Healthcare - Enterprise Innovation Institute

Helping Georgia’s Rural Hospitals

With support from the Healthcare Georgia Foundation, the Enterprise Innovation Institute is helping Georgia’s rural hospitals learn lean techniques that improve patient care and reduce costs. Shown is Nancy Peed, CEO of Peach Regional Medical Center in Fort Valley.

To improve customer satisfaction, enhance the quality of services and reduce costs, Peach Regional Medical Center has worked with the Georgia Institute of Technology to adopt process improvement techniques traditionally used by the manufacturing industry. Already, Peach Regional Medical Center’s Emergency Department has noted a 20 percent decrease in average length of stay for its patients.

“The bulk of our patients come through the emergency room, and people judge the care by how quickly they are seen and treated,” said Nancy Peed, CEO of Peach Regional Medical Center. “Peach Regional Medical Center provides care for 15,000 patients each year in our emergency department, and this volume continues to increase. That demand, coupled with an undersized and aging emergency department facility, means of course that we have throughput issues, and we are working diligently to manage and improve these issues.”

Earlier this year, Peed became aware of an initiative led by Georgia Tech’s Enterprise Innovation Institute to help train rural hospital staff in lean principles that identify waste in processes and find ways to eliminate it, while improving customer and staff satisfaction. The project is funded by a $349,000 grant from Healthcare Georgia Foundation. Georgia Tech has successfully used the approach with hospitals in Athens, Atlanta, Columbus, Newnan and Vidalia, and its training programs have been licensed for use nationwide by the American Hospital Association.

Matt Haynes, a Georgia Tech lean specialist, began the project by leading Peach Regional staff in lean overview training. Teams of six people from the medical center then developed value stream maps – diagrams of the entire patient admitting and discharge process – for both the medical surgical nursing and emergency departments.

“We identified 30-day quick fixes and also began implementing 5S, a method for organizing the workplace,” recalled Chance McGough, medical surgical nurse manager and lean coordinator for Peach Regional. “We organized the ER and utility rooms, labeled everything in the supply closets and color-coded materials so they are easier to find. That has helped facilitate flow through the ER because we spend less time looking for things and more time taking care of patients.”

In addition to the lean implementation, senior management at Peach Regional attended a Disney Institute workshop in Atlanta titled “Common Sense to Common Practice: Lessons for Healthcare.” Topics included how to improve the patient experience and motivate health care staff while delivering top-notch health care service, an imperative in a state where approximately 85 percent of hospitals are operating at a loss, Peed said. This training was also funded by the Healthcare Georgia Foundation grant.

“If we can come up with ways from within of doing things quicker, more efficiently and with less duplication, we’re ahead of the game and we can be even more successful and provide even better care to our patients,” noted Peed. “It’s not good enough to meet customer needs; you have to exceed them every time.”

Rural hospitals in Georgia face a financial crisis because their patients are less likely than those of metropolitan hospitals to have health insurance. At the same time, hospitals in underserved areas face other competitive disadvantages as they confront rising costs.

“The current recession has impacted the rural hospitals more so than those in metro Atlanta,” Haynes noted. “Improving the process of how patients are seen is having a positive impact on both patient treatment and the hospital’s profit.”

Such facilities need to find sustainable ways to become more efficient, which is why Healthcare Georgia Foundation provided the grant to Georgia Tech. In addition to Peach Regional Medical Center, hospitals participating in the program include Upson Regional Medical Center in Thomaston, Monroe County Hospital in Forsyth, Morgan Memorial Hospital in Madison, Banks-Jackson-Commerce Hospital in Commerce, West Georgia Medical Center in LaGrange, and Hutcheson Medical Center in Fort Oglethorpe.

The projects are expected to be completed by June 2010.

About Healthcare Georgia Foundation: Healthcare Georgia Foundation is a statewide, private independent foundation. The Foundation’s mission is to advance the health of all Georgians and to expand access to affordable, quality healthcare for underserved individuals and communities. Through its strategic grant-making, Healthcare Georgia Foundation supports organizations that drive positive change, promotes programs that improve health and healthcare among underserved individuals and communities, and connects people, partners and resources across Georgia. For more information, please visit the Foundation online at (www.healthcaregeorgia.org).

About the Enterprise Innovation Institute: The Georgia Tech Enterprise Innovation Institute helps companies, entrepreneurs, economic developers and communities improve their competitiveness through the application of science, technology and innovation. It is one of the most comprehensive university-based programs of business and industry assistance, technology commercialization and economic development in the nation. For more information, visit (www.innovate.gatech.edu).

Enterprise Innovation Institute

Georgia Institute of Technology

75 Fifth Street, N.W., Suite 314

Atlanta, Georgia 30308 USA

Media Relations Contact: John Toon (404-894-6986); E-mail: (john.toon@innovate.gatech.edu).

Writer: Nancy Fullbright

Children’s Healthcare Reduces Length of Stay, Increases Patient Satisfaction with Georgia Tech Assistance

In April of 2008, Children’s contacted Georgia Tech’s Enterprise Innovation Institute for assistance in implementing lean principles in its emergency department.

In 2008, Children’s Healthcare of Atlanta saw more than 170,000 patients across three of its three emergency departments. That kind of volume demands an effective and efficient process, and staff spent the past three years developing a master facility plan to do just that. However, moving into a larger space did not yield the expected results.

“We increased the size of our departments thinking capacity would resolve turnaround time issues,” said Marianne Hatfield, director of Children’s emergency services. “But what we found was we didn’t really get any better once we moved into the bigger space; we got slower. We really had not examined whether or not our process needed to change.”

A visit to Seattle Children’s Hospital convinced Hatfield that CHOA’s processes had to change to truly improve performance. Seattle Children’s Hospital is a leader in lean management principles – a set of tools derived mostly from the Toyota Production System and widely used in manufacturing – that helps identify and steadily eliminate waste from an organization’s operations. In April of 2008, Children’s contacted Georgia Tech’s Enterprise Innovation Institute for assistance in implementing lean principles in its emergency department.

“We knew we had to do something for turnaround time in our emergency department and we began interviewing people to teach lean. We thought Georgia Tech was the best fit. They were nearby and we could see what they had done with some other hospitals,” Hatfield recalled. “The week they spent with us changed the lives of the physicians and the frontline staff; they all think differently now. There was so much impact to that week together, where everyone really started to examine waste in our system. I don’t think we would have been able to do that on our own.”

Kelley Hundt and Matt Haynes, lean specialists with Georgia Tech’s Healthcare Performance Group, led a team of Children’s physicians, nurses, technicians and administrators to analyze and streamline flow processes from the moment a patient arrives in the emergency department until he or she is discharged. The team, which implemented lean principles primarily on Children’s Scottish Rite campus, identified both value-added and non-value-added activities and made a number of observations.

“By studying the processes, we learned that time was being wasted because of searching, re-work, travel and variation in processes,” observed Jeff Rehberg, manager of clinical process improvement at Children’s and a 1996 industrial engineering graduate of Georgia Tech. “Our goal was to reduce the length of time children who did not need to be admitted waited in the emergency department. Using lean principles, the team developed a model for pulling rather than pushing the patients through the emergency department.”

In a push system, the emergency department tries to push a patient through triage regardless of whether or not the physician is available. The new system, dubbed TAPP (Team Assessment Pull Process), anticipates emergency department demand and has both a physician and a nurse ready before the patient is called back.

“A lot of times when you hear people talk about emergency department flow, you hear them say ‘pull ‘til full,’ and we completely changed that. Before, as soon as we had an empty room, we would put patients in it – regardless of whether we had enough staff or physicians – because we thought people were happier if they weren’t in the waiting room and in an exam room,” Hatfield said. “Now we match the two resources before the patient comes back. When the patient comes into the exam room, both the physician and nurse are there and the work starts immediately.”

The new process noticeably reduced the time patients spent waiting for a physician assessment, enhanced physician and nurse partnering, eliminated order confusion and allowed discharge from the first room if no other treatment was needed. Most importantly, it improved the patient family experience by providing a more timely initial interaction with a physician.

“I am always trying to be more efficient and take out the waste in my own practice and patient care interactions without sacrificing quality,” said Dr. Michael Shaffner, a physician who helped develop the new process and a 1987 industrial engineering graduate of Georgia Tech. “There were no new concepts, but the implementation was fresh and greatly appreciated.”

From September 2007 to January 2008, the median length of stay in Children’s main emergency department was 190 minutes. A year later, length of stay had decreased to 163 minutes during the same season. In addition, the median time patients wait between being greeted and being seen by a provider has decreased by 37 percent.

“We did a one-month trial from mid-June to mid-July 2008, and we saw some frustration because physicians had to leave some rooms in search of supplies,” Hatfield recalled. “So we took a separate 5S team another four to six weeks to standardize all the rooms so the physicians have everything they need.”

5S refers to improving organization of the workspace in five steps: sort, set in order, shine, standardize and sustain. As a result of the 5S project, hospital carts are labeled and stocked in the same way, blood pressure cuffs are organized by size and small items frequently used by physicians are easy to grab and keep clean. Visual cues signify when it is time to re-stock a certain supply. The cumulative effects have been good for both hospital staff and patients, according to Hatfield.

“The way customer service scores normally work is when there is high volume, the score drops, but with low volume, customer satisfaction goes way up,” she observed. “September through January we were at the 99th percentile and this has been maintained month after month. We have to believe it’s the process because we’ve not really done anything different.”

Hundt says that a critical component of Children’s success was the support and involvement of top management.

“Management would not let the team fail; they stuck with it. They followed the model of plan, do, study and adjust and have seen tremendous benefits,” she said. “Before there was a lot of wasted time with interruptions and now they are working in an uninterrupted fashion. They developed a process that allows them to eliminate interruptions.”

To continually improve the lean process, Children’s is also implementing a lean education program that focuses on transforming all employees into problem solvers that can identify and eliminate waste. Ultimately, says Rehberg, lean principles will be applied to other areas of patient care, such as operating room, inpatient units and radiology.

“After other staff members heard about the great things going on in the emergency department, they started banging down our doors,” Rehberg said. “The more people that understand the concept, the better the process flows.”

For more information on lean health care services offered by Georgia Tech’s Enterprise Innovation Institute, contact Frank Mewborn, director of the Healthcare Performance Group (706-338-0072); E-mail: (frank.mewborn@innovate.gatech.edu).

About Enterprise Innovation Institute:
The Georgia Tech Enterprise Innovation Institute helps companies, entrepreneurs, economic developers and communities improve their competitiveness through the application of science, technology and innovation. It is one of the most comprehensive university-based programs of business and industry assistance, technology commercialization and economic development in the nation.

Research News & Publications Office
Enterprise Innovation Institute
Georgia Institute of Technology
75 Fifth Street, N.W., Suite 314
Atlanta, Georgia 30308 USA

Media Relations Contact: John Toon (404-894-6986); E-mail (john.toon@innovate.gatech.edu).

Writer: Nancy Fullbright

Process Improvement: New Initiative Will Help Georgia Rural Hospitals Adopt Performance Improvement Techniques

Seven rural Georgia hospitals will participate in a new initiative, led by Georgia Tech’s Enterprise Innovation Institute, designed to help increase their capacity to serve patients, improve the quality of their services and reduce costs.

Seven rural Georgia hospitals will participate in a new initiative designed to help increase their capacity to serve patients, improve the quality of their services and reduce costs. The benefits will come from adopting performance improvement techniques that are already widely used in manufacturing industry.

The two-year demonstration project, to be led by the Georgia Institute of Technology’s Enterprise Innovation Institute through a $349,000 grant from Healthcare Georgia Foundation, will help train hospital staff in “lean” techniques that identify waste in processes and find ways to eliminate it.

Georgia Tech has successfully used the approach with hospitals in Atlanta, Columbus, Newnan and Vidalia. Its “lean health care” training programs have been licensed for use nationwide by the American Hospital Association.

“We want to take the techniques that have proven to be so successful in large hospitals and use them in small, rural hospitals,” said Frank Mewborn, director of the Health Care Performance Group in Georgia Tech’s Enterprise Innovation Institute. “Rural hospitals typically don’t have the resources to hire outside consultants to help with performance improvement issues, so we very much appreciate the support from Healthcare Georgia Foundation to make this initiative possible.”

Georgia Tech project leaders will work with health care professionals at the participating hospitals to conduct lean assessments, teach basic lean concepts, develop value stream maps to analyze the flow of materials and information, and implement rapid process improvement techniques. Because the techniques rely on input from those closest to the processes being improved, each hospital will dedicate staff members to work with Georgia Tech.

“This is a substantial investment on the part of the hospitals because they must pull front-line staff from their normal responsibilities during the process improvement activities,” Mewborn noted. “Involvement of these key people is essential to the process, and it pays off long-term through better processes and buy-in from those who are on the front lines of providing patient care.”

Beyond direct process improvements, the initiative will also provide long-term benefits through senior leadership and hospital staff who have been trained in the lean techniques and who will share them with other departments and facilities. Success will be measured by improvements made during the process, and by the ability of each hospital to continue the process improvement efforts after the initiative’s conclusion.

“A lot of rural hospitals are struggling to make payroll every month,” Mewborn noted. “They don’t have revenue opportunities from more profitable kinds of surgeries because they may not have a large enough market. They are meeting an essential need for health care in their areas, but their reimbursement rates tend to be low.”

Such facilities need to find sustainable ways to become more efficient, which is why Healthcare Georgia Foundation provided the grant to Georgia Tech.

“This grant award represents a tremendous opportunity to achieve greater efficiencies in health care quality and costs,” said Gary D. Nelson, president of the Foundation. “By taking this issue on from both clinical and operational perspectives, we can achieve sustainable efficiencies where they are most needed in our state.”

One of Georgia Tech’s first lean health care projects was with the emergency department at Meadows Regional Medical Center in Vidalia, Ga. As a result of the process improvement activities done there, the average time patients remained in the emergency department was reduced 44 percent and physicians were able to see more patients per hour – all while maintaining a 92 percent patient satisfaction rating.

Other hospital process improvement projects done by Georgia Tech have:

Shortened the lead time and reduced errors in blood testing,
Developed a time-saving system for managing intravenous pumps,
Reduced errors and lead time for collecting and processing tissue samples,
Increased capacity by reducing room down-times between patients,
Boosted laboratory capacity and reduced errors through improved organization,
Increased physician productivity through standardized work processes, and
Streamlined pre-registration processes.

Hospitals that have agreed to participate in the program include Upson Regional Medical Center in Thomaston, Peach Regional Medical Center in Fort Valley, Monroe County Hospital in Forsyth, Morgan Memorial Hospital in Madison, Banks-Jackson-Commerce Hospital in Commerce, West Georgia Medical Center in LaGrange, and Hutcheson Medical Center in Fort Oglethorpe.

The projects are expected to be completed by June 2010.

About Healthcare Georgia Foundation: Healthcare Georgia Foundation is a statewide, private independent foundation. The Foundation’s mission is to advance the health of all Georgians and to expand access to affordable, quality healthcare for underserved individuals and communities. Through its strategic grant-making, Healthcare Georgia Foundation supports organizations that drive positive change, promotes programs that improve health and healthcare among underserved individuals and communities, and connects people, partners and resources across Georgia. For more information, please visit the Foundation online at (www.healthcaregeorgia.org).

About the Enterprise Innovation Institute: The Georgia Tech Enterprise Innovation Institute helps companies, entrepreneurs, economic developers and communities improve their competitiveness through the application of science, technology and innovation. It is one of the most comprehensive university-based programs of business and industry assistance, technology commercialization and economic development in the nation.

Research News & Publications Office
Georgia Institute of Technology
75 Fifth Street, N.W., Suite 314
Atlanta, Georgia 30308 USA

Media Relations Contact: John Toon (404-894-6986); E-mail: (john.toon@innovate.gatech.edu).

Writer: John Toon

Piedmont Newnan Hospital Wins 2008 VHA Georgia Regional Leadership Award

Piedmont Newnan Hospital has been selected as a winner of the 2008 VHA Inc. Georgia Regional Leadership Awards in the Operational Excellence category for their improvements in the operating room that increased patient care and improved patient and physician satisfaction. The improvements were part of assistance from Georgia Tech’s Enterprise Innovation Institute.

“We are thrilled to be recognized by VHA Georgia for our lean initiative in the operating room,” said Michael Bass, president and CEO of Piedmont Newnan Hospital. “The lean project was initiated in November 2007 in order to improve on our operating room’s service and quality, and it feels great to be recognized for our efforts.”

In their work toward improving Piedmont Newnan Hospital’s operational excellence to enhance patient services, the hospital identified the need to enhance efficiency in several ways including increasing the utilization of operating rooms by 10 percent and reducing turnaround time. With these goals in mind, the hospital, in conjunction with Georgia Tech’s Enterprise Innovation Institute, applied lean, a set of tools widely used in manufacturing to help identify and steadily eliminate waste from an organization’s operations, to their operating room processes.

A cross-functional team of employees identified three rapid process improvement areas: case cart and instrument process flow, standardization of the supply area, operating rooms and central sterile, and room turnaround and specialty team concept. As a result of the lean project, Piedmont Newnan Hospital successfully achieved decreased operating room turnaround times and continues to increase operating room utilization.

“These awards exemplify the efforts that are underway across the state to improve the quality health care being delivered to Georgians. Instead of reinventing the wheel, our members are learning from each others’ successes and failures, and by recognizing these few hospitals, we hope to point others in the right direction,” said Richard T. Howerton, III, FACHE, president and chief executive officer of VHA’s regional office in Atlanta.

VHA Georgia, part of the national health care alliance VHA Inc., recognized 10 Georgia hospitals for improving their supply chain performance, clinical care, operational efficiency and community benefit performance. Each year VHA Georgia, through its annual VHA Georgia Regional Leadership Awards and Expo, honors its member organizations that have exhibited exceptional and innovative improvements. VHA Georgia selects a panel of peers to blindly review the award entries. This year the organization awarded 12 awards, three in each category, out of 51 applications.

Piedmont Newnan Hospital and Georgia Tech’s Enterprise Innovation Institute will present their winning project at the VHA Regional Leadership Expo on Oct. 15, 2008, at the Georgia International Convention Center in Atlanta. The event brings together health care organizations from across the state to network and learn from each other in order to become the state’s and the nation’s best performers.

About Piedmont Newnan Hospital:
Piedmont Newnan Hospital (PNH) is a 143-bed, acute-care hospital in Newnan, Georgia, offering 24-hour emergency services, women’s and children’s services (including OB and inpatient pediatrics), and general medical/surgical services. Diagnostic services include CT, nuclear medicine, MRI, PET, ultrasound and fluoroscopy. A complete range of medical/surgical services includes laparoscopic surgery, physical therapy, respiratory therapy, sleep studies and cardiac catheterization and rehabilitation. With approximately 1,000 employees and a medical staff of more than 150 physicians, PNH is a member of Piedmont Healthcare (PHC), a not-for-profit organization that also includes Piedmont Hospital, a 481-bed acute tertiary care facility offering all major medical, surgical and diagnostic services located on 26 acres in the north Atlanta community of Buckhead; Piedmont Fayette Hospital, a 143-bed, acute-care community hospital located on Highway 54 in Fayetteville; Piedmont Mountainside Hospital, a 42-bed community hospital in Jasper; the Piedmont Heart Institute, an integrated cardiovascular healthcare delivery system that combines premier cardiovascular physicians with the prestigious Fuqua Heart Center of Atlanta; the Piedmont Hospital Foundation, the philanthropic entity for private fundraising initiatives; the Piedmont Physicians Group, with more than 80 primary care physicians in more than 30 offices throughout metro Atlanta; and the Piedmont Clinic, a 563-member physician network. For more information, visit www.piedmontnewnan.org.

About VHA:
VHA Inc., based in Irving, Texas, is a national alliance that provides industry-leading supply chain management services and supports the formation of regional and national networks to help members improve their clinical and economic performance. With 16 offices across the U.S., VHA has a track record of proven results in serving more than 1,400 not-for-profit hospitals and more than 23,000 non-acute health care organizations nationwide.

About Enterprise Innovation Institute:
The Georgia Tech Enterprise Innovation Institute helps companies, organizations, entrepreneurs, economic developers and communities improve their competitiveness through the application of science, technology and innovation. It is one of the most comprehensive university-based programs of business and industry assistance, technology commercialization and economic development in the nation. In 2008, the Enterprise Innovation Institute (EII) created a health care performance group to help address rising costs and improve the quality of health care. The group works with health care providers and service organizations to apply lean management principles – a set of tools derived mostly from the Toyota Production System widely used in manufacturing – that helps identify and steadily eliminate waste from an organization’s operations. For more information, visit www.innovate.gatech.edu.

Research News & Publications Office
Enterprise Innovation Institute
Georgia Institute of Technology
75 Fifth Street, N.W., Suite 314
Atlanta, Georgia 30308 USA

Media Relations Contacts: Kelly Hines (770-304-4243); E-mail (kelly.hines@piedmontnewnan.org).

Columbus Hospital Increases Patient Satisfaction and Safety with Lean

stfrancis3 — Nurse Lisa Williams displays the visual cues used for locating IV pumps, a system that has saved 750 minutes of nurse time each day. Photo by Leah Yetter

Jahanna Ray and Lisa Williams don’t get as much exercise as they used to, at least not while they’re working as registered nurses and clinical coordinators at St. Francis Hospital in Columbus, Ga. Before implementing lean management principles, nurses were losing approximately 750 minutes each day by walking 50,000 feet – or nine and a half miles – to retrieve IV pumps from the hospital’s Sterile Processing Department (SPD).

“The Sterile Processing Department used to be somewhat centrally located, but when they built new operating rooms, they appropriately located the department underneath the OR,” recalled Ray. “But what that did to the nurses was it required them to walk 15 minutes to get a pump. That’s with no interruptions and no multi-tasking.”

With so much nursing downtime, hospital management had real concerns about delay in patient treatment, potential for error and decreased nurse and physician satisfaction. According to Ray, nurses traveling to retrieve pumps were in a so-called electronic “dead zone,” where they could not be reached should their patients need emergency assistance.

It was then that Bob Gilson, chair of the St. Francis Board of Trustees, suggested that the hospital consider applying lean management principles: a set of tools derived mostly from the Toyota Production System widely used in manufacturing to help identify and steadily eliminate waste from an organization’s operations. As a member of the Industry Services Board of the Georgia Institute of Technology’s Enterprise Innovation Institute, he was already familiar with the organization’s efforts in lean health care through its Lean Healthcare Performance Group.

“Bob Gilson had contact with Georgia Tech and suggested to our CEO that we become involved with the Chamber of Commerce’s lean initiative for Columbus. What we’re trying to do is create a lean community in Columbus with lean services in health care and city government, as an innovative way of recruiting industries that might want to locate here,” noted Jill Hiers, director of operations improvement for St. Francis. “We decided to try it here and see what we could do as a project.”

Senior leadership and directors at St. Francis met to develop a list of all the issues that needed to be addressed, and then narrowed that list down to five possible projects. According to Hiers, the project that would have the greatest impact on the nursing staff was the intravenous (IV) pump project, dubbed the “Having the Right Equipment in the Right Place and at the Right Time” initiative.

Over a one-week period in November of 2007, Frank Mewborn, Jennifer Trapp-Lingenfelter and Derek Woodham, lean specialists with the Enterprise Innovation Institute, trained St. Francis staff on lean principles, assisted with data analysis, brainstormed and prioritized ideas, updated management on the new process and implemented the lean plan. Now, a certain number of IV pumps are kept on each floor and each floor has clean, sterile space for an overflow or staging area. Pumps are cleaned by nurses within three to five minutes of use, as opposed to the previous turnaround time of 12 to 24 hours.

“We developed inventory levels for each floor, and there are visual cues to signal when the pumps get down to a certain level. A tag should be taken to the clinical coordinator to let them know the pumps are potentially running low and to locate additional pumps,” said Trapp-Lingenfelter. “Basically, in manufacturing terms, they developed a kanban system.”

As expected, there was also a dramatic impact on the Sterile Processing Department staff time, since it no longer had to retrieve pumps from the floor, return them to the holding area and sterilize them. According to Williams, it took more than 45 minutes for one staff member to retrieve the pumps and take them back to Sterile Processing, let alone clean the pumps and distribute them back to each floor.

“There was a lot of elimination of non-value added activities in Sterile Processing because now they’re freed up to spend their time on other equipment that needs to be cleaned,” Williams explained. “We no longer have to manually log the pumps because each floor has its own stock. If there’s a floor that’s short, and one floor has excess pumps, they can just borrow between the floors.”

Those saved footsteps also correlate to the bottom line: before the lean implementation, nurses’ trips to the Sterile Processing Department equated to $7,500 a month, or $90,000 a year. The estimated cost of time wasted by SPD to retrieve pumps was nearly $600 a month, or more than $7,000 a year. Nurse satisfaction has also increased tremendously.

“The comment that stuck out to me the most from the nurses was, ‘You mean we can actually design the process and put it into practice? We have the autonomy to take the process and fix it?’” recalled Hiers. “For every problem we’ve encountered since the implementation, we’ve come up with a solution. We are continually growing improvements.”

In fact, the clinical coordinators at St. Francis are participating in the Center for Frontline Leadership, the hospital’s commitment to provide professional development for employees. This semester, each unit is working together to identify some process that needs to be improved and then implement the new process. Future lean projects will focus on the delivery of medication, the discharge process and improving wait times in the emergency room.

Julia Downey, the team coordinator for customer quality initiatives at St. Francis, said she was especially impressed with how much the team was able to accomplish with Georgia Tech’s assistance in such a short time.

“I really was amazed at how quickly we were able to work through the process and implement something by the end of the week,” she said. “Sometimes you lose people and sometimes the dynamics change, but just being able to work through the process and have something implemented by the weekend was wonderful.”

St. Francis is a faith-based, not-for-profit community hospital founded in 1950 in Columbus, Ga. The 376-bed facility specializes in cardiac care, stroke and chest pain, and employs more than 1,800 people, including 275 board-certified physicians.

For more information on lean health care services offered by Georgia Tech’s Enterprise Innovation Institute, contact Jennifer Trapp-Lingenfelter (404-386-7472); E-mail: (jenn.lingenfelter@innovate.gatech.edu).

Research News & Publications Office
Enterprise Innovation Institute
Georgia Institute of Technology
75 Fifth Street, N.W., Suite 314
Atlanta, Georgia 30308 USA

Media Relations Contact: John Toon (404-894-6986); E-mail (john.toon@innovate.gatech.edu).

Writer: Nancy Fullbright

Georgia Tech Forms Health Care Performance Group to Apply Lean Management Principles

To help address rising costs and improve the quality of health care, the Enterprise Innovation Institute (EII) has created a health care performance group. The new group will work with health care providers and service organizations to apply lean management principles – a set of tools derived mostly from the Toyota Production System widely used in manufacturing – that helps identify and steadily eliminate waste from an organization’s operations.

“The United States is facing a health care crisis because of rising costs, bottlenecks in the system and declining customer satisfaction,” said Wayne Hodges, vice provost in the Enterprise Innovation Institute. “Health care is an integral part of our economy, and this group will explore the opportunities to improve efficiency in the health care sector.”

Project leaders in the newly-formed group will work with health care professionals to conduct lean assessments, teach basic lean concepts, develop value stream maps to analyze the flow of materials and information, and implement rapid process improvement projects. The group has already begun working with nine hospitals across the state.

One of the group’s first projects was with the emergency department at Meadows Regional Medical Center in Vidalia, Ga. As a result of the lean health care implementation, Meadows realized outstanding results. Physicians, on average, are seeing more patients per hour than before the lean implementation. In 2005, average length of stay per patient was 247 minutes; in 2007, it was 139 minutes – a 44 percent reduction. Success is also reflected in a 92 percent patient satisfaction rating.

At Meadows, the lean implementation in the emergency department was just the first step.

“Our next steps involve applying lean to the registration process, including online patient registration, self check-in kiosks and bar-coding. In addition, when we build a new, state-of-the-art facility, we want to use lean processes before architects even draw up the building,” said Alan Kent, president and CEO of Meadows. “We’ll draw a building around the parameters of the number of ER visits, OR visits, square footage needed, beds needed, budget, et cetera. We want to optimize process before we draw the first line. We want form to follow function.”

Steve Mayfield, senior vice president of quality and performance improvement at the American Hospital Association’s Quality Center, believes Georgia Tech’s lean health care methods could improve hospitals nationwide.

“Hospitals that focus on the flow of the patient while reducing non-value added steps see accompanying gains that include improved outcomes, increased operational performance, enhanced safety and higher satisfaction for patients and care providers,” he said. “The Quality Center is licensing Georgia Tech’s simulation model, and we regularly partner with them to demonstrate these tools and techniques to hospital leaders.”

Through its Healthcare Performance Group, Georgia Tech project leaders work with healthcare professionals to conduct lean assessments, teach basic lean concepts, develop value stream maps to analyze the flow of materials and information, create quality systems and implement rapid process improvement projects. For more information on healthcare performance improvement services offered by Georgia Tech’s Enterprise Innovation Institute, contact Jennifer Trapp-Lingenfelter () or (jenn.lingenfelter@innovate.gatech.edu).

Research News & Publications Office
Enterprise Innovation Institute
Georgia Institute of Technology
75 Fifth Street, N.W., Suite 314
Atlanta, Georgia 30308 USA

Media Relations Contact: John Toon (404-894-6986); E-mail (john.toon@innovate.gatech.edu).

Writer: Nancy Fullbright

Vidalia Hospital Implements Lean, Increases Efficiency

070601R055 — Alan Kent, president and CEO of Meadows Regional Medical Center in Vidalia, Ga., was a champion for implementing lean principles in the hospital’s emergency department. Photo by Gary Meek

Emergency rooms in the United States aren’t known for their efficiency. Data from the Centers for Disease Control and Prevention (CDC) shows that the 110 million people who visited an emergency room in 2004 spent an average of 3.3 hours from check-in to physician visit to discharge.

American emergency rooms are not just inefficient, they are facing a crisis. Most ER visits are made by the elderly or the uninsured at a time when the number of hospital emergency departments has been cut by 14 percent. Other CDC statistics show that ER visits by adults aged 22 to 49 increased 19 percent while visits by Americans aged 50 to 64 grew 15 percent.

Peggy Fountain, director of the emergency department at Meadows Regional Medical Center in Vidalia, Ga., is all too familiar with these issues. At one point, the average length of stay for her emergency department patients soared to more than 200 minutes, well below the national average, but still unacceptable to Meadows’ management.

“We had issues with bottlenecking, turnaround times, decreased satisfaction and overworked nurses,” she recalled. “One day, our president and CEO, Alan Kent, asked if I would be interested in having Georgia Tech assist us. Working here 24/7, there may be things that need to be changed that I can’t see but an outsider could.”

With funding from the Georgia Rural Economic Development Center (GREDC) at East Georgia College in Swainsboro, lean specialists with Georgia Tech’s Enterprise Innovation Institute conducted a three-day lean overview workshop and value stream mapping event with Meadows’ emergency department in June 2005. In addition to Fountain and Kent, workshop participants included the ER nursing staff, an ER physician, the radiology director, laboratory manager and business office staff.

“You shouldn’t ask your employees to do something you’re not willing to do yourself. How will you know where to deploy resources if you don’t learn about the opportunities themselves?” asked Kent. “The engagement of senior management is critical to any significant organizational change.”

Frank Mewborn, the Georgia Tech lean specialist who led the events at Meadows, agrees with Kent’s assessment. “It is important to involve top management as well as those who are in the trenches every day,” he noted. “The first day of training we had about 20 people across all departments, and about 12 participated when we actually did the value stream mapping.”

The lean team at Meadows developed 44 action items for reducing lead time to admit, treat and discharge a non-critical ER patient, 18 of which were determined to be low-cost and high-impact. The ideas fell into one of seven categories: 5S and visual controls, cross-training, equipment, hospital procedures, patient information, general procedures and staffing. 5S — which stands for sort, straighten, shine, systemize and sustain is a philosophy and a way of organizing and managing the workspace so morale and efficiency are increased.

“Our Pyxis system — which is an automated mobile supply station that we pull supplies from based on a patient’s name — were all set up differently,” Fountain said. “Now they are all standardized so they contain the same general supplies in the same place, and that has helped nursing a lot.”

Other changes that were made included labeling racks, trays and drawers; installing a color-coded flag system outside patient rooms; issuing patients red allergy armbands to alert medical staff; and adding a holding area for patients who need to see a doctor but don’t need a room. Fountain also touts the implementation of the T System , a software program specifically designed for the emergency department that is able to interface with other software systems used throughout the hospital.

Integrated with the T System is a large, plasma screen monitor in the nurses’ station that can show staff who is in the waiting room, who needs an X-ray and who can be put into a room or a wheelchair. The T System also documents length of stay, lab tests ordered, physician and nurse assigned to the patient and discharge disposition, as well as patient name, room number and prior ER visits, if applicable.

Meadows has also created incentives for its emergency department staff for meeting the stated goal of 110 minutes length of stay. Timers set to 30-minute increments are activated once patients come in the door, and a team of nurses assist with getting IVs started, providing respiratory assistance or monitoring them with an EKG. Already, the emergency department staff has met that goal on numerous occasions.

“After the value stream mapping exercise, we had about 75 sticky notes posted on a wall that signified different changes that needed to be made,” Kent remembered. “As those ideas were implemented, the staff would cross them off and move them to another wall. Over a period of months, I saw those 75 notes drop to about 20. About half of the items in there were low or no cost.”

As a result of the lean health care implementation, Meadows has realized outstanding results. Physicians, on average, are seeing more patients per hour than before the lean implementation. In 2005, average length of stay per patient was 247 minutes; thus far in 2007, it is 139 minutes — an astounding 43.7 percent reduction. That success is reflected in patient satisfaction numbers as well: approximately 92 percent of patients reported that “Overall, I am pleased with the quality of care provided at this facility.”

“We’ve grown our business overall by 10 percent while reducing our turnaround time, which in an emergency room relates almost directly to patient satisfaction and willingness to come back as a repeat client,” noted Kent, a 1979 health systems graduate of Georgia Tech. “It also has improved work life for participants so turnover is lower. We ended up with some good cross-training opportunities and more of a team environment in the ER now.”

Fountain also points out that emergency room staff is more empowered to take initiative and make changes that could positively impact their work process.

“Staff members realize that it’s not just the ER’s problem it’s everyone’s problem. Whatever we can do to improve the process makes everyone’s job easier,” she said. “Walking into this ER is stressful enough you don’t need to walk in stressed out about the process part of it, in addition to what you’re going to see that day.”

Meadows’ management plans on utilizing lean health care principles when it builds a new, state-of-the-art hospital. The original facility, built in 1963, employs 600 people and operates 87 beds as well as a 35-bed nursing home, an eight-bed outpatient facility, and one part-time and two full-time operating rooms.

“We want to design the new facility using lean processes before architects draw up the building,” said Kent, who also plans to incorporate online patient registration, self check-in kiosks and bar-coding into the new hospital. “We’ll draw a building around the parameters of the number of ER visits, OR visits, square footage needed, beds needed, budget, et cetera. We want to optimize process before we draw the first line. We want form to follow function.”

Jack Bareford, GREDC director, believes Meadows’ success can be replicated in other rural Georgia hospitals. GREDC focuses on economic development issues that build economic strength and develops innovative, practical strategies that prepare rural communities to prosper.

“Rural health care is one of the most important issues in successful economic development, and communities that have access to good health care can survive and grow,” Bareford said. “With the many challenges there are to rural hospitals, such as care for the uninsured, reliance on lower-paying publicly-funded insurance plans, skyrocketing liability costs and shortages of health care professionals, the lean health care model can save time and resources to help hospitals remain healthy.”

Kent agrees that Meadows’ approach could be successful in other hospitals, but notes that change is often difficult, especially in health care.

“In health care, we live in these little silos. People should be hovering over us asking how we implemented lean. Success in the past does not necessarily ensure success in the future. If you don’t change and innovate, it will kill you,” Kent noted. “One of the goals of lean health care is to awaken a new level of thinking and introduce manufacturing approaches that have been proven to produce excellent efficiency and profitability.”

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Writer: Nancy Fullbright