steps to

better healthcare

12

WHITE PAPER

ike it or not, we are addicted to some unhealthy habits in healthcare.

We make people wait. We overload our schedules. We let everybody do things

differently. We focus on filling rooms. We blame people, instead of processes, for

errors. We divide care into isolated silos. We cling to outdated systems and

hierarchies. We hesitate to question dangerous conditions or practices. And so on…

What have these habits done for us? The current results are alarming:

• We waste half of every dollar spent.1

• We perform dozens of wrong-site/wrong-patient surgeries every week.2

• We commit one medication error per day for every patient in the hospital.3

• We make patients wait an average of 20 minutes to see their physician.4

• We commit errors that result in 100,000 preventable deaths each year.5

Obviously, these are not the intended results. But how do we change them?

The only way to change the results is to change the processes of care delivery –

the ways work is performed, the flow of information and people, the consumption of

resources, and the systems of learning and innovation.

At Workflow Diagnostics, we have identified 12 such changes that can help save

time, money and lives – and, in our minds, the system itself. Whether you are an

administrator, care provider or enabler, you can use these steps to improve the

effectiveness and efficiency of your part of the system.

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12 Steps to Better Healthcare

1. Document your processes. Processes are living

organisms. They change over time, often in ways that

are undesirable, including workarounds or shortcuts.

They need attention and regular pruning. Your

patients’ needs change; your processes have to

change right alongside. And as a wise teacher once

said, “If you can’t describe what you are doing as a

process, you don’t know what you’re doing.” Ideas:

Meet with one function at a time and document

current procedures. Create a process diagram by

connecting steps in order. Then, check with others

outside the team to validate. Do this until all functions

are documented. Remember: If you don’t have a

process, you don’t have anything to improve.

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4. Read what’s in your suggestion box. You see these almost

everywhere, but you never see anybody empty one. Do it. Great

ideas await you, as well as the “real” truth about how well you’re

doing. Ideas: Go one step further to engage your patients. Hold a

small focus group with a cross-section of patients, or distribute

surveys and offer a small token in return for a response (nothing

big enough to sway the results).

2. Eliminate redundancy. When you document processes, be on the lookout for

repeated steps, particularly by different areas. For example, it’s not uncommon for

different areas to capture the same information in a different place or form. When

patients answer the same questions multiple times, from three different people, they

start to wonder if anybody is listening. Don’t rely on

redundancy to fix a bad process. If you don’t trust the

effectiveness of the first process, improve it and then

eliminate the redundant steps. Ideas: Reports and records.

Data collection. Interview questions. These are all areas that

breed redundancy. First determine what is necessary; then,

strive to do it, create it or capture it only once.

3. Standardize. Unnecessary variation and complexity consume enormous amounts

of time that provide little or no value and could be focused on patient care or

customer relations. Everybody likes to do things their own way, but this produces

inconsistent results, confusion and complaints. Determine the most

efficient, effective or safest way to do something

and standardize around it, across personnel, shifts and

roles. Is there one acceptable way to perform a function

(e.g. draw blood; insert a catheter)? Definitely standardize

this. Expect a few battles along the way. OK – a lot of

battles. But these are battles worth fighting. Otherwise,

you will never be able to standardize around the optimal

patient experience and outcomes. Ideas: Start with room

layouts and supply placement; signage; scheduling and

test ordering procedures; and room setup / cleanup protocols. Make sure you put

accountability measures in place to back up any standard you create.

12 Steps to Better Healthcare

5. Foster problem-solving. Everyone is solving

small problems all day long, but do they have a

standard and effective method for solving

persistent or complex problems? Are they trained

in root-cause-analysis? If not, implement one of

many improvement methodologies, such as PDSA,

Lean Six Sigma DMAIC, A3, Kaizen or another. This

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6. Clarify roles. This is more than reviewing job

descriptions. Where roles connect or overlap, discuss who

does what. Alleviate ambiguities or disagreements. Defer to

the best and safest choice for the patient or the practice.

Ideas: Review your medication reconciliation procedures.

Who is responsible for documenting medications? Who

reviews them? Who discusses with the patient? This is an

area of consistent ambiguity.

is an investment in your people and the future of your organization Ideas: Train all

associates in the seven basic Quality tools or the fundamentals of Lean Six Sigma

(consider our Quality Clinic course, for example.) Provide FMEA training for Quality

personnel. Select key associates for certification in Lean Six Sigma.

7. Use visual status indicators. In the old days, we

used flags outside the exam rooms to indicate

“ready,” “in use” or “available.” Why did we stop?

Today we have color-coding on computer screens,

and because the information often lags, doesn’t

match our workflows or is incorrect, we don’t trust

it. Visual indicators and cues should make it obvious to everyone – particularly physicians – what the status of a resource is, and where

they should go next. After all, how much time do you have for uncertainty? Ideas: Try

a number card system – each room has a number on a card; when a patient leaves,

the number is hung on a hook in a plainly visible location. This makes it obvious the

room is available. The next person who boards a patient in that room hangs the card

on the room door, making it obvious to others the room is in use. And the process

repeats itself. Patient tracking boards with key elements such as appointment time,

room number and status also keep everyone on the same page.

12 Steps to Better Healthcare

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10. Minimize suppliers and inventories. “Strive for 1,” as we

call it. In other words, aim for 1 standard item, and 1 standard

supplier, in various categories. Ideas: Office supplies. Forms.

Testing and supplies. Billing services. Uniforms. Deliveries. You

name it – strive for 1 standard item, and 1 supplier, in each

category. This will also help you negotiate bulkier purchases

with single suppliers.

8. Keep supplies where you use them. This is called “point of

use.” Locate supplies in the place where they are most

frequently used, and put seldom used supplies away. This will

reduce the time spent retrieving key supplies, using an

unsuitable alternative or just doing without. Ideas: Blood

pressure cuffs, educational materials, sterile supply packs, key

phone numbers and other essential supplies and information.

9. Throw away anything broken, expired or

unnecessary. Broken or expired materials not only take up

valuable space and energy, but they may also pose a

significant safety risk. Ideas: Do you have a process for

regularly identifying or discarding such items? If not, you

need one – now. Meet with your team and write it out.

Then implement it. Certainly include drugs, chemicals and

other agents that you store, but don’t overlook office

supplies and record archives.

11. Hold still. Strive to do as much as you can with as little

energy as possible. This means less walking, particularly of the

back-and-forth variety … to the supply closet, the exam rooms,

offices, the hallways, nurse’s station, etc. Equip workspaces so

that multiple tasks can be completed in one place. Ideas:

Create work cells where doctors, mid-levels, nurses and/or

other staff can be co-located to improve communication;

document visits on a laptop or tablet between patients;

minimize the number of rooms allocated to each provider.

12 Steps to Better Healthcare

So, there you have it! Twelve simple, but powerful,

steps you can take right now to improve efficiency and

reduce waste in your office, practice or unit. Remember:

You have finite resources – time, energy, space, people

and money – to commit to patient care. You owe it to your

patients – and yourself – to ensure every resource is

wisely used for their benefit.

With these strategies and others, you can drive

organic healthcare reform that makes a real difference –

saving time, money and lives, and changing the harmful

habits that have become too costly to maintain.

A healthier process will have healthier results.

12. Practice one-piece flow. This is the opposite of batching or multi-tasking, which

is prevalent but deceptively inefficient. When we “batch” items, the first item to

arrive waits until the last item arrives before it is completed, creating unnecessary

delays and reducing “flow.” Instead, complete one project

or task, or as much as you possibly can, then go to the

next. You’ll no longer have to remember where you left-

off, repeat steps or miss a deadline. And work is delivered

continuously, rather than in spurts. Ideas: Physicians:

Complete patient visit notes between each patient;

otherwise, the backlog that haunts you at the end of each

day will continue to do so. You’ll also improve accuracy

and completeness. Everyone: Create “safe” zones that say

to the outside world, “no interruptions,” to improve your

ability to focus on one activity.

Check out our latest book, Go Get Your Muda!, available on

Amazon. You can also follow us on Twitter (@workflowdx) and

Wordpress (“Quality Matters”). Better yet, contact us today to set

up a free consultation. We’d love to hear from you.

Want more ideas?

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12 Steps to Better Healthcare

1. PricewaterhouseCoopers, The Price of Excess, April 2008,

http://www.pwc.com/us/en/healthcare/publications/the-price-of-excess.jhtml

2. Joint Commission Center for Transforming Healthcare, Wrong Site Surgery Project,

http://www.centerfortransforminghealthcare.org/projects/detail.aspx?Project=2

3. Johns Hopkins Bloomberg School of Public Health,

http://www.jhsph.edu/news/stories/2006/wu_medication_errors.html

4. Medical Economics, http://medicaleconomics.modernmedicine.com/medical-

economics/news/modernmedicine/modern-medicine-feature-articles/20-minutes-

magic-number-patie

5. The Commonwealth Fund, “Five Years After ‘To Err is Human’: What Have We

Learned?,” http://www.commonwealthfund.org/Publications/In-the-

Literature/2005/May/Five-Years-After--To-Err-Is-Human---What-Have-We-

Learned.aspx

PO Box 4233, Lynchburg, VA 24502, 1-855-FLOWDOC, workflowdiagnostics.com

References

Copyright 2014

12 Steps to Better Healthcare