Too often, hospitals rely on institutional memory and "the go-to guy" to get things done, and end up scrambling for continuity once he leaves. Leaders at Memorial Medical Center, Springfield, Ill., have looked to avoid that pitfall.

Using techniques from Lean Six Sigma, deeper data and a structured process for how to respond when things go awry, the 500-bed tertiary hospital has transformed the care it provides. During a recent three-month pilot, the facility was able to slash length of stay by almost three days, which could save more than $2 million if maintained the entire year.

"Too much in health care, we've relied on superhuman efforts by key people," says Charles Callahan, vice president of quality operations for Memorial Health System, the hospital's parent organization. "Why did your system fall apart? Well, Susie retired. We have too many Susies in health care, where it works well when somebody's here 8 to 5, but bad at night or on the weekend. If you have strong processes where everyone is working together in a designed system, it doesn't matter what day of the week you come in to get your care, it's going to be delivered at the same, predictable high level regardless, and that's what you want as a customer."

Memorial Medical Center's journey dates back a couple of years. With health reform taking shape, funding pressures from the state of Illinois and declining reimbursements, Callahan says the system knew it had to start thinking about second-curve tactics and proactive ways to reshape care.

The system bolstered its data to include deeper information about each service line, now updated in a much more frequent fashion. Drilling down, they found that length of stay for patients with severely acute psychiatric illnesses — major depression, bipolar disorder, schizophrenia — were above the norm at more than eight days.

Pouring through the data and finding the root causes of the problem and using Lean Six Sigma methods, the hospital came up with a three-pronged solution. Memorial started using a more "assertive," evidence-based approach to prescribing medicines for patients suffering from psychosis — including a pharmacist on the care team, using stabilizing medicines early on in the stay, and making sure each prescription was linked to best practices.

Memorial also analyzed its resources and determined that it had a nearby treatment center with six crisis beds that might be better suited for certain patients. Some inpatient visitors were staying longer because of other exacerbating factors, such as homelessness or substance abuse, and were better suited to a different setting, Callahan says. Others were relocated to a partial hospitalization program, where they could receive treatment from 8 a.m. to 4 p.m. and go home at the end of the day, freeing up inpatient beds for acute care.

With the third piece of the revamped approach, Memorial implemented more structured, interdisciplinary rounds twice a week in the hospital, led by the psychiatrist. It was important to have every member of the care team, face to face, during the week to figure out when patients might be ready for discharge, Callahan says, or a more appropriate care setting.

"It really organized the thinking so that everybody had all the information together for the ultimate decision-making," he says. "While ideally you'd hope that your medical chart or electronic health record puts everything in front of everybody, even as good as those tools can become, it's just not the same as having that face-to-face, very brief, focused dialogue by the caregivers."

After just three months ending in January, the pilot program has shown tremendous success. The average length of stay for patients suffering from psychosis has dropped from 8.4 days to 5.6. The average cost for each of those patients has dipped by 22 percent, down to $6,749. Readmissions have stayed relatively stable during the pilot, Callahan says, and doctors have been satisfied with the new approach.

If such successes were maintained for the entire year, Memorial Medical Center estimates it could save more than $2 million annually, and serve an extra 400 patients because of the gained bed space.

Finding time for all the members of the care team to meet up, and a lack of evidence-based information on inpatient psychiatric health were a couple of the hurdles that Memorial Medical Center had to overcome. But other hospitals can easily duplicate their results if they have a structured approach, using a method such as Lean Six Sigma, to home in on what's ailing the organization, Callahan says.

"It's a very important methodology," he says. "Honestly, everybody in health care wants to get a better outcome, but if you don't have a process, then frankly, you're only praying. We don't want to pray for outcomes. We want to have a process to get there."

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