In a bright hallway at Tidelands Georgetown Memorial Hospital, six staff members gather at a large bulletin board papered with trend charts and graphs.
For the next few minutes, they study shift reports, compare admissions numbers, and discuss an upcoming “rapid improvement event.” The goal for these team meetings is to monitor what’s working well at the hospital – and fix what isn’t.
“We go through the metrics, look at how we’re doing and see what we can correct,” says Gary Kollm, Tidelands’ director of Performance Excellence. “We set the goal, and then we hold ourselves accountable to monitoring it.”
Tidelands, in coastal South Carolina, is one of 29 hospitals in the Carolinas working to offer better patient care through a business transformation practice called Lean. First used by manufacturers, Lean emphasizes continuous improvement by tapping the expertise of staff to eliminate activities that don’t add value to a process.
The Duke Endowment funded the initiative; technical assistance came from Simpler Consulting, a Lean management coaching firm. Valuable contributions and expertise also came from the North Carolina Healthcare Association and the South Carolina Hospital Association and the offices of Rural Health in both states. Each participating hospital invested financial and human resources to maximize impact.
“We thought we were running a pretty efficient health care system until we looked at it through the lens of Lean,” says Bruce Bailey, president and CEO of Tidelands Health. “In an environment where everybody is looking for health care to be more efficient, more effective, and less expensive, Lean is helping us adapt, transform and improve.”
What is Lean?
In an article about the Carolinas Lean initiative, HealthLeaders Media explains that Lean “works by focusing on specific value streams within the organization and performing a series of ‘rapid improvement events’ that map out the entire workflow, identify areas of waste, find places to trim, and apply a new process.”
As one hospital CEO said, “It's remarkable to watch employees sit down and map out issues and discover possible solutions in a team environment and then have the wherewithal and the authority to implement these changes and see if they work."
Savings – and Better Care
During the multi-year collaborative, more than 5,300 employees completed training, learning how to use the Lean approach in their everyday work. As patient wait times dropped, medication errors decreased and pharmacies and labs became more efficient, leaders saw a collective savings of nearly $74 million between 2008 and 2017.
Some changes were straightforward, but even simple fixes produced big outcomes.
At Pardee Hospital, for example, staff members worked to reduce the percentage of patients who left the emergency department without having been seen, from 5.4 percent to 1.8.
At Randolph Health, the length of stay in the emergency department dropped from an average of 154 minutes to under 100 minutes.
Beaufort Memorial decreased time spent searching for supplies and equipment in one of its inpatient units from an average of 20 minutes to 2.
Scotland Healthcare System identified a potential $134,400 in annual savings by addressing its linen handling process.
“By simply improving the way that laundry got delivered, there’s now a faster room turnover rate, which means that patients aren’t waiting as long to be admitted,” says Tatyana Kelly, vice president of member services with the North Carolina Healthcare Association. “One of the beauties of this collaborative is that it allowed hospitals to look strategically at their work and say, ‘Where do we need to focus first and why?’ In Lean, the patient was always at the center of the process.”
Bailey credits the collaborative with helping the hospitals develop a strong learning community, contributing resources and best practices. When he attends national meetings, other health care leaders often ask him about the Carolinas Lean Collaborative and how it ran.
“I don’t know where else you’d find competing health systems sharing ideas,” he says. “This initiative challenged all of us to work together and do better.”
For Tidelands Health – with one hospital in Georgetown and a second in Murrells Inlet –participating in the collaborative has led to $5 million in savings, and Bailey believes that estimate is conservative.
At the hospital in Georgetown, a reorganized storage room helps nurses gather supplies quickly. Sections are now color coded – red is for cardiac equipment, blue is for respiratory – and shelves are tidy.
Staff satisfaction has gone up as a result. “Health professionals want to spend time at the bedside delivering patient care,” says Nursing Director Ranee Stephens, “not frantically hunting for equipment.”
At the hospital in Murrells Inlet, a Lean effort has targeted the emergency department. With design criteria developed by physicians, nurses, patients and security officers, renovations include “senior-friendly” enhancements, space for behavioral health patients, and a nurse’s station with 360-degree views. Patients needing urgent care will have rooms near the EMS arrival area; another area will serve less-urgent cases.
“As we grew, we realized we were having issues with workflow and patient placement,” says David Nelson, Lean facilitator for the department. “We pulled our team together and everybody got to say what they would like. It’s an ongoing process, but the changes are increasing teamwork and communication, and will provide a much better experience for the patient.”
For Bailey, that’s a perfect example of the Lean journey.
“Lean reveals ‘aha moments’ when you see that a process that worked three or four years ago isn’t holding up within current challenges,” he says. “If you don’t call timeout and try to make the process better – if you don’t discipline yourself to look for ways to improve – you’re just dealing with the alligators that bite at you every day.
“Small and rural hospitals have tighter margins and less room for error,” he says. “We always need to make sure we’re working as efficiently as possible with the resources we have. We owe that to our patients, our nurses, our providers and our communities.”
Jay E. Kennedy
Program Officer, Health Care