Service Quality

Study: Risk of hospital infections increases at end of work shifts

A study published in the Journal of Applied Psychology reveals that nurses, physicians and other hospital workers tend to wash their hands less frequently as their work shift progresses, with a nearly 9 percent drop in compliance with handwashing protocols from the beginning to the end of a 12-hour shift. Researchers studied three years of hand-washing data on 4,157 healthcare workers in 35 U.S. hospitals. They attribute the decline in compliance to mental fatigue and the fact that hand hygiene is considered a low-priority task among health workers.

STUDY - Hospital executive walk-rounds can improve safety

New research published in BMJ Quality & Safety reveals that a specific method for fostering interactions between hospital executives and front-line health workers can reduce staff burnout and improve hospitals' safety cultures.

Isn't it time to finish the transformation of management that Deming started?

On July 13, 1950, Dr. Deming was invited to meet with 21 presidents of Japan's leading industries representing about 80% of the country's capital. Dr. Deming told the Japanese presidents many things on this day, the most important being that if the Japanese followed his teachings that the world would be screaming for protection from their quality products within five years. According to Dr. Deming, "they did it in four (years)."

Safety culture with supporting processes help lower and prevent HAIs - A Roundtable

Healthcare-acquired infections remain a serious patient care issue and an avoidable high expense. HAIs are preventable, yet many hospitals and healthcare systems are finding it difficult to decrease the number of injuries to patients. Read why HAI prevention and treatment depends less on procedures and more on culture, leadership and organizational commitment.

Newest item on the Gawande checklist: Greater integration

Dr. Atul Gawande has popularized the use of checklists to reduce errors and targeting the sickest and costliest patients as a way of holding down costs. But Monday, he ventured into new territory. In his keynote speech at the Healthcare Financial Management Association's Annual Nation Institute, he challenged finance officers to help lead their organizations toward greater integration and assume financial risk for patient outcomes.

Online reviews could help fix medicine

The University of Utah was the first healthcare system to post reviews from patients online - the good, the bad, the ugly. Think of it as Yelp for doctors. This sort of transparency can be stressful for doctors - as it would be for anyone whose performance is open to the public - but the positive effects are undeniable.

Practice Fusion launches free real-time database

Cloud-based electronic health record vendor Practice Fusion has launched a continuously updated database of de-identified patient information.

What's the difference between 'cost' and 'cost'?

Virtually everybody, from CMS to veteran muckraker Steven Brill, argues that healthcare costs are too high- but which costs are they really talking about? It's often hard to tell. After cracking his dusty business school textbooks and making the rounds of his finance experts, Michael Koppenheffer can tell you for certain what the problem is: People are talking about no fewer than six different types of "costs." Michael Koppenheffer outlines these six types of costs in an infographic.

Freestanding Emergency Departments

This white paper from the New York State Department of Health describes operational differences between freestanding emergency department and urgent care centers and gives pros and cons compared with hospital-based emergency departments.

Cleveland Clinic's value-based care team improves patient wait times, saves costs

Cleveland Clinic has found ways to reduce cost and increase throughput by adding support staff for primary care visits.

Top-Five list to improve emergency medicine and reduce costs

The Daily Rx summarizes on a study led by Jeremiah D. Schuur, M.D., an emergency medicine specialist at Brigham and Women's Hospital in Boston, to reduce excess utilization and costs in the Emergency Department.

Developing a cost-effective pressure-ulcer prevention program in an acute-care setting

This article in the Wound Care Advisor is a case study describing a cost-effective pressure-ulcer program in a 350-bed acute care hospital. The authors report that the program they put in place is saving over $2 million annually.

Engaging frontline employees in problem solving to provide ideal care in the PICU- East Tennessee Children's Hospital

This poster presented at the 2013 Healthcare Systems Process Improvement Conference describes a staff-driven approach for improving patient care in a pediatric intensive care unit (PICU). Thanks to Mark Graban for identifying this poster.

Feds eye crackdown on cut-and-paste EHR fraud

A recent article in Modern Healthcare cites that with the broader adoption of electronic health records (EHRs) the cost of Medicare claims has increased. CMS is investigating whether cut-and-paste features of some of the new EHRs is contributing to either fraudulent and inadvertent up-coding by charging for services that were never provided.

IIE member research abstract promoted via YouTube

IIE Member and doctoral student Avinash Konkani is featured in a YouTube video describing research he is doing to reduce noise and medical device alarm fatigue. Avinash is attending Oakland University and is doing research at Crittenton Hospital in Rochester, Mich. Avinash is also a member of the SHS Newsletter committee.

Patient and resource scheduling of multi-step medical procedures in nuclear medicine

Managing patients in nuclear medicine departments is a very challenging problem with limited research reported in the literature. The complexity involved in this health care setting makes this problem unique. In this paper, the authors derive and implement algorithms for scheduling nuclear medicine patients and resources.

Geisinger looks at all the pathways: Case study in healthcare logistics

This paper and presentation at the 2013 SHS Healthcare Systems Process Improvement Conference describes efforts to optimize logistics (transportation of goods and services to and from patient care areas) in a large regional medical center. The basis of the project was the application of simulation modeling to better understand the complexity and interaction of the various logistic activities.

Professors use industrial lean methods to re-engineer clinic

What began as an MBA class project at Purdue University's Krannert School of Management ended up with participants applying factory management techniques that hold promise for improving medical clinic productivity and quality. The research was supported by the Regenstrief Center for Healthcare Engineering at Purdue's Discovery Park. The improvements improved the capacity of the clinic by 37 percent with no additional resources.

How we revolutionized our Emergency Department

This article in the Harvard Business Review describes how one emergency department went from the sixth to the 99th percentile in patient satisfaction using a lean framework to eliminate waste.

A framework for reducing suffering in healthcare - HBR Blog

The authors posit that the time has come to deconstruct suffering by breaking it down into meaningful categories that reflect the experience of patients and help caregivers identify opportunities to reduce it. The authors propose a framework for major types of patient suffering so that health care providers can organize themselves to address suffering more effectively.

Management tools for internists, designing the patient schedule

This article describes best practices for setting up a productive internal medicine clinic. Many of the practices described in this article can be applied for improved throughput and patient satisfaction in other types of ambulatory clinics.

Driving unwarranted clinical variation out of a hospital: Key strategies

This article is a summary of the discussion from a webinar hosted by Becker's Hospital Review with experts from Objective Health, a McKinsey Solution, on strategies for hospitals to reduce unwarranted clinical variation. The strategies and analyses presented in the webinar focused on hospitals' unwarranted variation, which involves treatment protocols, physicians' clinical supply choices and resource utilization. The article also provides links to view or download the webinar as well as a copy of the presentation.

Quality Improvement in pharmacy inventory control - 2013 Healthcare System Process Improvement Conference presentation

This presentation covers many aspects of quality improvement in the pharmacy with a focus on improving flow. This presentation covers the project from the lean aspect as well as information technology, facility redesign and human factors.

Through the eyes of the workforce - creating joy, meaning, and safer healthcare

"Workplace safety is inextricably linked to patient safety. Unless caregivers are given the protection, respect, and support they need, they are more likely to make errors, fail to follow safe practices, and not work well in teams." 

This report addresses what can be done and what is being done to improve the physical and psychological harm to healthcare employees that ultimately impacts the safety and quality of patient care. The report provides a list of strategies and supporting tactics to improve conditions impacting the health and safety of the workforce.

Achieving small batch work flow in anatomic pathology to achieve faster TAT and better quality results

This presentation at the 2012 Lab Quality Confab describes how a centralized anatomic pathology lab can be as efficient as a small local lab through applying lean and industrial engineering principles.

Kaiser Permanente's healthcare IT journey

This presentation (large download) at the 2012 World of Health IT Conference describes how Kaiser Permanente is successfully leveraging IT resources to improve patient care.

Are patient surveys valuable as a service improvement tool in health services? An overview

This article in the Journal of Healthcare Leadership reviews the role of patient surveys as a quality improvement tool in healthcare. The article explores the characteristics, types, merits, and pitfalls of various patient surveys, as well as their application in identifying gaps in service provision. The article demonstrates that conducting patient surveys and using the results for improvement are two different processes.

An appointment order outpatient scheduling system for improved outpatient experience

Yu-Li Huang , Ph.D., provides an analytical model in a paper and presentation with practical applications for improving the order of scheduling patients for outpatient services.

Central line infection reduction using Lean Sigma at Presbyterian Healthcare Services, Albuquerque, N.M.

A multidisciplinary group at Presbyterian Healthcare Services teamed together to meet the Joint Commission National Patient Safety Goal and to reduce the central line infection rate to less than 1 per 1,000 patient days. The team used a lean Sigma improvement methodology to identify a number of countermeasures including checklists, education, defined observer, and a standardized central line kit. In the first six months of the project, the central line infection rate was reduced to .22 infections per 1,000 patient days.

Transforming care at the bedside: increasing patient satisfaction through employee engagement and teamwork at Our Lady of Lourdes Medical Center, Camden, New Jersey

Nursing leaders at Our Lady of Lourdes Medical Center in Camden, N.J., engaged staff to improve patient and employee satisfaction and reduce staff turnover on a medical-surgical unit using the Transforming Care at the Bedside (TCAB) model developed by Robert Woods Johnson Foundation and the Institute for Healthcare Improvement. The team focused on a set of directed methodologies and conducted a number of experiments that resulted in dramatic improvement.

Industrial and systems engineers cure some of healthcare's ills - Watson Institute for Systems Excellence at Binghamton University

A recent feature in Binghamton's Watson Review describes ongoing healthcare improvement research at the Watson Institute for Systems Excellence (WISE). Ongoing healthcare research at WISE includes research in ED throughput and supply chain. WISE researchers collaborate with a number of hospital systems including Vitua, Mayo, and Wilson and Binghamton General Hospitals. Thirteen research assistants in the WISE program have recently been placed in healthcare organizations.

What makes a hospital great 

In a recent New York Times article, Dr. Pauline W. Chen makes a case that organizational culture is more important than technique and technology in providing quality healthcare.

Undergraduates in action - Utilizing lean techniques for improved patient and information flow, UMass Memorial Hospital

Students at Worcester Polytechnic Institute and in coordination with UMass' Center for Innovation and Transformational Change examined how lean tools can eliminate non-value added work, improve resource management, and create lean flow at the UMass Memorial Hospital. After implementing a number of changes, the team saw a reduction in patient throughput time, elimination of defects in the chart tracking process, and a decrease in stocked inventory.

Improving pediatric emergency department patient throughput and operational performance

A multidisciplinary team working at the Rady Children's Hospital in San Diego, Calif., was formed to improve ED throughput. Based on comprehensive variability analysis the team implemented a number of changes including daily performance reporting, a fast track for lower acuity patients, and standardized nurse and physician rounding. The changes resulted in a 10 percent lower length of stay and a 50 percent reduction in left without being seen. These changes are planned to improve revenue by $782,000 to be budgeted in the next fiscal year.

Total productive maintenance in the OR - A case study at Kadlec Regional Medical Center

A team at Kadlec Regional Medical Center in Richland, Wash., took a lean approach to improving the availability and reliability of anesthesia related equipment in the OR. The team included physicians, staff, and external consultants. The article describes the background of total productive maintenance and how it was applied by a multidisciplinary team including physicians, OR staff, and clinical engineering. View related photos 

How to ace your joint commission survey with lean 

In this Ezine article author Gerald Leone describes how lean tools and principles were successfully applied in preparation for a Joint Commission Survey.

Evaluation of industrial engineering students' competencies for process improvement in hospitals

In an article recently published in the Journal of Industrial Engineering and Management, the authors concluded that while IE students working in hospitals focused on technical approaches to improvement, mastery and application of softer skills may be more beneficial.  

The journey to eliminating preventable harm - Nationwide Children's Hospital

In this presentation at the 2011 Society for Health Systems conference, Cindy Hafer provides a comprehensive look at how Nationwide Children's Hospital in Cincinnati is moving to eliminating all preventable harm to patients through a comprehensive safety initiative.

Case Study on transforming care at the bedside (TCAB), Good Samaritan Hospital

At a recent Premier Breakthroughs Conference and Exhibition, clinical and performance improvement staff at the 370-bed Good Samaritan Hospital in Suffern, New York, presented a case study of improvement on a nursing unit using the TCAB model.

University of Windsor Industrial and Manufacturing Systems Engineering students help to improve lab processes in the ED at Sunnybrook Health Sciences Centre

Sunnybrook Health Sciences Centre is considering implementing recommendations made by three fourth-year students at the University of Windsor Industrial and Manufacturing Systems Engineering as part of their capstone project. Ben de Mendonca, Josh Vandermeer and Andrew Phibbs, conducted an intensive examination of the system used by the emergency department to collect and label patient blood samples.

Human factors engineering to reduce patient falls

In a recent presentation at the 2011 SHS Conference, Brian H. Fillipo delivered a presentation on a comprehensive approach to reducing patient falls across seven Bon Secours hospitals in Virginia.

Case study on patient flow improvement, streamlining admissions from the emergency department

In a case study on the AHRQ website, the 340-bed Forbes Regional Campus of Western Pennsylvania Hospital developed a number of strategies to reduce delays in patient admission and discharge resulting in improved patient flow.

Helping a hospital shine

In an article previously published in Industrial Engineer magazine, industrial engineering researchers at Clemson University assisted Cannon Memorial Hospital in Pickens, S.C., in a number of hospital-wide and service specific improvements resulting in increased efficiency.

40 hospital benchmarks

Becker's Hospital Review recently compiled a list of 40 hospital benchmarks derived from recently reported information in the public domain. This limited benchmark provides some comparison of performance in quality, patient experience, finance and operations.

Significance of case management 

The increasing importance of case management in reducing costs and improving reimbursement in the current environment.

Dartmouth Institute for Health Policy and Clinical Practice takes lead on data and analysis for national collaboration for reducing healthcare costs

The Dartmouth Institute for Health Policy and Clinical Practice, TDI, has been selected to support a national collaboration aimed at reducing costs for high-volume, high-cost chronic and acute medical conditions that have high cost variation. Dartmouth-Hitchcock Medical Center, Cleveland Clinic, Denver Health, Geisinger Health System, Intermountain Healthcare and the Mayo Clinic have teamed together to take on such things as knee-replacement surgery where there is up to 50 percent cost variation.

Patient tracker

A case study of a centralized patient tracking system at Sentara Careplex Hospital in Hampton, Va. The case study shows how Sentara was able to reduce patient registration labor by over 50 percent and save over $300,000 per year. 

The art of implementing Lean from AORN Management Connections

A recent article in AORN Management Connections by Carina Stanton describes how three healthcare organizations are implementing Lean.

Video presentation on models, measurement techniques, and tests for analyzing adherence and performance of evidenced based medicine

In this 2010 presentation at the Dartmouth School of Engineering, SHS contributor and past president, James Benneyan, Ph.D., from the school of Mechanical, Industrial and Manufacturing Engineering at Northeastern University discusses that challenges of measuring performance of evidenced-based medicine and provides solutions to address these challenges.

Audible alarms and workplace noise in nursing units: An envioronmental factors case study

A case study for reducing workplace noise on a pediatric nursing unit and maintaining appropriate noise levels.

University of Wisconsin-Madison researchers post final report on Industrial and Systems Engineering (ISyE) in Health Care

In research sponsored by the Agency for Healthcare Research and Quality (AHRQ), UW researchers summarize findings and associated research from a 2009 conference in a report entitled Industrial and Systems Engineering and Health Care: Critical Areas of Research.

Texas Tech industrial engineering researchers reduce ED waits and discharge delays at Odessa's Medical Center Hospital

Industrial engineering principles are applied in improving patient flow at Odessa's Medical Center Hospital in Texas.

Using Lean to identify process improvement opportunities and improve effectiveness of blood transfusion

The authors provide a description of improvements in blood transfusion processing by applying lean concepts at 14 different laboratories in three different countries. Average savings per site was over $190,000 excluding savings associated with improved inventory management.

The Influence of Empowerment - An A3 Performance ImprovementSM Success Story

Cancer Treatment Centers of America has recently adopted the A3 as a Lean tool to help empower stakeholders in improving key processes. This article provides a case study of how stakeholders are coached through the A3 to improve the patient and family service experience.

Patient Transport – One Hospital’s Approach to Improve Both Service and Productivity

In this SHS conference presentation the authors provide an analytical framework for addressing patient transport at Christiana Hospital, a large Level I trauma center. The authors describe data collection, analysis, and countermeasures that resulted in a 35 percent increase in productivity and an almost 10% increase in on-time performance. The presentation uses a number of different methods of data presentation that enhanced the analysis.

The Importance of Communication for Patient Satisfaction

A discussion of survey results regarding communication between providers and the patient. The visit quality as perceived by the patient increases with fewer communications.

Adding Value to the Surgical PAT Process

Using Lean Six Sigma tools, a hospital redesigns its PAT department process so that all charting is completed 72 hours prior to the day of surgery.

Management Engineers

Management Engineering: What is it?

An Introduction to External Funding for Health Care Improvement

Management engineers may need money to implement healthcare improvement. This article outlines several potential funding sources.

Using Material Pull to Improve a Pharmacy Process

Replenishment of IV fluids and medications can be more methodical than repeated visual inspections.

Improving Medical Equipment Availability at Barnes-Jewish Hospital

One hospital details improvements to their medical equipment retrieval, cleaning, and distribution process.

Sustaining VAP Bundle Compliance in the ICU: A Model of CQI

Using Lean Six Sigma tools, a hospital redesigns and implements new ICU protocols for patients on mechanical ventilation. The article details how the initial sustainability effort failed, but was brought back into long-run control.

Recruiting Change: Process and Productivity Improvement in Human Resources

A traditional process improvement methodology leads to changes within a hospital's HR department. Results from time studies, swim lanes, and simulation are used to support the proposed solutions.

Optimizing Caregiver Workflow in a PICU

Physician and Nursing roles and responsibilities within a PICU are redefined using lean tools to decrease LOS while increasing outcomes.

5 Projects, 5 Hospitals: Using DMAIC for Rapid Quality Improvements

Pressure Ulcer, Falls, Catheter-Associated UTI, Central Line Infection, and Objects Left in Surgery are addressed using process improvement methodologies.

Beginning the Lean Improvement Journey in the Clinical Laboratory

Using examples from several clinical lab redesigns, the sequence of steps utilized during a lean improvement effort are described.

Medication Administration and the Complexity of Nursing Workflow

This article studies the work processes of nurses involved in the administration of medication.  The goal is to reduce errors and improve efficiency.

Enhancing Hospital Health Information Management using Industrial Engineering Tools

Lean tools and simulation are used to recommend improvements to HIM operational processes.

Achieving a Shared Baseline: Implementing Evidence Based Clinical Practices

The authors propose a methodology for shortening the time gap between discovery of new evidence-based clinical results and hospital (provider) utilization of the new practice.

Using the Theory of Constraints to Supercharge Inpatient Throughput

A consulting group presented their throughput ideas, including reasons why some department-specific projects fail to realize proposed improvements.

The Journey Toward a Lean ED

A 100,000 annual visit hospital ED is redesigned using lean principles. Wait times decrease and pt satisfaction and revenue increases.  Simulation shows further viability of new processes.  This presentation is made by a MD who became a lean coach.

A Revolution in ED Patient Throughput Management

ED throughput process improvement projects are discussed.  The presenter is a MD.  Several changes are shown with great results.

Lean Concepts for the Service Industry: Healthcare Pharmacy Example

A lean project is done with a general physician clinic and an outpatient pharmacy; results are discussed.

Improve Outpatient Clinic Access and Service with Lean Six Sigma

A lean project is done at a cardiac clinic.  Problem is to reduce wait time for an appt and cycle time of the appointment.  Results are discussed.

Creating a WOW! Experience At the First Point of Contact

A performance improvement team tackles a call center.  Issues and lessons learned are discussed.

Optimization of Overtime Costs and Operating Room Utilization

A program is proposed that effectively confronts a majority of the issues with scheduling patient surgeries.

Modelling Influenza Pandemic, Intervention Strategies, and Food Distribution

A model is proposed for disaster preparedness regarding pandemics.

Design the Greatest Emergency Department - Applying Basic & Advanced Lean Healthcare Tools!

The author facilitates a lean educational journey through an ED.

Optimizing Cargiver Workflow in a New Pediatric Intensive Care Unit

A lean project generated proposals for rescheduling the providers' workload. During testing of the proposals, daily departmental volume was completed significantly earlier in the day.

5S An Entire Hospital System in 5 Months

A system-wide rollout of 5S was performed. Results as well as lessons learned are discussed.

Delivering Faster Lab Turnaround Through Lean

Lab collection and processing techniques are examined and improved. Results are discussed.

"Never Events" and HACs - You Break It, You Buy It

Medicare's changes to payment require a higher degree of awareness from hospitals nationwide. This presentation addresses some of the concerns and discusses mitigation efforts currently underway.

Measuring the Success of Hospital Acquired Pressure Ulcer Prevention

Pressure Ulcers are a known issue with long hospitalizations. This presentation deals with several issues surrounding eliminating their occurrence.