Poster presentations
Connect. Engage. Transform.
Member success stories
Premier members also celebrated their successes by preparing poster presentations which were displayed at the Breakthroughs Conference. These success stories may also be viewed here.
VTE Prevention Kaizen
Baptist Hospital East - Louisville, KY
Early investigation indicated a low percentage of compliance for VTE
prevention. The nursing quality council was challenged to reduce the incidence
of VTE at Baptist Hospital East. A team was formed and a Kaizen event was
conducted to redesign the process by utilizing Lean concepts. The Kaizen process
allowed the team to modify the VTE order set, standardize the process and
location of the order set in the chart, add checklists to improve patient care
in a short period of time. Education was conducted for all disciplines on their
role and importance of VTE prevention. Education and communication is the key to
maintaining the new process.
Productivity Improvement in the ED Through Focused Monitoring
Baton Rouge General Medical Center
The challenge was to assist with improving the Emergency Department
productivity performance two facilities. The Mid City ED generates approximately
50,000 annual visits and was operating at 2.81 WHpU with a productivity index of
83.2%. The Bluebonnet ED generates approximately 36,000 annual visits and was
operating at 3.15 WHpU with a productivity index of 74.5%. Monthly performance
partner meetings were conducted with ED leadership to discuss and review
strategies for operational and productivity improvement. After 21 pay periods,
Mid City has improved to 2.31 WHpU, 101.2% productivity, a change of 11.48 FTEs,
while Bluebonnet has improved to 2.55 WHpU, 92.3% productivity, a change of
10.27 FTEs.
A Guide for Conducting an Improvement Opportunity Assessment in your Facility
Baystate Franklin Medical Center
The challenge was to develop an understanding of the concept, data, and the
comparative benchmarking process. By analyzing internal performance data for
each cost center and comparing the data to Premier OA benchmarks; using this
information to identify improvement opportunities and develop performance
targets; and develop step-by-step performance improvement plans for each
identified opportunity; $625,000 in cost reduction savings was identified.
Decreasing Readmissions Through Education
Bon Secours Memorial Regional Medical Center, Mechanicsville, VA
The Challenge was to increase the quality of life for Heart Failure patients,
measured by a reduction in readmissions. With Rapid Cycle Improvement using Six
Sigma methods a decrease in the readmission rate was achieved.
Turning Budget Jeers to Cheers
Bon Secours Health System
By implementing a very simple process, and integrating multiple levels of
Premier resources alongside detailed knowledge shared by department managers, we
were able to produce a budget that the hospitals could support and believe in.
Our biggest obstacle was convincing Senior Leadership, Finance, and departmental
leadership, that we had a flawed process and that Performance Engineering could
help resolve the issues. We continue to refine this process during every budget
year, and continue to receive positive feedback from all areas of the hospitals.
A Physician Practice Operational Improvement Engagement
Central Baptist Hospital
With an objective to improve patient flow and patient experiences in a hospital
run obstetrics practice. The physicians specialize in high risk pregnancies and
volumes are generated by referral. Used Lean Six Sigma techniques to document
processes in patient flow analysis and billing flow analysis. Results include a
new schedule which allows for smoother patient flow; meets current 30 patient
visits volume; and provides a cushion & added time for new, complex & worked in
patients.
Solving the Psych Sitter Conundrum
Cleveland Regional Medical Center, Shelby, NC
The psych sitter policy produced burdens on hospital resources due to the
cost of supporting one-on-one psych sitters, employees’ frustration at working
short staffed, peak psych sitter hours causing significant declines in
department productivity. Through data analysis and the creation of a psych
sitter pool there are budgeted projected cost savings of $107,000.
Bedside Glucose Analysis
Conway Medical Center
The VP of Ancillary Services requested a review of the current bedside glucose
process. This included an evaluation of the volume of beside glucose tests being
performed by the laboratory and the volume being performed by the nursing units,
an evaluation of the current process and a recommended streamlined process.
Furthermore, an evaluation of the impact of transitioning the responsibility for
bedside glucose testing for all inpatient units to their respective nursing
staffs was requested.
Implementation of Operations Advisor™ Productivity and Attaining Labor Cost Saving via Operational Opportunity Assessment
Genesis Healthcare System - Davenport, Iowa
Premier Labor Resource Management – Operational Opportunity Assessment
benchmarked Genesis labor utilization to national median peer performance and
revealed opportunity to: Realize a savings of 100+ FTEs, have departments flex
to volume more timely, realize as much as possibly $6.6 million savings
identified in opportunity assessment. The solution was to chose Premier’s
LaborConnectTM labor management program which includes OperationsAdvisorTM and
Premier’s Performance Partner ProgramTM. The Steering Committee adopted $2
million first-year savings goal. From June to March 2009 financial impacts of
$2.6 million were identified.
Nursing Care Re-Design
Good Samaritan Hospital, Suffern, NY
Good Samaritan Hospital’s overall patient satisfaction scores are ranked 23.5
compared to PRC norm data. Staff job enjoyment score less than 50%. Overtime
usage for nursing above 7%. The objective was to implement Transforming Care at
the Bedside within Good Samaritan Hospital improving both patient and staff
satisfaction scores. Empower employees to create solutions. Patient Satisfaction
scores rose from 2.7% excellence rank to 91% excellence rank, there is Improved
team work so staff is able to take breaks resulting in reduced no lunch punches
by 10%.
Sterile Processing and Distribution Departmental Assessment
Hardin Memorial Hospital, Hardin, KY
Hardin Memoiral had a need to identify opportunities to stream-line and improve
processes in Sterile Processing that would a) Improve employee satisfaction and
moral, and b) Reduce workload on staff and increase departmental efficiency.
Staffing was already between the 25th and 33rd percentiles, however overtime use
was high and some processes were inefficient which impacted staff moral. Through
the use of 5S and other Lean principles, the department underwent a change to
improve performance and moral.
Improving the Discharge Experience for Patients and Families while Discharging Patients Earlier
Heartland Regional Medical Center, St. Joseph, MO
Implemented an intervention in a 48 bed in-patient cardiovascular step-down
unit with the goal to strategically promote improvement in the overall care
experience for patients and their families while discharging patients earlier.
Processes were developed to promote common vision, focus and language to engage
staff focusing on reducing length of stay and delivering high quality, cost
effective care utilizing expertise from all levels of leadership and multiple
frontline staff departments within the organization.
Pathology Support – Lean Lab 101
Henry Ford Health System
The Lab is a bottleneck operation for throughput and LOS. Results are not
routinely ready for physician rounding. There are inconsistent Stat Turn Around
Times, and high productivity numbers (WHpU productivity > 105%), resulting in
coordinators and supervisors not having time for problem solving. After applying
lean methodologies, the projected STAT turnaround time will be reduced by 12.5
min to 9.5 min. There is more order in the department as everyone know what
their responsibilities are.
Limited Departmental Focused Review 2nd Floor Medical/Surgical/Pediatrics Unit
Kingman Regional Medical Center, Kingman, Arizona
Premier Labor Resource Management – Operational Opportunity Assessment
benchmarked 2nd Floor Medical/Surgical/Pediatrics Unit finding Median Comparable
opportunity of 5.84 WFTE and $351,615, Quartile Comparable opportunity 8.484
WFTE and $503,134. Multiple recommendations a were made to improve performance.
Departmental Focused Review Orthopedic Services
Memorial Regional Medical Center, Mechanicsville, VA
The facility-wide productivity committee requested a benchmarking review of the
Orthopedic Unit be conducted to identify potential labor efficiency
opportunities. Using Premier Performance Partners assessment methodology, an
assessment focusing on patient flow, flexing and adjusting staffing, utilization
of overtime, and other operational issues was conducted. The assessment has
resulted in an estimated annualized savings of over $225,000 as the unit
incurred a 9.4% increase in activity while maintaining their worked FTEs within
their budgeted target.
How Hospital Performance Workgroups are Making a Difference
North Carolina and SE Atlantic PWGs
PWG members are selected and join by invitation only. They are non-competitors
and more open to sharing best practices; similar facilities in size and scope of
services, with much in common and relevant comparatives; willing to share
comparative data on a regular basis with similar and non-competitive facilities;
participating regularly in surveys of best practices with other PWG members; and
are committed to each others success.
A Case Study for Evidence Based Practice - The Journey to Green
Sharp Grossmont Hospital, La Mesa, CA
Despite the large volume of literature supporting the American Heart Association
guidelines, patients do not always receive evidence based care. Creation of
standard orders and pocket guides, Report cards, Improved physician reporting,
Cardiac dashboard, 6 sigma efficiency studies, Enrollment in Get with the
Guidelines program from American Heart Association, Hired nurse practitioner,
and dedicated senior cardiac specialists to acute myocardial infarction (AMI)
and heart failure (HF). This resulted in AMI and HF care improved, dashboard
converted to GREEN, mortality and readmissions decreased, and Door to Balloon
times improved.
Managing Staffing to Volume Using a Daily Staffing Tool
Southeastern Regional Medical Center, Lumberton, NC
Challenged to meet budgeted productivity targets in the face of fluctuating
volumes and obtaining Nurse Manager buy-in. With the establishment of a Labor
Management Program and accountability the manager began to track and monitor
productivity on a daily basis in November Productivity steadily improved from
80% in October to an average of 101% for January through March. This resulted in
fiscal year to date labor savings (through March) of $182,500 including benefits
(or $365,000 annually) compared to October’s performance.
EVS Staffing Needs in the Spartanburg Regional Operating Room
Spartanburg Regional Healthcare System
Spartanburg, SC SRHS was opening a new OR more than doubling square footage.
Concerns existed about EVS staffing requirements for OR Terminal cleanings. The
current cleaning process is not fully standardized. The objective was to
determine/validate the staffing matrix and needs of Environmental Services at
terminal cleaning (3rd shift) of the hospital’s OR. After data collection,
observation, gap and overlap analysis, and recommended changes, $300,000 revenue
enhancement was identified.
Reallocating Registration Resources
Spartanburg Regional Healthcare System, Spartanburg, SC
Two new diagnostic testing centers are starting operations and want to transfer
registration resources away from centralized registration area where patients
used to report, but the centralized registration area is concerned cuts may be
too deep to their own operations. Simply reducing resources by the percentage of
patients moving to new area may not be appropriate since hours of operation
still need to be covered. Time studies and process simulation will determine how
many resources need to stay in centralized registration. A reduction of 4 FTEs
and associated savings of $106,400 was identified.
Lessons Learned in Benchmarking
Texas Health
Benchmarking can be a valuable tool for identifying variances from peers that
operate at a high performance level. Choosing a peer group, and the
characteristics that can be evaluated to choose that peer group, can sometimes
have an impact on the results of a benchmark assessment. A recent study of a
Food and Nutrition Department using OperationsAdvisorTM illustrates some of
these points. A peer of “all hospitals” was initially utilized to determine if
benchmark opportunity existed. The hospital then developed a “global peer
group”; i.e. peers were identified as “like” hospitals with similar census and
acuity. A “custom peer group” was then developed based on similar Food and
Nutrition characteristics, specifically number of meals served.
Reducing Supply Costs in Orthopedic Implants Using Premier Tools and Resources
Wayne Memorial Hospital
Wayne Memorial is a full-service, 316 license bed general acute care hospital
located in Goldsboro, NC with about $38 million in total annual supply expenses.
Part of their strategic goals is to put into place systems and processes to
assure services are delivered in an efficient manner without compromising
quality and safety. This is to be, in part, realized through assessing
operational efficiency to include medical and surgical supply expenses by
implementing additional Premier software to better monitor compliance with
contract pricing. Premier helps Wayne Memorial achieve this goal through Wayne’s
current subscriptions to several Informatics tools and collaboration efforts, as
well as, engagement of Executives, Directors, and Service line staff with
Premier onsite Informatics Performance Engineer and Purchasing Partners Region
Director. To date, supply focus opportunities have uncovered contract savings of
$100,000 in Orthopedic Implants for one supplier.
Working Towards a Lean Emergency Department
Western Baptist Hospital, Paducah, KY
The Emergency Department was chosen based on a recommendation from the Chief
Medical Officer and low patient satisfaction scores. Some of the challenges
include keeping focus on specific processes as it spans across literally every
department within the hospital. The issue is to improve ED processes in order to
reduce length of stay and therefore improve patient satisfaction scores.
Utilizing Lean methodology has produced many improvements, particularly in
establishing better communication, which leads to less waste. The direct
involvement of staff and the support of leadership are integral to success.
Results include improved patient satisfaction scores and reduced lengths of
stay.
Creating a Productivity Standard When Conflict Exists in Management
The challenge was to create a worked hour per surgical minute standard that would help contain costs to the hospital’s budget. By gathering data, interviewing management and staff, watching the process, created a standard that satisfied both senior administration and OR staff.
Evaluating the Labor Component of an Environmental Services Contract Proposal
Dissatisfied with the quality of service being delivered by their current Environmental Services vendor the hospital wanted to look at other providers. They wanted to make sure that the labor component of their new contract would be appropriate given their service level expectations and effort to control costs. Analysis of proposals and meetings with the vendors, resulted in savings of over $250,000 on the cost of the Environmental Services contract.
Implementing a Culture of Labor Management
Premier was asked to implement a Labor Management Program in order to assess the current labor situation and provide support and guidance in helping departments achieve a targeted level of performance. After an assessment by the OperationsAdvisor Implementation Team, a $4,227,000 opportunity was identified and could be realized if all departments were to achieve a median level of performance when compared to their peers. A Premier Performance Partner was assigned to provide the necessary tools and coaching to help departments achieve their goal. As of January 2009 Worked FTEs have been reduced from 655.21 to 632.73, and productivity has increased from 88.29% to 103.46%.
Performance Work Groups
Group of healthcare organizations sharing methods and best practices, through networking and collaborating, to improve performance and deliver value. Groups include CEO's, CFO's and COO's. Previous focus areas include: Corporate Overhead System Comparisons, Performance Excellence, Physician/Economic Alignment Strategies, Business Case for Quality, System Strategic Goals and Report Cards, Service Line Structure/Leadership/Education, State of HIT and Where it is Heading, IT Strategy, Physician Practice Infrastructure/Organization
Sometimes You Just Have to Do the Homework
An active neonatal ICU, with a budgeted productivity standard of 13.16 worked hours per patient-day and worked FTEs of 92.94, experienced a period of heavy patient demand and operated at a staffing level more than 10 percent above that prescribed by the standard. Being sensitive to patient safety as well as physician and nursing needs, the hospital administration requested the situation to be reviewed to determine if the standard should be increased. With such a large variance, considerable funds could have been at stake. But some relatively straightforward homework revealed that the nurses had done the right thing and that the standard was fine with no increase.
Where is a Radiologist When You Need One?
This project actually started as a question posted on Premier’s Performance Improvement Portal and turned into extensive research on Radiology Staffing. Premier Clients can follow the identified steps to help guide thought-provoking questions that can enable them to prioritize needs and determine the most optimal radiology staffing strategy for the facility. This detailed information can be found in the Premier Performance Improvement Portal and is available to all subscribers.