Using LEAN principles in every aspect of client service, Sheridan has a passion for process improvement. Our lean transformation model focuses on increasing quality, timeliness and productivity at the hospitals we serve. We are committed to continuous improvements that enable change while minimizing disruption.
ER patients at a South Florida hospital were experiencing substantial delays in being admitted into the hospital. Length of stay (LOS) times averaged 289 minutes, which led to unnecessary anxiety for patients and delayed access to the best possible care.
The problem was defined and the scope of the Kaizen was specified. A team was selected with participants from a variety of roles in the Emergency Department. The chief of emergency medicine led the team and received a complete set of lean resources to review before the Kaizen began.
During the Kaizen, a value stream map was used to track and better visualize the process and identify value-adding moments. An average LOS of 289 minutes was confirmed. Using lean principals as their guide, the Kaizen team focused on reduction of waste, lead times, cycle times and hand-offs. Examination of the future state value stream map found that 60 minutes could be reduced from the process through standardization of certain elements. During the entire event, the Kaizen team began each morning by detailing the tools and principles to be used, as well as facilitating the decision-making processes through guidance. Each day concluded with a leaders' meeting report to administration.
Patient flow at this facility was tracked along a series of stations for every case. One month after the Kaizen, the average patient wait time for the following stages was reduced:
- "In Bed" to "Physician Greet" from 12 minutes to six, a 50% reduction
- "Physician Greet" to "Disposition, Admissions" from 242 minutes to 224, a 7% reduction
- "Physician Greet" to "Disposition, Departs" from 137 minutes to 120, a 12% reduction
- Overall Average Length of Stay from 289 minutes to 243, a 16% reduction
The facility, which had been tagged as "worst in the system" of over 20 hospitals, received regular postings as "best in the system" after the Kaizen.
High cancellation rates approaching 20 percent were causing scheduling conflicts and disruptions in service for a mid-sized, South Florida anesthesia group. Inefficiencies in flow of information, wide variance in daily case volumes and daily work processes were contributing to staff member stress.
Once the problem was defined and the scope was specified, team members were selected comprising a variety of roles in the surgical and anesthesia units, including nursing, registration, IT and a unit secretary. The chief of anesthesia volunteered to lead the transformation, with the hospital's COO as a co-leader.
A detailed agenda was laid out for team members, showing the format needed to move the department toward its goals. Issues offering the most fruitful opportunities for improvement were identified. These included the general clutter of charts, the possibility of collecting information farther upstream and the reduction of charting errors. Team members openly shared suggestions and the most promising solutions were implemented. Improvements included specified positions for each patient chart, in keeping with its stage of PAT (pre-admission testing), in order to support organization and visual management. Requiring insurance verification at an earlier interval was found to increase quality, reduce cancelations and free up time closer to the day of surgery; 72-hour pre-op requirements were also attached to the existing booking sheet for a similar purpose, all of which now receive quality checks innate to the process.
Three weeks after the Kaizen event, the department averaged chart completion of five days before surgery, an improvement from two days. The team continues to strive for seven days advance completion.
- Cancellation rate within 24 hours has dropped to 5%
- Massive waste and rework have been eliminated
Recently, Sheridan's radiology department completed a Kaizen event to improve critical IV-tPA workflows in both the ER and radiology departments of a hospital. Periodic delays between the time when a stroke alert was called and when the final radiologist has signed off so that the ED can determine the appropriate tPA, posed an ongoing problem.
The team established standard time allotments for each step of the stroke alert process during the Golden Hour IV-tPA cycle. Visual representation of each step helped set benchmarks for the group.
Working with both departments, the Sheridan Radiology team identified communication issues and other opportunities for improvement. Tactical changes were then introduced to help streamline the process and reduce response times.
After the Kaizen event, stroke alert response at the facility was vastly improved.
- The IV-tPA cycle time was reduced by 20%
- Visual controls were also placed at the facility for daily use
Women's and Children's Departments
A South Florida hospital introduced Couplet Care—a pilot program designed for newborns and their mothers with the goal of easing postpartum depression and to aid in successful lactation. Adopting the new program proved challenging due to numerous conflicts with current workflows, extended nursing hours and demand for additional space.
Working together, the hospital and nursing team identified specific areas of concern and outlined a plan to analyze facility constraints while addressing low compliance with nursing standards. Several issues affecting patient satisfaction also emerged during the Kaizen event.
During the Kaizen, the hospital and nursing team created a new concept for care and discovered numerous opportunities to improve patient satisfaction. Workflows were observed and a list of key issues were confirmed and adjustments were made accordingly. Relatively simple changes, such as reconfiguring the floor layout, had a significant effect on successful integration of the new program.
In only six weeks, new changes led to substantial improvement in the Couplet Care Program:
- Successful lactation rates increased to 90%—from under 30% before the event
- More than 90% compliance with nursing standards—an improvement from below 20%
- Improved nursing workflow and overall patient satisfaction
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