In my last LeanBrief article in the August issue, I discussed the concepts behind Lean Healthcare, and the benefits to be realized. In this LeanBrief, I would like to share the results from an actual Hospital Emergency Department (ED) case study, in order to demonstrate the practical benefits to all those who “brave the challenge.”With participation from key stakeholders, a Lean Six Sigma Process Improvement Team (PIT) was formed and as part of their data gathering efforts, a LeanStream™ Mapping Session was held to address radiology turnaround time for emergency patients. Through this process, they quickly developed and implemented staffing adjustments and other solutions, while they continued their detailed analysis.
This analysis showed that focusing on the hospital’s Express Care program would present the greatest potential for change with the least amount of difficulty. Data showed that it took nearly twice as long to see a physician in Express Care as it did in the balance of the department. Since this was under the control of the emergency department leadership, the lion’s share of improvement for this initial project would come from this area. The team got to work using the LeanStream™ Mapping along with data already collected to identify problems with flow. Almost immediately they began to work through the issues.
Analysis also revealed that using learned methods and knowing when and where to use various tools was very beneficial for the team. They discovered that the appropriate use of Lean and Six Sigma helps to achieve greater efficiency within a shorter amount of time. By mapping their process flows or traffic patterns within the emergency department, various bottlenecks were flagged to help the team analyze the current situation and identify any potential opportunities to streamline the department using Lean techniques. They also discovered that there was quite a bit of entanglement and waste movement, which led to a streamlining and reduction of process steps and cycle time.
Another Lean technique used was 5S Red Tag (Sort – Standardize – Simplify – Sweep – Sustain), to identify and eliminate waste throughout the Express Care area of the ED. The team physically walked through the process of moving from quick registration to express care, and rapidly moved supplies and workstations (where possible) to facilitate the flow of the patient. Red tags were used for those changes that could not be immediately addressed, and the simple 5S changes of sorting and streamlining were accomplished within 24 hours.
Small things can matter. Uncovering the use of antiquated fax machines in express care helped identify a barrier to communication. As so often happens in healthcare, the hospital staff was unaware that a problem existed because they had developed “workarounds” to the issue. The project team helped staff to recognize the delays and customer satisfaction issues caused by these everyday problems and empowered them to make changes.
Summary
By leveraging both Six Sigma and Lean methods within the emergency department, the team was able to realize the following accomplishments:
• Mean wait time reduced by 25 minutes, or 38%
• Std Dev (Standard Deviation) reduced by 17 minutes, or 38%
• Range of process flow reduced by 46%
• Z-score improved by 0.44 sigma (a z-score can tell you how far you are from the mean average and how well you performed)
• Defects (DPMO) reduced by 158,333 per million opportunities, or almost 50%
• Flow improved with elimination of non-value-added process steps
• Standards were created to sustain change
• Over $1.2 million in annual cost savings
This LeanBrief was designed to share the real-world problems that we are working to address at Nova Southeastern University and why we designed the Lean Healthcare: A Lean Six Sigma Yellow Belt Certification for the Healthcare Professional.
This includes ideas, changes, and methods that we are fostering, developing and testing to help organizations make breakthrough improvements, and the early results where they may exist.
