Background
As patients arriving at White Plains Hospital’s Emergency Department encountered longer and longer wait times, hospital leadership decided to employ Lean Hospital principles and techniques to drive measureable improvements in clinical care, medical outcomes and patient satisfaction. Leonardo Group Americas led this comprehensive project over a 16-month period in 2013 and 2014.
White Plains is a medium-size urban hospital of 290 beds located in White Plains, NY. Its Emergency Department, housed in a newly-remodeled wing, was logging nearly 60,000 annual patient visits as the project began. Average door-to-provider times approached 60 minutes – double the accepted standard, and cumbersome admission procedures left many admitted patients waiting in the Emergency Department for orders to be written or nursing unit rooms to become available.
The Challenge
The challenge was to document all the steps of care involved in a range of case types, and then identify the obstacles, delays, and potential failure points along those “paths” that patients followed.
Leonardo Solution
Two Leonardo Coaches began with a five-day assessment workshop with 16 key ED providers and technical staff. A detailed Value Stream Map charted a prototypical patient case including all the services that affect patient flow: lab, radiology, admitting hospitalists, consulting specialists, and environmental services.
The Value Stream Map indicated that 75% of this patient’s length of stay was unnecessary delay, or non-value added time! The week concluded with listing and grouping all the opportunities for eliminating these delays and improving patient flow.
Over the next year, one Leonardo Coach led monthly “Lean Weeks”, to develop Lean solutions for each of the issues affecting patient flow. These solutions included a much quicker triage system, improved hand-off of admitted patients from Emergency physician to hospitalist, Fast Track care for low-acuity patients; faster turnaround time for lab results, scheduling radiologists for real-time imaging; organizing providers (MDs, RNs, PAs, and techs) into independent patient care teams, aligning ED staff schedules to actual patient arrival rates, increasing inpatient bed capacity with quicker changeover/cleaning strategies, and speeding transfer of patients from ED to nursing unit.
All of these initiatives were developed by cross-functional teams, and all of them were proved out in actual pilot tests with data collection and follow-up. Several have already been fully implemented, and others continue to progress. Lengths of stay metrics for the Emergency Department have improved, some by 10% or more. A Joint Commission visit, in late summer of 2013, made positive note of the Lean projects underway, and since the ED works with and depends heavily on other hospital departments, there is a much higher awareness across the White Plains Hospital organization of how all departments and stakeholders contribute to smooth patient flow and the best possible medical outcomes.