Throughput Case Studies to Reduce Worked Hours
Case 1: Morton Plant realizes over $4 Million in ED flow improvement while increasing patient satisfaction 56 percent
(as published in Caldwell, et. al. 2005. Lean-Six for Healthcare: A Senior Leader Guide to Improve Cost and Throughput. Milwaukee, WI: American Society for Quality Press. www.qualitypress.asq.org)
Morton Plant Hospital, a 687-bed facility located in Clearwater, Florida, and winner of all categories of the Top 100, as well as, the Florida Quality Award, was facing serious overcrowding in the Emergency Department. The ED was frequently on diversion and an alarming number of patients were “Leaving Without Treatment” (LWOTs). Overcrowding had significantly affected patient satisfaction scores as well as those of employees. Morton Plant’s senior management acknowledged the need to achieve rapid gains in patient throughput and improve patient flow.
Morton Plant’s Needs
• Reduce the number of diversions and LWOTs
• Increase patient throughput and reduce LOS
• Improve patient satisfaction scores
• Increase revenue and decrease operating costs
Morton Plant deploys Lean-Six Sigma and implements Caldwell & Associates’ 100-Day Workout method
Morton Plant engaged Caldwell & Associates to critically examine the productivity and work flow of its ED. Caldwell & Associates applied its skill in Lean-Six Sigma to assist senior management in isolating potential changes that would yield the most significant improvements in patient care and productivity. Caldwell & Associates employed the DMAIC method (Define-Measure-Analyze-Improve-Control) and the 100-Day Workout Productivity Series to systematically achieve the desired results.
Process Flow and Statistical Analysis: Caldwell & Associates deployed its expertise in Lean-Six Sigma methodologies to identify and quantify potential opportunities for enhancing the performance of the ED. Caldwell & Associates completed a statistically driven 14-day longitudinal study of the ED’s process flow and examined the 7 categories of waste.
Change Concepts Identified: Caldwell & Associates used its extensive healthcare experience to assist Morton Plant in transforming the results of the analysis into specific Change Concepts for improving the performance of the ED. The team targeted 4 key areas of focus, and with the assistance of Caldwell & Associates, developed a plan for deploying and testing each concept.
Implementation of Rapid Cycle Testing: Once potential improvement opportunities were identified, Caldwell & Associates initiated rapid cycle testing of each Change Concept. In addition, three cycles of the 100-Day Workout were launched to improve hospital-wide productivity. Each change concept was analyzed for effectiveness and the estimated ROI was computed and validated by the finance department.
Demonstrated Results of Morton Plant Implementation
As a direct result of the services provided by Caldwell & Associates, Morton Plant was able to achieve:Measurable benefits
• A $4 million improvement in financial operating performance.
• Improved Patient Satisfaction scores increased from 61% to over 90%.
• A 14% reduction in ED length of stay.
• An ROI on Caldwell & Associates services 16:1.Intangible benefits
• Staff acceptance of nonnegotiable goals.
• Organization -wide determination to close operating gaps.
• Rapid deployment of proven methods and techniques for improving productivity and performance.
• Sustainable processes through on-site mentoring and apprenticing.Case 2: River Region Faced Unfavorable Managed Care Contract
River Region Medical Center, a multi-hospital system located in Vicksburg, Mississippi faced significant cost issues resulting from aggressive renegotiation from their largest payor. In addition, the Emergency Department found patients were frequently “leaving without treatment” (LWOTs) and ED patient satisfaction fell below the 5th percentile. River Region’s senior management acknowledged they needed to achieve immed
iate gains in their cost structure. In addition, there was a strong desire to optimize ED patient flow to reduce LWOTs and improve ED patient satisfaction.
• Improve the Medical Center’s cost position
• Reduce the number of ED LWOT’s below 3.2%
• Improve patient satisfaction scores
River Region engaged Chip Caldwell & Associates to critically examine operations waste, productivity, and work flow of its emergency department.
Caldwell & Associates applied its skills in Lean-Six Sigma methodology to assist senior management in isolating the changes with the potential to yield the most significant improvements in patient care and productivity. Caldwell & Associates expert staff employed the 100-Day Operations Waste Workout, techniques for enhancing accountability, and the DMAIC method (Define-Measure-Analyze-Improve-Control) to systematically produce the desired results.
Non-Negotiable Goal-Setting Workshop: To assure the year-long process remained focused, Caldwell & Associates led managers in a 3-hour Non-Negotiable Goal-Setting Workshop thirty days prior to 100-Day Operations Waste Workout. Each manager’s goals were set at benchmark levels resulting in a 39 FTE reduction target on a 1002 FTE base, plus a 3 percent non-salary cost target.
100-Day Operations Waste Workout: Caldwell & Associated provided managers with the tools and support required to achieve their goals. Support included the services of a master blackbelt in Lean-Six Sigma methodologies to identify opportunities for improving workflow. Training also included workshops in the 7 categories of waste and the Waste Walk Methodology. As part of the 100-Day Workout, Caldwell & Associates assisted managers in creating 100-Day Action plans and deploying a system for monitoring progress.
Lean -Six Sigma Deployed in ED / DMAIC:: Caldwell & Associates then used its extensive healthcare experience to complete a through analysis of River Region Medical Center’s workflow. This information was transformed into specific strategies for improving the performance of the Emergency Depatment. The team had targeted 3 key areas of focus and designed specific strategies to realize the opportunity contained in each area.Demonstrated Results of River Region Implementation
Through two cycles of 100-Day Operations Waste Workouts and ED DMAIC project facilitated by Caldwell & Associates, River Region Medical Center gained:Measurable Benefits
· 35% reduction in LOS, thereby achieving the worldclass benchmark of 1.9 ED LOS
· Patient satisfaction scores increased from 2 percentile to the 77th percentile
· River Region realized a $1 million improvement in cost position
· ROI on investment in Caldwell & Associates services were 5:1Intangible Benefits
As a result of deploying Caldwell & Associates’ expertise, River Region achieved:
· Staff acceptance of nonnegotiable goals
· Rapid deployment of proven methods and techniques for improving productivity and performance
· Apprenticed in Lean-Six Sigma Design Techniques and 100-Day Workout method to ensured sustainability
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