Hospitals Borrowing Efficiency-Improvement Techniques from Industry
Source: AMN Healthcare – February 11, 2010
By: Debra Wood, RN, contributor
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Hospitals aiming to work smarter and more efficiently are turning to quality assessment and improvement techniques pioneered in industry, deploying Six Sigma and Lean tools to change cultures and to improve results.
“It really focuses on your steps in the process that are waste, non-value-added,” said Kristie Geil, RN, MSN, director of risk and quality at CGH Medical Center, Sterling, Illinois, about the LEAN process she used to improve operations in physicians’ offices.
CGH contracted with Guidon Performance Solutions of Mesa, Arizona, to help it function more efficiently. The company uses a blend of Lean Thinking and Six Sigma techniques, employed respectively by Toyota and Motorola. Ron Wince, chief executive officer of Guidon, encourages staff to view the healthcare experience from a different viewpoint, that of the patient, to map each step, to identify delays and redundancies and then eliminate them.
“A lot of hospitals are already doing it and a lot want to do it,” Wince said. “Even small practices are looking at ways of getting rid of waste from the patient’s perspective.”
To increase turnaround time in CGH clinics, Geil and colleagues examined flow from the time the patient scheduled an appointment until he or she left the building. They assessed each step and whether it added value or not. Those that didn’t were eliminated.
“It helps smooth things out and streamline your processes,” Geil said.
The team also watched physicians, armed with a stopwatch and timed how they spent their time. In one office, they noted the physician kept returning to a central printer, wasting steps. The team bought a second printer and within 24 hours improved efficiency.
“He was going in a circle and didn’t realize it,” Geil said. “We’ve made successful change we have been able to sustain.”
Geil described the process as intense and hands-on. Data collection, testing and tracking results takes place over four days. Staff nurses devote a week to the process, rather than fit in quality improvement meetings over a period of months.
“From the nursing perspective, pulling someone off for one week to work on a project is better for scheduling for nurse managers [than intermittent meetings],” Geil said.
Next up, CGH plans to use LeanSigma methods to improve inpatient discharge flow to get patients out earlier in the day.
Newton-Wellesley Hospital in Newton, Massachusetts has employed Six Sigma to improve the functioning of many of its processes, including throughput in the emergency department.
Judy Thorpe, RN, BSN, MS, nursing resource coordinator at Newton-Wellesley, recently completed a project to ensure the medical cardiology unit had enough staff to always be able to admit new patients. The team looked at multiple factors, including nurse staffing, which they found was inconsistent. Various supervisors and charge nurses staffed differently when faced with the same workload.
“We tried to decrease variability,” Thorpe said. “Rather than trying to predict the future, which is tough to do accurately, we decided to try to react to changes in patients and workload and staffing needs-and react on a consistent basis.”
The process ended with staffing based on a standardized approach and projected admissions. Patients aren’t holding in the emergency department, improving flow, and it will save the hospital $63,000 annually.
One Midwest hospital Guidon worked with found through implementing LeanSigma that its nurses spent a considerable amount of time tracking down lab reports and equipment, steps that didn’t add value but consumed resources. They decided to move supplies closer to the patient, allowing nurses to spend more time at the bedside.
“Nurses realize this is a way to step outside the day-to-day work and make dramatic changes quickly, using commonsense tools,” Wince said. “There is a new way of doing things. Even though it’s borrowed from industry, it’s very effective.”
All contents © 2010 AMN Healthcare, Inc. All Rights Reserved.
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