Management • SNAPSHOT
According to a report from Thompson Reuters, an estimated $700 billion is wasted annually across the U.S. healthcare system, which includes administrative inefficiency, redundant paperwork, medical mistakes, and overuse of medication and tests. Many forward-thinking hospitals across the country are actively eliminating waste out of their health systems, thereby saving millions of dollars each year without cutting staff or services.
Lean is a management approach that enables the true performance potential of a business (like a hospital) or a process (like admitting patients) to be realized. Lean management is a set of fundamental applications of various tools that help employees see and eliminate waste. Any process, whether treating patients or building cars, is susceptible to the following forms of waste that are often roadblocks to optimizing a process: overproducing, waiting, transportation, inventory, unnecessary motions, processing waste, defects and unused human potential. The goal of lean management is to identify and eliminate these forms of waste.
Lean healthcare organizations empower members (e.g., physicians, nurses, administrative staff) on the front lines by teaching them how to identify wasteful process steps, followed by problem-solving tools to be used in their daily work and on project teams. The place to start is examining every individual's work, identifying steps that can be eliminated and focusing on delivering value to the patient.
Case Example: Collaborative Care Unit
One department that has produced incredible results is ThedaCare's collaborative care units. These units offer a new inpatient care process where the nurse, pharmacist and physician meet with a patient and their family within the first 90 minutes of their hospital admission to develop a single plan. In the past, each of these clinicians had three separate care plans, and the nurse had to act as the conduit in between.
The Problem
Nurses have always struggled with balancing time between their workloads. In fact, employee satisfaction and nurse retention continue to be challenges for many hospitals as the volume of patients and the demand for quality care rises. A new care process needed to be created at ThedaCare's Appleton Medical Center in Wisconsin to relieve the burden of administrative tasks from the nurse, allowing her to perform a higher scope of practice.
The Solutions
Employees use lean management to identify processes that need improvement, then develop ways to make what they're doing even better. Some of the solutions included:
• One central plan of care: Nurses collaborate more closely with the physician and pharmacist to develop a care plan and ensure the team is on the same page. The use of "the trio" cuts down on waste because patients or their families don't have to repeat the same information to the doctor, nurse and pharmacist, and communication among disciplines is more open and improved.
• Moving medication closer to the bedside: Medications, supplies and new electronic record-keeping systems for medications are now located at the bedside, allowing nurses instant access to medication records. As a result, the unit has not had a single medication reconciliation error.
• Decreasing the burden on administrative work with nurses: The system has slashed documentation time in half, enabling nurses to increase time with patients by 70 percent.
• Designing a new space: Delivering collaborative care requires an environment not found in many hospitals. The standard wing design of a central nursing station was replaced with smaller work stations closer to patient rooms. Patient rooms were also remodeled to not only be safer, but to include in-room storage for the most-used items, cutting down the number of steps staff members take to get what they need. Visual management systems now increase communication among health professionals, and between the staff and patient and their families.
• Daily management: Staff huddles and real-time problem-solving are critical elements of ThedaCare's lean management approach that has yielded daily continuous improvement and breakthrough results.
The Results
• Cost: To date, collaborative care has experienced a 25 percent reduction in total cost of care ($1,318 reduction in admissions/patient).
• Patient Satisfaction: At the end of 2007, 87 percent of patients graded the unit a 4 or 5 on a scale of 1-5. In 2011, that percent rose to 99 percent.
• Length of Stay: Patients are also more satisfied with their treatment and leave the hospital sooner. In the first year of operation, the average stay of a patient in the collaborative care wing decreased 20 percent with reduced length of stay by 16 percent while lowering readmission rates.
• Employee Satisfaction: Using the same 1-5 scale regarding job satisfaction, nursing staff had an average of 3.72 in 2007. In 2008, satisfaction levels rose to 4.37and have been maintained.
Applying lean tools can transform healthcare and impact critical objectives like improving quality, capacity and cost. In fact, patient and staff safety and access all improve while congruently lowering costs. Lean-thinking hospitals put the patient first to improve patient outcomes and reduce costs. ThedaCare saved more than $27 million in the first 3 years of their lean journey and many more millions since.
Marc Hafer is chief executive officer of Simpler Consulting. John Toussaint is CEO emeritus of ThedaCare, and founder and president of the ThedaCare Center for Healthcare Value.