Soft­ware gives Lean an assist

Modern Healthcare - - INNOVATIONS - By Beth Kutscher

Health­care providers are quickly and en­thu­si­as­ti­cally em­brac­ing Lean process im­prove­ment prin­ci­ples to cut costs, be­come more ef­fi­cient and en­hance qual­ity. But there’s room for im­prove­ment even in the process of im­prov­ing.

The best ideas don’t nec­es­sar­ily flow from man­age­ment and are just as likely to come from staff mem­bers on the front lines of patient care, such as doc­tors, nurses and tech­ni­cians. “Those are the folks who have all the knowl­edge about where the in­ef­fi­cien­cies are,” said Dr. Greg Ja­cob­son, an emer­gency medicine physi­cian and founder of a com­pany called KaiNexus. “But they have no power or medium to change all that.”

KaiNexus’ soft­ware al­lows em­ploy­ees at all lev­els of an or­ga­ni­za­tion to share ideas for sav­ing money, gen­er­at­ing rev­enue or im­prov­ing patient care. Users ac­cess the plat­form through the web or a mo­bile app. Their sug­ges­tions are vis­i­ble to ev­ery­one in the group and ideas can’t be sub­mit­ted anony­mously.

“KaiNexus is built on this con­cept of vis­i­bil­ity,” Ja­cob­son said. “It’s a big deal. The cus­tomers that keep score, you can see it in their data, they do a bet­ter job. Peo­ple start to speak the same lan­guage around it.”

The com­pany is used to its plat­form be­ing com­pared to an on­line sug­ges­tion box but in­sists that its tech­nol­ogy is much more than that. Man­agers im­ple­ment less than 3% of ideas from a sug­ges­tion box but carry out more than 80% of ideas that are sub­mit­ted through KaiNexus, Ja­cob­son said.

“A mod­ern, con­tin­u­ous im­prove­ment sys­tem is dif­fer­ent from a sug­ges­tion box,” said Mark Gra­ban, au­thor of Lean Hos­pi­tals: Im­prov­ing Qual­ity, Patient Safety, and Em­ployee En­gage­ment and a con­sul­tant to KaiNexus. “In a sug­ges­tion box model, ba­si­cally ev­ery­thing bub­bles up to a com­mit­tee. The kaizen model (the Lean phi­los­o­phy) is based on lo­cal teams man­ag­ing lo­cal de­ci­sions.”

In ad­di­tion to the trans­parency the soft­ware pro­vides, it’s also de­signed to be a col­lab­o­ra­tive rather than a pas­sive tool. Man­agers have a cer­tain amount of time to re­spond to an idea and will re­ceive alerts when they haven’t done so.

“The speed in which you an­swer a new idea re­ally mat­ters,” Ja­cob­son said. Oth­er­wise, em­ploy­ees “get dis­en­fran­chised and feel like man­age­ment isn’t lis­ten­ing to them.”

Mary Gree­ley Med­i­cal Cen­ter in Ames, Iowa, has been work­ing on Lean process im­prove­ment since 2009 and be­gan look­ing for a project man­age­ment tool about three years later. That’s when it dis­cov­ered KaiNexus.

It com­pleted its first 100 Day Work­out in Jan­uary 2014, when it chal­lenged about 100 man­agers to come up with ideas that would ei­ther cut costs or bring in new rev­enue. That ex­er­cise yielded $600,000 in di­rect sav­ings— and closer to $800,000 when fac­tor­ing in “soft sav­ings,” such as peo­ple’s time, said Karen Kiel Rosser, the hos­pi­tal’s vice pres­i­dent and qual­ity im­prove­ment of­fi­cer.

Mary Gree­ley pre­vi­ously used an­other soft­ware tool to man­age ideas, but the plat­form didn’t en­cour­age the same level of in­volve­ment. “It was all driven top-down by man­age­ment and we to­tally turned that up­side down,” Kiel Rosser said. “We com­pletely flipped the tri­an­gle.”

The hos­pi­tal has now ex­panded KaiNexus to all 1,300 em­ploy­ees and re­cently com­pleted an­other 100 Day Work­out. Em­ploy­ees sub­mit­ted 52 ideas for im­prove­ment, and 40 have been im­ple­mented. Al­though most of the low-hang­ing fruit had al­ready been iden­ti­fied dur­ing the first Work­out, sav­ings still to­taled $327,000.

“We’re re­ally ask­ing the em­ploy­ees to solve the prob­lem,” Kiel Rosser said. “Every em­ployee in this sys­tem is con­nected to their leader and their de­part­ment. The sys­tem tracks all that, man­ages all that and makes it eas­ier to work on these things.”

To get the ideas flow­ing, KaiNexus en­cour­ages hos­pi­tals to think be­yond just cost sav­ings and en­cour­age em­ploy­ees to come up with sug­ges­tions that im­prove the patient ex­pe­ri­ence or even their own job sat­is­fac­tion.

“Talk­ing about cost is the least likely thing to get peo­ple en­gaged,” Gra­ban said. “If you get peo­ple en­gaged in im­prove­ment, the cost sav­ings fol­low. It’s sort of a happy side ef­fect.”

One em­ployee at an en­docrinol­ogy clinic, for in­stance, came up with the idea of no­ti­fy­ing pa­tients that the hos­pi­tal had its own in­house phar­macy for fill­ing pre­scrip­tions. The idea was touted as a way to increase the con­ve­nience for pa­tients. Yet the sug­ges­tion gen­er­ated $600,000 in rev­enue in the first three months af­ter it was im­ple­mented.

Irv­ing, Texas-based KaiNexus, founded in 2009, has 40 cus­tomers, two-thirds of which are health­care or­ga­ni­za­tions. It has raised $1.7 mil­lion from an­gel in­vestors and has 10 em­ploy­ees.

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