sampling of client success stories
Post on 23-Dec-2021
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Partnering to achieve the NEXT LEVEL of Performance
NEXT LEVEL Partners® HealthCare
For More Information, Contact:
Brian S Maready, Vice President-Lean Healthcare, www.nl-p.com
bmaready@nl-p.com, Cell: (719) 330 5604
Sampling of Client Success Stories
Revenue CycleStory
Peri OpStory
EDStory
Patient FlowStory
Revenue Cycle Case Study
•Denials have increased over 400% between 2011 – 2017
•$6.1M/month in denial charges• Unnecessary delays in receiving payment
• Excessive time spent on denial management & resolution
• Senior VP of Revenue Cycle reached out to NLP for help
2
System Wide
Situation Summary
• Reduce denial quantity and total charges by 30%
• Identify Pilot Hospital and Area of Focus
• Improve Productivity by reducing time spent working on denials
3
Client Objectives
• 6 month target timeframe
• Complexity of process requires multi-disciplinary teams
Other considerations
• Pilot hospital - 800 beds, 12,000 in-patient admissions per year
• Planned roll out to 4 additional sites4
Approach
• 62.7% reduction in Denials (exceeded goal)
• 63.3% ($4.1M) reduction in denial total charges
• $703K in Labor Savings (9 FTEs reallocated)
• Trained 2 Subject Matter Experts in lean tools
5
Results
RIE = Rapid Improvement Event aka Kaizen event
ROI of 10.1x
PeriOp Case Study
•Delayed/late cases, low productivity, excess & obsolete supplies
• Variation in patient prep RN to RN, missing
• Significant wait time for lab results
• Inconsistent process to pull and charge for supplies
• Excessive room changeover times
6
Situation Summary
• Identify long range plan for lean implementation with clear business results defined: •Improve operational efficiency•Improve patient safety and outcomes •Improve patient satisfaction scores•Improve quality of work life •Improve financial performance
• Improve contribution margin by improving OR utilization
7
Client Objectives
Road Map
Data Prepared Surgical Service VSM Event
VS Owner John Brothers
Team Leader Robin Luehr/Dana Troutman
Data Prepared 6/15/2012
#Action - SYSTEM
EventsWhere
Event
Type
Potential
LeaderExpected Results
1
Improve Data flow and collection.
Non-standard metrics.
Improve accuracy and consistency
of data. (Definitions)
BI, OR, IT SW John Brothers
Standardized Process for compiling OR data.
Develop standardized metrics of measurement for all 3 campuses
Standardize process for compiling data - datasource, definitions
Understand the reporting forums. Have standardized metrics and targets
shared by all 3 hospitals.
Identify metrics for Patient Satisfaction, Quality, Quality of Worklife and
Financial Performance
2
IT System Analysis for OR
Multiple Information Systems
utilized in the OR/Surgical
Services (different systems utilized
at the campuses)
OR Just do it John Brothers
Understanding OR systems: What does future state look like for it?
(Decrease in systems)
Patient Satisfaction, Improve outcomes, Quality of Work Life, Financial
performance.
3Scheduling/Requesting key
information/Block TimeOR SW John Brothers
Standardization of scheduling and key information needed (process & IT)
Eliminate redundancy of requesting physician orders multiple times
Review Block Time Utilization/Improve OR Utilization
Goal is to improve unused Block Time by 25%
Patient Satisfaction, Improve outcomes, Quality of Work Life, Financial
performance.
4Patient has multiple registrations
preparing for OR
Registration
sSW John Brothers
Can we reduce #/registrations? Pre- reg?
Create Standard Work for Registration
Patient Satisfaction, Improve outcomes, Quality of Work Life, Financial
performance.
5
Results Realization Check: Verify
that intended results-to-date have
been realized and endorsed by local
leadership
Administratio
nR2K Site COO/CFO
Validate realization of desired performance improvement results. If not,
conduct 2-3 day Results Realization Rapid Cycle Improvement Event before
proceeding with any further rapid cycle improvement events
6Pre-Anesthesia/Pre-OP/non-
standardized
Pre-
Anesth../
Pre- Op
Testing
SW John Brothers
Standardize what patients need to come to the hospital for a pre-
anesthesia visit
Standardize information required.
Eliminate/Reduce duplicative testing (lab testing done in the physician's
office, repeated in Pre-Anesthesia testing, H&P's)
Clear roles and responsibilities.
Develop process for some testing to be completed on the morning of OR.
Standardize Pre-Anesthesia orders/criteria
Decrease motion and transportation within hospital
Patient Satisfaction, Improve outcomes, Quality of Work Life, Financial
performance.
VALUE STREAM ROAD MAP
Value Stream Map
• Pilot hospital – typical start in large hospital
• Then roll out to regional hospitals and rural critical care centers8
Approach
• $3.4 million increased capacity in the Operating Room
• $1.9 million increased contribution margin at largest campus by improving OR utilization
• 17% operational throughput for Same Day Surgery
• $50,000 reduction in obsolete inventory
• $53,600 reduction in overtime & staff turnover
9
Results
ROI of > 10x
Emergency Department Case Study
•Patient dissatisfaction, long wait times, inconsistent processes, poor interdepartmental communication• High LWOT – patients dissatisfied and leave before treatment
• Lack of standard work for staff & nurse protocols
• Door to Doctor time & Doctor to Unit time too long
• Variation in patient prep RN to RN
• Significant wait times for lab results
10
Situation Summary
•Improve patient flow with reduced wait times
•Improve visit outcomes with fewer LWOTs
•Improve process with standardized patient care processes
•Improve patient satisfaction with staff-patient interactions
11
Client Objectives
Road Map
Value Stream Map
Net Revenue
per visit
Annual Net
Revenue
Decrease LWOTS 1,000
Level 5 380 $31 $11,780
Level 4 450 $88 $39,600
Level 3 170 $231 $39,270
Annual Net revenue From ED $90,650
Expected Admits from LWOTS 8%
Estimated additional Admits 80
Net revenue per Admit 8,945 $715,604
Total increase in Net Revenue $806,254
Reduce S&T transfer by 10 per month 120
Net Revenue per admit 8,945 $1,073,406
Reduce Re-admits by 25% 72
Impact to penalty 2,986 $215,000
Decrease LAB TAT 25% 8532
Additional Studies anually 1,280 31.65 $40,506
TOTAL $2,135,166
Future StateCurrent State VSM
• Started in main 275 bed/29,000 annual ED visit hospital
12
Approach
Value Stream Mapping:
Emergency Department
Identifying
Diagnosing & Prioritizing
opportunities
Quantifying the benefits
Creating a plan
RIE –
Triage & Registration
Standard Work
RIE –
Door to Doc & Admit
time
RIE –
Lab standard work for
results
RIE –
RN std wk (transfer,
admits,handoff)
Changing the process.
Engaging the people.
Realizing the results
5 Months
ED Transformation Road Map w/RIEs
(Rapid Improvement Events)
• Overall $2,100,000 improved financial performance
• $800,000 decreased LWOT, increased admissions (included above)
• 44% reduction in average door to doc time (27 min to 15 min)
• 25% Lab TAT ($40k) reduction in lab result turnaround time & subsequent increased studies
13
Results
ROI of > 13x
Patient Flow Case Study
•Patient dissatisfaction regarding discharge. Slow flow through diagnosis & test processes• Up to a four hour wait for discharge after orders are written
• Long wait times for short procedures – staff “searches” for patients
• Lack of standard work for nurses and duplicate systems create waste
14
Situation Summary
• Improve patient experience
• Reduce Length of Stay
• Reduce LWOTs
• Increase capacity to support more revenue
• Standardize the discharge process
15
Client Objectives
Current State understanding
Action plan and ChartersSJRMC Admit to Discharge VSM
Action Step/ Kaizen Events Owner Event Dates Status Benefits
Problem: We rely on 2-way communication for all communication, no
way to prioritize calls. Actions: 1. Analyze call volume / sources /
content. 2. Establish Physician rounding schedules (SEE ITEM 6), 3.
Investigate Communication Systems - (pager?) 4. Review Nurse initiated
protocols - k+, mag. 5. Reduce calls from / to areas (SEE ITEM 7). 6.
Increase implementation of Responder 5. 7. Educate all staff to think "Is
this call necessary?" before it is made. 8. Review Housekeeping
process. 9. Paging Standard Work.
CindyKaizen (TPI /
SW)8-15 to 8-19
25% reduction in minutes spent on Phone, increase pt.
Satisfaction, increase staff Satisfaction (Combine with 7)
Problem: Multiple incoming calls interrupting Pt care and nursing tasks.
Actions: 1. Id Source and reason for calls, 2. Identify calls that need to
be handled by RN (immediate, return call), 3. Obtain IT report - # of calls
/ minutes spent per shift. 4. Create standard work for Unit Secretaries
Communication
Kaizen (SEE 3)
25% reduction in minutes spent on Phone, increase pt.
Satisfaction, increase staff Satisfaction (Combine with 3)
Problem: Lack of consistency in rounding times can delay discharge,
and delay care and increase phone calls (SEE 7 and 3). Actions: 1.
Assess Rounding routines by group and specialty 2. Research bylaws
for rounding (1X per day). 3. Determine Cost of avoidable days /
Revenue capture. 4. Set a standard (goal) time for Discharge Orders.
5.Educate / monitor for improvement.
Kaizen(TPI/SW)Improve pt. Satisfaction, Improve discharge time, Improved
coordination, Improved patient safety, Decrease LOS.
Problem: Incorrect patient status / information entered into Meditech,
resulting in missed revenue and unnecessary communication loops.
Action Steps: 1. Root Cause analysis - Why is this happening? 2.
Review Access Nurse - MRN communication Process, 3. Implement Fix
Theresa Kaizen (SW) TBD Improve revenue capture.
Problem: Nurse delaying discharge even if all other processes are in
place and complete. Actions: 1. Root Cause Analysis (perception vs.
reality), 2. Define Standard Time to discharge / Steps to take (Standard
Work), 3. Gap to Standard Analysis. 4. Re-work process to eliminate
and re-address incentives and disincentives of the process. 5. Educate
/ Apply resources to optimize process efficiency. 6. Set up structure for
data collection / monitor data over time.
Megan Kaizen (SW) 7/18-7/22
Decrease Order to Discharge time - (Target 2 hours), Increase
Pt. Satisfaction (HCAPS), Increase throughput (decrease
boarders / holding patients), Increase Staff Satisfaction
(Turnover Reduction).
Problem: Relocation of Pt. takes time and resources Actions: Quantify
impact, do RCA, ID trends (units, seasonality etc.) Develop
countermeasures, Standardize Process. Address physician preference
issues.
HeatherMeeting /
Project1-Sep
Decrease time spent turning rooms, improve safety, decrease
supply cost, decrease cost of care.
Problem: Delays in entering pt status (ADT) on admission/transfer/DC
causes a delay in PT care, and room readiness for next pt. Actions: 1)
Define timeframes/expectations on when ADT is completed 2) Educate
staff on expectations, 3. Develop report to monitor ADT times. Educate
leaders to run report, Hold Staff accountable.
Karen Meeting / JDI 1-AugImprove room turnover times (26% failure Currently - Target <
10%), Eliminate delays to patient care.
Problem: Stocking Pyxis during peak med Admin times 0900 - 1400 -
2100 - 0600 delays med delivery. Action: Review current Pharmacy /
Materials Schedule for stocking, review staffing of pharmacy / Materials,
(Align pharmacy / Materials schedule to med delivery schedule).
Investigate options (mini pyxsis) 5) re-inforce Red-Zone / Quiet Zone, 6)
Review policy and Procedure for timeframe to Admin Meds 7) A
message to Pharmacy for 1st Doses, Out of stock, needed
Kim Meeting(s) 31-JulDecrease calls, smoother workflow, eliminate delays to care -
waiting for Pharm, increase Safey,
Problem: Excess Motion and time primarily nursing. Actions: Root
Cause analysis to find excess motion - extra physical steps for care and
supplies, 2. Physical mapping of South and North Pods / Central Pods.
3. Standardize Pyxis (Supply and Meds), 4. Identify biggest impact
areas, Develop countermeasures, re-map
Terry Project 1-Oct
Improve Staff Satisfaction, Improve efficiency, Safety - able to find
tools, Improve patient satisfaction, Big impact on short stays.
Decrease steps in a day.
Problem:We spend too much time logging into computers, causing
delays in care Solving: Implement solution being used in ED.Cindy JDI Dec-16
Improve Employee satisfaction, decrease time to dispense
medication, decrease wasted time.
Problem: Discharge instructions (education) are hard to follow /
understand. Actions: Can Revisions be made to format?, Review format
/ layout of Discharge Summary, Develop Alternative format, Test
formats, Take product to Clinical Informatics.
Becky Project 1-Nov
Improved pt. understanding, Decrease re-admissions,
decrease phone calls backs, decrease time spent on
discharge, Patient awareness of follow-ups.
Problem: Long registration process can delay care / throw off schedules
for procedural areas. Action Steps: 1. Review screens to see if there is
any opportunity (Why doesn't information copy over from registration to
Nursing Admission Summary?), 2. Evaluate what we are currently doing
and what is required. 3. Investigate online registration. 4. Clarify
signage at Registration. 5. Map Reg Process for procedural areas. 6.
Simplify and Clarify process / paperwork.
Theresa Project 1-NovImprove HCAP scores, Reduce Pt. confusion, reduce reg times,
reduce patient motion.
Problem: Obs. Status Stays are treated the same as inpatients leading
to going over OBS hours and loss of revenue. Action Steps: 0.
Understand commonality among observation stays / trending for
potential standardization of care. 1. Tier Priorities for ancillary studies
(Lab Best Practices?). 2. Promote a cultural shift of obs status
Dr. Greenberg Kaizen (TPI)11/14 -
11/18
Increase throughput, Increase Revenue, Evidence based care,
Patients will not suffer financially (Bill Issues), Less Administrative
Overprocessing, Clarity for case RN managing = Less Rework,
Less Time delays + obs hours @SJRMC, Less confusion among
staff, Accountability and enhanced case protocols, Pt and Staff
Problem: two processes exsist for provider orders resulting in errors and
increased time spent processing and clarifying orders. Actions: 1.
Track errors based on CPOE vs handwritten orders. 2. Revise Quantros
investigation report to include CPOE vs. or handwritten. 3. Investigate
voice recognition CPOE. 4) Quantify provider time saved by using
CPOE? 5) Continue to document and quantify impact on Nursing
Dr. Hoffman Project Dec-16Decrease Order entry errors, decrease sime spent clarifying and
transcribing orders, Improve NSG / Staff / Satisfaction
Problem: Documentation quality is poor - (unclear, incomplete, lacks
depth, is not timely) creates additional work, causes delays in care,
makes us look bad, leads to a loss in revenue, can cause safety issues.
Actions to Solve: 1. Review what standards exist today. 1a, Priortize
groups based quality issues. 2. Further clarify documentation
requirements - Supplier and Customer perspectives. 3. Agreement on
"new" standards. 4. Educate and Sustain "new" standards.
GingerTPI (Quality)
Kaizen
12/19 -
12/23
Improve communication, throughput, increase resiliancy to
medical necessity denials, improve revenue. Reduce LOS by 1
day. Improve compliance with regulatory agencies.
Problem: Patient has to wait at various times during their hospitalization.
Action Steps: 1. Identify wait times and locations. 2. RCA on extended
wait times. 3. Clarify Patient expectations 4. Develop scripting for staff
5. Improve patient communication / education. 6. Schedule times for
follow-up 7. Improve communication between departments.
Dawn Project 31-Oct
Decrease wait times, increase patient satisfaction (HCAPS).
Increased employee satisfaction (EOS). Improved communication
inter department communication. Decrease in Service
Complaints.
Problem: Multiple computer systems lead to fragmented patient care
and lost records Actions: Assess current State, Can we eliminate /
improve current systems?, Identify, eliminate/mitigate navigation wastes,
duplicate information entry, (create clinically relevant default PCI tab),
Implement and Educate on changes.
CammieMeeting to
determine Proj /
Kaizen
1-AugImprove Staff Satisfaction, Save time, increase efficiency,
Improve patient Safety, improve continuity of care
Create VSM / Improvement Roadmap to Improve time it takes to
discharge a patientVSM 6/20-6/24
Identify road map to improve time to discharge. Target a XX%
Improvement.
Improvements made need to be sustained / improved. Implement Lean
Daily Management - select 5 impacted departments and develop LDM
process and KPI boards
Kaizen (LDM) TBD
Validate Results realization - R2K - review results 60-90 days after
KaizenR2K 10/15/2016
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