Published on January 23, 2014
12 steps to better healthcare WHITE PAPER
12 Steps to Better Healthcare L ike it or not, we are addicted to some unhealthy habits in healthcare. We make people wait. We overload our schedules. We let everybody do things differently. We focus on filling rooms. We blame people, instead of processes, for errors. We divide care into isolated silos. We cling to outdated systems and hierarchies. We hesitate to question dangerous conditions or practices. And so on… What have these habits done for us? The current results are alarming: • We waste half of every dollar spent.1 • We perform dozens of wrong-site/wrong-patient surgeries every week.2 • We commit one medication error per day for every patient in the hospital.3 • We make patients wait an average of 20 minutes to see their physician.4 • We commit errors that result in 100,000 preventable deaths each year.5 Obviously, these are not the intended results. But how do we change them? The only way to change the results is to change the processes of care delivery – the ways work is performed, the flow of information and people, the consumption of resources, and the systems of learning and innovation. At Workflow Diagnostics, we have identified 12 such changes that can help save time, money and lives – and, in our minds, the system itself. Whether you are an administrator, care provider or enabler, you can use these steps to improve the effectiveness and efficiency of your part of the system. 1. Document your processes. Processes are living organisms. They change over time, often in ways that are undesirable, including workarounds or shortcuts. They need attention and regular pruning. Your patients’ needs change; your processes have to change right alongside. And as a wise teacher once said, “If you can’t describe what you are doing as a process, you don’t know what you’re doing.” Ideas: Meet with one function at a time and document current procedures. Create a process diagram by connecting steps in order. Then, check with others outside the team to validate. Do this until all functions are documented. Remember: If you don’t have a process, you don’t have anything to improve. 2
12 Steps to Better Healthcare 2. Eliminate redundancy. When you document processes, be on the lookout for repeated steps, particularly by different areas. For example, it’s not uncommon for different areas to capture the same information in a different place or form. When patients answer the same questions multiple times, from three different people, they start to wonder if anybody is listening. Don’t rely on redundancy to fix a bad process. If you don’t trust the effectiveness of the first process, improve it and then eliminate the redundant steps. Ideas: Reports and records. Data collection. Interview questions. These are all areas that breed redundancy. First determine what is necessary; then, strive to do it, create it or capture it only once. 3. Standardize. Unnecessary variation and complexity consume enormous amounts of time that provide little or no value and could be focused on patient care or customer relations. Everybody likes to do things their own way, but this produces inconsistent results, confusion and complaints. Determine the most efficient, effective or safest way to do something and standardize around it, across personnel, shifts and roles. Is there one acceptable way to perform a function (e.g. draw blood; insert a catheter)? Definitely standardize this. Expect a few battles along the way. OK – a lot of battles. But these are battles worth fighting. Otherwise, you will never be able to standardize around the optimal patient experience and outcomes. Ideas: Start with room layouts and supply placement; signage; scheduling and test ordering procedures; and room setup / cleanup protocols. Make sure you put accountability measures in place to back up any standard you create. 4. Read what’s in your suggestion box. You see these almost everywhere, but you never see anybody empty one. Do it. Great ideas await you, as well as the “real” truth about how well you’re doing. Ideas: Go one step further to engage your patients. Hold a small focus group with a cross-section of patients, or distribute surveys and offer a small token in return for a response (nothing big enough to sway the results). 3
12 Steps to Better Healthcare 5. Foster problem-solving. Everyone is solving small problems all day long, but do they have a standard and effective method for solving persistent or complex problems? Are they trained in root-cause-analysis? If not, implement one of many improvement methodologies, such as PDSA, Lean Six Sigma DMAIC, A3, Kaizen or another. This is an investment in your people and the future of your organization Ideas: Train all associates in the seven basic Quality tools or the fundamentals of Lean Six Sigma (consider our Quality Clinic course, for example.) Provide FMEA training for Quality personnel. Select key associates for certification in Lean Six Sigma. 6. Clarify roles. This is more than reviewing job descriptions. Where roles connect or overlap, discuss who does what. Alleviate ambiguities or disagreements. Defer to the best and safest choice for the patient or the practice. Ideas: Review your medication reconciliation procedures. Who is responsible for documenting medications? Who reviews them? Who discusses with the patient? This is an area of consistent ambiguity. 7. Use visual status indicators. In the old days, we used flags outside the exam rooms to indicate “ready,” “in use” or “available.” Why did we stop? Today we have color-coding on computer screens, and because the information often lags, doesn’t match our workflows or is incorrect, we don’t trust it. Visual indicators and cues should make it obvious to everyone – particularly physicians – what the status of a resource is, and where they should go next. After all, how much time do you have for uncertainty? Ideas: Try a number card system – each room has a number on a card; when a patient leaves, the number is hung on a hook in a plainly visible location. This makes it obvious the room is available. The next person who boards a patient in that room hangs the card on the room door, making it obvious to others the room is in use. And the process repeats itself. Patient tracking boards with key elements such as appointment time, room number and status also keep everyone on the same page. 4
12 Steps to Better Healthcare 8. Keep supplies where you use them. This is called “point of use.” Locate supplies in the place where they are most frequently used, and put seldom used supplies away. This will reduce the time spent retrieving key supplies, using an unsuitable alternative or just doing without. Ideas: Blood pressure cuffs, educational materials, sterile supply packs, key phone numbers and other essential supplies and information. 9. Throw away anything broken, expired or unnecessary. Broken or expired materials not only take up valuable space and energy, but they may also pose a significant safety risk. Ideas: Do you have a process for regularly identifying or discarding such items? If not, you need one – now. Meet with your team and write it out. Then implement it. Certainly include drugs, chemicals and other agents that you store, but don’t overlook office supplies and record archives. 10. Minimize suppliers and inventories. “Strive for 1,” as we call it. In other words, aim for 1 standard item, and 1 standard supplier, in various categories. Ideas: Office supplies. Forms. Testing and supplies. Billing services. Uniforms. Deliveries. You name it – strive for 1 standard item, and 1 supplier, in each category. This will also help you negotiate bulkier purchases with single suppliers. 11. Hold still. Strive to do as much as you can with as little energy as possible. This means less walking, particularly of the back-and-forth variety … to the supply closet, the exam rooms, offices, the hallways, nurse’s station, etc. Equip workspaces so that multiple tasks can be completed in one place. Ideas: Create work cells where doctors, mid-levels, nurses and/or other staff can be co-located to improve communication; document visits on a laptop or tablet between patients; minimize the number of rooms allocated to each provider. 5
12 Steps to Better Healthcare 12. Practice one-piece flow. This is the opposite of batching or multi-tasking, which is prevalent but deceptively inefficient. When we “batch” items, the first item to arrive waits until the last item arrives before it is completed, creating unnecessary delays and reducing “flow.” Instead, complete one project or task, or as much as you possibly can, then go to the next. You’ll no longer have to remember where you leftoff, repeat steps or miss a deadline. And work is delivered continuously, rather than in spurts. Ideas: Physicians: Complete patient visit notes between each patient; otherwise, the backlog that haunts you at the end of each day will continue to do so. You’ll also improve accuracy and completeness. Everyone: Create “safe” zones that say to the outside world, “no interruptions,” to improve your ability to focus on one activity. So, there you have it! Twelve simple, but powerful, steps you can take right now to improve efficiency and reduce waste in your office, practice or unit. Remember: You have finite resources – time, energy, space, people and money – to commit to patient care. You owe it to your patients – and yourself – to ensure every resource is wisely used for their benefit. With these strategies and others, you can drive organic healthcare reform that makes a real difference – saving time, money and lives, and changing the harmful habits that have become too costly to maintain. A healthier process will have healthier results. Want more ideas? Check out our latest book, Go Get Your Muda!, available on Amazon. You can also follow us on Twitter (@workflowdx) and Wordpress (“Quality Matters”). Better yet, contact us today to set up a free consultation. We’d love to hear from you. 6
12 Steps to Better Healthcare References 1. PricewaterhouseCoopers, The Price of Excess, April 2008, http://www.pwc.com/us/en/healthcare/publications/the-price-of-excess.jhtml 2. Joint Commission Center for Transforming Healthcare, Wrong Site Surgery Project, http://www.centerfortransforminghealthcare.org/projects/detail.aspx?Project=2 3. Johns Hopkins Bloomberg School of Public Health, http://www.jhsph.edu/news/stories/2006/wu_medication_errors.html 4. Medical Economics, http://medicaleconomics.modernmedicine.com/medicaleconomics/news/modernmedicine/modern-medicine-feature-articles/20-minutesmagic-number-patie 5. The Commonwealth Fund, “Five Years After ‘To Err is Human’: What Have We Learned?,” http://www.commonwealthfund.org/Publications/In-theLiterature/2005/May/Five-Years-After--To-Err-Is-Human---What-Have-WeLearned.aspx Copyright 2014 PO Box 4233, Lynchburg, VA 24502, 1-855-FLOWDOC, workflowdiagnostics.com
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