ICON Interventional: Transforming Vascular Intervention

A new ATDC member company is poised to revolutionize the cardiovascular medical device industry with two innovative products. ICON Interventional, housed in the ATDC Life Sciences Incubator at Georgia Tech, is developing both a bioabsorbable stent and a new stent material that is 50 percent thinner than the most advanced commercial coronary stent available.

“We have a breakthrough alloy material. Any cardiologist who’s looked at this has been wowed, and we think we have something,” said Jack Merritt, president and CEO of ICON. Merritt has more than 30 years of experience in the medical device arena, and he led the commercialization of the original Palmaz-Schatz Coronary Stent.

ICON has developed a proprietary metal alloy dubbed Nuloy™, and its properties permit the manufacture of stents with extremely thin struts without sacrificing radial strength. A stent is a small metal tube made of wire lattice that is inserted permanently into an artery to hold it open to allow blood flow. Stents currently on the market are made of either stainless steel or cobalt chromium.

ICON is using the Nuloy material to make both bare metal stents and drug-eluting stents, which use drugs to reduce the narrowing of arteries after stent placement. The company says its Nuloy material out-performs its competitors’ wall thickness, radial strength, recoil, deliverability and radiopacity – the ability to easily see the stents in X-rays.

“It’s very important that the stent be visible on angiography while physicians are doing a procedure, and our stents are much more visible compared to other well-known stents,” noted Merritt. “An ideal system has to maintain access, have a low risk of plaque recurring and be easy to deliver. This is more than a drawing and an animation – it’s a real-life product.”

Having successfully completed its first human clinical trial, ICON announced in 2007 that it had entered into a license agreement with ARIAD Pharmaceuticals, Inc. to develop and commercialize drug-eluting stents that deliver deforolimus, a drug that prevents restenosis (the recurrence of an abnormal narrowing of a blood vessel).

“ICON is one of the most innovative and promising medical device companies with broadly applicable technologies,” said Harvey J. Berger, M.D., chairman and chief executive officer of ARIAD. “ICON’s design and manufacturing capabilities have led to highly differentiated stent platforms and bioabsorbable polymer formulations that should enable its deforolimus-eluting stents to provide substantial benefit to patients with coronary and peripheral vascular disease.”

ICON is also developing a bioabsorbable stent called Biosorb™ that would eliminate the need for permanent, traditional metallic implants. In addition for allowing for extreme motion without strut fractures, the Biosorb stent technology incorporates a unique system of microneedles that delivers medication directly to the site of the inflammation that’s causing the narrowing. This controlled delivery of drug followed by stent absorption may result in improved outcomes. Mark Allen, Georgia Tech senior vice provost for research and innovation, serves as chief scientific consultant for ICON and has provided guidance in this area.

In February 2008, ICON was recognized by the Technology Association of Georgia as one of the top 40 most innovative technology companies in Georgia. The company, which has already raised around $15 million, will soon begin international and U.S. trials for the Nuloy bare metal stent and complete enrollment for a pivotal U.S. clinical trial in early 2009. The total worldwide stent market is estimated at more than $5 billion.

“Being a member of ATDC gives us access to facilities and programs at Georgia Tech, and we have already utilized analytical equipment that has allowed us to accelerate our product development efforts. In addition, there are expert resources on campus that always seem ready to provide advice,” Merritt said.

About the ATDC: The Advanced Technology Development Center (ATDC) is a nationally recognized science and technology incubator that helps Georgia entrepreneurs launch and build successful companies. ATDC provides strategic business advice and connects its member companies to the people and resources they need to succeed. More than 100 companies have emerged from the ATDC.

Headquartered at the Georgia Institute of Technology, ATDC has been recognized by both Inc. and BusinessWeek magazines as among the nation’s top nonprofit incubators. ATDC was formed in 1980 to stimulate growth in Georgia’s technology business base, and now has locations in Atlanta and Savannah. ATDC is part of Georgia Tech’s Enterprise Innovation Institute. For more information, please visit (www.atdc.org).

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: (ude.hcetag.etavonninull@noot.nhoj).

Writer: Nancy Fullbright

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.

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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 (gro.nanwentnomdeipnull@senih.yllek).

Columbus Hospital Increases Patient Satisfaction and Safety with Lean

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: (ude.hcetag.etavonninull@retlefnegnil.nnej).

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 (ude.hcetag.etavonninull@noot.nhoj).

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 (ude.hcetag.etavonninull@retlefnegnil.nnej).

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 (ude.hcetag.etavonninull@noot.nhoj).

Writer: Nancy Fullbright

Velocity Medical: Revolutionizing the Oncology Imaging Market

Tim Fox, one of the founders of Velocity Medical Solutions, LLC, tells people that radiation oncology is akin to designing a war plan on a map – there are areas that are meant to be targeted and areas that need to be avoided. Velocity, a developer of post-diagnostic medical imaging software, was recently accepted into the Advanced Technology Development Center (ATDC), Georgia Tech’s nationally-recognized science and technology incubator that helps Georgia entrepreneurs launch and build successful companies.

“The goal in radiation oncology is to maximize the dose to the tumor volume and minimize the dose to surrounding normal tissue,” he explained. “Physicians need better tools for multi-modality medical imaging and quantitative assessment, and we’ve built a very sophisticated software system that does just that.”

Velocity was founded in 2004 by a group of Emory University School of Medicine colleagues: Fox, Ph.D., board-certified in medical physics and an associate professor of radiation oncology; Ian Crocker, M.D., a board-certified oncologist and professor of radiation oncology; and Paul Pantalone, M.S., a senior computational imaging scientist. According to Fox, the company was born out of their own needs in radiation oncology for better imaging tools.

“We’ve looked at our competitors and focused on what we think are strengths and weaknesses. At Emory, we use other software tools side-by-side with our product, and clinicians are migrating over to our system,” said Fox, who received his Ph.D. in nuclear engineering from Georgia Tech. “Our strength lies in our ability to incorporate leading-edge molecular imaging techniques while adhering to a physician-based user design.”

The technology – Velocity Advanced Imaging (VelocityAI™) – uses proprietary, scientific algorithms and was approved by the Food and Drug Administration (FDA) last March. Version 1.0, which holds copyright IP protection for the software code, is already in use and features multi-modality image registration and automated tumor contouring technology. This allows various scans such as positron emission tomography (PET), computed tomography (CT), magnetic resonance (MR) and single photon emission computed tomography (SPECT) to be overlaid, used and assessed together.

According to Pantalone, who oversees software development, Velocity has incorporated a unique user interface with sophisticated visualization that allows physicians to easily delineate tumor extent, manage workflow and integrate the results into conventional treatment planning systems.

“More and more medical images are being acquired for cancer patients, and VelocityAI™ has the ability to fuse and blend all of these images together,” he noted. “Another simple way of looking at our product is comparing the value contained in weather maps. Combining satellite imagery with Doppler radar provides valuable information to everyone on planning their daily lives. With this product, physicians have a more objective way to plan the ultimate tumor border by viewing many different types of images. When we show this product to them, they immediately see the value.”

Future versions of the software will feature deformable image registration, a means of warping a set of images to match the patient’s planning image with disease sites where the body may morph due to positional changes or changes in the patient’s anatomy. New software will also include atlas-based auto-segmentation, which transposes atlases of normal tissue anatomy onto a patient’s treatment plan. According to Crocker, current systems have very limited anatomical auto-segmentation, so Velocity’s developments in this area will be appreciated by the radiation oncology community.

“Today a physician may spend hours outlining normal tissues on CT and MRI images for an individual patient and this problem is becoming more acute because of the quantity of image information that we have to handle,” commented Crocker.  “Like the atlas-based tool, there are no good tools available commercially to meet this important clinical need.”

Other key differences between Velocity and its competitors include the system’s competitive pricing, the ability to increase physicians’ productivity and its simplicity and mobility. For physicians who move between centers, having a software program that can be installed on a laptop is a big plus.

Velocity capitalizes on three market forces: continually rising cancer incidence rates, profitable reimbursement for radiation treatment and the increasing use of functional imaging, which is expected to grow 189 percent over the next 10 years. According to Fox, the product provides a better visualization and localization of the actual disease, thereby increasing treatment success rates.

“Our soon-to-be released therapy response assessment module capitalizes on an unmet need for a product to provide information on the efficacy of cancer therapies,” he stated. “If you can determine at a certain stage that a particular medication is not working, you can switch to another drug. Response assessment during treatment using molecular imaging will certainly be valuable to drug companies.”

Hospital-based treatment sites and freestanding clinics will serve as Velocity’s two primary customer targets; already there have been five site installations. Eventually, the company will perform installations remotely and will offer training sessions in Atlanta.

“In total, we expect to canvas at least 75 to 80 percent of the potential market through a multi-pronged approach,” said Fox. “As a startup, the key is to convince customers that we will be here next year and will be available for product support. We want to selectively target the first 10 to 20 customers, because we understand that having buy-in from certain institutions will make it easier for us to sell to others.”

Currently, the Velocity team includes three employees, not including the three founders. Future growth plans include expanding the engineering group and establishing a service organization for product support as well as a sales and marketing team. Fox said that in five years he expects Velocity to have 30 employees with annual revenues in excess of $10 million.

“As a new company with an FDA-approved medical device on the market, we hope to tap into ATDC’s expertise in developing our sales and service organizations for Velocity. Using the fundraising connections within ATDC, we plan to explore the options for an infusion of outside capital over the next year,” he said. “Our expertise in medical software development combined with FDA regulatory knowledge will complement ATDC’s strengths in marketing, finance and service development.”

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: (ude.hcetag.etavonninull@noot.nhoj).

Writer: Nancy Fullbright

Vidalia Hospital Implements Lean, Increases Efficiency

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.”

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 (ude.hcetag.etavonninull@noot.nhoj).

Writer: Nancy Fullbright