BG: My background is in manufacturing, so I have only been in healthcare the past six years. I worked at Pella Windows, Tyson Foods, and Rain Bird Irrigation Company prior to working for Ascension Health in Tucson. I moved to Central Florida two years ago to work for Health First.
So I have a different background from most people in healthcare. However, my whole career has been working with Lean and Six Sigma. When I started at Pella, they were just rolling out their Lean program, so I got into the front end of the training process. Every job since then has been process improvement, performance improvement, a main Six Sigma-type role, and that is what I have today.
We have four hospitals at Health First, and I am based out of our largest, Holmes Regional Medical Center, a 550-bed Level 2 Trauma center. We also have three community hospitals all located in Brevard County, the country’s largest multi-specialty physicians group, and largest health-insurance provider. Health First also operates health plans with more than 250 provider medical groups, and many outpatient services that include gyms, hospice and home-care services.
HMT: What were some of the issues going on with your organization, and what led you to look for a solution to solve those types of problems?
BG: We wanted to improve throughput – getting patients from the ER to the floor, from surgery to the floor, that type of scenario. We also wanted to streamline the process for discharging patients and transferring patients between units. We did not have a centralized patient model. Our four hospitals were acting independently instead of cohesively as a team. We had lots of patient movement in some cases, and we didn’t have patient movement where we needed it in other cases.
HMT: What were some of the considerations in terms of the solutions you were looking for? What were you hoping to find?
BG: The big one to me is having data and being able to pull data basically at a moment’s notice. If something comes up, we need to go into the business platform, build a report and dig into the details. By far, we discovered that TeleTracking had the best reporting function and the best data function.
If you pull the KLAS reports, they have been the patient flow category leader for a number of years. It wasn’t really a question once we got to that point, knowing what we needed and how we were going to fix it. TeleTracking appeared to have the solution we needed.
HMT: Tell us a little bit about implementation.
BG: We started doing value stream analysis, which is basically walking through the big process step-by-step. We started with the ER-to-the-floor process. We pulled the ER team, nursing team, transport, environmental services, and patient-flow administrators into a room and literally went through the process, step-by-step of what it takes to move a patient from the ER to the floor.
We documented the time, the paperwork, the steps and then took all that information to our valuestream analysis. We then looked for waste within the process, such as times the patient was waiting doing nothing, and then duplication or rework. We looked to streamline that process so that we had a standardized process across the four hospitals.
Then we used TeleTracking to automate and provide data to support across that new process. We integrated our EMR (the Sunrise Clinical Manager system) and TeleTracking together, so we had a streamlined approach to data to help us manage that process. Then it became a matter of daily management of that data and process, and fixing outliers as they came up.
HMT Can you tell us a little bit about some unexpected glitches or workarounds that had to be created, if any?
BG: There always are. For example, the patient transport process was something we had to address. Once we got the process standardized with the ER and the floor, we realized we had an issue with patient transport. The first thing everyone says is, “add more people.” Looking at the data, we realized it wasn’t people, it was the staging – the scheduling of those people was at the wrong times. We had to become more nimble with our scheduling of patient transport.
Before, we would post a six-week schedule for transport; now we do a two-week schedule so that we can flex our schedule every two weeks based upon volumes coming out of the ER and time of season and adjusting for start time. Instead of your typical 8 am-to-4 pm cycle, we actually have people coming in every couple hours during the day. We constantly have an influx of associates coming in, and then staff going home later in the evening. Instead of just a flat shift, it was more of a streamlined approach matching the volumes from the ER.
HMT: What about the front staff workers? What were some of the initial questions, comments or concerns, and what sort of feedback did you get in the initial stages of implementation?
BG: Any time you change a process, it is always going to be a challenge. Most people don’t like change whether it is because they don’t know the details, they don’t understand it, etc. A lot of it was, “Give us two weeks. We will work through the system and fix the bugs.” A lot of it was coaching and training – helping them understand more than they are used to. Then it was providing them with TeleTracking’s Capacity Management Suite system and Custom Reporting Solution. It has an electronic bed board that allows us to push daily reports in very specific formats, so front-line associates can see hour-by-hour performance and transporters can see hour-by-hour work from the previous day. That data really helped us get through those concerns about the change.
It was more of a cultural mindset of, “We have this problem, and is it going to create more problems?” And essentially the proof was in the data. Once things were going, the staff bought into it and it became abundantly clear that they were realizing the efficiencies they wanted to see.
BG: We found processes we didn’t even know existed that had been around since before the electronic processes were implemented. When we started finding outliers, we identified things that could be eliminated. For example, some staff felt that the house supervisor or patient administrator had to review all the downgrades coming out of the ICU.
We have an intensivist program led by physicians, and they don’t need to review any of those. The physician drives their care, and the physician knows what is best for that patient. We were adding an extra step of delay waiting for the health supervisor to come and review, when we didn’t need to do that. We eliminated that process, and we wouldn’t have seen that without the data.
