Process Improvement (PI) has been used in all industries to reduce cycle time, improve quality, and lower costs. Healthcare, specifically hospitals, was a later entrant using this methodology but PI gained significant traction and momentum in not just the “administrative” areas of hospitals, but in clinical and ancillary departments as well.
A process improvement in a large Midwestern hospital, for example, led to an entire sub industry being developed offering formal software products that allow nurses to “bid” on open shifts. Nurses register for the system by completing a standardized skills profile and supplying the types of shifts desired and availability. When a shift is open, the Supervisor completes the “skills required” template and qualified nurses are then notified of the open shift, and the bidding begins. This approach saves overtime costs, provides a superior level of care through pre-screened qualified nurses, increases nursing staff satisfaction, and reduces costs of using Traveler Nurses.
Retrieving blood samples from patients is a recurring event and requires trained staff to draw blood, package the specimen, label the blood vial(s) with a pre-printed bar coded label, and send to the Pathology Lab for analysis. The more advanced path labs read the bar code to register the vial prior to the analysis. Often, in some cases as high as 50%, the labels are incorrectly placed on the vial which prevents the bar code reader from reading the bar code. Upon analysis of the Path Lab process, it was observed that this situation then creates a manual process to retrieve the data from the label, create a new identical label, reposition the label on the affected vials, then send the vial back through the bar code reader. The process improvement initiative detailed the process, frequency of occurrence, effect of the defects, and identified root causes. The result was to change the process on the front end, the labeling of the vials by the nurses. By decreasing the size of the labels and retraining the nurses / phlebotomists on where to place the labels, the staff were able to place the labels on the vials in a defect free fashion. The effect was an increase in specimen turnaround time by 11% and the elimination of 3,000 hours per year of rework.
Clinical unit process improvements can lead to direct patient outcome improvements. By changing the process for IV line changes which typically occurs every 24, 48, 72, or 96 hours, a hospital was able to reduce blood stream infections by 76%. This improvement entailed moving critical IV line changing supplies (consisting of female luer locks, alcohol prep pads, 30ml flush syringes, cotton balls, and tape) to the bed side making it more convenient for the nurses, and ensuring that all necessary supplies are immediately available.
Process Improvements of workflows in a Gastroenterology / Bronchoscopy clinic reduced patient assessment, time by 12%, improved nurse productivity by 31%, reduced patient mailer turnaround time from 8 days to 2 days, and increased revenue by reducing enough time to allow an additional procedure to be added each day with no added fixed costs.