"12 Steps to Better Healthcare" is filled with ideas that you can use right away to improve the efficiency and effectiveness of your healthcare organization. These steps can help you save time, money and lives, as you take part in the rebuilding of our healthcare system from the ground up.

1. 12
steps to
better
healthcare
WHITE PAPER

2. 12 Steps to Better Healthcare
L
ike it or not, we are addicted to some unhealthy habits in healthcare.
We make people wait. We overload our schedules. We let everybody do things
differently. We focus on filling rooms. We blame people, instead of processes, for
errors. We divide care into isolated silos. We cling to outdated systems and
hierarchies. We hesitate to question dangerous conditions or practices. And so on…
What have these habits done for us? The current results are alarming:
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We waste half of every dollar spent.1
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We perform dozens of wrong-site/wrong-patient surgeries every week.2
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We commit one medication error per day for every patient in the hospital.3
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We make patients wait an average of 20 minutes to see their physician.4
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We commit errors that result in 100,000 preventable deaths each year.5
Obviously, these are not the intended results. But how do we change them?
The only way to change the results is to change the processes of care delivery –
the ways work is performed, the flow of information and people, the consumption of
resources, and the systems of learning and innovation.
At Workflow Diagnostics, we have identified 12 such changes that can help save
time, money and lives – and, in our minds, the system itself. Whether you are an
administrator, care provider or enabler, you can use these steps to improve the
effectiveness and efficiency of your part of the system.
1. Document your processes. Processes are living
organisms. They change over time, often in ways that
are undesirable, including workarounds or shortcuts.
They need attention and regular pruning. Your
patients’ needs change; your processes have to
change right alongside. And as a wise teacher once
said, “If you can’t describe what you are doing as a
process, you don’t know what you’re doing.” Ideas:
Meet with one function at a time and document
current procedures. Create a process diagram by
connecting steps in order. Then, check with others
outside the team to validate. Do this until all functions
are documented. Remember: If you don’t have a
process, you don’t have anything to improve.
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3. 12 Steps to Better Healthcare
2. Eliminate redundancy. When you document processes, be on the lookout for
repeated steps, particularly by different areas. For example, it’s not uncommon for
different areas to capture the same information in a different place or form. When
patients answer the same questions multiple times, from three different people, they
start to wonder if anybody is listening. Don’t rely on
redundancy to fix a bad process. If you don’t trust the
effectiveness of the first process, improve it and then
eliminate the redundant steps. Ideas: Reports and records.
Data collection. Interview questions. These are all areas that
breed redundancy. First determine what is necessary; then,
strive to do it, create it or capture it only once.
3. Standardize. Unnecessary variation and complexity consume enormous amounts
of time that provide little or no value and could be focused on patient care or
customer relations. Everybody likes to do things their own way, but this produces
inconsistent results, confusion and complaints. Determine the most
efficient, effective or safest way to do something
and standardize around it, across personnel, shifts and
roles. Is there one acceptable way to perform a function
(e.g. draw blood; insert a catheter)? Definitely standardize
this. Expect a few battles along the way. OK – a lot of
battles. But these are battles worth fighting. Otherwise,
you will never be able to standardize around the optimal
patient experience and outcomes. Ideas: Start with room
layouts and supply placement; signage; scheduling and
test ordering procedures; and room setup / cleanup protocols. Make sure you put
accountability measures in place to back up any standard you create.
4. Read what’s in your suggestion box. You see these almost
everywhere, but you never see anybody empty one. Do it. Great
ideas await you, as well as the “real” truth about how well you’re
doing. Ideas: Go one step further to engage your patients. Hold a
small focus group with a cross-section of patients, or distribute
surveys and offer a small token in return for a response (nothing
big enough to sway the results).
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5. Foster problem-solving. Everyone is solving
small problems all day long, but do they have a
standard and effective method for solving
persistent or complex problems? Are they trained
in root-cause-analysis? If not, implement one of
many improvement methodologies, such as PDSA,
Lean Six Sigma DMAIC, A3, Kaizen or another. This
is an investment in your people and the future of your organization Ideas: Train all
associates in the seven basic Quality tools or the fundamentals of Lean Six Sigma
(consider our Quality Clinic course, for example.) Provide FMEA training for Quality
personnel. Select key associates for certification in Lean Six Sigma.
6. Clarify roles. This is more than reviewing job
descriptions. Where roles connect or overlap, discuss who
does what. Alleviate ambiguities or disagreements. Defer to
the best and safest choice for the patient or the practice.
Ideas: Review your medication reconciliation procedures.
Who is responsible for documenting medications? Who
reviews them? Who discusses with the patient? This is an
area of consistent ambiguity.
7. Use visual status indicators. In the old days, we
used flags outside the exam rooms to indicate
“ready,” “in use” or “available.” Why did we stop?
Today we have color-coding on computer screens,
and because the information often lags, doesn’t
match our workflows or is incorrect, we don’t trust
it. Visual indicators and cues should make it obvious
to everyone – particularly physicians – what the status of a resource is, and where
they should go next. After all, how much time do you have for uncertainty? Ideas: Try
a number card system – each room has a number on a card; when a patient leaves,
the number is hung on a hook in a plainly visible location. This makes it obvious the
room is available. The next person who boards a patient in that room hangs the card
on the room door, making it obvious to others the room is in use. And the process
repeats itself. Patient tracking boards with key elements such as appointment time,
room number and status also keep everyone on the same page.
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8. Keep supplies where you use them. This is called “point of
use.” Locate supplies in the place where they are most
frequently used, and put seldom used supplies away. This will
reduce the time spent retrieving key supplies, using an
unsuitable alternative or just doing without. Ideas: Blood
pressure cuffs, educational materials, sterile supply packs, key
phone numbers and other essential supplies and information.
9. Throw away anything broken, expired or
unnecessary. Broken or expired materials not only take up
valuable space and energy, but they may also pose a
significant safety risk. Ideas: Do you have a process for
regularly identifying or discarding such items? If not, you
need one – now. Meet with your team and write it out.
Then implement it. Certainly include drugs, chemicals and
other agents that you store, but don’t overlook office
supplies and record archives.
10. Minimize suppliers and inventories. “Strive for 1,” as we
call it. In other words, aim for 1 standard item, and 1 standard
supplier, in various categories. Ideas: Office supplies. Forms.
Testing and supplies. Billing services. Uniforms. Deliveries. You
name it – strive for 1 standard item, and 1 supplier, in each
category. This will also help you negotiate bulkier purchases
with single suppliers.
11. Hold still. Strive to do as much as you can with as little
energy as possible. This means less walking, particularly of the
back-and-forth variety … to the supply closet, the exam rooms,
offices, the hallways, nurse’s station, etc. Equip workspaces so
that multiple tasks can be completed in one place. Ideas:
Create work cells where doctors, mid-levels, nurses and/or
other staff can be co-located to improve communication;
document visits on a laptop or tablet between patients;
minimize the number of rooms allocated to each provider.
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12. Practice one-piece flow. This is the opposite of batching or multi-tasking, which
is prevalent but deceptively inefficient. When we “batch” items, the first item to
arrive waits until the last item arrives before it is completed, creating unnecessary
delays and reducing “flow.” Instead, complete one project
or task, or as much as you possibly can, then go to the
next. You’ll no longer have to remember where you leftoff, repeat steps or miss a deadline. And work is delivered
continuously, rather than in spurts. Ideas: Physicians:
Complete patient visit notes between each patient;
otherwise, the backlog that haunts you at the end of each
day will continue to do so. You’ll also improve accuracy
and completeness. Everyone: Create “safe” zones that say
to the outside world, “no interruptions,” to improve your
ability to focus on one activity.
So, there you have it! Twelve simple, but powerful,
steps you can take right now to improve efficiency and
reduce waste in your office, practice or unit. Remember:
You have finite resources – time, energy, space, people
and money – to commit to patient care. You owe it to your
patients – and yourself – to ensure every resource is
wisely used for their benefit.
With these strategies and others, you can drive
organic healthcare reform that makes a real difference –
saving time, money and lives, and changing the harmful
habits that have become too costly to maintain.
A healthier process will have healthier results.
Want more ideas?
Check out our latest book, Go Get Your Muda!, available on
Amazon. You can also follow us on Twitter (@workflowdx) and
Wordpress (“Quality Matters”). Better yet, contact us today to set
up a free consultation. We’d love to hear from you.
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References
1. PricewaterhouseCoopers, The Price of Excess, April 2008,
http://www.pwc.com/us/en/healthcare/publications/the-price-of-excess.jhtml
2. Joint Commission Center for Transforming Healthcare, Wrong Site Surgery Project,
http://www.centerfortransforminghealthcare.org/projects/detail.aspx?Project=2
3. Johns Hopkins Bloomberg School of Public Health,
http://www.jhsph.edu/news/stories/2006/wu_medication_errors.html
4. Medical Economics, http://medicaleconomics.modernmedicine.com/medicaleconomics/news/modernmedicine/modern-medicine-feature-articles/20-minutesmagic-number-patie
5. The Commonwealth Fund, “Five Years After ‘To Err is Human’: What Have We
Learned?,” http://www.commonwealthfund.org/Publications/In-theLiterature/2005/May/Five-Years-After--To-Err-Is-Human---What-Have-WeLearned.aspx
Copyright 2014
PO Box 4233, Lynchburg, VA 24502, 1-855-FLOWDOC, workflowdiagnostics.com