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Organizational Improvement

Vertical value stream analysis to chart a course to patient centered medical home

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.

Case study series on pneumonia care improvement measures: Improvement strategies of top-performing hospitals

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.

The importance of communication for patient satisfaction

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.

Geisinger looks at all the pathways: Case study in healthcare logistics

This paper and presentation at the 2013 SHS Healthcare Systems Process Improvement Conference describes efforts to optimize logistics (transportation of goods and services to and from patient care areas) in a large regional medical center. The basis of the project was the application of simulation modeling to better understand the complexity and interaction. 

Visualizing conversation structure across time: Insights into effective doctor-patient consultations

This study uses a highly efficient and time-economic automated computer visualization measurement technique called Discursis to analyze conversational behavior in consultations.

Driving value through clinical practice variation reduction: A case study for total joint replacement process improvement

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.

Hybrid field: Nursing and industrial engineering

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.

Patient experience and physician productivity: Debunking the mythical divide at HealthPartners Clinics 

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.

Do I want to become a consultant?

Many people consider becoming a consultant at some point in their career. Longtime SHS contributor, John Templin, shares his perspective as a person with more than 40 years consulting experience. The presentation and paper describe some of the behind-the-scenes aspects of consulting including marketing, pricing, estimating time, career options and what it takes to run a healthcare consulting business. Presentation - Financial worksheet 

Continuous improvement methods better than best practices from the Joint Commission 

In an online article in Hospitals and Health Network Daily, Haydn Bush describes how Mark Chassin, M.D., president of the Joint Commission, believes it may be time for hospitals to move away from best practices and adopt comprehensive improvement methods that allow for deeper, more specific analyses of their patient safety requirements. Dr. Chassin cites examples of multiple failure modes of various processes in different facilities that can't effectively be addressed by best practices alone.

­­­­­New England Veterans Engineering Resource Center (VERC) integrates applied projects, student projects and research collaborations to improve care for veterans 

Under the New England VERC, engineering faculty and students from Northeastern University, Worcester Polytechnic Institute and Massachusetts Institute of Technology are working on projects within VA facilities. VERC members are learning firsthand about healthcare issues and developing solutions and approaches that will improve care.

What healthcare needs is systems engineering 

Dr. John D. Evans shares his thoughts in this video presentation, at the 2011 Stanford Graduate School of Business Healthcare Summit, about the importance of leveraging systems engineering in the healthcare sector. Using intensive care units as an example, Evans points out that no one has ever really sat down with a clean sheet of paper and said, "This is the mission." He says what the intensive care unit, and the healthcare market in general, needs is for innovators to create efficient designs not just for individual technologies, but for the whole system. Evans presents a generalized model for a systems engineering that he believes should be applied to healthcare.

Developing a sustainable improvement infrastructure

This presentation at the 2012 Healthcare Systems Process Improvement Conference describes how the Operational Improvement team at Nebraska Medical Center is organized for sustained improvement. The leader of the OI team describes the process to identify potential projects and prioritize centralized project leadership resources based on organizational benefits, while simultaneously developing these individuals as future organizational leaders.

How industrial engineers improve healthcare - University of Wisconsin-Madison College of Engineering, Department of Industrial and Systems Engineering

A recent article in the UW-Madison College of Engineering Alumni Magazine describes ongoing research in the Department of Industrial and System Engineering to improve healthcare. One research project led by Professor Doug Wiegmann is being done to develop better methods to improve flow and communication in the operating room. Data is being collected at Cedars-Sinai Medical Center in Los Angeles, where graduate students follow trauma cases from the emergency department through surgery. The research is sponsored in part with a $1.2 million grant from the U.S. Department of Defense.

10 Tips from a hospital CEO for process improvement specialists - from the 2012 Healthcare Systems Process Improvement Conference

Mark Graban blogs on Steve Markovich's keynote address, "Bringing Value to Your CEO." Steve Markovich is president of Riverside Methodist Hospital in the OhioHealth System. Markovich is also a family practice physician, Brigadier General in the Ohio National Guard and an F-16 fighter pilot.

Lehigh Valley Health Network nurses go lean

An online article in American Nurse Today, describes how Lehigh Valley Health Network (LVHN) in eastern Pennsylvania, is working to implement Lean. LVHN calls their approach the "System for Partners in Performance Improvement (SPPI)." The goal of the organization is to discover more efficient ways to provide health care by using lean tools and concepts that reduce waste and repetition. The article provides a detailed description of the five-day rapid improvement event process in use at LVHN.

Reducing length of stay using service line lean concepts

In this presentation at the 2011 SHS Conference, Jonathan Flanders describes how a 400 bed hospital reduced average LOS for Hospitalist patients by 1.0 day using lean concepts applied at the service-line level. The presentation is a comprehensive case study for the application of lean and six sigma tools. The use of multi-level value stream mapping applied to an inpatient care unit will be of particular benefit for readers struggling in this area.

Sustaining financial performance through a large scale system wide performance improvement initiative

In this presentation at the 2011 SHS Conference, Lynn Alters describes how a system-wide performance improvement initiative improved margins by 40 percent at WellStar Health System using internal resources and fostering an environment of trust and respect.  In addition to the financial benefits, the initiative created stronger leaders and will soon exceed its initial goals by three-fold.

Central line infection reduction using Lean Sigma at Presbyterian Healthcare Services, Albuquerque, N.M.

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.

Lessons learned from moving to Web-based surgical requests

The authors delivered a presentation and paper at the 2011 SHS Conference providing a comprehensive case study of how the Sir Mortimer B. Davis-Jewish General Hospital in Montreal, Quebec, moved from a paper surgical request process to a web based system. The lessons learned described by the authors will be valuable for anyone undertaking a similar large scale IT change.

Transforming care at the bedside: increasing patient satisfaction through employee engagement and teamwork at Our Lady of Lourdes Medical Center, Camden, New Jersey

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.

Industrial and systems engineers cure some of healthcare's ills - Watson Institute for Systems Excellence at Binghamton University

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. 

What makes a hospital great 

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.

Nurse Scheduling: From the Theoretical Modeling to Practical Resolution

In this paper recognized at the SHS 2011 Conference, the authors from the École Polytechnique de Montréal address the difficulty and complexity of nurse scheduling. The authors developed an algorithm to optimize nurse scheduling and also a heuristic model that can be applied without complex computer analysis that results in considerable improvement over the current methodologies. The authors applied the optimization and heuristic models to two different hospitals in Montreal.

Cowboys and pit crews: 2011 Harvard Medical School commencement address

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.

Improving pediatric emergency department patient throughput and operational performance

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.

Evaluation of industrial engineering students' competencies for process improvement in hospitals

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.

The journey to eliminating preventable harm - Nationwide Children's Hospital

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.

Case Study on transforming care at the bedside (TCAB), Good Samaritan Hospital 

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.

8 ways to cut labor costs in your hospital

Rachel Fields summarized the opinion of Dennis Patterson, chairman of The Collaborative for Healthcare Leadership, on the top ways to cut labor expenses in hospitals.

University of Windsor Industrial and Manufacturing Systems Engineering students help to improve lab processes in the ED at Sunnybrook Health Sciences Centre

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.

Indiana hospital pharmacy saves $1 million annually with lean improvements

Pharmacy leaders at Elkhart General Hospital, in Elkhart, Ind., applied a number of lean concepts resulting in lower operational costs and improved patient care.

Study finds high quality hospitals deliver trauma care at lower cost

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.

Human factors engineering to reduce patient falls 

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.

Case study on patient flow improvement, streamlining admissions from the emergency department

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.

Helping a hospital shine

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.

Significance of case management

Discusses the increasing importance of case management in reducing costs and improving reimbursement in the current environment. 

Barnes-Jewish Hospital featured for process improvement efforts 

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. 

Dartmouth Institute for Health Policy and Clinical Practice takes lead on data and analysis for national collaboration for reducing healthcare costs

The Dartmouth Institute for Health Policy and Clinical Practice, TDI, has been selected to support a national collaboration aimed at reducing costs for high-volume, high-cost chronic and acute medical conditions that have high cost variation. Dartmouth-Hitchcock Medical Center, Cleveland Clinic, Denver Health, Geisinger Health System, Intermountain Healthcare and the Mayo Clinic have teamed together to take on such things as knee-replacement surgery where there is up to 50 percent cost variation. 

A stratified sampling plan for billing accuracy in healthcare systems

Many U.S. healthcare organizations are already being exposed to Recovery Audit Contractor (RAC) reviews of Medicare and Medicaid billing as well as other third-party payor audits to assure accurate and non-fraudulent billing. In response, the authors propose an analytical approach to efficiently evaluate the accuracy of billing. 

Patient tracker

A case study of a centralized patient tracking system at Sentara Careplex Hospital in Hampton, Va. The case study shows how Sentara was able to reduce patient registration labor by over 50 percent and save over $300,000 per year. 

The art of implementing Lean from AORN Management Connections

A recent article in AORN Management Connections by Carina Stanton describes how three healthcare organizations are implementing lean.

Adaptive Technology: The Engine Driving Performance 

It's time for hospital operations to be built on the back of adaptive technology instead of human performance alone. As other industry transformations have demonstrated, adaptive technology can become the engine driving sustainable performance over time.

The Importance of Communication for Patient Satisfaction

A discussion of survey results regarding communication between providers and the patient.  The visit quality as perceived by the patient increases with fewer communications.

Adding Value to the Surgical PAT Process

Using Lean Six Sigma tools, a hospital redesigns its PAT department process so that all charting is completed 72 hours prior to the day of surgery.

Management Engineers

Management Engineering: What is it?

An Introduction to External Funding for Health Care Improvement

Management engineers may need money to implement healthcare improvement.  This article outlines several potential funding sources.

Improving Medical Equipment Availability at Barnes-Jewish Hospital

One hospital details improvements to their medical equipment retrieval, cleaning, and distribution process.

Sustaining VAP Bundle Compliance in the ICU: A Model of CQI

Using Lean Six Sigma tools, a hospital redesigns and implements new ICU protocols for patients on mechanical ventilation.  The article details how the initial sustainability effort failed, but was brought back into long-run control.

Recruiting Change: Process and Productivity Improvement in Human Resources

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.

Optimizing Caregiver Workflow in a PICU

Physician and Nursing roles and responsibilities within a PICU are redefined using lean tools to decrease LOS while increasing outcomes.

Beginning the Lean Improvement Journey in the Clinical Laboratory

Using examples from several clinical lab redesigns, the sequence of steps utilized during a lean improvement effort are described.

Additional Thoughts Regarding our Roundtable with the Experts

Karen Martin describes the steps needed to ensure an improvement effort is successful at a system level, and ways for a performance improvement consultant to continuously improve their professional skills.

SHS Roundtable with the Experts: Summarizing Health Care Improvement Challenges

Four experts discuss various health care issues and potential solutions.  The implementation of lean, the importance of sustainability, the necessity of crafting appropriate technology solutions, and the ultimate need for improvements to come from within an organization are covered.

In by 9 Out by 6 - Level Loading

A CT scan department has its demand smoothed.

SHS Time-release fix: 5S is the little big secret for improving health care

5S theory and implementations are discussed

SHS Helping a Hospital Shine

Lean tools are used to redesign processes throughout a hospital.

SHS Paging Dr Toyota

Discussion of applications of lean within the OR.

Lollipops for Excellence

System-level quality and effectiveness programs are implemented using Six Sigma at a childrens' hospital in Washington DC.

SHS Attacking Waste and Variation Hospital-Wide: A Comprehensive Lean Sigma Deployment

Improvement projects in surgery, nursing, and the ED are discussed.  The process of moving a hospital towards adoption of Lean Six Sigma is also described.

SHS Data Driven Decision Making to Control Pharmacy Costs

Pharmacy decision-making is discussed, with focus on controlling costs.

SHS Education, Ceritification, Participation, Mentoring - Building a Career and a Future

What are the parts of a rewarding career as an engineer in health care?  This presentation proposes an answer.

SHS Development and Implementation of a Healthcare-Based Economic Evaluation Methodology

A methodology for standardized evaluation of the financial impact of operational and patient care improvements is discussed.

SHS Encouraging Management Engineering in Safety Net Hospitals

Several change management projects are covered in brief, moving rapidly through high-level descriptions of problem / intervention / impact steps.

SHS In by 9 out by 6 - Load Leveling

Detailed description of a lean project to improve TAT in the CT Scan department.

SHS Improved Scheduling in a for Profit Surgical Center

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.

SHS Pursuing Process Excellence - What's Holding You Back?

Why do some improvement projects fail and others succeed? What are some big-picture concepts that could move organizations to success with process improvement projects?  This is a big-picture discussion of several issues.

SHS Building Lean From the Ground Up

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.

SHS In the Quest for Performance Excellence: Deployment of Lean Manufacturing Principles in Healthcare Delivery Processes

Three successful lean projects are discussed in detail.  The ED, Radiology, and HR departments all show significant improvement.

SHS Using Lean Methodology to Improve Patient Safety and Clinical Quality

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.

SHS Achieving a Shared Baseline: Implementing Evidence Based Clinical Practices

The authors propose a methodology for shortening the time gap between discovery of new evidence-based clinical results and hospital (provider) utilization of the new practice.

SHS Reaching New Levels of Patient Safety Through Improved Specimen Labeling

Results of a hospital-wide specimen labeling lean project is discussed.

SHS Re-positioning Accountability in Labor Management: Success Stories

Implementation of productivity monitoring programs are discussed

SHS Get em In - Get em Out

Multiple projects and results are discussed in the goal to continuously improve patient flow.

SHS StaffingMatrix - A Powerful Tool for Balancing Staffing and Demand

A hospital implements improvements in staffing to hourly changes in RN demand.

SHS Using the Theory of Constraints to Supercharge Inpatient Throughput

A consulting group presented their throughput ideas, including reasons why some department-specific projects fail to realize proposed improvements.

SHS Enhancing Performance Excellence: Total Emergency Services Redesign

All processes in an ED are redesigned, with multiple outcomes showing improvement.

SHS The Journey Toward a Lean ED

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.

SHS Changing Organization Culture through Performance Management

A systemwide linking of departmental performance to manager and employee annual pay is discussed.

SHS Using Six Sigma to Improve ICU Patient Flow

A Lean Six Sigma project focusing on ICU throughput times is completed.  Lessons learned and successes are shared.

SHS Improve Outpatient Clinic Access and Service with Lean Six Sigma

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.

SHS Creating a WOW! Experience At the First Point of Contact

A performance improvement team tackles a call center.  Issues and lessons learned are discussed.

SHS Optimization of Surgical Scheduling

An OR's case scheduling process is studied; improvement projects are proposed.

SHS Streamlining Your OR

A hospital undertakes a systemic improvement of their OR suite.  The process and final results are detailed.

SHS Moving Up the Curve: From Individual to Team to Organizational Effectiveness

Management team-building requires careful thought and planning. The presentation goes over several common pitfalls and proposes solutions.

SHS How Change Management Transformed a Multi-site GI Practice

Replacing manual processes and disparate systems with a multi-site Gastroenterology electronic medical record system in a large multispecialty practice had many challenges.

SHS Change Management-The Key to Successfully Re-engineering Health Care Solutions

The presentation is a discussion of change management proposals and policies.. Some are successful yet some fail miserably.

SHS Ways and Wonders of Change?

Key success factors for change as well as the keys to team dynamics are considered and explained within this paper.

SHS Applying SHS Conference Learnings Back at the Ranch

Emergent Care was redesigned to decrease wait time significantly.

SHS Managing Variability in Patient Flow - Data, Process, Sustainability

Methods of confronting and smoothing the variability of patient flow are discussed.

SHS Engaging Staff in Lean Improvements for Patient Care Settings

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.

SHS Our Lean Journey Continues and What A Year It's Been!

Lean projects at Kaiser Permanente are detailed and discussed. The report is a system-level presentation showing many departmental improvements.

SHS Transforming Organizational Culture

A senior member of the Johnson&Johson consulting group discusses his approach to organizational culture change and the importance of sustained leadership commitment.

SHS Under Pressure - Efforts to Reduce Hospital Acquired Bed Sores

Root cause analysis was conducted to determine reasons for bed sores. This presentation and paper is the result of their team's effort. Sustainability and ongoing improvements are discussed.

SHS 5 Projects, 5 Hospitals: Using DMAIC for Rapid Quality Improvement

System-wide implementation of Lean Six Sigma has resulted in many successes. This presentation discusses the rationale for their overall strategy.

SHS Sustaining VAP Bundle Compliance in the ICU: A Model of CQI

The IHI Bundle was implemented; metric changes are documented and discussed. Several nursing practices were also changed.

SHS "Never Events" and HACs - You Break It, You Buy It

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 underway.

SHS Measuring the Success of Hospital Acquired Pressure Ulcer Prevention

Pressure Ulcers are a known issue with long hospitalizations. This presentation deals with several issues surrounding eliminating their occurrence.

SHS Capturing Supply Charges in the Emergency Department: How and Why?

ED charge capture is a constant problem for hospitals. This presentation covers one system-wide approach to increasing the capture rate.

SHS Premium Pay - Are You Paying Too Much for Your Labor?

HCA discusses its methodology for monitoring its usage of premium pay to ensure they use as little as possible.

SHS Connecting the Revenue Cycle to the World Wide Web

A pre-registration Internet interface was successfully developed. Lessons learned and sustainability are also discussed.

SHS Pursuing Process Excellence in Health Care

This presentation motivates the approach to management of a hospital as continuous improvement of many systems.

SHS The Cult of Healthcare - A Warning to New Arrivals

Although healthcare is unlike any other service industry, improvement concepts are immediately applicable. This presentation teases out some specifics and attempts to answer student questions regarding the complexities of health care.

SHS A Six Sigma Approach to Denials Management

Payment denials were decreased, resulting in a cost savings of $1.6 million annually. This project steps through the list of improvements made.



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