Health care providers are taking a page from the manufacturing world and utilizing lean operations to increase efficiency. While the emphasis in manufacturing has been on lowering costs, in the health care sector, the focus of such techniques is on improving quality of service.
“Especially with direct-care people, it”™s a way to get rid of stuff they don”™t like to do and spend more time on what”™s important to them,” said Tom Phillips, executive director at The Hudson Valley Technology Development Center (HVTDC), located in Fishkill.
The HVTDC is currently working with two health care organizations, Benedictine Hospital in Kingston and The Astor Home for Children, a non-profit mental health organization based in Rhinebeck, to implement lean techniques in various aspects of their operations.
At Benedictine, HVTCD consultants are working with nurses to help them eliminate distractions and spend more time with patients. “On average, our nurses spend 27 percent of each day directly at the patients”™ bedsides. We want to increase that to 50 percent of each day,” said Kathy Guido, the hospital”™s vice president of patient services.
Known by numerous other monikers, such as “just in time” manufacturing, lean operations are designed to cut out waste from a process. Forty years ago, after analyzing U.S. auto manufacturing facilities, Toyota Motor Company developed a system that minimized consumption of resources that didn”™t add value to the finished product. It was the first example of lean manufacturing. Lean processes incorporate the Japanese philosophy of “Kaizen” (meaning “change for the better”), which is based on the concept of taking a process apart, examining it, and improving it by reconstructing the parts in a new way.
Guido, a registered nurse who also holds an MBA, said Benedictine had previously applied lean operations to its chemotherapy and fast-track emergency department divisions, with great success. In the chemotherapy department, applying lean techniques has resulted in reducing the insurance reimbursement process from an average of 53 days to 14 days.
In using lean operations in the development of its fast-track emergency department program, which is designed to separate out and speed up the treatment of ED patients with minor injuries, the hospital has achieved an average length of stay of 63 minutes. That”™s close to the national gold standard for emergency room fast-track length of stay of 60 minutes, said Guido.
In the first stage of the nurses”™ lean training, HVDTC consultants tracked two nurses in the cardiac step-down unit as they went through their shifts, writing down each action and interruption. “They found that one nurse walked an average of eight miles a day,” said Guido. Benedictine is about to embark on stage two, which is testing several of the suggested changes over a three-month period.
Nurses on the cardiac floor will experiment using mobile carts designed to carry everything they need, including a laptop, linens, equipment and medicine. They”™ll also use a voice mail system with one line dedicated to a patient”™s family members. “We”™ll see what works,” said Guido, noting the nurses”™ retention rates, amount of overtime, patient satisfaction and other quantifiable measures of performance will be tracked.
Â
“For some reason, we tend to think of health care as an enigma,” she said. “But we”™re starting to realize there are business methodologies that fit, and some nurses are getting their MBAs.”
The Astor Home is using money from a grant it was awarded from the New York State Department of Labor Workforce Development and Training Division to apply lean techniques to the front-desk operations of its seven clinics in Dutchess County. The community clinics treat children from age 5 to 18 with mental health problems. A lot of the clientele belong to poor families and are recipients of Medicaid. HVTDC”™s lean trainers are working with front-desk staff to improve their productivity and reduce operational costs, by eliminating redundancies, for example.
Earlier this year, The Astor Home hired HVTCD consultants to apply lean techniques to improving efficiency in its billing department. The nonprofit has a $42 million budget and is affiliated with the Catholic charities of the Archdiocese of New York; besides the clinics, it maintains a residence for mentally ill children and offers a host of services, including early childhood and special education programs, throughout the mid-Hudson Valley and the Bronx.
One goal of the billing initiative is to achieve 100 percent compliance with Medicaid, said Melinda Weisberg, The Astor Home”™s director of public policy and strategic initiatives. She said the organization had reached a compliance rate of 95 percent, up from 81 percent. Weisberg said the nonprofit had also improved the accuracy of the bills it sends to insurance companies. Before, “we were getting a lot of denials” from the insurance companies, which required staff to spend more time on paperwork.
Utilizing lean operations in its clinics is a nontraditional application that could improve client care significantly, she said. Representatives from the clinics recently spent a day together meeting with the HVTCD trainers comparing visual maps of their processes, which each had compiled. “Folks identified similarities and differences,” said Weisberg. “We”™ll be compiling the future state map by taking from all those current maps.” She said representatives from the county, which is involved with the billing for each clinic, were also present. “They can offer suggestions from their perspective. It”™s about communication.”
Weisberg said The Astor Home has scheduled a week of intensive training with lean experts in January, designed to reduce the amount of paperwork generated at each clinic. “It”™ll be like cleaning out your closet,” she said.
Besides working with the HVTCD, the nonprofit will also undertake some in-house training, focusing on a continual application of lean principles. Weisberg is “Six Sigma” certified, which refers to a system made famous by Motorola that emphasizes the continuance of the process. “We want to look at HR, accounting, and IT,” said Weisberg. “We are making a long-term agency commitment.”
The HVTDC, which was founded in 1988, is one of 10 regional technology development centers in the state funded through the state Foundation for Science, Technology and Innovation and the National Institute of Standards & Technology. Phillips said the original mission of the HVTDC was to provide expertise to small and midsized manufacturers in the region. But lately, he”™s been expanding his organization”™s reach to the health care, government and education sectors.
Â
Nicole Stansbury, program director of GEMs and Kids Connection.
When I was a little girl, called Little Sisters, it”™s always been areally big program in our community for African American girls, as I grew up aa and latino, in white plains. All my friends came to little sisters, it was a way for my ommo a single working mom, to h provide place was safe, provided cultural activies, when on trips. Went there afer school, a camp during the summer. My first job, at age 14, I was placed back to LS to be camp counselor thorugh the white plains youth bureau. I went on to hs, I was not continue, I didn”™t graduate a striver, I stopped in middle of hs b/c of family transition I had, I was still affiliated. Went to college cam back, I worked at WP youth bue, last jan, I was given oportunityto be program dire. A blessing for me, dir of program I feel so indepted to, took care of me when I was younger, taught me so many values, now to do that to other young girls is a blessing. So many girls parents have already gone through the program, this program has produced generation of women out of the community, now women”™s children.
Â
Basically same type of needs, only thing changed since I was little girl, we were able to do a lot more there was more funding, no camp , do summer pgoram for high school girls. We”™d like to have more funding. We help provide after school. Ls meet one daya a week, girls here 5 days a week. We provide transportation home. 103 girls in program, 5 years to 18 years.
Â
The thing mad ethe mos impression we used to have these guest speakers, I rembmer they used to brig lawyers and drs. People would do diff workshops it impressed upon us to work hard and reach out goals.
Â
Phillips said the HVTDC”™s original mission was to provide expertise to small to midsize manufacturers in the region. One of ten regional technology development centers funded by the NYS Foundation for Science, Technology and Innovation and the National Institute of Standards & Technology, the HVTDC was founded in 1988 and has worked with dozens of manufacturers.
Â
But recently the organization has reached out to the health care, government and education sectors, with the aim of “making them more competitive and productive with the resources they have,” said Phillips.
Â
