To reach cost reduction targets, hospitals are focusing on improving efficiency. This is a tricky task, because efficiency can be evaluated differently depending on who’s defining it. The definition will likely differ across the organization, or the community, or payers. We suffer somewhat from that fact that we have no definition of “true” efficiency. The Agency for Healthcare Research and Quality states it well: “There is insufficient evidence to say with certainty what and how many healthcare service inputs will yield the greatest efficiency and with what risks and benefits. For example, a variety of imaging approaches can be used to make a diagnosis, each with varying risks, benefits, and acceptability to patient and provider.”
It’s important that we ensure resources are dedicated to improving safety and quality and are not spent wastefully. Most efficiency initiatives focus on two resource areas: labor-related subjects such as “productivity” and supply chain issues such as “inventory turns.” In some instances, efforts to improve efficiency span both areas.
When addressing labor efficiency, the knee-jerk assumption is that this approach should first involve a staffing evaluation. Not true. Medical literature fully supports the benefits of appropriate nursing care and patients suffer when nursing care is diminished. At VHA, we’ve convened several educational forums over the past few years on “the business case for nursing” and we’ve learned that one key to efficient healthcare is using nursing staff effectively in adequately supported care environments. Hospitals that can identify and eliminate inefficiencies in nursing care create better places to work and improve experiences for patients. Addressing “stuff” before “staff,” meaning a focus on supply chain efficiency first, has been used successfully as an approach to “waste management.”
Here are seven ideas that hospitals can leverage to increase efficiency while reducing costs and better managing patient care:
1. Evaluate: Survey your clinical staff: what are the top 10 supplies they hunt for? Learn from them and build solutions based on what they already know. Make sure all staff are familiar with where supplies are. One study indicated that it took temporary nurses nearly twice as long to find supplies as regular staff nurses, at least initially, which reduced time available to do other tasks.
2. Redesign: Redesign nursing unit layouts to improve access to frequently used supplies and to prevent nurses from stockpiling what they need (and later discarding) unused supplies.
3. Ask: Survey your exchange cart staff: what products are out of place most often? Do any work arounds exist, such as hoarding or product relocation?
4. Purge: Get rid of antiquated capital equipment. Antiquated equipment breaks often and challenges staff to cope with unnecessary delays, create workarounds to make the equipment work, or takes extra time to complete processes.
5. Shadow: The director of materials management can shadow a nurse for a few hours. Walking a mile (many nurses walk four miles each day) in the nurse’s shoes can build perspective for the daily constraints that must be overcome and enable materials leaders to develop new processes that make the most of both nursing time and resources.
6. Organize: Arrange supply and medication rooms so they are the same or similar on every nursing unit. Supply techs become more efficient with the standardized layout during stocking activities, and staff (especially those who float, travelers, or are reassigned to different units), don’t have to guess where a product is located.
7. Track: Unused but discarded supplies can be costly. Operating rooms have learned the lessons about this reality, and this mindset can be spread to medical–surgical units. But we can’t improve what we can’t measure, so being able to quantify what is unused is crucial, and is a key first step to developing process changes that can send dollars straight to the bottom line.