Eliminating waste and improving patient care has become a cornerstone of a new lean management system that has been implemented at Ashe Memorial Hospital.

Lean management in the health care industry is transforming the way health care is delivered through a system of analyses that tests and implements theories to eliminate waste in the care’s delivery system, Jeff Spade, Vice President of the North Carolina Hospital Association said.

One of the goals of lean transfer is to bring quality care in a more timely matter.

AMH is actually one of five hospitals that have joined a regional collaborative effort that was organized by Simpler North America’s health care improvement system. Cannon, Caldwell, McDowell, and Blue Ridge hospitals have joined AMH in an effort to improve patient care by identifying and eliminating wasteful steps in the patient care process. This five hospital system is the only one of its kind in the nation and it is Simpler’s aim is to apply the lessons learned through it to the national level one day.

Funding for the program is facilitated through a grant from the Golden Leaf Foundation which will provide funds through a three-year cycle. Additional funding may be forthcoming, hospital officials said. To date, AMH has not had to dip into their operating expense account to fund lean transfer and officials feel that the program will more than pay for itself in time.

Spade explained that the lean management system in the five hospital collaborative is revolutionary in the sense that it allows the ‘frontline workers’, or hospital staff members such as nurses, to identify the problems they see in how patient care is delivered and give those workers the power to make suggestions on how to correct the problem and then implement it as they see fit.

“Since these individuals are the workers who deal with these problems on a daily basis, it seems only natural that they should be the ones given the means to correct it,” Spade said.

The system that identifies these potential wasteful steps is done through what is known as a value stream analysis. This analysis pulls 8-12 of these frontline hospital workers from their normal duties and encourages them to act as a team in identifying potential wasteful steps in how that care is delivered to the patients.

“The beauty of this collaborative is that it allows the transfer of knowledge and employees among the other four hospitals,” AMH Chief Executive Officer R.D. Williams explained.

Within a week’s time, this team of frontline workers can identify waste, test potential solutions, and implement a new process of how to better deliver that care by the end of that same work week. This type of timely testing and implementation is known as a rapid improvement event.

Hospital officials can later monitor these results and use the knowledge they obtained in these analyses and apply that to other value streams. The goal of conducting a VSA is that these analyses will eventually touch every part of the organization and usher in a better approach in delivering quality care as a whole, Williams explained.

Another advantage of the collaborative group effort is that one hospital does not necessarily have to supply the entire value stream analysis team. These staff members can participate in any rapid improvement event at any of the participating hospitals, thus minimizing the event’s impact on each facility.

Since its implementation last year, Williams explained that the hospital’s first value stream took place in the imaging department, commonly referred to as the radiology or x-ray department. One of the segments of patient care that the VSA examined in that department was the behind the scenes work that could be completed prior to the patients visit such as the preparation of patient registration and insurance information.

By doing so, the hospital staff can reduce the patients’ wait time. In most cases, patients are being seen by physicians within 20 minutes of their scheduled appointment. Only 6 percent of the patients had to wait longer than 20 minutes to be seen, Williams said.

The amount of time technicians are spending locating equipment and supplies has also been reduced by an organized placement system that allows staff members to quickly find what they need thus reducing the legwork incurred in a normal work day.

Officials have also seen a drop off in “hand-offs,” or patient transfers that would typically take place between the patient’s bed and the imaging department for an appointment as well as any paperwork involved. Overall, officials have noticed a 70 percent improvement rate in the in hospital transfer time. The average transfer time is now only three minutes and only includes the amount of time it takes to transport the patient to the imaging department.

“What we are seeing from these value stream analyses are that these lessons can be applied to other departments,” Williams said. “The specialized care for each patient will always be different but the processes involved in that care can be applied elsewhere.”

The hospital’s second rapid improvement event took place in August within the hospital’s acute care nursing department. This VSA enabled the nurses to point out areas of focus for improvement for patient care. One of areas of attention that hospital nurses concentrated on was the amount of time nurses spent racing back and forth between patient beds and supply rooms.

By stocking each care room with common hospital items utilized by the nursing staff, nurses could reduce the amount of time they were spending locating supplies such as bed linens and disinfectants, Williams explained. A mobile supply cart with an inventory of supplies mandated by the VSA has also reduced trips to the supply closet.

The same practice of proper supply placement was implemented in the imaging department’s CT room. By having the proper equipment located in a designated area, technicians were walking approximately 2.5 miles less per day.

The end of result of eliminating this waste or the time staff members spend finding materials means more time that they can spend with patients.

“If nurses are spending less time trying to find these common supplies we can increase the amount of time that they are spending with the patients,” Williams said. “This in turn will make the patient more comfortable during their stay here.”

Williams also said that it allows for safer care in a more efficient manner.

This type of efficiency has been a goal of the hospital for some time.

“We’ve always tried to become more efficient and spending less money in the delivery of care,” Williams said.. “Up till now we didn’t have the tools to make that happen but Simpler has brought the education, tools, and processes necessary to make that happen.”

One of the key’s to lean transfer success is in the system’s standardization.

“The system makes sure everyone is doing the same thing the same way, that way if there is a problem in the process then it can be indentified easier,” Williams said.

For more information on lean transformation in health care, please visit www.simpler.com.