Lean Health Application for

Small Rural FacilitiesBased on the

Experience of First Care Medical Services

Fosston, Minnesotaby

Patricia WanglerChief Executive Officer

Produced by: Joey Johnson, Administrative Assistant

“We Are “Small” Demographics” 206 Employees

168 FTE’s

$15,000,000 Annual Expenses

640 Admissions

600 Surgical Procedures

45 Births

17,000 Nursing Home Days

590 Home Health/Hospice Admissions

9000 Service Area Population

So Why Did We Invest? Building project and new services were putting a lot of pressure on staff work volumes

Processes seemed to be getting more complex

We were not achieving goals for customer satisfaction

Patients

Staff

A great opportunity presented itself that provided the education through Northland Community and Technical College

We made a commitment of staff time to the value of $50,000 which turned into higher real numbers due to overtime and replacement of staff

Where Are We - The first cohort of 24 management staff have completed 96 hours of:

TPS (A-3’s)

Kaizen (5-S)

PI (Performance Improvement Methodology)

Six Sigma – One staff member has Greenbelt

The second cohort of staff training is nearly completed

We are in the second year of LEAN

What Have We Accomplished:

1. 37 A-3 projects completed

2. Potential savings of

3. Both soft and hard savings are included

• Soft saving of time and supply reduction

• Hard savings are actual recoupment of revenue / loss charges / lost visits

4. Time reduced from projects 5,798 hours

$100,000

Strategic Goal:First Care Medical Services leadership

and staff work together to become a premier employer achieving staff turnover below 17%.

Strategy:Simplify work processes through

“LEAN” to achieve 10% more staff time with patients as measured by

time savedtotal hours

How Will Staff Be Rewarded For Commitment:

1. Work processes will flow smoother

2. Process points bridging two departments will unite staff rather than divide.

Intrinsic:

Extrinsic:1. Performance Bonus

$100,000

Award Winning Projects

Processing of Bills Business

Office $13,081.00

hard savings.

Processing of BillsBusiness Office

Situation:

Current processes were not changed with the implementation of new electronic billing systems. We continued to do manual process steps that were required under previous system.

Processing of Bills (continued)What we did:

• Mapped out the current flow of work.

• Mapped flow as it should go with the new technology.

• Identified several routine, manual processes that added no value.

• Eliminated:

1. Bills being printed and filed by patient name for every date of service.

2. Bills being pulled from patient files each time a payment is made on that bill. (This happened each month until the bill was paid in full.

3. Bills being pulled from patient files each time an insurance company is called.

Processing of Bills (continued)

Initiated:

1. Communications on patient accounts being completed on the information system, which enables individuals to search account information from their desk.

Processing of Bills (continued)

What we achieved:

• $13,081.00 of hard savings in time.

• Enabled reallocating saved time to the upfront collections process being implemented

Elimination of Manual

Duplication in Radiology $19,000.00

combination of soft and hard

savings.

Elimination of Manual Duplication in Radiology

History:

• Development and Implementation of Digital Radiology, PACS and Teleradiology Network.

• Became filmless with exception of Mammography Voice Recognition Software enabled interpretation to be joined to the image and stored in PACS.

Elimination of Manual Duplication in Radiology (continued)

Situation:

Manual processes of printing interpretations and placing in a film jacket continued as in the past.

Elimination of Manual Duplication in Radiology (continued)

What we did:

• Completed Value Stream Mapping

• Value of manual steps timed, cost and questioned

• Process revised to use digital report as the only archive – Takes trust in automation!!!

Elimination of Manual Duplication in Radiology (continued)

What we achieved:

• $19,000.00 soft saving of time.

• $700.00 hard savings of jackets and paper.

• Value of space saved – Not quantified.

• $17,300 Reduced in Soft Costs of Time and Outdates.

• Reduced Inventory on Hand by $16,000.

• Total Impact of Over $33,000.

Pharmacy Inventory Management

Pharmacy Inventory Management (continued)

History:1. Pharmacy Inventory creep evident.(Benchmark for facilities our size = $50,000)2. All Pharmacy processes manual and time consuming.

What we did:

• Mapped out current flow of work.

• Value of manual steps timed, cost and questioned.

• Process re-mapped with expiration date coding done at time of entering drug into inventory.

Pharmacy Inventory Management (continued)

• Reduced the number of steps in the process from seven to two and reduced time spent by 145 minutes per month. Value of time saved is $1,400 per year.

• Implemented system of flagging outdates on entry to inventory at a cost of $100.00 for stickers. Stickers are coded by month allowing visual inspection for outdates versus reading every container for expiration.

• Net savings of $1,300.

What we achieved:

Pharmacy Inventory Management (continued)

Reduced outdates from $19,000 annually to $3,000 in one year for immediate soft cost savings of $16,000.

• Implemented tracking system to develop database of drugs that expired.

• Pharmacy and Therapeutics committee reviewed list of drugs and removed from inventory.

• Reduced inventory on hand from $72,000 to $56,000. For a total hard cash savings of $16,000.

What we achieved:

Pharmacy Inventory Management (continued)

Sustain Improvements In Inventory Management:• Installed Pharmacy software package to further automate and improve inventory management. The value of the software package is too new to be measured, however, continued improvement are expected.

• Goal: Having the right drugs on hand in the right amounts to ensure quality care of patients while continuing to eliminate and/or reduce supply of drugs that outdate. Continue to work toward $50,000 inventory benchmark.

Pharmacy Inventory Management (continued)

Misrouted Phone CallsCurrent Situation:

• Phone calls enter through the switchboard/reception area.

• Departments reporting receiving calls for other departments/staff.

• Hospital patient services decided to track the calls and the amount of interference into their patient care delivery.

• Study showed a projected 207 hours spent on misrouted phone calls annually.

• Switchboard receiving so many calls that they were answering and transferring hurriedly.

Misrouted Phone Calls (continued)

What we did:

• Worked with switchboard staff on phone answering protocols.

• In process of installing more DID lines with the expectations that staff will share their number with persons who call them.

Misrouted Phone Calls (continued)

What we accomplished:

• Reduce up to 207 hours worth of nursing interruption annually.

• Soft value is over $5000.00.

• Reduce number of calls going through switchboard by DID lines.

• Soft costs of DID lines not known as been measured at this time.

First Care and Lean – Are we best buds yet?

• We’re just starting.

• Staff are seeing the potential.

• Peers nominated two of the project champions for Excellence Awards in Innovation.

• Discussion at Department, leadership and All Staff Meetings is increasingly Performance Improvement focused.

Where Are We Going With Lean?• We’re going to harness the processes

and use them to help make work life easier.

• We’re in it for the long haul.

• Staff are beginning to get excited.

• Excited staff are great!!!