Change (Personal, Team, Culture)
In a "Spring Break Practicum" program, industrial and systems engineering students from USC conducted an intense week of student-led projects resulting in improving efficiency in hospital operations.
Cleveland Clinic has found ways to reduce cost and increase throughput by adding support staff for primary care visits.
This is a summary presentation of one year results from a project at Mayo Clinic in Florida aimed at improving the operational performance of a hospital's operating rooms by assessing and managing variability. The changes resulted in a 5 per cent increase in OR utilization and net revenue and a 27 percent reduction in overtime. These data were also published in the June 2013 Journal of The American College of Surgeons.
New video: Understanding control charts
IHI Executive Director of Performance Improvement, Bob Lloyd, Ph.D. has been teaching the science of improvement all over the world for more than 20 years. The IHI Open School has compiled a series of short "whiteboard" videos in which Lloyd breaks down the core concepts of improvement science. The latest addition to the series is a two-part video on understanding control charts.
This article describes how one self-described introvert addressed a perception of shyness and increased his influence at work.
A recent article in Modern Healthcare cites that with the broader adoption of electronic health records (EHRs) the cost of Medicare claims has increased. CMS is investigating whether cut-and-paste features of some of the new EHRs is contributing to either fraudulent and inadvertent up-coding by charging for services that were never provided.
This presentation at the 2013 SHS Healthcare Systems Process Improvement Conference addresses the unique set of skills, knowledge and personal attributes for nurses in order to match individual nurses to various nursing roles. More and more, personality measures are being used to assess an individual's fit within various industries. Investigating the traits of registered nurses may provide a means to improving job performance, satisfaction and retention to meet the demands associated with nursing.
Department of Industrial and Systems Engineering, Human Systems Engineering Lab, Mississippi State University
On the surface, communication appears to be a simple concept within health care. Patients talk to doctors, nurses, and staff members. Doctors explain treatment options to patients. However, many obstacles often get in the way of understandable, quality communication. In our research, we investigate 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 article describes how one self-described introvert addressed a perception of shyness and increased his influence at work.
This poster presented at the 2013 Healthcare Systems Process Improvement Conference describes a staff-driven approach for improving patient care in a pediatric intensive care unit (PICU). Thanks to Mark Graban for identifying this poster.
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 recent article from the American Institute of Architects describes progressive improvements to ED design from the author's perspective. Examples of this evolution are provided from University Hospital in Cincinnati, Strong Memorial Hospital, Marymount Hospital, and University of Pittsburgh Mercy Hospital.
This presentation at the 2012 Healthcare Systems Process Improvement Conference describes the first part of a lean Six Sigma journey at BJC HealthCare. The author provides a candid discussion of the difficulty of change in a large organization and provides important lessons for anyone undertaking a similar challenge.
Application of lean Six Sigma in healthcare, improvement of nursing shift directors - a graduate-level-directed project experience
In this graduate-level-directed project, the workload of nursing shift directors (NSD) has been analyzed. The purpose of this study is to create a baseline metric of the existing process; collect operational data and analyze ways to improve the work efficiency by eliminating the non-value-added tasks from the daily workload; automate some of the tasks performed by NSD; and monitor and provide control methodologies for sustainability.
While healthcare systems among the developed nations of the world differ widely, they all are facing a common challenge: How to improve care quality and outcomes while reducing costs.
W. Edwards Deming: The man and the method
This presentation provided by Doris Quinn provides some insight into the latter part of W. Edwards Deming's life as well as some of the key values, teachings and goals of his lifelong work.
PowerPoint presentation | Diary following Deming in his final years | Video presentation
In this article, Robert Miller of the Shingo Prize expounds on the need for a principle-based foundation to achieve lasting organizational improvement.
In this presentation at the 2012 Healthcare Systems Process Improvement Conference, the authors provide 20 practical applications to use right now in your change efforts.
A recent article in the Journal on Quality and Patient Safety describes how Healthcare giant, Kaiser Permanente, has spent the last several years completing a transformation initiative to improve its performance improvement capabilities. While not formally adopting a Lean or Six Sigma approach, Kaiser has developed six key capabilities that align with those methodologies including leadership priority setting and developing a problem solving culture. Kaiser uses a large number of process advisors to assist and mentor in the transformation.
Prolific contributor to healthcare improvement Duke Rohe of MD Anderson Cancer Center provides his personal perspective on change in this paper delivered at a recent healthcare improvement conference.
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.
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.
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 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 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.
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.
Pharmacy leaders at Elkhart General Hospital, in Elkhart, Ind., applied a number of lean concepts resulting in lower operational costs and improved patient care.
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.
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.
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 recent article in AORN Management Connections by Carina Stanton describes how three healthcare organizations are implementing lean.
Effective leadership is the most important consideration for successfully implementing organizational change. In this paper presented at the 2010 SHS/ASQ Healthcare Division annual conference in Atlanta, Dr. Norka Saldaña describes a comprehensive change leadership model based on the current literature and her extensive experience in industry.
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 Engineering: What is it?
Management engineers may need money to implement healthcare improvement. This article outlines several potential funding sources.
One hospital details improvements to their medical equipment retrieval, cleaning, and distribution process.
This paper details the errors in medical history records that can occur over time within the present U.S. system, and proposes a solution.
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.
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.
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.
This article profiles Frank Gilbreth and Henry Ford. Gilbreth initiated the study of time and motion in the OR, and Ford was the first to attempt to decrease wasted motion among nursing staff.
Lean tools and simulation are used to recommend improvements to HIM operational processes.
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.
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.
A list of suggestions for new college graduates entering the work force.
A short overview of tools made available through IHI is presented. The web-based Improvement Tracker and Measures tools are an introduction to a system's need for customization of both project definition and outcome measurement.
A CT scan department has its demand smoothed.
5S theory and implementations are discussed
Lean tools are used to redesign processes throughout a hospital.
Discussion of applications of lean within the OR.
System-level quality and effectiveness programs are implemented using Six Sigma at a childrens' hospital in Washington DC.
An ED is redesigned after patient flows were modelled using queuing theory.
The process of creating and achieving approval of an ED simulation is discussed.
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.
Improvements to a provider appointment-making system are motivated, tested, and sustained
What are the parts of a rewarding career as an engineer in health care? This presentation proposes an answer.
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.
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.
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.
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.
This is an overview of several lean redesign projects in the ED with overall solutions discussed and analyzed.
ED throughput process improvement projects are discussed. The presenter is a MD. Several changes are shown with great results.
Multiple projects are performed to improve an ED. Problems are stated and results are given.
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.
A Lean Six Sigma project focusing on ICU throughput times is completed. Lessons learned and successes are shared.
A discussion of the importance of metric and measurement accuracy during execution of improvement projects.
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.
Resources are described and analyzed that could enable the viewer/reader to improve their skills and talents.
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.
Surgical services projects often have many barriers to success; this presentation helps illuminate and identify where they may be for your hospital.
A hospital undertakes a systemic improvement of their OR suite. The process and final results are detailed.
Replacing manual processes and disparate systems with a multi-site Gastroenterology electronic medical record system in a large multispecialty practice had many challenges.
The presentation is a discussion of change management proposals and policies.. Some are successful yet some fail miserably.
Key success factors for change as well as the keys to team dynamics are considered and explained within this paper.
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.
A system-wide reporting tool for each cost center is developed and implemented. It is adopted as part of the budgeting process.
Task analysis of an RN's shift on a med/surg unit is performed, using spaghetti maps and other lean tools. Integration of a new medicine delivery system is studied to examine how RN efficiency is affected.
Lean projects at Kaiser Permanente are detailed and discussed. The report is a system-level presentation showing many departmental improvements.
Lean improvements within the radiology suite and laboratory workspace yield notable improvements. Project benefits are discussed.
A system-wide rollout of 5S was performed. Results as well as lessons learned are discussed.
5S implementation strategies at multiple systems of varying sizes are presented and contrasted.
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.
Lab collection and processing techniques are examined and improved. Results are discussed.
A senior member of the Johnson&Johson consulting group discusses his approach to organizational culture change and the importance of sustained leadership commitment.
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.
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.
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.
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.
A pre-registration Internet interface was successfully developed. Lessons learned and sustainability are also discussed.
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.
This presentation motivates the approach to management of a hospital as continuous improvement of many systems.
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.