Lean Health Application for Small Rural Facilities

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Lean Health Application for Small Rural
Facilities
Based on the
Experience of First Care Medical
ServicesFosston, Minnesota
byPatricia WanglerChief Executive Officer
Produced by Joey Johnson, Administrative
Assistant
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We Are Small Demographics

• 206 Employees
• 168 FTEs
• 15,000,000 Annual Expenses
• 640 Admissions
• 600 Surgical Procedures
• 45 Births
• 17,000 Nursing Home Days
• 590 Home Health/Hospice Admissions
• 9000 Service Area Population

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So Why Did We Invest?

• Building project and new services were putting a
  lot of pressure on staff work volumes
• Processes seemed to be getting more complex
• We were not achieving goals for customer
  satisfaction
• Patients
• Staff
• A great opportunity presented itself that
  provided the education through Northland
  Community and Technical College
• We made a commitment of staff time to the value
  of 50,000 which turned into higher real numbers
  due to overtime and replacement of staff

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Where Are We -

• The first cohort of 24 management staff have
  completed 96 hours of
• TPS (A-3s)
• Kaizen (5-S)
• PI (Performance Improvement Methodology)
• Six Sigma One staff member has Greenbelt
• The second cohort of staff training is nearly
  completed
• We are in the second year of LEAN

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What Have We Accomplished

• 37 A-3 projects completed
• Potential savings of
• Both soft and hard savings are included
• Soft saving of time and supply reduction
• Hard savings are actual recoupment of revenue /
  loss charges / lost visits
• Time reduced from projects 5,798 hours

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Strategic Goal
First Care Medical Services leadership and staff
work together to become a premier employer
achieving staff turnover below
17. Strategy Simplify work processes through
LEAN to achieve 10 more staff time with
patients as measured by
time saved
total hours
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How Will Staff Be Rewarded For Commitment
Intrinsic

• Work processes will flow smoother
• Process points bridging two departments will
  unite staff rather than divide.

Extrinsic
1. Performance Bonus
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Award Winning Projects
Processing of Bills Business Office 13,081.00
hard savings.
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Processing of BillsBusiness Office
Situation Current processes were not changed
with the implementation of new electronic billing
systems. We continued to do manual process steps
that were required under previous system.
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Processing of Bills (continued)

• What we did
• Mapped out the current flow of work.
• Mapped flow as it should go with the new
  technology.
• Identified several routine, manual processes
  that added no value.
• Eliminated
• 1. Bills being printed and filed by patient name
  for every date of service. 2. Bills being pulled
  from patient files each time a payment is made on
  that bill. (This happened each month until the
  bill was paid in full. 3. Bills being pulled
  from patient files each time an insurance company
  is called.

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Processing of Bills (continued)
Initiated 1. Communications on patient accounts
being completed on the information system, which
enables individuals to search account information
from their desk.
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Processing of Bills (continued)

• What we achieved
• 13,081.00 of hard savings in time.
• Enabled reallocating saved time to the upfront
  collections process being implemented

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Elimination of Manual Duplication in Radiology
19,000.00 combination of soft and hard savings.
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Elimination of Manual Duplication in Radiology

• History
• Development and Implementation of Digital
  Radiology, PACS and Teleradiology Network.
• Became filmless with exception of Mammography
  Voice Recognition Software enabled interpretation
  to be joined to the image and stored in PACS.

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Elimination of Manual Duplication in Radiology
(continued)
Situation Manual processes of printing
interpretations and placing in a film jacket
continued as in the past.
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Elimination of Manual Duplication in Radiology
(continued)

• What we did
• Completed Value Stream Mapping
• Value of manual steps timed, cost and questioned
• Process revised to use digital report as the
  only archive Takes trust in automation!!!

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Elimination of Manual Duplication in Radiology
(continued)

• What we achieved
• 19,000.00 soft saving of time.
• 700.00 hard savings of jackets and paper.
• Value of space saved Not quantified.

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Pharmacy Inventory Management

• 17,300 Reduced in Soft Costs of Time and
  Outdates.
• Reduced Inventory on Hand by 16,000.
• Total Impact of Over 33,000.

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Pharmacy Inventory Management (continued)
History1. Pharmacy Inventory creep
evident.(Benchmark for facilities our size
50,000)2. All Pharmacy processes manual and
time consuming.
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Pharmacy Inventory Management (continued)

• What we did
• Mapped out current flow of work.
• Value of manual steps timed, cost and
  questioned.
• Process re-mapped with expiration date coding
  done at time of entering drug into inventory.

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Pharmacy Inventory Management (continued)
What we achieved

• Reduced the number of steps in the process from
  seven to two and reduced time spent by 145
  minutes per month. Value of time saved is 1,400
  per year.
• Implemented system of flagging outdates on entry
  to inventory at a cost of 100.00 for stickers.
  Stickers are coded by month allowing visual
  inspection for outdates versus reading every
  container for expiration.
• Net savings of 1,300.

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Pharmacy Inventory Management (continued)
What we achieved

• Reduced outdates from 19,000 annually to 3,000
  in one year for immediate soft cost savings of
  16,000.
• Implemented tracking system to develop database
  of drugs that expired.
• Pharmacy and Therapeutics committee reviewed
  list of drugs and removed from inventory.
• Reduced inventory on hand from 72,000 to
  56,000. For a total hard cash savings of 16,000.

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Pharmacy Inventory Management (continued)
Sustain Improvements In Inventory Management

• Installed Pharmacy software package to further
  automate and improve inventory management. The
  value of the software package is too new to be
  measured, however, continued improvement are
  expected.
• Goal Having the right drugs on hand in the
  right amounts to ensure quality care of patients
  while continuing to eliminate and/or reduce
  supply of drugs that outdate. Continue to work
  toward 50,000 inventory benchmark.

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Misrouted Phone Calls

• Current Situation
• Phone calls enter through the switchboard/recepti
  on area.
• Departments reporting receiving calls for other
  departments/staff.
• Hospital patient services decided to track the
  calls and the amount of interference into their
  patient care delivery.
• Study showed a projected 207 hours spent on
  misrouted phone calls annually.
• Switchboard receiving so many calls that they
  were answering and transferring hurriedly.

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Misrouted Phone Calls (continued)

• What we did
• Worked with switchboard staff on phone answering
  protocols.
• In process of installing more DID lines with the
  expectations that staff will share their number
  with persons who call them.

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Misrouted Phone Calls (continued)

• What we accomplished
• Reduce up to 207 hours worth of nursing
  interruption annually.
• Soft value is over 5000.00.
• Reduce number of calls going through switchboard
  by DID lines.
• Soft costs of DID lines not known as been
  measured at this time.

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First Care and Lean Are we best buds yet?

• Were just starting.
• Staff are seeing the potential.
• Peers nominated two of the project champions for
  Excellence Awards in Innovation.
• Discussion at Department, leadership and All
  Staff Meetings is increasingly Performance
  Improvement focused.

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Where Are We Going With Lean?

• Were going to harness the processes and use
  them to help make work life easier.
• Were in it for the long haul.
• Staff are beginning to get excited.
• Excited staff are great!!!