Editor's note: This blog is part of Fiscal Fitness, a regular H&HN series exploring the cost containment strategies hospitals are employing in response to reimbursement pressures and an uncertain economic climate. Read more at our Fiscal Fitness page.
About six years ago, Columbus Regional Hospital in Indiana took the first tentative steps on a journey that is quickly becoming a strategic imperative for health care organizations around the country: improving the quality of care delivered to patients while bringing a rational approach to work processes in order to contain the spiraling expenses of doing business.
Executives at Cummins Inc., a Fortune 500 company in Columbus, were enthusiastic proponents of Six Sigma and Lean management methodologies, and were eager to help other local businesses climb on board. At Cummins' invitation, Columbus Regional executives underwent training and decided to set up a department dedicated to process improvement.
Fast forward six and a half years: CRH has so far completed more than 100 projects and has realized a net savings of more than $18 million, says Doug Sabotin, director of the hospital's Lean Sigma program. "Those are dark green, real dollars," he says.
Lean methodology primarily focuses on making a process faster by removing delays and "non-value-added" steps. Six Sigma uses a statistical model to make sure the process is as effective as possible. "By marrying the two, you get a process that's both efficient and effective," Sabotin says. "Hence, Lean Sigma."
While reducing expenses is certainly desirable, it's not the main focus of CRH's Lean Sigma effort. Every project is based on a formula: quality plus safety plus satisfaction over cost. "We want to make sure that in every project, we're maximizing quality, keeping our patients, families and employees as safe and satisfied as possible, and we want to try if at all possible to reduce cost," Sabotin says. "But if all we're here to do is reduce cost, we're missing the boat."
As an example of how Lean Sigma works, Sabotin pointed to a project that involved nursing admissions, which take place when a patient is admitted to the floor. There were a variety of reasons it took a long time, given a nurse's hectic workday. And there was wide variation among the hospital's 500 nurses in how the process was performed.
"By capturing data, we found that without a standard process it was taking nurses anywhere from 75 to 110 minutes to do a full admission," Sabotin says. "By standardizing the way it is done every time, we have been able to get an admission down to about 45 to 50 minutes. That is real time a nurse gets back to take better care of patients."
Eliminating variation benefited quality of care, patient and employee satisfaction and patient throughput, and it made more gainful use of staff hours.
In the coming year, the Lean Sigma team will look at processes across multiple departments. For instance: A patient in the emergency department undergoes a test to make sure he can swallow food once he's admitted. When he's admitted to the floor, he's tested again. That's a waste of time and it's a discomfort for him. Moreover, Sabotin says, "it's additional dollars, because we're not going to get reimbursed for doing an exam twice."
Some people are wary of Lean and Six Sigma because they seem complex and rigid. "People think, 'I have be a statistician,' and in the early days you do have to follow the discipline and rigor," Sabotin says. After six years, his staff is comfortable enough with the techniques to apply them with more flexibility and creativity. And the hospital has hired the consulting firm IDEO to introduce "human-centered design," a concept that encourages "disruptive innovation" for those process challenges that don't lend themselves to the structured Lean Sigma methodology.
One "must" for success: a C-suite and board that are vocal in their support. "Without the championing of the leadership team, we would not be where we are, period," Sabotin says.
Another key is establishing a distinct department, like CRH's six-person Lean Sigma department, with staff strictly focused on process improvement. "It can't be part of your job some of the time," he says. "We've seen time and time again that dedicating staff to understanding the discipline and building relationships with managers and directors is incredibly important."
Speaking of building relationships, Sabotin notes that while his staff oversees a project, the real work is done by a team of front-line workers, vice presidents, supervisors, directors and managers. "We're the experts at using the tools and the methods, but we don't come up with any answers. They do." That's especially important when it comes time to implement a new process. "When they take these solutions back to their departments, it's easy for them to be champions because they're the ones who did it. We're just supporting them along the way."
And when the fiscal benefits of a project are calculated — either in money saved or dollars earned — the Lean Sigma department and the individual department involved both get credit. "So it's not an either/or, it's a both/and," Sabotin says. It doesn't create silos, it's a sharing of success."
Bill Santamour is managing editor of Hospitals & Health Networks. Follow our tweets at www.twitter.com/hhnmag.