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LEAN HEALTHCARE PROCESSES at PELLA REGIONAL HEALTH CENTER

The staff at Pella Regional Health Center, like the employees of healthcare providers everywhere, is searching constantly for a better way to workto be efficient and effective while still providing compassionate care. The difference at Pella Regional, though, is that they must do it with a small staff and a limited budget. But they are doing itand have become the example that Lean Healthcare is possible anywhere. Pella Regional Health Center, a 25-bed Critical Access Hospital in Iowa, has implemented Lean Healthcare Processes that: Functions without consultants, except for an initial 8-week training session. Use front-line staff on the job as opposed to the 5-day event model. Have provided staff with tools to structure and organize their problem-solving. Have empowered front-line staff to form their own multi-disciplinary teams and take the lead as the Resident Experts, exemplifying the pull theory of Lean. Have become engrained in the culture of working at Pella Regional; employees of all levels regularly use lean tools to solve problems and deal with issues. Lean Healthcare Processes at Pella Regional Health Center are coordinated by Sarah Cottington, BS, CPHQ, RHIT scottington@pellahealth.org 641.628.6781

(As featured in The Joint Commissions: The Source June, 2007)

Lean Healthcare Case Study #1

The Issue: Patient care may be delayed due to nurse to nurse report taking longer than 30 minutes at end of shift. This problem was identified by frontline staff nurses at Pella Regional Health Center.
The nurses worked on the above A3 and created a handoff communication tool to format their report giving, and other countermeasures to help minimize interruptions. The time they save each day in delivering report to the next shift equates to dollars saved by the hospital and more time for patient care at the bedside.

Countermeasures:
1. Able to arrange coverage for RNs due to schedule specified for when RN will report to oncoming staff. Off-going staff will be aware of when expected for report and will be available. 2. Clear guidelines established for when report is in session -sign posted on door and enforced by requiring knocking if absolutely necessary to enter room, otherwise no intrusions allowed. 3. New Report -change of shift communication plan re-designed.

Cost Benefit/Waste Recognition ~ *Total Estimated Cost Savings (Annual) = $59,130*

Lean Healthcare Case Study #2

The Issue: Increased spread of germs due to poor handwashing practices by PRHC personnel.
Healthcare Associated Infections (HAI) affect nearly 2 million individuals annually in the United States and are responsible for approximately 80,000 deaths each year (IHI). Initial direct observations of handwashing at PRHC were low and variable at 20-100% (Feb, 2008). This problem was facility-wide and addressed by the Shared Governance Quality Council which is comprised of front line staff nurses from every discipline of PRHC. The Quality Council worked on the above A3 and created a formal monitoring system to monitor hand hygiene throughout the Pella Medical Clinic, Outreach Clinics, Hospice, Home Health and all levels of Pella Regional Health Center. There is no way to know a hard dollar return on investment but each healthcare associated infection prevented is PRICELESS.

Countermeasures:
1. Handwashing readily available. 2. Education to all Pella Regional Health Center staff. 3. Establish a hand hygiene monitoring system for Pella Regional Health Center. 4. Establish a culture of safety at Pella Regional Health Center.

Cost Benefit/Waste Recognition~*Total Estimated Cost Savings per patient = $35,000*


Reference: CDC. Retrieved from the web December 3, 2008. http://www.cdc.gov/ncidod/eid/vol5no1/rubin.htm

Lean Healthcare Case Study #3

The Issue: Cannot easily identify outdates on sample medications in the clinic. Sample meds were stored in cabinets in the clinics and outdates were checked monthly. This process used to take an additional 8 hours/mo. to be completed by a nurse. A nurse was scheduled to come in specifically to do sample medication outdates and re-ordering.
The Pella Medical Clinic nurses worked on the above A3 to create a defined system to manage sample medications. This has resulted in the sample medications being managed during the course of work and kept current with no outdates dispensed.

Countermeasures:
1. 5S sample med cabinet to create and maintain organized and clean cabinets. 2. Label sample meds with sticker method used by PRHC pharmacy. 3. Sample med cabinet responsibilities completed by three clinic schedulers. 4. Each doctor/nurse team set par levels of sample meds they use to guide re-ordering and upkeep of cabinet.

Cost Benefit/Waste Recognition~*Total Estimated Cost Savings (Annual) = $3,054.59*

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