‘Jour­ney to zero’

Clar­ity and fo­cus lead hos­pi­tal to ef­fi­ciency

Modern Healthcare - - From The C-suite - Dr. Im­ran An­drabi Dr. Im­ran An­drabi is CEO of Mercy St. Vin­cent Med­i­cal Cen­ter in Toledo, Ohio.

By all ex­ter­nal stan­dards, 445-bed Mercy St. Vin­cent Med­i­cal Cen­ter in Toledo, Ohio, was a high-per­form­ing hos­pi­tal. We re­cently won a top 100 hos­pi­tal des­ig­na­tion, earned a J.D. Power & As­so­ciates top per­former award and rated equally well on other stan­dards of per­for­mance, in­clud­ing pa­tient sat­is­fac­tion scores, reg­u­la­tory com­pli­ance and core mea­sure out­comes.

Like many other high­achieve­ment hos­pi­tals, we had al­ready ini­ti­ated a Lean and Six Sigma depart­ment. Yet, pa­tient through­put prob­lems per­sisted, which neg­a­tively af­fected or­ga­ni­za­tional per­for­mance.

To ad­dress the is­sue, we en­gaged strate­gic part­ners to ad­dress our silo-lim­ited mind­set and to iden­tify po­ten­tial op­er­a­tional im­prove­ments. These analy­ses found that we had lay­ered one im­prove­ment pro­gram on top of the next at the ex­pense of sus­tain­able to­tal hos­pi­tal ef­fi­ciency. The very same process im­prove­ment method­olo­gies that were sup­posed to fa­cil­i­tate and en­hance to­tal op­er­a­tional per­for­mance were ac­tu­ally pre­vent­ing it.

Be­cause the im­prove­ment ef­forts were fo­cused on dif­fer­ent si­los, per­for­mance did not trans­late to a sys­temwide ini­tia­tive. As a re­sult, competition for lim­ited re­sources arose be­tween de­part­ments and there was no se­nior ex­ec­u­tive with re­spon­si­bil­ity for own­ing pa­tient flow through­out the en­ter­prise.

We came to un­der­stand that de­spite pro­cesses hav­ing been worked on pre­vi­ously, there were many non­va­lue-added ac­tiv­i­ties (“white spaces”) still in­her­ent in our through­put pro­cesses. One ex­am­ple was the phone calls and time re­quired for nurses to co­or­di­nate di­ag­nos­tic, pro­ce­dural and other pa­tient ser­vices. An­other was the cross-de­part­men­tal co­or­di­na­tion and phone calls nec­es­sary to fa­cil­i­tate a unit trans­fer. Once the root cause chal­lenges were un­der­stood and pri­or­i­tized, we were able to reengi­neer our work flow and be­gin the trans­for­ma­tion to­ward to­tal hos­pi­tal ef­fi­ciency.

Our sys­tem aim be­came “pa­tient first, jour­ney to zero”—zero de­fects and zero re­work in our pa­tient through­put, qual­ity and hos­pi­tal­wide co­or­di­na­tion pro­cesses. The clar­ity of our aim en­abled us to see op­er­a­tions dif­fer­ently, which helped us launch a cen­tral­ized care co­or­di­na­tion hub to man­age hos­pi­tal­wide opera- tions; in­te­grate case man­age­ment into op­er­a­tions and pa­tient flow lo­gis­tics; and des­ig­nate clin­i­cal-care co­or­di­na­tors in each op­er­a­tional unit to in­ter­act with the hub.

We also con­sid­ered physi­cian through­put needs as we re­designed our pro­cesses. For ex­am­ple, it proved very im­por­tant to the physi­cians that we cre­ate a cen­tral lo­gis­tics hub and de­part­men­tal clin­i­cal-care co­or­di­na­tors so pa­tient move­ment and sta­tus no­ti­fi­ca­tions could be ex­pe­dited.

In or­der to ef­fec­tu­ate and sus­tain Mercy St. Vin­cent’s im­prove­ments, the new pro­cesses were hard­wired into an adap­tive lo­gis­tics soft­ware plat­form so the chaos of hos­pi­tal op­er­a­tions could be ef­fec­tively chore­ographed. By us­ing tech­nol­ogy to co­or­di­nate and in­te­grate all the clin­i­cal and non­clin­i­cal pa­tient move­ments and or­der ex­e­cu­tions, we achieved sig­nif­i­cant value, in­clud­ing re­mov­ing the bur­den of lo­gis­tics and sched­ul­ing from nurses; and as­sur­ing key per­for­mance in­di­ca­tors were re­ported in real time so ad­just­ments in staffing, flow and other crit­i­cal com­po­nents could be made.

In the two years since ini­ti­at­ing to­tal hos­pi­tal ef­fi­ciency, Mercy St. Vin­cent re­duced its av­er­age length of stay from 5.2 to 4.6 days. The ALOS im­prove­ments saved us 10,400 days an­nu­ally, giv­ing us the abil­ity to care for 2,260 more ad­mis­sions with no ad­di­tional cap­i­tal or fixed costs. The to­tal eco­nomic im­pact of these changes was $48.4 mil­lion and a sig­nif­i­cantly im­proved op­er­at­ing mar­gin. Be­cause of this process change, our qual­ity scores and pa­tient-sat­is­fac­tion scores went up while our nurse sep­a­ra­tion rate im­proved by 41%.

As we work through our third year, we con­tinue to see ALOS mea­sure­ments de­crease and other sav­ings ac­crue as more in­ef­fi­ciency is re­moved from the sys­tem. Our jour­ney to­ward to­tal hos­pi­tal ef­fi­ciency be­gan with the re­al­iza­tion that the dis­con­nected pro­cesses and si­los we thought were best prac­tices were in fact con­tribut­ing to work-arounds and waste­ful white space. Hav­ing iden­ti­fied this waste, we were able to re­align our or­ga­ni­za­tion and achieve re­mark­able per­for­mance im­prove­ment—some­thing that is within reach of ev­ery hos­pi­tal.

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