Operations Optimizationcases / operations
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Issues / Opportunities for Improvement: Client was in bottom 10% of peer group for a critical lab test, Troponin, which indicates the likelihood of an impending heart attack. Cycle time was 80 minutes, the gold standard was 60 minutes. Management believed the only way to improve performance was to hire more phlebotomists to draw blood in a timely manner.
CHC Solution: CHC documented the process and found many opportunities for improvement. Multiple draws of blood were interfering with efficient processing, use of a pneumatic tube system to convey samples was causing a bottleneck, and the instrument processing samples did not advise technicians that it was finished with its testing. CHC ran a parallel process with only single draws, redistribution of drawn blood to bypass the bottleneck and an audible alarm to notify technicians that results were available.
Outcome: Cycle time decreased to below 60 minutes, moving client from bottom of its peer group to the top.
Issues / Opportunities for Improvement: Like most hospitals, this CHC client suffered from a crowded ED, many patients left without being seen, and the cycle time to get in and out of the hospital was nearly 4 hours. Further analysis revealed that the admissions process for patients from the ED was nearly 2 hours, meaning half of their stay in the ED was spent waiting for a bed in the hospital.
CHC Solution: CHC implemented a variety of tactics to streamline admissions from the ED. “Middlemen” were removed from the process and redeployed. A housekeeping application was used to detect beds being cleaned to accelerate their assignment to ED patients.
Outcome: Throughput in the ED improved by 10%, translating into over $500,000 in annual net income improvement to the hospital, not counting the value of redeployed staff or acceleration of inpatient revenue. The ED reported a positive budget variance for the first time in the hospital’s history.
Issues / Opportunities for Improvement: An inner city hospital found itself incapable of collecting from ED patients due to faulty processes. Patients became quite skilled at evading financial counselors. Information gathered by clerks was unreliable and inaccurate. Bad debt in the hospital was climbing to unprecedented levels.
CHC Solution: CHC implemented a process known as “Design of Experiments” to run several collections processes in parallel in order to determine the optimal and most effective method to collect from patients with the clear ability to pay.
Outcome: ED collections soared after implementation of this process. Since CHC had implemented a 3:1 return on investment guarantee, the hospital not only experienced the gains, but gladly compensated CHC for their part in making it possible.
Issues / Opportunities for Improvement: Client was completing construction of a new hospital, and also starting up several new software platforms. Existing processes to track and deliver medical supplies were either non-existent for the new system, or were going to become obsolete.
CHC Solution: CHC analyzed the existing processes and software systems to identify critical gaps. A total of 12 sub-processes were designed and implemented. An FMEA-like analysis identified which supplies needed to be stocked on medical-surgical floors, and which could remain in a centralized stockroom. Inventories of supplies were slashed, yet bedside availability of supplies improved. Tracking of supply consumption became more accurate, expiration of time-sensitive items dropped, and handling of supplier outages improved.
Outcome: The client experienced fewer lost charges, lower inventory costs, and reduced patient risk.
Issues / Opportunities for Improvement: Over 50% of patients discharged had at least one error in their prescription paper work. Patients were at risk, and rework was excessive.
CHC Solution: An FMEA Risk Priority Number enabled the team to quantify the unique impact of each error type, and a baseline level of risk was established. A DMAIC team identified root causes, implemented solutions, and verified results.
Outcome: Total risk to patients reduced by 75%. Rework slashed, increasing productivity.
