HIMSS: Lean leads to $1.8M savings for Ark. hospital

NEW ORLEANS—A two-year Lean implementation has transformed a 465-bed hospital from an inconsistent performer to a consistent achiever that realized in $1.8 million in net savings in 2012, according to a March 5 presentation at the Healthcare Information and Management Systems Society (HIMSS) annual conference.

Healthcare has broken processes, Susan Greenwood, RN, BNS, MBA, vice president risk management at St. Bernard’s Medical in Jonesboro, Ark., told the audience. Healthcare also boasts a committed workforce. St. Bernard’s journey to mend its broken processes and leverage its staff led the hospital to Lean project management.

Prior to Lean, St. Bernard’s set high goals, aiming for the top 10 percent in the U.S. for quality, safety, customer service and cost. Greenwood characterized the hospital’s performance as a roller coaster. As it achieved its goals in one area, it fell short in another. The hospital could not consistently sustain high performance.

As the organization rolled out its EHR, it also confronted other challenges—from a stable leadership team that struggled in the role of change agent to sustainability and staffing issues.

Lean, Greenwood said, provides an internal approach to problem-solving by focusing on removing waste from the system. The approach categorizes waste as eight types, using the acronym DOWNTIME. These are:

• Defects;
• Over-production
• Waiting
• Not clear processes (confusion)
• Transporting
• Inventory
• Motion
• Excess processing

Greenwood and colleagues completed Lean healthcare certification training in February 2011, and kicked off the hospital’s Lean implementation. St. Bernard’s also engaged a Lean healthcare consultant for an 18-month contract. A consultant is essential because an outsider observes inefficient set-ups and processes with fresh eyes and can provide expert advice to convince reluctant participants, Greenwood said. However, the consultant is not Lean; his or her role consists of developing a Lean culture and training internal facilitators and should include an exit strategy, so the organization can continue Lean independently.

The St. Bernard’s Lean team first focused on medication management, and achieved several critical outcomes. It reduced the time from chart check to medication administration by 64 percent, improved availability of medication from 82 percent to 99 percent, eliminated four medication pass times each day to save day 72 minutes a day of nursing time and reduced pharmacy re-dispenses by 27 percent.

The team also authorized staff to complete a re-design of a nursing station, eliminating cluttering and streamlining flow. Greenwood emphasized that Lean projects should be staff-led and not management-driven, which requires buy-in.

Buy-in can be lost; however, if an organization translates labor-saving changes into staff cuts. “Leadership has to send the message that changes may entail re-deployment but not labor cuts.” Consistent messaging regarding human resources was essential as St. Bernard’s recaptured lost labor time, for instance, eliminating patient placement faxes to save 730 hours annually in staff time.

In fall 2011, the team added a concurrent project to its agenda and attempted to apply Lean to revenue cycle management. One initial win was increasing the percent of correct first billing passes from 11 percent to 68 percent.

However, as the team dived into revenue cycle issues, they realized much of the hospital’s waste could be attributed to under-utilization of the EHR. Specifically, information was duplicated, per different departments, multiple times, but data weren’t shareable. Take for example NPO (nothing by mouth) orders. The EHR contained nine different types of NPOs. Consequently, it was more likely than not that the order might not reach the correct staff. The patient would fed, and procedures would be delayed, adding unnecessary costs and delays to procedures.

The realization led to phase 3 of the project, which included an EHR redesign and alignment between Lean and organization goals. “IT and clinical quality and safety cannot have silo mentalities,” said Greenwood. Departmental silos compromise patient safety, she continued.

Greenwood concluded with other strategies for Lean success.

• Lean fails when leaders fail to lead;
• Change is rapid—staff must be empowered to make needed changes without unnecessary hoops and processes;
• The role of leader is to coach and mentor staff;
• Solutions can be identified by going where work is done, not in management meetings behind closed doors; and
• Improvement happens as close to the problem as possible, by those doing work and supported by a coach.
• as possible, by those doing work and supported by a coach.