Outcomes:

Problem / Challenge: Long patient wait times are resulting in patient dissatisfaction and overall flow issues.

Proposed Solution: Establish a lean improvement team to determine causes of patient waiting and implement improvements to reduce wait time.

Methodology and Outcomes:

Team & Training: Team members attended 4-Day UAH Lean Healthcare Academy training developed a project plan to reduce wait time.

Mapping: The team created a high-level process map of four major areas: Waiting Room, Pre-Op, Procedure and Recovery. They then constructed cause and effect diagram to identify potential causes and identified communication and scheduling as key improvement areas.

Simulation: UAH Lean Healthcare practitioners developed a simulation model to illustrate impact of scheduling changes on patient wait time and to study capacity due to changes in physician and patient routing.

Countermeasures:
The team implemented the following improvements:
• Improve communication between clinic, procedure staff and physicians.
• Develop standard schedule for each physician.
• Change appointment schedule to 15 minute increments (in line with procedure process time)
Results
As a result of the activities, patient wait time decreased 34%.

Methodology and Outcomes:

Team & Training: The hospital assembled a cross-functional team of nurses, doctors, administration, and engineers. The team then participated in lean healthcare and value stream mapping overview training from UAH Lean Healthcare practitioners. 

Mapping: The team decided to focus improvement efforts on the front end of the process, as it would have a positive impact on the steps downstream. The team mapped the front end data collection step in higher detail and looked for waste. Once the waste was identified, the team envisioned their ideal state and brainstormed improvements to help achieve it

Standard Procedure: The team developed a standard operating procedure in the form of a checklist. This checklist, if followed correctly, ensures that all of the data sources are used. At the same time, the checklist standardizes the med rec process for all nursing staff. After the checklist showed improvement, the team decided to add the concept of verification levels. Verification levels correspond to the number of data sources on which the medication appears. These levels help doctors make decisions and mitigate risk when prescribing medications.

Benefits
With the standard checklist in place,
• The total errors dropped by 60%
• The variance reduced by over half
• The percentage of patients with errors on their home med sheets reduced by 34%.

Problem / Challenge: Cardiac Short Stay unit was experiencing delays in receiving lab values. This delay created interruptions in Cath and EP lab schedules and caused delays for patients and physicians leaving.
Proposed Solution: Establish a lean improvement team to identify causes of delays in lab values and implement near-term improvements.

Methodology and Outcomes:

Team & Training: Team members attended 4-Day UAH Lean Healthcare Academy training developed a project plan to reduce lab value turnaround time.

Mapping: The team mapped the cardiac short stay process, created a spaghetti diagram of nurse activities and identified opportunities to reduce lead time and processing time. The team then conducted a cost/benefit analysis and developed a prioritized action plan.

Countermeasures
The team implemented the following improvements:
• Created visual status of labs
• Created standardized lab order sets
• Implemented room setup time reduction

Results: As a result of the work of the team, the lab results turnaround time was reduced by 7.9% and lab costs were reduced by $94K annually.