There are two keys to successful cost-cutting in healthcare: the first - necessary but not sufficient - is to apply proven tools and tactics from industrial engineering, lean, Six Sigma, and business process reengineering; the second is to align the initiative with the organization's mission and culture and engage clinical and administrative staff across the organization to collaborate in the process. This post from the HBR Blog Network describes how Banner Health, one of the nation's largest health systems, did it.
Identifying the areas of improvement in an effort to reduce operation room turnaround time and the inaccuracy of surgery scheduling is explored through case study examples including first person observations from the University of Pittsburgh industrial engineering case study at UPMC Presbyterian and Montefiore Surgery Departments. This article was previously published in the proceedings of the Industrial and Systems Engineering Research Conference 2012.
Management systems focused on standardization strategies like lean result in better health outcomes and lower mortality rates, according to a new JAMA report based on a study from the Oregon Health and Science University.
Tools for healthcare improvement - What tools can you share?
Swati Verma, management engineer at Southwest General Health Center, contributed templates for project charters and a monthly scorecard. The newsletter committee wants to make Tools for Healthcare Improvement a regular feature with contributions from SHS members and SHS Newsletter readers. If you have a tool you've had success with, please share by e-mailing the tool with a short description to: Tools for Healthcare Improvement.
In this one-page presentation at the 2012 Healthcare Systems Process Improvement Conference, the authors use the Plan-Do-Check-Act (PDCA) improvement methodology enhanced with specifics from Lean and Six Sigma to make improvements in the initial nursing assessment. These improvements include the removal of process redundancies, accurate identification of patient problems and an appropriate and viable plan of care which drives improved patient outcomes.
In this presentation at the 2011 Healthcare Process Improvement Conference, Christian Rizzo of OhioHealth describes a system-wide effort to reduce sternal wound infection by leveraging lean tools such as standard work, process maps, daily gemba walks and performance metrics. OhioHealth was able to standardize care using evidenced-based practices extending from the doctors' offices to case management. This presentation demonstrates how lean tools are utilized and describes how the system was able to sustain a reduction in infections of more than 60 percent.
Undergraduates Joshua Wimble, Kristine DeSotto, Casey Krawic and Zachary Theoharidis at WPI completed a project as part of their graduate requirements resulting in a reduction of missing medications at the West Roxbury campus of the VA Hospital.
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.
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?
One hospital details improvements to their medical equipment retrieval, cleaning, and distribution process.
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.
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.
Lean tools and simulation are used to recommend improvements to HIM operational processes.
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.
When applying value stream mapping, don't forget that sometimes patients will need to be grouped just like part families - and each of those may need a unique VSM.
A CT scan department has its demand smoothed.
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.
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.
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.
A lean event focused on patient flow out of the ED was conducted, and results are discussed
ED throughput process improvement projects are discussed. The presenter is a MD. Several changes are shown with great results.
A performance improvement team tackles a call center. Issues and lessons learned are discussed.
A Premier consultant discusses lessons learned from performing many Lean ED projects during her career.
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.
Two supply cost projects are described, analyzed, and discussed.
The IHI Bundle was implemented; metric changes are documented and discussed. Several nursing practices were also changed.
ED charge capture is a constant problem for hospitals. This presentation covers one system-wide approach to increasing the capture rate.
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.
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.