This paper and presentation delivered at the 2013 Healthcare Systems Process Improvement Conference describes work done in the Ochsner Health System to reduce orthopedic joint replacement costs and improve quality for the patient. High quality care at an affordable cost is an attainable goal that is both in the best interest of the patient and the healthcare system. Driving value through minimization of clinical variation enabled OHS to meet a higher standard of patient care while ensuring the long-term financial stability of the organization.
IIE Member and doctoral student Avinash Konkani is featured in a YouTube video describing research he is doing to reduce noise and medical device alarm fatigue. Avinash is attending Oakland University and is doing research at Crittenton Hospital in Rochester, Mich. Avinash is also a member of the SHS Newsletter committee.
This article describes best practices for setting up a productive internal medicine clinic. Many of the practices described in this article can be applied for improved throughput and patient satisfaction in other types of ambulatory clinics.
This presentation at the 2013 Healthcare Systems Process Improvement Conference provides a case study in the use of vertical value streams for large, complex improvements. Vertical value streams are a multi-layered value stream approach using rigorous project management. Boulder Community Hospital applied this methodology to the opening a Patient Centered Medical Home.
The following synthesis of performance improvement strategies is based on a case study series published on The Commonwealth Fund website, WhyNotTheBest.org. The hospitals profiled in this series were identified based on their performance on the pneumonia care improvement measures that are reported to the Centers for Medicare and Medicaid Services. Please see the case studies for a full description of the selection methodology.
In this study we used a highly efficient and time economic automated computer visualization measurement technique called discursis to analyze conversational behavior in consultations.
This research investigates the effect of communication complexity level on patients' perceived quality. The amount of communication was measured by self reports regarding the patient's visit.
This guest post in the Harvard Business Review describes how the Minneapolis Heart Institute has started to use a validated risk-prediction tool to distinguish between patients who require an extended hospital stay after a severe heart attack and those who can safely go home within 48 hours.
Sepsis continues to be a disease with high mortality, low clinical standard adherence, and high cost variation for many healthcare organizations. This Sepsis Toolkit from down under may be a useful reference for organizations looking to improve the quality of care for treating sepsis.
The authors post that the time has come to deconstruct suffering by breaking it down into meaningful categories that reflect the experience of patients and help caregivers identify opportunities to reduce it. The authors propose a framework for major types of patient suffering so that health care providers can organize themselves to address suffering more effectively.
This article in the Wound Care Advisor is a case study describing a cost-effective pressure-ulcer program in a 350-bed acute care hospital. The authors report that the program they put in place is saving over $2 million annually.
What began as an MBA class project at Purdue University's Krannert School of Management ended up with participants applying factory management techniques that hold promise for improving medical clinic productivity and quality. The research was supported by the Regenstrief Center for Healthcare Engineering at Purdue's Discovery Park. The improvements improved the capacity of the clinic by 37 percent with no additional resources.
This post on the HBR Blog Network describes a visual tool at Virginia Mason Medical Center in Seattle that has accelerated patient mobility. Research has shown that early mobility is an important aspect for improved patient outcomes and shortened length of stay.
The Hospital Inpatient Waste Identification Tool provides a systematic method for hospital front-line clinical staff, members of the financial team, and leaders to identify clinical and operational waste and subsequently prioritize and implement waste reduction initiatives that will result in cost savings for the organization.
This article is a summary of the discussion from a webinar hosted by Becker's Hospital Review with experts from Objective Health, a McKinsey Solution, on strategies for hospitals to reduce unwarranted clinical variation. The strategies and analyses presented in the webinar focused on hospitals' unwarranted variation, which involves treatment protocols, physicians' clinical supply choices and resource utilization. The article also provides links to view or download the webinar as well as a copy of the presentation.
In this article, Patti Brennan, the Lillian L. Moehlman Bascom Professor in the School of Nursing and College of Engineering at the University of Wisconsin, discusses the intersecting fields of industrial engineering and clinical care with members of University of Missouri's Industrial and Manufacturing Systems Engineering Department.
This article, in the British publication Pediatric Anesthesia, describes how patient safety can be improved using race car pit stop and aviation analogies based on a prospective study. A new handover protocol was developed that reduced technical and informational errors by up to 50 percent.
A multidisciplinary group at Presbyterian Healthcare Services teamed together to meet the Joint Commission National Patient Safety Goal and to reduce the central line infection rate to less than 1 per 1,000 patient days. The team used a Lean Sigma improvement methodology to identify a number of countermeasures including checklists, education, defined observer, and a standardized central line kit. In the first six months of the project, the central line infection rate was reduced to .22 infections per 1,000 patient days.
Nursing leaders at Our Lady of Lourdes Medical Center in Camden, New Jersey, engaged staff to improve patient and employee satisfaction and reduce staff turnover on a medical-surgical unit using the Transforming Care at the Bedside (TCAB) model developed by Robert Woods Johnson Foundation and the Institute for Healthcare Improvement. The team focused on a set of directed methodologies and conducted a number of experiments that resulted in dramatic improvement.
A recent feature in Binghamton's Watson Review describes ongoing healthcare improvement research at the Watson Institute for Systems Excellence (WISE). Ongoing healthcare research at WISE includes research in ED throughput and supply chain. WISE researchers collaborate with a number of hospital systems including Vitua, Mayo, and Wilson and Binghamton General Hospitals.Thirteen research assistants in the WISE program have recently been placed in healthcare organizations.
In a recent New York Times article, Dr. Pauline W. Chen makes a case that organizational culture is more important than technique and technology in providing quality healthcare.
Popular author and speaker Atul Gawande challenged the 200 graduates of the 2011 Harvard Medical School to pursue a more systematic approach to delivering healthcare. He used pit crews and cowboys as examples of working as a system.
Prevailing misperception is that implementing any EHR complies with HITECH ACT requirements and incentive qualification. EHR implementation is only one part of meaningful use. Meaningful Use depends on workflow, evidence based clinical practice, measurement and reporting. In this presentation prepared for SHS by Kevin Martin, meaningful use is described along with the practical applications for organizations providing clinical care.
Students at Worcester Polytechnic Institute and in coordination with UMass' Center for Innovation and Transformational Change examined how lean tools can eliminate non-value added work, improve resource management, and create lean flow at the UMass Memorial Hospital. After implementing a number of changes, the team saw a reduction in patient throughput time, elimination of defects in the chart tracking process, and a decrease in stocked inventory.
A multidisciplinary team working at the Rady Children's Hospital in San Diego, Calif., was formed to improve ED throughput. Based on comprehensive variability analysis the team implemented a number of changes including daily performance reporting, a fast track for lower acuity patients, and standardized nurse and physician rounding. The changes resulted in a 10 percent lower length of stay and a 50 percent reduction in left without being seen. These changes are planned to improve revenue by $782,000 to be budgeted in the next fiscal year.
A team at Kadlec Regional Medical Center in Richland, Wash., took a lean approach to improving the availability and reliability of anesthesia related equipment in the OR. The team included physicians, staff, and external consultants. The article describes the background of total productive maintenance and how it was applied by a multidisciplinary team including physicians, OR staff, and clinical engineering. View related photos
In this Ezine article author Gerald Leone describes how lean tools and principles were successfully applied in preparation for a Joint Commission Survey.
In an article recently published in the Journal of Industrial Engineering and Management, the authors concluded that while IE students working in hospitals focused on technical approaches to improvement, mastery and application of softer skills may be more beneficial.
In this presentation at the 2011 Society for Health Systems conference, Cindy Hafer provides a comprehensive look at how Nationwide Children's Hospital in Cincinnati is moving to eliminating all preventable harm to patients through a comprehensive safety initiative.
At a recent Premier Breakthroughs Conference and Exhibition, clinical and performance improvement staff at the 370-bed Good Samaritan Hospital in Suffern, New York presented a case study of improvement on a nursing unit using the TCAB model.
Sunnybrook Health Sciences Centre is considering implementing recommendations made by three fourth-year students at the University of Windsor Industrial and Manufacturing Systems Engineering as part of their capstone project. Ben de Mendonca, Josh Vandermeer and Andrew Phibbs, conducted an intensive examination of the system used by the emergency department to collect and label patient blood samples.
Pharmacy leaders at Elkhart General Hospital, in Elkhart, Ind., applied a number of lean concepts resulting in lower operational costs and improved patient care. Examples of improvements cited in the Modern Medicine e-zine article were to redeploy two pharmacists to clinical roles, consolidate unit medications, and reduce batching of IV medications.
A recent study in the Annals of Surgery found that high quality hospitals deliver lower cost care to trauma patients, according to a news release by the University of Rochester Medical Center.
In a recent presentation at the 2011 SHS Conference, Brian H. Fillipo delivered a presentation on a comprehensive approach to reducing patient falls across seven Bon Secours hospitals in Virginia.
In a case study on the AHRQ website, the 340-bed Forbes Regional Campus of Western Pennsylvania Hospital developed a number of strategies to reduce delays in patient admission and discharge resulting in improved patient flow. The improvements were made during a weeklong kaizen blitz.
In an article previously published in Industrial Engineer magazine, industrial engineering researchers at Clemson University assisted Cannon Memorial Hospital in Pickens, S.C., in a number of hospital-wide and service specific improvements resulting in increased efficiency.
Becker's Hospital Review recently compiled a list of 40 hospital benchmarks derived from recently reported information in the public domain. This limited benchmark provides some comparison of performance in quality, patient experience, finance and operations.
The stltoday.com website recently featured efforts at Barnes-Jewish Hospital in St. Louis to provide improved patient-centered-care using a number of lean management principles. A number of examples of process improvement in the OR and peri-operative services are discussed.
In this 2010 presentation at the Dartmouth School of Engineering, SHS contributor and past president, James Benneyan, Ph.D., from the School of Mechanical, Industrial and Manufacturing Engineering at Northeastern University discusses that challenges of measuring performance of evidenced-based medicine and provides solutions to address these challenges.
In research sponsored by the Agency for Healthcare Research and Quality (AHRQ), UW researchers summarize findings and associated research from a 2009 conference in a report entitled Industrial and Systems Engineering and Health Care: Critical Areas of Research.
Susan F. South, senior consultant, ValuMetrix® Services and Jo Ann S. Hegarty, worldwide marketing director, ValuMetrix® Services provide a description of improvements in blood transfusion processing by applying lean concepts at 14 different laboratories in three different countries. Average savings per site was over $190,000 excluding savings associated with improved inventory management.
One hospital details improvements to their medical equipment retrieval, cleaning and distribution process.
Physician and nursing roles and responsibilities within a PICU are redefined using lean tools to decrease LOS while increasing outcomes.
Pressure ulcer, falls, catheter-associated UTI, central line infection and objects left in surgery are addressed using process improvement methodologies.
Using examples from several clinical lab redesigns, the sequence of steps utilized during a lean improvement effort are described.
This article studies the work processes of nurses involved in the administration of medication. The goal is to reduce errors and improve efficiency.
An EMR is described that links physician and hospital records so that the same information is available in both doctors' offices and hospitals whenever the patient presents.
One implementation of rapid response teams is discussed.
Detailed description of a lean project to improve TAT in the CT Scan department.
Clinical improvement results are discussed for glucose control, rapid response teams, vent bundles and bloodstream infection projects.
A pharmacy is simulated and the results are discussed.
A 100,000-annual-visit hospital ED is redesigned using lean principles. Wait times decrease and pt satisfaction and revenue increases. Simulation shows further viability of new processes. This presentation is made by an M.D. who became a lean coach.
ED throughput process improvement projects are discussed. The presenter is an M.D. Several changes are shown with great results.
A lean Six Sigma project focusing on ICU throughput times is completed. Lessons learned and successes are shared.
Reasons for delay in creation of case carts are addressed. SPD often has inefficient workarounds as part of their daily routine.
Methods of confronting and smoothing the variability of patient flow are discussed.
A lean project generated proposals for rescheduling the providers' workload. During testing of the proposals, daily departmental volume was completed significantly earlier in the day.
Lean projects at Kaiser Permanente are detailed and discussed. The report is a system-level presentation showing many departmental improvements.
Medicare's changes to payment require a higher degree of awareness from hospitals nationwide. This presentation addresses some of the concerns and discusses mitigation efforts currently under way.
Pressure ulcers are a known issue with long hospitalizations. This presentation deals with several issues surrounding eliminating their occurrence.