Process Management and Mapping

Hospital re-engineers ED processes to cut wait times

Dr. Richard Zane quickly spotted huge waste and inefficiency soon after he was hired to head the University of Colorado Hospital emergency department in 2012.

Making process improvement 'stick'

Process improvements have become a main goal at hospitals, particularly as demands for greater efficiency in care delivery rise alongside care costs and pressures to improve outcomes. Hospitals can facilitate these improvements by first explaining to staff why the changes are necessary, then encouraging leaders to champion the improvements by tying their evaluations to the outcome, as well as ensuring staff and leaders have the skills necessary to achieve those goals.

10 habits of successful process professionals

Wondering how you can become a process professional with high impact in your organization? Here are ten (well, really eight) habits of successful process professionals. Spoiler Alert: Focus on listening. Listen to the business. Listen to your customers. Listen to your employees.

USC Students team up with Eisenhower Hospital to tackle inefficiency

In a "Spring Break Practicum" program, industrial and systems engineering students from USC conducted an intense week of student-led projects resulting in improving efficiency in hospital operations.

The Seven Tenets of Healthcare Process Improvement

In this presentation, Lou Keller calls on 45 years of experience dealing with every manner of healthcare planning, management, design, control and implementation problem to paint a compelling and entertaining picture, not just of the critical differences between healthcare and all other management systems, but how to use an in-depth understanding and appreciation of those differences to achieve continual and lasting healthcare process improvement.

Modeling and optimizing emergency department workflow

The authors of this presentation describe how industrial engineering research improved patient access and reduced cost by applying a machine learning simulation approach at Grady Health System in Atlanta.

Lean Six Sigma tools improve more than turn-around-time for ED blood draws

This case study from the Healthcare Systems Process Improvement Conference presents the analysis of the ED-LAB blood draw system for a large tertiary teaching hospital.

Paper | Presentation 

Here's how a Cincinnati ER cut its wait time by 70 percent - The Cincinnati Business Courier

Dr. Stephen Feagins, vice president of medical affairs, describes how ER wait times were reduced by 70 percent at Mercy Health's Anderson Hospital in an interview with the Cincinnati Business Courier.

Operations Improvement Methods: Choosing a Path for Hospitals and Clinics

Dr. David Belson describes various operations improvement methods used by management engineers in healthcare in this paper prepared for the California Healthcare Foundation.

A tool to improve mobility in hospitalized patients

This post on the HBR Blog Network describes a visual tool at Virginia Mason Medical Center in Seattle that has accelerated patient mobility. Research has shown that early mobility is an important aspect for improved patient outcomes and shortened length of stay.

Reducing patient charges by eliminating amylase from lab panels - HBR Blog Network

One hospital was able to reduce patient charges by over $300,000 annually by reducing the frequency of amylase and lipase testing for ED patients with abdominal pain and other conditions.

To survive or not to survive? WMH's Surgical Services 5S journey

Some necessary reconstruction had Wayne Memorial in a bit of a quandary in early 2011. Most of their surgical services supplies and equipment had been literally squeezed out into the hallways for storage and they were literally busting out at the seams. A five-step performance improvement approach helped Wayne Memorial to better organize and locate surgical supplies and equipment and in removing outdated/unneeded supplies & items all over the entire division, thereby, improving patient safety and reducing supply costs as well as staff time spent searching for needed items.

From bad to great: How one radiology department made the transition

A recent article in Radiology Business Journal highlights changes made at Advocate Condell Medical Center that dramatically improved customer service. SHS member and conference presenter Airica Steed, Ed.D., R.N., led the improvements.

Vertical value stream analysis to chart a course to patient centered medical home

This presentation at the 2013 Healthcare Systems Process Improvement Conference provides a case study in the use of vertical value streams for large, complex improvements. Vertical value streams are a multi-layered value stream approach using rigorous project management.  Boulder Community Hospital applied this methodology to the opening a Patient Centered Medical Home.

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 healthcare setting makes this problem unique. In this paper, the authors derive and implement algorithms for scheduling nuclear medicine patients and resources.

Driving value through clinical practice variation reduction: A case study for total joint replacement process improvement

This paper and presentation delivered at the 2013 Healthcare Systems Process Improvement Conference describes work done in the Ochsner Health System to reduce orthopedic joint replacement costs and improve quality for the patient. High quality care at an affordable cost is an attainable goal that is both in the best interest of the patient and the healthcare system. Driving value through minimization of clinical variation enabled OHS to meet a higher standard of patient care while ensuring the long-term financial stability of the organization.

Routine incorporation of Pulsed Xenon UV (PX-UV) after standard cleaning of rooms previously occupied by patients with C. Difficile or Vancomycin resistant infections or colonizations

The purpose of this study was to determine if the use of PX-UV in place of bleach would adversely impact the incidence of C. diff. infections and to also determine its impact on HA-VRE rates.

Behind the scenes of inventory management: A generalized approach

This presentation at the 2013 Healthcare Systems Process Improvement Conference is focused on describing a generalized strategy for improving inventory management using communication, spatial layout, and physical organization, standardization of process and inventory par levels. In healthcare settings, particularly surgery, creating or establishing this standard requires a complete system perspective of inventory.

Tools, techniques, and best practices in the emergency room

Long waits in the waiting room, patients leaving without being seen, patients boarding and holding in the ED, delayed test results, and diversions. Have you encountered these issues in your ED? This presentation from a prior SHS Conference highlights improvements through several ED projects at HCA and will provide you with a sample of the tools utilized, results, best practices, and lessons learned. 

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.

Surviving the global healthcare perfect storm

The authors describe the application of operational planning and capacity management methods to improve patient care, improve revenue, and lower costs. Article 

Introduction to Value Stream Mapping 

This presentation, from the Ontario Ministry of Health and Long Term Care, provides an introduction to value-stream mapping with the objectives of providing instruction on how to lead a value stream mapping event, identifying value added and non-value added steps, and prioritizing high level opportunities for improvement.

 Value Stream Mapping: Applied to Healthcare Background & Case Studies             

This presentation from the 2011 SHS Conference focuses on the question, "How VSM methodology is successfully used to visualize waste, reduce cost and improve quality in the health care?" It provides various examples of VSM, metrics used to measure the success, and future research direction on the observed gaps found in the literature.

Reducing length of stay using service line lean concepts

In this presentation at the 2011 SHS Conference, Jonathan Flanders describes how a 400 bed hospital reduced average LOS for Hospitalist patients by 1.0 day using lean concepts applied at the service-line level. The presentation is a comprehensive case study for the application of lean and six sigma tools. The use of multi-level value stream mapping applied to an inpatient care unit will be of particular benefit for readers struggling in this area.

Undergraduates at Worcester Polytechnic Institute reduce missing medications at VA Hospital

Undergraduates Joshua Wimble, Kristine DeSotto, Casey Krawic and Zachary Theoharidis at WPI completed a project as part of their graduate requirements resulting in a reduction of missing medications at the West Roxbury campus of the VA Hospital.

Standarizing patient care to improve outcomes in cardiac surgery

In this presentation at the 2011 Healthcare Process Improvement Conference, Christian Rizzo of OhioHealth describes a system-wide effort to reduce sternal wound infection by leveraging lean tools such as standard work, process maps, daily gemba walks and performance metrics. OhioHealth was able to standardize care using evidenced-based practices extending from the doctors' offices to case management. This presentation demonstrates how lean tools are utilized and describes how the system was able to sustain a reduction in infections of more than 60 percent.

A human factors perspective of information flow in healthcare

This paper presented at the 2011 SHS conference by Sandra Garrett, Clemson University, and Ashley Benedict, Purdue University; describes a human factors perspective of information flows based on the increasing complexity in healthcare. The presenters introduce a novel model for addressing this complexity and demonstrate application of the model with a case study in an outpatient prescribing process.

Original films of Frank B. Gilbreth

Part 1 & Part 2
From Internet Archive website, these films are essentially a summary of work analysis films which were taken by Frank B. Gilbreth between 1910 and 1924 showing a number of industrial operations from which the motion study technique was developed.
This movie is part of the collection: Prelinger Archives.
Producer: Presented by James S. Perkins in collaboration with Dr. Lillian M. Gilbreth & Dr. Ralph M. Barnes
Sponsor: Chicago Chapter of the Society for the Advancement of Management

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.

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.

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.

Significance of case management

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

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.

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.

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?

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.

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.

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.

Work Measurement in Skilled Labor Environments

Methods of measuring work done by skilled labor are discussed

Value Stream Mapping Got You Down? The Problem May Not Be You.

When applying value stream mapping, don't forget that sometimes patients will need to be grouped just like part families - and each of those may need a unique VSM.

SHSSimple Queuing Theory Tools You Can Use in Healthcare

Queuing simulation results are applied to healthcare problems.

In by 9 Out by 6 - Level Loading

A CT scan department has its demand smoothed.

Of Pandemics and Process Flows

A blog post discusses process flows used to battle pandemic illness.

SHSPaging Dr Toyota

Discussion of applications of lean within the OR.

SHSA Life-Saving Role

Future advances in medical devices and informatics within health care IT are described in this article.

SHSAttacking Waste and Variation Hospital-Wide: A Comprehensive Lean Sigma Deployment

Improvement projects in surgery, nursing, and the ED are discussed.  The process of moving a hospital towards adoption of Lean Six Sigma is also described.

SHSDevelopment and Implementation of a Healthcare-Based Economic Evaluation Methodology

A methodology for standardized evaluation of the financial impact of operational and patient care improvements is discussed.

SHSUtilizing Industrial Engineering Student Teams to Benefit Management Engineering Efforts

An ED lean project is discussed, highlighting some advantages that undergraduates can bring when partnered with professionals in the field.

SHSEncouraging Management Engineering in Safety Net Hospitals

Several change management projects are covered in brief, moving rapidly through high-level descriptions of problem / intervention / impact steps.

SHSIn by 9 out by 6 - Load Leveling

Detailed description of a lean project to improve TAT in the CT Scan department.

SHSImproved Scheduling in a for Profit Surgical Center

In a for-profit ambulatory surgical center, the current scheduling method often results in cases starting later than the initial plan.  The presentation describes an implementation of clustering as well as multiple simulations of different possibilities.

SHSBuilding Lean From the Ground Up

The surgical admitting process is targeted with a lean event.  Current and future state is described, the process of improvement is shown, and results are discussed.

SHSIn the Quest for Performance Excellence: Deployment of Lean Manufacturing Principles in Healthcare Delivery Processes

Three successful lean projects are discussed in detail.  The ED, Radiology, and HR departments all show significant improvement.

SHSUsing Lean Methodology to Improve Patient Safety and Clinical Quality

Three successful lean projects are discussed in detail.  Specimen Labeling, Surgery and Endoscopy Pre-Op, and Inpatient Nursing Crash Cart projects all demonstrate significant improvement.

SHSReaching New Levels of Patient Safety Through Improved Specimen Labeling

Results of a hospital-wide specimen labeling lean project is discussed.

SHSEstablishing Nursing Staffing Requirements in an Imaging Environment

A study is done to improve the communication between and expense of the nursing staff associated with all imaging modalities.

SHSImproving Patient Flow from the ED to a Nursing Unit

A lean event focused on patient flow out of the ED was conducted, and results are discussed

SHSEnhancing Performance Excellence: Total Emergency Services Redesign

All processes in an ED are redesigned, with multiple outcomes showing improvement.

SHSThe 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.

SHSApplying Redesign Principles to Design ED and Hospital Patient Flow Processes

This is an overview of several lean redesign projects in the ED with overall solutions discussed and analyzed.

SHSA 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.

SHSUsing Six Sigma to Improve ICU Patient Flow

A Lean Six Sigma project focusing on ICU throughput times is completed.  Lessons learned and successes are shared.

SHSKey Performance Indicators: Relevant Metrics that Sell Results and Drive Ongoing Improvement

A discussion of the importance of metric and measurement accuracy during execution of improvement projects.

SHSCreating a WOW! Experience At the First Point of Contact

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

SHSOptimization of Surgical Scheduling

An OR's case scheduling process is studied; improvement projects are proposed.

SHSStreamlining Your OR

A hospital undertakes a systemic improvement of their OR suite.  The process and final results are detailed.

SHSSize Matters; How Big Does Your ED Need to Be?

A Premier consultant discusses lessons learned from performing many Lean ED projects during her career.

SHSApplying SHS Conference Learnings Back at the Ranch

Emergent Care was redesigned to decrease wait time significantly.

SHSManaging Variability in Patient Flow - Data, Process, Sustainability

Methods of confronting and smoothing the variability of patient flow are discussed.

SHSOptimizing 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.

SHSEngaging Staff in Lean Improvements for Patient Care Settings

4 lean projects were performed - pharmacy, lab, outpatient clinic, and telemetry unit. Each project was meticulously documented in the presentation. Pre- and post- metrics are included, as well as a discussion of sustainability.

SHSRecruiting Change: Process and Productivity Improvement in Human Resources

Improvements within an HR department are proposed and implemented. Results are examined, as well as a simulation of the process.

SHSA World of Innovation: Beyond Productivity at The Ohio State University Medical Center

A system-wide reporting tool for each cost center is developed and implemented. It is adopted as part of the budgeting process.

SHSMedication Administration and the Complexity of Nursing Workflow

Task analysis of an RN's shift on a med/surg unit is performed, using spaghetti maps and other lean tools. Integration of a new medicine delivery system is studied to examine how RN efficiency is affected.

SHSOur Lean Journey Continues and What A Year It's Been!

Lean projects at Kaiser Permanente are detailed and discussed. The report is a system-level presentation showing many departmental improvements.

SHSLean in the Laboratory and Radiology: A Patient Throughput Imperative

Lean improvements within the radiology suite and laboratory workspace yield notable improvements. Project benefits are discussed.

SHSA Better Way to Manage Supplies

Two supply cost projects are described, analyzed, and discussed.

SHSEnhancing Hospital Health Information Management Using Industrial Engineering Tools

Lean principles are utilized during analysis and transformation of a HIM department. Results and lessons learned are discussed.

SHSHenry Ford West Bloomfield Hospital Recruitment Redesign

HR process redesign cuts down the time spent at each process step. Lessons learned, sustainability, and metrics are discussed with the group during this presentation.

SHSDelivering Faster Lab Turnaround Through Lean

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

SHSCapturing Supply Charges in the Emergency Department: How and Why?

ED charge capture is a constant problem for hospitals. This presentation covers one system-wide approach to increasing the capture rate.

SHSConnecting the Revenue Cycle to the World Wide Web

A pre-registration Internet interface was successfully developed. Lessons learned and sustainability are also discussed.

SHSReducing Inventory Waste Through Material Pull

A pull system is implemented within a surgical suite, saving on inventory cost. Other accomplishments and lessons learned are discussed.

SHSLessons Learned Implementing Lean Sigma in Healthcare

Any organization implementing lean six sigma will experience both success and failure. This presentation describes some of the "growing pains" of one system, as well as a methodical demonstration of the lean tools utilized in their improvement efforts.

SHSBeginning a Hospital Lean Improvement Journey in the Clinical Laboratory

Motivation is made for performing lean improvements within the lab.

SHSA Six Sigma Approach to Denials Management

Payment denials were decreased, resulting in a cost savings of $1.6 million annually. This project steps through the list of improvements made.

SHSUsing Lean Techniques to Improve Turnaround Time and First Case Starts in the Operating Room

Turnarounds and first case starts are improved using a variety of lean techniques. Sustainability, achievement of buy-in and metric details are also discussed.

SHSImproving Surgical Services Through Enhanced Ancillary Support

Lean improvement projects are performed within the supplies delivery function of a surgical services suite.