When it comes to large, integrated health systems, the accumulation of wasted minutes, hours — and even days — can result in millions of dollars in unnecessary spending, not to mention damage to patient care and satisfaction levels. But the days of watching time and money slip down the hospital drain may be numbered. Organizations are turning to Lean methodologies, which have long driven efficiencies in the manufacturing sector, to tackle wasteful processes that bedevil the healthcare sector.
Health First, the only fully integrated healthcare network in Central Florida, is seeing remarkable improvements by applying Lean methodologies to many of its administrative and clinical processes. The provider began its Lean journey three years ago, and, to date, the initiative has reduced Health First’s hospital discharge window from more than 9 hours to a mere 1.7 hours, exceeding national best practice standards of 2 to 2.2 hours. Lean methodologies have also reduced average lengths of stay at Health First’s large level 2 trauma center from 5.75 days to 4.4 days, freeing up roughly 80 more beds per day. At the same time, Health First has increased its patient transfer volume by 30 percent, allowing more patients who had been waiting for specialized care to occupy the trauma center’s newly open beds. Meanwhile, Lean methods have allowed Health First to decrease its emergency department wait times by 70 percent, even as ED visits have increased 12 percent.
Compiled by Neal Learner, Contributing Writer
By combining Kaizen methodologies with real-time asset tracking technology, Health First has reduced patient discharge times, wait times, and overall length of stay.
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When it comes to large, integrated health systems, the accumulation of wasted minutes, hours — and even days — can result in millions of dollars in unnecessary spending, not to mention damage to patient care and satisfaction levels. But the days of watching time and money slip down the hospital drain may be numbered. Organizations are turning to Lean methodologies, which have long driven efficiencies in the manufacturing sector, to tackle wasteful processes that bedevil the healthcare sector.
Health First, the only fully integrated healthcare network in Central Florida, is seeing remarkable improvements by applying Lean methodologies to many of its administrative and clinical processes. The provider began its Lean journey three years ago, and, to date, the initiative has reduced Health First’s hospital discharge window from more than 9 hours to a mere 1.7 hours, exceeding national best practice standards of 2 to 2.2 hours. Lean methodologies have also reduced average lengths of stay at Health First’s large level 2 trauma center from 5.75 days to 4.4 days, freeing up roughly 80 more beds per day. At the same time, Health First has increased its patient transfer volume by 30 percent, allowing more patients who had been waiting for specialized care to occupy the trauma center’s newly open beds. Meanwhile, Lean methods have allowed Health First to decrease its emergency department wait times by 70 percent, even as ED visits have increased 12 percent.
Bill Griffith, Health First’s director of operational excellence, has overseen Lean implementation across the organization, which includes four hospitals totaling 950 beds, a large multispecialty medical group, outpatient and wellness services, and health insurance plans. Health IT Outcomes caught up with Griffith to get his insights on how Lean methodologies, along with the application of technology monitoring, achieves and locks in efficiency gains.
Q: In what ways can Lean methodology be applied in healthcare?
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A: I’ve used Lean in both the call and customer service centers, anywhere you can eliminate waste. Look at primary care, for example. The only value of a primary care office is when you see the physician, you get your script for a ZPak because you have a sinus infection, and you start taking your medication. But all of the time it takes to schedule your appointment, fill out paperwork, wait in the waiting room, wait in the exam room, wait to get your script filled at the pharmacy — all of that provides no value to a customer. My job is to help eliminate or reduce as much of the waste in that process as possible.
Q: How have you applied Lean to eliminate waste at Health First?
A: Take the discharge, where we started at 9.25 hours. We were able to get it down to between 4 and 4.5 hours, then stagnated for several months. I challenged one of my team members to go do a Kaizen event (i.e., an event that gathers employees from across the spectrum to identify and suggest solutions to reduce waste and improve efficiencies). We pulled our physicians, case managers, nursing, housekeeping, and centralized bed placement into a team for five days. We started from the point when we decide to discharge a patient and looked at every step of the process from there to when the patient arrives either at a home, a skilled nursing facility, rehab, or wherever they’re going next. We mapped out every step of the process and started figuring out the gaps, the roadblocks, the delays, the missed handoffs — any scenario that kept a patient waiting. We literally fine-tuned every handoff and laid out a standard workflow. Everyone knew what everyone else was doing, what was supposed be done, and the time it was going to take to do it, to the point we could make them accountable for those various steps. If something fell apart, we knew exactly where and whom to go talk with, and how to push the buttons to make it move. It’s been over a year now, and we’ve been able to maintain 1.7 hours since last September.
Q: Did you get any staff resistance during the process?
A: You do get resistance initially. However, when you can show them data that illustrates our existing ways of doing things don’t meet the current best practices established by CMS or Medicare, then obviously there’s a problem. We need to do value-stream analysis to find out why the current process does not meet the best practice and ask: “What do you do, what is the process, what are the systems, what is the paperwork?” Value-stream analysis is the most eye-opening experience for everyone in the room because the surgeon has never watched a housekeeper clean a room before, and a housekeeper has never watched a surgery before. Going through that step-by-step process is a great way to build a team because now everyone understands how important every role is. A surgeon here is just as important as a nurse, as a patient transporter, or as a housekeeper.
That’s the nice thing about Kaizen. When you’re in the room, titles don’t matter. It doesn’t matter if you’re a CEO, a surgeon, or a housekeeper. Everyone has an opinion and an idea, and we very closely monitor that to make sure everyone has a say.
Q: How much efficiency is gained by changing human behavior?
A: You can get a big bump based on human behavior; that’s the change management. However, you have to tie it back to metrics because that’s where the control comes in. Everything we do, whether it’s human behavior or not, we always tie it back to a metric that we can get to through a data source. Human behavior is like a rubber band; it’s going to snap right back if you don’t keep it under control.
Q: What technology platforms do you use that help facilitate this effort?
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A: We use TeleTracking for all of our operational sites, whether it’s bed placement, transfer access center, transport, housekeeping, surgery operations, or centralized patient logistics. It allows us to see the performance across the entire system of four hospitals. It allows us to see if there are any issues in real time. We have dashboards so we can see performance, and, if for some reason one of our hospitals is getting too busy or if one of our ERs is jammed up, we can route those transfers to one of our other three community hospitals. We have over 300 customized reports built that we push out daily, weekly, monthly, and annually to track and identify outliers or issues and go fix them immediately.
Q: How does this tracking technology connect with other systems to drive efficiencies?
A: We’re looking to integrate Trakkar, a system we use to manage our daily clean process in housekeeping. We’re integrating these systems so we can pull the daily census into Trakkar and better manage our housekeeping processes based on real-time events. For example, if we have a high number of discharges on a specific day, we may pull housekeeping resources from cleaning the lab and focus more effort on cleaning common areas like hallways and bathrooms. This will impact the customer experience because discharged patients use these common areas and never see the lab. We’re also working on integrating MiDAS Management Systems, which is our case management system. We’re working on pulling data out of MiDAS and into TeleTracking to eliminate the duplicate documentation that might be happening in the two systems.
When it comes to large, integrated health systems, the accumulation of wasted minutes, hours — and even days — can result in millions of dollars in unnecessary spending, not to mention damage to patient care and satisfaction levels. But the days of watching time and money slip down the hospital drain may be numbered. Organizations are turning to Lean methodologies, which have long driven efficiencies in the manufacturing sector, to tackle wasteful processes that bedevil the healthcare sector.
A: I’ve used Lean in both the call and customer service centers, anywhere you can eliminate waste. Look at primary care, for example. The only value of a primary care office is when you see the physician, you get your script for a ZPak because you have a sinus infection, and you start taking your medication. But all of the time it takes to schedule your appointment, fill out paperwork, wait in the waiting room, wait in the exam room, wait to get your script filled at the pharmacy — all of that provides no value to a customer. My job is to help eliminate or reduce as much of the waste in that process as possible.
A: We use TeleTracking for all of our operational sites, whether it’s bed placement, transfer access center, transport, housekeeping, surgery operations, or centralized patient logistics. It allows us to see the performance across the entire system of four hospitals. It allows us to see if there are any issues in real time. We have dashboards so we can see performance, and, if for some reason one of our hospitals is getting too busy or if one of our ERs is jammed up, we can route those transfers to one of our other three community hospitals. We have over 300 customized reports built that we push out daily, weekly, monthly, and annually to track and identify outliers or issues and go fix them immediately.
