion we are
95 %
required ressources for the following working on avoiding risks and
morning are identified the evening reducing unnecessary processes for 90 %
before the surgery – this is only one our employees“, Brigitte Angermann 85 %
important pre-condition for a states. 100 % -3 % -9 %
80 %
on-time start. Operations with little
variability are performed first so that 75 %
deviations do not disturb the entire
2007 2008 2009
schedule.