Investor-owned hospital chains are enjoying momentum under healthcare reform that isn't sweeping along their not-for-profit counterparts. Analysts expect another strong year from the for-profit operators because they've cut costs and adopted new initiatives to bring in more patients.
Healthcare spending rose 3.6 percent, or $2.9 trillion, from 2012 to 2013, marking the lowest growth rate since the federal government began tracking healthcare expenditures in 1960.
The president of the Society of Hospital Medicine identifies attributes of industrial engineers that make for a better hospitalist and where to acquire tools and skills to succeed in a multifaceted role.
This paper is a case study of work done at Parkland Memorial Hospital in Dallas, Texas, to improve interventional radiology throughput with the main objective of reducing patient wait times and avoiding costly capital investment.
Researchers applied lean and Six Sigma methodologies to improve OR efficiency. Multidisciplinary teams addressed minimizing volume variation; streamlining the preoperative process; reducing non-operative time; eliminating redundant information; and promoting employee engagement.
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.
Lean Six Sigma tools improve more than turn-around-time for ED blood draws
This case study from the Healthcare Systems Process Improvement Conference presents the analysis of the ED-LAB blood draw system for a large tertiary teaching hospital.
Paper | Presentation
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.
An improvement team at Advocate Trinity Hospital in Chicago addressed the issue of a high rate of "left without being seen." This presentation at the 2012 Healthcare Systems Improvement Conference describes how an improvement team used information systems and analytical approaches to gather information on the root causes for problems and potential solutions in the ED. Leadership rounding throughout the ED, establishing effective treatment protocols and finally, front loading medical orders to help expedite patient treatment and prompt patient disposition. After implementation of the above planned measures, the LWOT percentage reduced from the highest rate of 12.4 percent in July 2009 to 1.1 percent in June 2011.
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.
Vision based recognition of hand gestures is being researched at Purdue University to control a robotic scrub nurse and access images during surgical cases. The research could lead to short case lengths and reduced infections according to the Purdue University News website.
A discussion of survey results regarding communication between providers and the patient. The visit quality as perceived by the patient increases with fewer communications.
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.
This article studies the work processes of nurses involved in the administration of medication. The goal is to reduce errors and improve efficiency.
Examples are used to detail the need for use of IE methods in the setting of departmental staffing levels
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.
5 organizational factors impacting system acceptance of lean tools are studied and discussed.
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.
Discussion of applications of lean within the OR.
System-level quality and effectiveness programs are implemented using Six Sigma at a children's hospital in Washington DC.
An ED is redesigned after patient flows were modeled using queuing theory.
The process of creating and achieving approval of an ED simulation is discussed.
One implementation of Rapid Response Teams 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
Improvements to a pediatric OR are proposed and tested with simulation.
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.
Detailed description of a lean project to improve TAT in the CT Scan department.
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.
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.
Clinical improvement results are discussed for glucose control, rapid response teams, vent bundles, and bloodstream infection projects.
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 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.
Process improvement within the HR department is shown through this project dealing with RN flex staffing.
A systemwide linking of departmental performance to manager and employee annual pay is discussed.
Billing error reduction as a Lean Six Sigma project
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 at a cardiac clinic. Problem is to reduce wait time for an appt and cycle time of the appointment. Results are discussed.
A performance improvement team tackles a call center. Issues and lessons learned 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.
What's the benefit of developing a team of lean experts? This presentation proposes an answer.
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.
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.
Management team-building requires careful thought and planning. The presentation goes over several common pitfalls and proposes solutions.
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.
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.
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.
A senior member of the Johnson&Johnson consulting group discusses his approach to organizational culture change and the importance of sustained leadership commitment.
This presentation motivates the approach to management of a hospital as continuous improvement of many systems.
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.