HEALTHCARE PROJECTS

  • Hospital Noise at Night Reduction
  • CMS required HCAHPS patient surveys run by PRC revealed noise at night to be a significant cause of sleeplessness and patient satisfaction. Patient care payments are partially based on 27 measures in the survey.
  • The project team looked into measurement systemspurchased a noise dosimeter, then identified key noise sources
  • Three major sources were Nurse Station chatter, general announcements and door closures, the team implemented improvements to reduce them
  • A control plan was set in place, along with random auditing to minimize recurrence of noise sources
  • RN Turnover Reduction
  • RN turnover was averaging close to 20%, with higher rates for newer employees.
  • The project team surveyed employees to identify root causes
  • The project team formed employee team & brainstormed improvements
  • The team researched & utilized best practices to retain new employees
  • Implemented more frequent stay interviews for new employees, a new employee network, improved new hire screening tools, invented and commercialized an improved measurement system.
  • Turnover decreased to 12% after the first year with the trend line showing additional downward movement.
  • In-patient Length of Stay Reduction
  • Team rank-ordered service lines with highest mean length of stay – neurology highest
  • Identified variation in lengths of stay as a function of provider, protocols & practices
  • After semi-standardization based on protocols & practices ALOS decreased from 4.5 days to 3 days.
  • Inconsistent Emergency Department to Clinic Appointment Scheduling
  • Over 70% of patients seen in ED were not provided post-ED clinic appointments
  • Process mapping showed inconsistent methods & training of ED discharge personnel
  • Standard work implemented to both insure appointments are made and explanation of need to reduce no-shows.
  • 80% of patients now provided convenient appointment times, post improve no-show measurements underway.
  • Optimal Care for Diabetes Patients
  • Primary care clinics were not meeting state goals for addressing primary contributors to diabetes
  • Process mapping showed inadequate and inconsistent rooming process
  • Rooming process should have included standardized diabetes questionnaire for provider to then focus efforts: HbA1c, LDL, Blood pressure, Kidney health, Eye health
  • All value stream personnel at pilot site trained in new process check-list with in-process measurements implemented resulting in clinics exceeding state score goals.
  • Pilot expanded to all 12 clinics
  • Increasing Payments from Medicaid
  • Implementation of a new invoicing system resulted in significant lost charges, valued at over $1MM per year revenue loss.
  • Process mapping with fishbone tool identified missing charge entry procedures at numerous clinics and missing claim rejection rework steps.
  • Standardized work formulated and implemented
  • Revenue now being captured
  • Home Health Visit Admissions Cycle Time Reduction
  • Mean time to home visit from time of clinic visit exceeded a 10 day state regulatory standard by 5 days
  • Value stream mapping identified batch queuing & extended provider times as largest wait time sources.
  • Single piece flow combined with standard physician order work in clinics reduced the mean time to 10 days average, further improvements implementation underway.
  • Total Joints Bundled Care Complications Reduction
  • Length of in-patient stays and readmissions rates for knee & hip joints higher than Geisinger benchmark
  • Project team investigation revealed inadequate or incomplete patient and family training in pre & post therapies & rehabilitation.
  • Improved education and therapy resulted in $900M cost savings.
  • Outpatients in Inpatient Beds
  • Data analysis reveals 3 key medical practice areas creating 80%+ defect
  • Standard work & process implementation in largest area resulted in 30% defect reduction
  • $90M per year cost reduction with a revenue improvement due to increased capacity
  • Improving Productivity in Neurosurgery Clinic
  • Primary constraint to increased throughput shown to be downstream of the clinic, constraint in surgical suites thus productivity improvement via increased patient flow not possible
  • Nurses’ & administrative assistant spaghetti diagramming showed excess motion areas.
  • Improvements allowed a small reduction of man-hours while cross-training enabled excess personnel usage in other clinics to help with demand surge as needed.
  • Improvement included utilizing more seasoned administrative assistants as “floaters” as they were better positioned to share learnings.
  • Decrease the Variation in Staff to Patient Ratio in Long Term Care Rehabilitation Centers
  • Team identified the double sided defect concerning having enough staff for safety but not too much staff for cost
  • Patient acuity & census to staffing ratio algorithm formulated with standard work implemented for adjusting daily staffing.
  • Safety guidelines for staffing levels met almost all the time after changes along with an $80,000 reduction in overstaffing costs.
  • Decrease use of Dietary Paper Products
  • Management determined that some costs could be saved but also an improvement in environmental stewardship could be met if recycled product could be used more consistently than disposable product
  • Data analysis revealed wrong product usually used for in-patients room delivery
  • Standard work implemented resulting in almost elimination of defect
  • Increasing Physical Therapy Appointment Access
  • The time between patient therapy appointment (receipt of order) and their practitioner visit (appt.) exceeded the 2 business days (48 hours) goal as mandated by the government. The mean was 3.3 business days. This resulted in higher staffing costs, potential patient satisfaction issues, & potential lost revenue.
  • 2 processes for 2 inputs mapped & improved: nursing home patients, outpatients. Standard work implemented.
  • Cycle time reduced to 1.8 days mean.
  • Annual Employee Education Development
  • Mandatory regulatory subject training formulation occurs longer than 10 weeks resulting in delayed training completion or non-completion or a shortened time for employees to gain a quality understanding of the subject matter.
  • No formal process existed in the Education Department to ensure required education is delivered by a pre-determined date. The opportunity existed to increase participation and completion rate for required education, as well as improve the employee experience.
  • A notification & follow-up process was formulated by the project team with a control plan implemented resulting in a less than 10 week delivery time, average being 5 weeks.
  • A post-improvement survey revealed employees felt they had more control over their mandatory training with about 70% less follow-up needed to encourage training completion.
  • Patient Hypertension Score Improvement
  • Department report cards were not impacting the balanced scorecard measures. Quality metrics were not driven down to the front line and process improvement was not owned by managers. Mandated semi-annual report out to the quality council had very little engagement.
  • The quality council was restructured along with implementation of standardized agendas & action plan formats. Department scorecards were re-designed to tie directly to the BSC. A control plan was implemented to hardwire process improvement into department reporting.
  • 1 year trend line data showed continuous improvement, meeting government goals for patient hypertension scores and associated blood pressure readings.
  • Laboratory Charge Capture
  • An estimated $4,200,000 annual revenue was lost upon conversion to new invoicing software system. Investigation reveals the new system was not collecting invoices properly.
  • Process mapping showed select pathology charges associated with specialty clinic outpatient procedures were not being entered into proper windows and some windows not activated.
  • Standard work was implemented utilizing newly installed poke-yoke windows and charges were recaptured for the accounts receivables department.
  • ICC (Intermediate Care Unit) Patient Assignment Redesign
  • Double bound defect = low acuity patients in high acuity beds (cost) and high acuity patients in low acuity beds (safety)
  • Data analysis showed a major source of wrong patient-wrong bed was the result of a competing metric of cycle time reductions (waiting period reduction) in ED. ED , ED wanted to move patients out of their department as quickly as possible
  • Decision tree & standard work communication hand-off formulated with flow coordinator tasking.
  • Control plan implemented, audits show $70M/year staffing cost reduction along with unquantified safety improvement.
  • Multi-Specialty & Primary Care Clinic Patient Registration Redesign
  • Complaints were received and investigation revealed patient wait times were averaging 20 minutes.
  • The variation was a function of staffing, demand surge & scheduling
  • Goal to decrease wait times to 3 minutes or less per customer surveys.
  • The team added a surge station, cross-trained telephone schedulers and initiated a visual queuing trigger for supervision to help manage patient flow
  • The process redesign attained < 5 minute average wait times, additional measurements underway to continuously improve.