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Collaborating to achieve a lean management culture

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  By Jeff Spade,  March 12, 2012

Rural hospitals band together to improve care.

At the 25th annual American Hospital Association's Rural Healthcare Leadership Conference in February, healthcare leaders from across the country joined together to share their thoughts on the current state of rural healthcare. One way these critical-access hospitals can meet the ever-growing challenges — such as healthcare reform, the economy and looming hospital closures — is by collaborating and working together to improve patient care.

Rural hospitals collaborate to improve care

In September 2008, five rural hospitals within western North Carolina committed to a collaborative partnership to improve patient care and hospital performance. The hospitals in the collaborative include Ashe Memorial Hospital, Cannon Memorial Hospital, Caldwell Memorial Hospital, Blue Ridge Regional Hospital and The McDowell Hospital.

Competitors by nature, the participating hospitals created a structure for working together by sharing information and resources to improve patient care. To help the hospitals reach their goals, the collaborative began working with management consulting firm Simpler Consulting to implement lean management to cut costs and improve patient care.

Lean management is a practice that enables the true performance potential of a business or process to be realized. The concept was developed by Toyota and has become a fundamental business strategy around the world. Lean-thinking healthcare organizations are patient-centric organizations that relentlessly define value in the eyes of their patients (not clinicians) and seek to identify and eliminate wasteful work elements from every aspect of their enterprise — both clinical and non-clinical.

Leadership from all participating hospitals recognized that if they were going to undergo a transformation, they needed a process where each leader would be committed to removing current barriers to truly become organizations defined by those they serve: their patients.

Creating a culture of problem solvers
Each organization recognized that the value in lean is not merely the actual solution itself, but how each team member is part of the problem-solving and improvement process. Lean teams consisted of staff from all levels, from front line workers to management to the C-suite.

Each hospital targeted two "care streams" in their waste-reduction efforts. Examples of the care streams include the emergency department, imaging and surgical services. Once a care stream was identified, the department began a series of rapid improvement events (RIE) that would help physicians, nurses and staff eliminate the waste in their daily tasks to reduce costs and improve patient care. In conducting a RIE, the Simpler Sensei (coach) leads selected members of the unit, caregivers and managers in an intensive forum where new ideas on how to eliminate waste are trialed and put in practice.

Additionally, hospital leaders met quarterly to review the work of the lean improvement teams and to strategically review goals and opportunities.

The results
Since embarking on its lean journey, the collaborative has achieved real improvement results. Through its work, some of the hospitals have seen a return on their investment (ROI) of greater than 4:1, with results including:
  • The imaging department at Ashe Memorial Hospital reduced patient transportation by 60 percent.

  • The emergency department (ED) at Cannon Memorial Hospital has experienced a 35 percent reduction in turnaround time for the top five laboratory tests ordered, and a reduction from 60 minutes to 28 minutes from when the patient presents in the ED to the first intervention.

  • Without adding additional staff or resources, Caldwell Memorial Hospital has reduced patient room turnaround time from a 90-minute average to a 45-minute average, with a capacity improvement of 230 patient days ($398,750 net revenue).

Given the success of the collaborative, it has since expanded to include healthcare organizations located in eastern North Carolina at Columbus Regional Hospital, Dosher Memorial Hospital, Duplin General Hospital, Johnston Health and Sampson Regional Medical Center. In the first eight months, the eastern collaborative experienced a savings of $1.4 million, with results including:
  • The emergency room at Columbus Regional Hospital reduced patient abandonment to less than two percent. Additionally, now more than 90 percent of patients see a physician within the first 60 minutes of entering the ED.

  • Sampson Regional Medical Center increased operating room on-time starts from seven percent to 64 percent and increased the usage of pre-operative antibiotics from 97 percent to 100 percent.

The North Carolina Rural Health Lean Transformation Collaborative is proof-positive that lean management improves quality and reduces costs, and the model has been adapted and implemented at healthcare organizations in Nebraska and Oregon. If other rural hospitals across the country adopted the North Carolina Rural Hospital Lean Transformation Collaborative model, hundreds of millions of dollars could be saved, making an impactful dent in reducing healthcare costs in this country.


About the author
Jeff Spade is the executive director of the North Carolina Center for Rural Health Innovation and Performance, a resource center supported by the North Carolina Hospital Association (NCHA), and vice president of NCHA. Spade is a Fellow in the American College of Healthcare Executives, with more than 25 years of experience as a healthcare leader.


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