Hospital has lost millions of dollars since 2005 and cannot uphold the mission statement to the community under current conditions. Services will be cut and employees will be laid off if the financial situation is not rectified. The Board of Directors issued a directive to find ways to meet the 2012 budget (a $3.5 million loss) and to break even in 2013.
The hospital schedules an average of 102 new patient visits per day. The hospital is not a contracted provider with the payers for approximately 10% of those visits. Failure to identify these visits prior to services being delivered results in cost in denied dollars, and resource cost to try to recover the loss.
The term "cancer survivor" refers to individuals who have been diagnosed with cancer and also includes the people in their lives who are affected by the diagnosis. These individuals manage numerous physical, psychological, social, spiritual, and financial issues throughout the diagnosis, treatment processes as well as, the remaining years of their lives. Poor coordination of care and communication of needs leads to tremendous distress in the patients, their caregivers and the medical team. Lack of validated assessment tools, approved education materials and inefficient, non-standardized processes have led to tremendous waste in our outpatient clinic. The addition of a nurse practitioner...
The Medical Center's heart failure patient's average length of stay in the Congestive Heart Failure Clinic is currently 89.2 minutes, which is 29.2 minutes greater than the appointment times of 60 minutes. Countermeasures put in place to mitigate this problem include: purchasing laptops
to decrease staff walking distance; level schedule and nursing assignments to accommodate better patient flow; implement standard work in regards to documentation to eliminate re-work; and implement point-of-care testing to decrease lab wait time. As a result of Lean initiatives implemented the Congestive Heart Failure Clinic has seen approximately a 19 minute decrease in patient length of stay,...
Mahoney, Patricia C.
The academic Faculty Group Practice (FGP) business office exists to support and manage revenue cycle functions associated with an institution's clinical practice mission. Activities such as producing and transmitting insurance claims and patient statements; posting payments, responding to customer billing inquiries occur. Key indicators for gauging performance include claim denial rates, collection rates, charge lags, days revenue outstanding (DRO). A portion of business office work involves charge corrections, an overlooked contributor to costs and rework. Corrections are often the result of internal processes, systems and behaviors. This improvement initiative focused on a business office's charge corrections from two perspectives: transaction...
In 2011, 8.6% of approximately 446,000 medical group patient visit encounters were not completed in Epic EMR within 2 days, resulting in incomplete records, causing subsequent care for patients to be less safe, delayed or lost revenue, and invalidation of a portion of at least 135 or more physician employment contracts. Causes for this condition included providers not being aware of the expectation or their performance relative to the expectation of work completion within 48 hours, technologic and workflow barriers, overutilization, and instability of work systems and inability to recover from work flow disruption. Countermeasures included Just Culture-framed dialogue for...
Reducing pre-op to incision time was the main goal of a collaborative multidisciplinary team in a
standalone heart and vascular operating room. The pre-op to incision time for the operating room
was >60 minutes over the allotted preparation time for surgery. On average, 45% of the
documents and orders required to pre-op a patient were missing the day of surgery. As a result,
the pre-op area was chaotic and surgeries failed to start on time. This has led to days running
longer than scheduled, and decreased patient, staff, and physician satisfaction. The project was
divided into two phases, phase I focused on the pre-op area and...
This project is the beginning of a large scale transformation of care in primary care clinics. In March of 2012 a Value Stream Analysis was conducted and a Target Condition identfied. A pilot clinic was determined along with a 13 month project plan of Kaizen workshops and projects to address the starbursts and opportunites on the Value Stream map. Noted along with the primary A3 are five additonal A3's addressing the first few Kaizen events and projects. Since we can only change and transform as fast as our cultures will allow, this is the very beginning of their journey. Physicians...
The primary issue is that perioperative delays are resulting in 22.3% worked hours in overtime and decreased patient, staff and physician satisfaction. This department is looking to increase surgical volume and needs to strengthen their ability to improve current workflows and respond to future growing demand. The primary countermeasure to this issue is to focus on room turnover delays. OR turnover times are exceeding the Health System target by 5 minutes per turnover (totaling 3 hours of potential value added time per day), 67% of the time. This is a significant contributor to the over perioperative delays.
An Ohio hospital operates two urgent care sites where time spent in an urgent care is critical to patient
satisfaction. In September of 2011, Length of stay in both Urgent Care sites was observed to be an
average of 99 minutes, which could cause patients to present to the ED (a serious business and quality
concern). A goal was set to reduce the median patient time between Registration and Discharge to be
less than 60 minutes. Lean Six Sigma tools utilized included: team charter, value stream mapping, 5S,
work leveling, visual management and control plans. Reduction of waste and daily management
systems were countermeasures put in...
Marstiller, Heather M.
The Patient Centered Medical Home model has a strong emphasis on Care Management activity. The
current burdens on the Care Team have not allowed time or a focus on care coordination and care
management outside of the standard office visit. Through a multifaceted effort to remove waste from
some of the care team's processes and appropriately align work, approximately 56 hours a week of
capacity was created among the team members. This has allowed opportunity to develop and
implement new work in a primary care practice focused population management and care coordination
across that patient's care continuum.
In Ohio, African Americans have the highest incidence rate of developing colorectal cancer and African American males have the highest mortality from colorectal cancer than any other gender/race group. As a result, African American men and women are needlessly dying, families are left devastated, and limited healthcare resources are being utilized to treat a cancer that could have been detected or prevented through screening colonoscopy. This Capstone Project, Development of a Screening Colonoscopy Program, begins with education to promote colorectal cancer screening with the initial focus on African American communities and identified lower socioeconomic neighborhoods. Following the identification and removal...
"Workforce Partnership national ranking (a measure of employee satisfaction and
engagement) drops from 52nd percentile (2008) to 29th percentile (2011). Analysis of
results from employee survey process identifies greatest deficiencies in direct
management scores. Target is established for 90th percentile (national benchmark)
equating to 80.0% mean score (current mean 70%) for Partnership measure.
Countermeasures focus on standard work for management throughout the
organization. Subsequent survey process in 2012 demonstrates overall improvement
of 3.1 percentage points in mean score (and the associated improvement in national
ranking to the 49th percentile). Process of establishing and deploying standard
management work continues."