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IT's Key Role in Lean Healthcare

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   January 07, 2014

Our guest columnist recounts the IT-clinical partnership at Sarah Bush Lincoln Health System that reduced ED patient walkouts by 1.2% and increased co-pay collections by 26%.

Guest column by Maggie Ratliff, Vice President & CIO, Sarah Bush Lincoln Health System, with Brian Murphy, IT Technical Director

Maggie Ratliff, Vice President & CIO,
Sarah Bush Lincoln Health System

Sarah Bush Lincoln Health System is going Lean. Our organization, a regional health system in central Illinois, has implemented a very aggressive process improvement strategy based on Lean Six Sigma practices. While the effort necessarily involves many functions within the organization, IT has a particularly important role to play.

In less than two years, the process improvement program has already resulted in hundreds of thousands of dollars in verified savings. We created a new "Performance Excellence" department and trained a number of facilitators to lead the charge. In just a few months, the Performance Excellence group has already conducted dozens of Rapid Improvement Events (RIEs). Further, to ensure that day-to-day Lean thinking is ingrained into our corporate culture, all directors, managers, and supervisors are now required to complete a Lean training course in their first year of employment, where they learn the tools and techniques of Lean and initiate their own improvement projects.

While Lean Six Sigma has many facets, the basic strategy is surprisingly simple. By focusing on driving the waste out of our processes and creating systems for continuous improvement, we reap the benefits not only of cost control but also improved quality of patient care.

By involving all areas of the health system and encouraging improvement at all levels, we have touched on a wide range of processes, from those as simple as reordering supplies to those as complex as a door-to-discharge examination of patient throughput in our emergency department. By involving frontline staff in cross-functional teams, we have been able to improve multiple aspects of shared workflows. In all of these projects, IT support has been essential.

In the example of our deep dive into the emergency department throughput, the Lean teams sought to both reduce patient walkouts and increase collections of co-payments. Once the improvement teams were formed, the teams mapped out the current state of our patient flow, identifying and eliminating those points in the process which did not add value to the patients or caregivers. Envisioning an ideal state and creating a roadmap to achieve it, the teams developed standard work to reduce variation and opportunities for errors. In conjunction with IT, they also identified key points where the judicious application of information technology could save time or add flexibility to work flows.

Our IT group bought a small number of laptops and mounted them on repurposed mobile carts we had in storage. This allowed our registration clerks to leave their stationary desks and meet patients at the bedside, rather than requiring that they spend additional time in the waiting room. We provided headset radios and pocket phones to the now mobile staff. Rich Fanelli, our Director of Patient Services, cites the use of this equipment and the ease of constant communication as critical to the success of the ED throughput project.

As patients enter the emergency department, they are greeted and received into our electronic system with very minimal information. They are quickly triaged and moved to a bed, allowing clinical staff to begin care almost immediately. The registration clerk completes the patient's registration and insurance verification at the bedside. Once treatment is complete, a "pending discharge" status is indicated on a patient tracker board. This prompts the registration clerk to return to the room and speak to the patient about any insurance co-payment.

In the first 90 days following the implementation of these changes, we have reduced patient walkouts by 1.2% and have increased co-pay collections by 26%. Emergency Department and Patient Services management continue to monitor key metrics at various points in the overall workflow to help identify further opportunities for improvement. This is just one example of the many benefits our organization has realized from leveraging appropriate technology in our Lean process improvement initiatives.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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