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Responding to a national reimbursement system that is shifting from a “pay-for-service” volume-centric model to a performance based model, healthcare providers are looking for ways to provide better care, reduce waste, increase efficiencies and remain competitive in the future.
Whether operational changes are driven from the top-down or bottom-up, associates at every level will be impacted by policy and procedural challenges. Therefore, open communication and continuing education are keys to success.
At Holy Cross Hospital in Fort Lauderdale, the mission to transform operations is at the core of our strategic plan. When we formalized our current process over three years ago, we began with a focus on 10 departments with the greatest opportunity. Today, we have over 40 departments utilizing the process with many more on the horizon. Here are some of the factors that support these initiatives and fuel a cultural change:
Define your Structure: “A3” is not only the name for an 11”x17” piece of paper, but also a problem solving approach and communication tool. Cross-functional teams utilize the A3 process (plan, do, check, act) until the desired result is achieved. Teams must complete a formal charter which is reviewed for approval. The charter includes the baseline data, business case, goal and target complete date.
Identify Your Priorities: You cannot act or educate without a common frame of reference. We identified our eight main areas of opportunity: perioperative services, clinical operations, supply utilization, pharmacy cost, growth, continuing care, workforce management and our physician network.
Devote the Resources: Every director, manager and supervisor has been identified as a transformation leader and is responsible for completing a project annually. We are continually training new “operational coaches” to help facilitate projects that require assistance. These coaches are mentored by a member of the Enterprise Performance Excellence team, which consists of three Six Sigma Black Belts.
Give Them the Tools They Need: In addition to offering business classes and training in Excel, we hold LEAN orientation classes for all leadership positions. We also have team-based training sessions in which project teams are trained over the course of eight weeks. During these classes, the project teams learn tools and receive coaching specific to their projects.
Data: Now that everything we do in healthcare is electronic, there is more data available than we can handle. Our job is to take this data, turn it into information, and use it to change our processes.
Remove Barriers: Leading our effort to transform operations is the performance excellence council comprised of the COO, CFO, CNO, CMO, my team and a representative from Patient Satisfaction, Quality, and IT. As projects are considered, any concerns and barriers can be addressed immediately and channels for workforce education are identified.
Set High Expectation and Accept the Challenge: We challenged our OR to improve their on-time starts and achieve 80% of first cases start within five minutes of the scheduled time. When surgical cases start late, subsequent cases may be delayed causing bottlenecks and frustrated patients, surgeons, and staff. Using the A3 process, the cross-functional team was able to suggest changes that resulted in reduced costs, increased satisfaction and increased capacity. The team reviewed available data and found several reasons for delayed starts to include utilization of morning-of testing, unclear definitions of roles, communication gaps, tardy surgeons and patients arriving late.
Standardize What You Can: Standardization is key to achieve efficiencies. In the example above we implemented changes that streamline the process to include: a patient education packet and revised preparation process, refined process flow maps for anesthesia consent, a charge nurse checklist and a continuous review of updated block polices.
Today, we have no choice but to learn to operate with less waste and achieve better results. The data to support change is available and by engaging associates it is possible to optimize practices throughout an organization that will drive the achievement of the triple aim: better health, better care, lower cost.
