Maintaining the Health of a Hospital

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.

As we move forward in the private sector with real healthcare reform, it is important, now more than ever, that we focus on the facts and identify ways to reduce costs while improving the quality of care at the same time for patients.

Lean Management

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 it is treating patients or building cars, is susceptible to the following eight common forms of waste that are often roadblocks to optimizing a process:

  1. overproducing,
  2. waiting,
  3. transportation,
  4. inventory,
  5. unnecessary motions,
  6. processing waste,
  7. defects and
  8. unused human potential.

The goal of lean management is to identify and eliminate these forms of waste.

Lean healthcare organizations empower their members (physicians, nurses, administrative staff, etc.) 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: Improving Patient Care in the Collaborative Care Unit

One department that has produced incredible results is ThedaCare’s Collaborative Care Units (CC). CC is 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 to relieve the burden of administrative tasks from the nurse, allowing him/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 since patients or their families don’t have to repeat the same information to the doctor, nurse and pharmacist. With all three providers working together from the beginning, communication among the different 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 admin work with nurses: The system has slashed documentation time in half, enabling nurses to increase the time they spend 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 eliminated and replaced with smaller work stations closer to the patient rooms. Patient rooms were also remodeled to not only be safer, but also to include in-room storage for the most used items, which cuts down the number of steps staff members take to get what they need. Visual management systems were implemented to 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, the CC 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 to 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: Patients aren’t the only ones satisfied with CC. Using the same 1 to 5 scale regarding job satisfaction, nursing staff members had an average of 3.72 in 2007. In 2008, satisfaction levels rose to 4.37and has 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 three years of their lean journey and many more millions since.

ThedaCare is just one example of forward thinking healthcare institutions that are applying lean management practices to reduce costs and improve the quality of care. While government reform is a now a component of the healthcare landscape, if the industry waits for the government to fix these systemic problems, it will be too late.

Marc Hafer is chief executive officer of Simpler Consulting. Dr. Toussaint is CEO emeritus of ThedaCare and founder and president of the ThedaCare Center for Healthcare Value.

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