Long waits in the waiting room, patients leaving without being seen, patients boarding and holding in the ED, delayed test results, and diversions. Have you encountered these issues in your ED? This presentation from a prior SHS Conference highlights improvements through several ED projects at HCA and will provide you with a sample of the tools utilized, results, best practices, and lessons learned.
This presentation at the Healthcare System Process Improvement Conference 2013 addresses labor productivity in the post-acute setting. As labor rates continue to rise and represent the highest expense in the post-acute and long term care industries, providers are turning their attention to scheduling solutions that more appropriately align their workforce to patients' need. Traditional industrial engineering tools such as work measurement are leveraged to provide a more accurate definition of cost of care as well as staffing models that closely align labor to patient care demands.
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 article in Medscape Today describes an approach at Cleveland Clinic to improving management of the operating room workforce. It provides some interesting reference values for average staffing per room, skill mix and in-room staff utilization percentages.
It is a common presumption that patients satisfaction and physician productivity are somewhat exclusive. This study in the Permanente Journal helps dispel commonly held myths about the exclusivity of productivity and patient satisfaction, suggesting that 1) there are many physicians who excel in both areas simultaneously, and 2) there are different characteristics associated with varying levels of performance.
This presentation (large download) at the 2012 World of Health IT Conference describes how Kaiser Permanente is successfully leveraging IT resources to improve patient care.
A 2011 report from the Commonwealth Fund describes how four top-performing hospitals in readmission rates for heart attacks, heart failure, and pneumonia, manage care processes.
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.
Management Engineering: What is it?
A traditional process improvement methodology leads to changes within a hospital's HR department. Results from time studies, swim lanes, and simulation are used to support the proposed solutions.
Pressure Ulcer, Falls, Catheter-Associated UTI, Central Line Infection, and Objects Left in Surgery are addressed using process improvement methodologies.
A system for appropriate oversight of budgeted FTE's is discussed.
Publicity article describing Premier's release of top performers
Pharmacy decision-making is discussed, with focus on controlling costs.
Successful supply chain management is discussed. Examples show potential savings and describe the buy-in needed to achieve those dollars.
A methodology for standardized evaluation of the financial impact of operational and patient care improvements is discussed.
An ED lean project is discussed, highlighting some advantages that undergraduates can bring when partnered with professionals in the field.
Several change management projects are covered in brief, moving rapidly through high-level descriptions of problem/intervention/impact steps.
Detailed description of a lean project to improve TAT in the CT Scan department.
In a for-profit ambulatory surgical center, the current scheduling method often results in cases starting later than the initial plan. The presentation describes an implementation of clustering as well as multiple simulations of different possibilities.
The surgical admitting process is targeted with a lean event. Current and future state is described, the process of improvement is shown, and results are discussed.
Three successful lean projects are discussed in detail. The ED, Radiology, and HR departments all show significant improvement.
Three successful lean projects are discussed in detail. Specimen Labeling, Surgery and Endoscopy Pre-Op, and Inpatient Nursing Crash Cart projects all demonstrate significant improvement.
Results of a hospital-wide specimen labeling lean project is discussed.
A productivity monitoring system is installed and used to manage budget
A study is done to improve the communication between and expense of the nursing staff associated with all imaging modalities.
A productivity monitoring system is installed and used for each department in the system to measure budget compliance, production efficiency, and patient satisfaction. Decisions must be made regarding the weighting factors of each input to determine each department's relative score.
Implementation of productivity monitoring programs are discussed
Multiple projects and results are discussed in the goal to continuously improve patient flow.
A hospital implements improvements in staffing to hourly changes in RN demand.
A lean event focused on patient flow out of the ED was conducted, and results are discussed
All processes in an ED are redesigned, with multiple outcomes showing improvement.
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 a MD who became a lean coach.
Issues with billing denials can be addressed by creating and addressing a Pareto chart of top reasons for lack of payment. This is analyzed through implementation.
Process improvement within the HR department is shown through this project dealing with RN flex staffing.
Observation of production processes is a key part of process improvement.
A lean project is done with a general physician clinic and an outpatient pharmacy; results are discussed.
A lean project is done at a cardiac clinic. Problem is to reduce wait time for an appt and cycle time of the appointment. Results are discussed.
Changing managerial thought is a process; this presentation demonstrates one way that managers are forced to confront the reality of differing goals/expectations of other managers they must work with.
New ways to display OR data are proposed in this presentation.
An OR's case scheduling process is studied; improvement projects are proposed.
Reasons for delay in creation of case carts are addressed. SPD often has inefficient workarounds as part of their daily routine.
A hospital undertakes a systemic improvement of their OR suite. The process and final results are detailed.
A Premier consultant discusses lessons learned from performing many Lean ED projects during her career.
Emergent Care was redesigned to decrease wait time significantly.
Methods of confronting and smoothing the variability of patient flow are discussed.
A 848-bed hospital is experiencing long LOS and targets ancillary service availability as one potential source of improvement. The project discussed tracks the data, demonstrates immediate results, and suggests future improvements.
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.
4 lean projects were performed - pharmacy, lab, outpatient clinic, and telemetry unit. Each project was meticulously documented in the presentation. Pre- and post- metrics are included, as well as a discussion of sustainability.
Improvements within an HR department are proposed and implemented. Results are examined, as well as a simulation of the process.
A system-wide reporting tool for each cost center is developed and implemented. It is adopted as part of the budgeting process.
Lean projects at Kaiser Permanente are detailed and discussed. The report is a system-level presentation showing many departmental improvements.
Two supply cost projects are described, analyzed, and discussed.
Lean principles are utilized during analysis and transformation of a HIM department. Results and lessons learned are discussed.
HR process redesign cuts down the time spent at each process step. Lessons learned, sustainability, and metrics are discussed with the group during this presentation.
Lab collection and processing techniques are examined and improved. Results are discussed.
The authors present a tool for introducing lean across a system. Results from selected projects are discussed.
System-wide implementation of Lean Six Sigma has resulted in many successes. This presentation discusses the rationale for their overall strategy.
The IHI Bundle was implemented; metric changes are documented and discussed. Several nursing practices were also changed.
Hospital IT implementations must make assumptions to generate and defend the ROI. Several assumptions relevant to initial facilities planning are considered within this presentation.
ED charge capture is a constant problem for hospitals. This presentation covers one system-wide approach to increasing the capture rate.
HCA discusses its methodology for monitoring its usage of premium pay to ensure they use as little as possible.
RFID tags are a solution to the problem of losing items within hospital walls. This presentation discusses some of the requirements, accomplishments, and potential drawbacks of systemwide installation.
A pull system is implemented within a surgical suite, saving on inventory cost. Other accomplishments and lessons learned are discussed.
Any organization implementing lean six sigma will experience both success and failure. This presentation describes some of the "growing pains" of one system, as well as a methodical demonstration of the lean tools utilized in their improvement efforts.
Motivation is made for performing lean improvements within the lab.
Payment denials were decreased, resulting in a cost savings of $1.6 million annually. This project steps through the list of improvements made.
Turnarounds and first case starts are improved using a variety of lean techniques. Sustainability, achievement of buy-in and metric details are also discussed.
Lean improvement projects are performed within the supplies delivery function of a surgical services suite.