June 14, 2013

As the health care industry continues to change and patients become more informed about health care costs, demanding more for their money, we're challenged to find innovative ways to provide patient care. Because we cannot expect team members just to work harder, we know we need to reduce inefficiencies in our everyday workflows.

To do that, front-line care providers - those who work directly with patients - must help identify things that hinder our ability to provide efficient, effective care. In addition, leadership has been challenged to find new and different ways of working.

The Performance Improvement department is providing the organization help in this effort in several ways: we're offering training programs and leading teams that focus on improving processes and eliminating waste while utilizing team members' competencies and skills to the max.

Training of leadership in Lean concepts: Executive leadership is committed to providing leadership with basic skills and knowledge about Lean. (Lean is a systematic approach to shorten time between customer requests and service delivery by eliminating wastes or non-value activities.)  They have challenged the organization to find more streamlined ways to provide care. Examples include:

• Dr. Lorraine Stephens and Diana Vollman worked on improving the process for notifying nursing units that a patient has been added to the surgery schedule. They developed a consistent process for the residents and piloted it on 12AB. Compliance for notifying the floor of surgery improved from a baseline of 22 percent to 48 percent in two weeks. Patient impact is the decrease in delays to prepare the patient for surgery.
• Brett Kirkpatrick and Dr. Regina Kohls tackled improving pneumovax vaccination rates in The Family Medical Group. They set up a pre-visit plan and standard work plan for when patients come into the office, which resulted in improvement from a baseline of 61 percent to 73 percent in one month with a target to hit 80 percent in June. The impact on patients has been a decrease in cases of preventable illnesses as more patients receive the vaccine.
• Dr. Diane Dolensky and Terry Hanlon worked on improving a mental health order to referral placement in the physician office. The former process resulted in the Medical Assistant interrupting the physician multiple times to report unsuccessful placement and looking for additional direction while the patient sat in the waiting room. The referral process was standardized and includes mental health agencies and their criteria for admission. This decreased interruptions of the physician and resulted in the patient getting connected quickly and out of the waiting room.
• Dr. Barreau and Sandra Lobert revised the process for obtaining physician certification statements, which are required to be on file for patients using Hospice services. Standardizing to one certification document and testing e-fax has reduced this process from three to seven days to two days, and correct certifications have risen from 60 percent to 89 percent.

These are just a few examples of small, but impactful, projects that leadership has accomplished during Lean training.

Training of front-line staff: Several teams have been trained in Lean concepts and have seen significant improvement while working on various projects. You may have seen the work of:

• Environmental Services (EVS), which is looking at ways to decrease time needed to complete work. Good Samaritan has focused on developing an organized process for stocking carts and the supply room and shaved 10 minutes off for each EVS staff member.
• PCAs are looking at more efficient ways to get reports, round in the morning and stock linens.
• Group Health improved its abandon call rate by 22 percent by redesigning the way they handle patient calls they receive.
• Bethesda Care Sharonville Occupational Medicine improved turnaround time in providing their clients with test results, reducing wait time from five days to one day.

Performance Improvement also has developed a Lean Breakthrough Series that will be offered twice a year. The goal is to help front-line staff and direct managers to learn about Lean and select a project to work on in their areas. Last session, Bethesda North improved how it stocks its Operating Room case carts; 4T100 improved its discharge process and made an 87 percent improvement in patient satisfaction scores on discharge; and Lab removed one day from its cytology processing of results.

So what is your role in all of the changes and improvements? Scrutinize the work you do every day and really look at what is waste and does not benefit your customer. Talk with your manager about ways you might improve your service. Trial new ways to do things that are more efficient, and if they work, make sure you have written guidelines so everyone does it the same way.

What else does Performance Improvement do?

Lean training and rollout of concepts is just one of many services that Performance Improvement (PI) offers. Performance Improvement also provides project management skills for strategic initiatives that are complex. PI has been instrumental in working on some of the complex strategic initiatives for the organization. We coordinate the tracking, organizing and facilitating of various tasks and decisions that need to be made on projects using project tools such as a charter, work plans and communication plans. Examples of our involvement include:

• Building projects such as the new Butler County Emergency Department, TriHealth Priority Care locations and Good Samaritan Western Ridge; and
• Improvement projects, such as decreasing the number of scanning errors, redesigning the flow in the Cath Lab, improving access and wait times in the occupational medicine office and standardizing the on-boarding process for physicians.

Finally, as Performance Improvement is involved in projects, we incorporate change management concepts. As TriHealth Connect was implemented, we looked at how we could help staff, physicians and managers better cope with the changes that would occur with Epic implementation. Communication materials and tools were created to help everyone understand the feelings they would experience, their normalcy and how they could help themselves and others deal with the multiple changes.

So, if you have a complex process to refine, need some consultation on quality tools or just some direction on how to improve your services, please feel free to contact Performance Improvement.