Finding Success in Healthcare

We apply Lean and Six Sigma methodologies and other specialized expertise to assess, educate and — many times — directly solve process-improvement issues that relate to care delivery; primary care/outpatient management; data utilization; quality reporting; cost containment; and more.

Success Stories

Found 31 Results
Customer
Goals
Results
Customer
Columbus Regional Health System & Services
Goals

Columbus Regional Hospital needed to get more than 35 providers to Stage 1 Meaningful Use in 2012 using two disparate Electronic Health Records (EHR) systems. While the hospital had a lot of expertise in one of the products, they had limited experience in the other. 

Results

The hospital partnered with PHA to assist its staff as they learned a new EHR system as well as applied the federal Meaningful Use objectives to their everyday workflows. PHA provided a HIPAA Security Risk Assessment, a Readiness Assessment, and Attestation Support and Guidance. 

PHA worked with ONC to determine the true intent of the law and how the data needed to be captured to be compliant with MU. We were then able to facilitate conversations between the client and their vendors to ensure the changes were made allowing for timely attestation. 

Customer
Rush Memorial Hospital
Goals

Rush Memorial Hospital officials wanted to ensure that its ePHI, either at rest or in motion, was secure under the best practices possible.

Results

With the latest assessment and validation tools, PHA supplemented Rush Memorial’s IT security/privacy measures through a Network Security/Risk Analysis that analyzed the data at rest and in transit; assessed both physical and virtual spaces; reviewed existing policies and procedures; sought vulnerabilities in system configurations and networks; conducted on-site interviews with select staff members; and presented a threat vulnerability assessment and mitigation plan. 

An external IT security review by PHA takes into account all persons with the ability to access, modify, and distribute ePHI as well as the administrative and technical deficiencies in EHR systems and the devices and networks used to access the EHR.

Customer
Haendiges & Associates, P.C.
Goals

Dr. Michelle Haendiges, physician and owner of kokomo-based Haendiges & Associates, P.C., was looking for a way to reduce the amount of time her staff took looking for patient charts.

Results

With assistance from Purdue Healthcare Advisors under a grant funded by the 2009 American Recovery and Reinvestment Act, the Kokomo doctor and more than 2,400 other Indiana physicians are moving toward using their EHRs in “meaningful” ways — ways that improve the quality, safety, and efficiency of healthcare delivery; reduce healthcare disparities; engage patients and families; improve care coordination; improve population and public health; and ensure adequate privacy and security protections for personal health information.

"Meeting the federal government’s EHR Meaningful Use standards usually require that providers make certain adjustments to how they see patients, utilize their EHR, and protect their patient information," said Randy Hountz, director of Purdue Healthcare Advisors' Regional Extension Center. "We expedite this somewhat disruptive process." Providers and hospitals that achieve the EHR Meaningful Use standard receive federal incentive payments as reimbursement for existing EHR systems. 

Customer
Heart City Health Center
Goals

Heart City Health Center, a South Bend-based FQHC, needed assistance to assess its information security risk in order to successfully attest to Meaningful Use, a federal incentives program created by the Affordable Care Act to accelerate physician efforts to become “meaningful users” of their electronic health records (EHR) systems. As part of “Meaningful Use” standards, providers must show that they can keep electronic patient health information (ePHI) safe and secure.

Results
Purdue Healthcare Advisors (PHA) manages the Purdue Regional Extension Center (PurdueREC), which is one of 62 centers nationwide created by the Affordable Care Act to help providers navigate federal standards that involve complying with thresholds for e-prescribing, patient portal interactions, immunization registry reporting, and more.
The PurdueREC’s IT team reviewed Heart City’s written security policies, then lead its staff through a battery of questions to determine exactly how the policies were being implemented. The IT team then did a physical walk-through of the center to evaluate risk from patient-flow perspective as well as a workflow perspective. They asked how staff members access the EHR, how passwords were being protected, and if monitors on desktops were visible to passersby. Finally, they assessed the IT operating system itself, checking its configuration. 
Heart City’s Operations Manager Fundisani Mangena says the PurdueREC’s thorough analysis has given the center “a new way of looking at our security policies,” and he praises Purdue for striking the right balance between securing patient information and keeping the data readily available to clinicians to provide the best possible care. 
Customer
Medium-sized Hospital
Goals

To reduce instances of Category E adverse drug effects (withdrawal symptoms) from Warfarin by 20%. 

Results

The Lean Team reduced Warfarin-related patient readmissions for out-patients as well as reduced lengths of stay for in-patients by appointing hospital pharmacists to monitor all inpatients on Warfarin, schedule INR testing at the same time daily, and administer all doses at 6:00 p.m. as long as the patient’s levels are within normal limits. Pharmacists also became involved in the discharge process for patients on Warfarin in order to pass along medication information to rehab units as well as to refer outpatients to a Warfarin/Coumadin Clinic. 

Customer
Putnam County Memorial Hospital
Goals

To decrease the risk of bleeding and other complications associated with elevated International Normalized Ratio (INR) levels to less than 5% for inpatients on anticoagulation therapy. 

Results

The Lean Team implemented a pharmacy-based dosing protocol for initiation and maintenance of Warfarin therapy for inpatients, and required INR's to be ordered daily on all inpatients and monitored by pharmacists. Patients on Warfarin also were given three related educational pieces upon discharge. The incidence of INRs >5 is 0% since implementation began, however since only five patients have been dosed on the protocol (42% of all inpatients receiving Warfarin), more data is needed to assess effectiveness of the solution.

Customer
Community Hospital Anderson
Goals

To reduce 30-day readmissions for congestive heart failure (CHF) patients, acute myocardial infarctions (AMIs) patients, and  pneumonia patients by 20%.

Results

The Lean Team reduced the age criterion for case manager “must-see” patients to 70. Case managers were to see patients who had been in the ED or otherwise admitted at least three times within the last three months as well as anyone readmitted in the last 30 days. Eight months after project implementation, readmissions for AMIs fell to zero. Of those readmitted for the other two observed ailments, 83.3% met the newly established criteria and had been seen by a case manager on the first visit. 

Customer
Critical Access Hospital
Goals

To reduce the readmission rate by ensuring 90% of all patients have a follow-up appointment scheduled and kept within two weeks of discharge.

Results

In five months, the Lean Team reduced readmissions from an average of 8.67% to 7.8% by implementing changes that included appointments scheduled within two weeks of discharge; patients educated on the reason for their follow-up appointment; and allowing one follow-up visit to patients who had outstanding bills. 

Customer
Franciscan St. Anthony Health
Goals

To reduce the readmission rate for CHF patients in the hospital’s cardiac care unit by at least 12%.

Results

Since the Lean project was handed off to front-line staff, readmission rates for heart failure within the cardiac care unit have remained below the previous year's baseline for eight months, with seven of those months at or below the project’s goal, and two of those months with zero readmissions for CHF. 

Customer
Hospital Outpatient Facility
Goals

To reduce the number of patients being readmitted within 30 days of being treated initially at the ambulatory facility.

Results

Preliminary results two months following Lean project implementation showed positive results. Based on the sample size, the 30-day readmission rate was 11.11% (or 1 in 9 patients). Only 28.6% (or 2 in 7 patients) of the total discharges failed to meet the criteria for a 3 p.m. dismissal. 

Customer
Parkview Noble Hospital
Goals

To reduce admissions coming into the hospital from nursing homes.

Results

For five consecutive months following the Lean project implementation, the hospital reported no preventable readmissions of targeted nursing home patients. The project has had far-reaching impacts. Two years later, readmission rates have decreased by 22.6% for CHF; by 72% for Pneumonia (PN); by 29% for patients discharged to home; and by 47% for patients discharged to nursing homes.

Customer
Putnam County Memorial Hospital
Goals

To increase the number of timely discharge summaries.

Results

Six months after Lean project implementation, the hospital's MR department rate of timely summary transmission had risen from 20% to 74%, while the readmission rate was reduced by half to 3.6%.

Customer
Critical Access Hospital
Goals

To decrease wait times to a 40-minutes (avg.) for ED-admitted patients waiting for transfer to Med/Surg and ACU.

Results

The Lean Team reduced the overall wait time from 58 to 33.5 minutes in the second quarter of 2013 by standardizing communication and access to information for unit coordinators so they could better communicate data and bed availability to the ED.

Customer
Critical Access Hospital
Goals

To reduce door-to-doctor average wait times in the ED by 30%.

Results

A Lean Team reduced the average ED wait time from 40 minutes to 28 minutes or less by relocating a patient tracking board to a centralized spot that was easier for all staff to access. The  board allows nurses and physicians to treat patients in their ED rooms before the necessary documentation is completed.

Customer
Critical Access Hospital
Goals

To decrease wait times to a 40-minutes (avg.) for ED-admitted patients waiting for transfer to Med/Surg and ACU.

Results

The Lean Team reduced the overall wait time from 58 to 33.5 minutes in the second quarter of 2013 by standardizing communication and access to information for unit coordinators so they could better communicate data and bed availability to the ED.

Customer
Putnam County Memorial Hospital
Goals

To increase patient's compliance with post-hospitalization appointments. 

Results

Over the following two months, there were neither any reports of errors or variances in medications nor omissions in therapy for patients recovering at home. There were zero readmissions in July for those patients who were dismissed in the previous month, saving the hospital a projected $105,000 in related costs. 

Customer
IU Health Tipton Hospital
Goals

To reduce the time it took for the hospital’s medical-surgical unit to admit those patients who needed placement in a “swing bed.”

Results

The length of stay in the med-surg unit prior to transfer to a swing bed was reduced from an average of 290 minutes to 121 minutes, an improvement of more than two and a half hours. The nurses were highly satisfied with the streamlined data transferal and admission times, and the improvements are estimated to save the hospital $35,250 annually. 

Customer
Critical Access Hospital
Goals

To reduce time to transfer patients from the ED to other units by an average of 10 minutes.

Results

The Lean Team reduced the time to transfer patients from the ED to other units from 56 minutes to 46 minutes on average.To cut down unnecessary wait time, protocol concerning patient calls was changed so that transport requests were made at the time of call rather than patient arrival, and the amount of paperwork necessary to move patients was reduced. Nurses were required to only fill a T-sheet for reference, and to make calls directly to the floor for verbal inquiries as opposed to faxing or tubing for verification. 

Customer
Critical Access Hospital
Goals

To increase the number of follow-up phone calls to patients that occur within the desired 72-hour window following the patient’s discharge from the hospital's med/surg units. 

Results

Within the first month following implementation, the Lean Team increased the the number of follow-up phone calls made with 72-hours post-discharge from 65% to 95% by revamping the discharge process. Changes included making phone calls to patients within 24 rather than 48 hours from discharge and requiring nurses to begin documenting for the discharge process at the time of admission. 

Customer
Critical Access Hospital
Goals

To improve patient safety by improving patient care hand-off communication between the ED and diagnostic imaging.

Results

A Lean Team reduced the risk for falls, medication errors, and wrong tests and/or procedures at the hospital by implementing a patient identification policy and hand-off tool (digital and paper) called Ticket to Ride from EPIC, and educating staff to use it.

Customer
Medium-sized Hospital
Goals

To reduce delays in getting patients from the ED to the floor. The time from ED to floor ranged from 20 to 133 minutes.

Results

The Lean Team defined the problem and current baseline processes by analyzing the voice of the customer and mapping the process. They identified key operational barriers using process observation and time trials before implementing solutions based on a future state process map and PDCA cycles.  The ED admissions' "time to bed" was reduced an average of nine minutes. 

Customer
Medium-sized Hospital
Goals

Hospital administrators wanted to increase the percentage of procedures that started on time in its operating rooms.

Results

Faculty from the Purdue Department of Organizational Leadership and Supervision/Lean Enterprise led an eight-week Lean Healthcare program for pre-op area and OR area staff, which included training, identification of key issues, and solution implementation. Over the eight-week period, the hospital team used workflow analysis, spaghetti diagrams, and other Lean tools to define the problem and identify current baseline processes, operational barriers, and process waste. The team then implemented a control process plan. 

On-time OR starts rose from 15% to 65%, with an estimated immediate savings of $100,000.

Customer
Critical Access Hospital
Goals

Critical access hospital administrators wanted to improve patient flow through the surgical process. Half of all procedures began later than scheduled times.

Results

A Purdue team of Nursing and Industrial Engineering faculty and graduate assistants analyzed surgical volumes, surgical scheduling bottlenecks, staff availability, and physical facility constraints. Recommendations were made related to staffing, training, scheduling, documentation, physician and staff arrival times, anesthesia, and unit/OR coordination.

On-time starts dramatically improved to a rate of more than 75 percent, leading to improved patient and staff satisfaction.

Customer
Large Hospital
Goals

Hospital administrators wanted to reduce or eliminate the bottlenecks that were occurring in a newly-automated laboratory as lab specimens were received.

Results

A Purdue team of faculty and graduate assistants from Organizational Leadership and Supervision and Nursing assessed lab specimen collection practices on the nursing units and the specimen receipt process in the lab, using time motion studies, process mapping, and other engineering principles. Recommendations included training, basic layout redesign, visual messaging on computers, and basic reprogramming of lab software. 

Front-end lab processing time has decreased following the successful implementation of solutions.

Customer
Large Hospital
Goals

Administrators at a large hospital wanted to reduce its clinical research revenue cycle, which routinely exceeded 45 days. 

Results

During an eight-week Lean Office program, staff from the clinical research billing office received training in Lean principles from faculty and graduate assistants at the Purdue department of Organizational Leadership and Supervision/Lean Enterprise. The team used value stream mapping, process capability studies, root cause analysis, and process flow mapping to identify current baseline processes and operational barriers. By successfully implementing short-term solutions, hospital administration approved plans to implement long-term solutions.

Implementing solutions reduced the revenue cycle by 33% before the project was even completed. 

Customer
Community Health Clinic
Goals

State health administrators wanted to create a planning framework to build resilience and capabilities for an effective response from community health clinics and primary care centers in the event of a natural or man-made disaster.

Results

Purdue Healthcare Advisors' staff has facilitated and guided the development of a Business Continuity Management Plan Toolkit to ensure financial integrity and continuity of healthcare services to healthcare facilities during an emergency. The planning process and Toolkit resources address all phases of emergency planning, including mitigation, preparedness, response, and recovery, with specific emphasis on the recovery phase. A Hazard Vulnerability Risk Assessment also is completed as part of the process. 

Customer
Community Health Clinic
Goals

State health administrators needed assistance in completing a Local Public Health Assessment (in association with the CDC's National Public Health Performance Standards) to examine the delivery of essential public health and healthcare services in the counties and healthcare service areas. 

 

 

 

Results

In 2007, no counties in Indiana had completed a Local Public Health Assessment. Since then, a multidisciplinary Purdue team has implemented the Local Public Health System Assessment in 41 counties. More than 1,000 individuals representing public health and healthcare organizations have participated in an assessment in Indiana. Each county receives a 32-page report with detailed results of how public health services are being delivered in the county. Results are prioritized for community-based health improvement planning.

Customer
Community Health Clinic
Goals

State administrators wanted to increase the number of counties in Indiana that conduct regular, comprehensive community health assessments and develop evidence-based community health improvement plans for the populations they serve.

Results

Purdue Healthcare Advisors' staff, displaying their expertise in population health and quality improvement, conduct Lean Six Sigma Yellow Belt Training specifically focused on public and population health. Training teams consist of broad-based public health and healthcare system partners with a common vision for improving the health of their population. The curriculum meets ASQ training standards, and individual certification is available to each participant. Upon completion of training, a single one-half day review is provided by the Purdue team and a written Certification Exam is administered. Successfully completing the exam demonstrates a minimum level of competency in QI concepts and use of QI tools at this level. The outcome of training for each team is a project charter and implementation of a community health improvement plan. If requested, plans may be focused on a more specific health behavior or outcome. 

Customer
Parkview Huntington Hospital
Goals

The Lean Team at Parkview Huntington Hospital in Huntington, Ind., wanted to decrease the rate of elective labor inductions for women not yet 39 weeks pregnant. Inducing labor prior to 39 weeks is not considered a healthcare best practice as the developing baby’s lungs and brain need all the time they can get to fully grow before birth. Even though the rate of early elective deliveries at Parkview Huntington Hospital was 0.4%, well below the national benchmark data of 3%, the Lean Team set a goal to eliminate all elective deliveries (without medical indication) prior to 39 weeks.

Results

When the team began to research the issue with guidance from Purdue Healthcare Advisors, it found that the hospital had no requirements in place for physicians to meet medical or obstetrical indications for early induction of singletons or for scheduled C-sections.  Medical indications would include a placenta separating from the uterus; an intrauterine infection; pregnancy-caused high blood pressure; water breaking with no contractions; a growth problem for the baby; or other health problems such as diabetes or Rh disease.

The team found that physicians have used the practice of early induction as a convenience for themselves and/or their patients (to promote patient satisfaction), and that there was no “hard stop” or policy to prevent the practice.  To create that “hard stop” and to build buy-in for prevention of early elective inductions, the team recommended that the hospital 1) implement policies that required a medical indication for singleton elective deliveries; 2) develop a scheduling process that required approval by medical officers for all early elective deliveries prior to 39 weeks; and 3) educate staff, physicians and patients on the risks to babies from early induced deliveries.

The hospital enacted the team’s recommendations and, since the plan was implemented at the end of 2012, Parkview Huntington Hospital has not experienced any additional elective deliveries prior to 39 weeks without medical indication.

Customer
Family Health Clinics in Carroll and White Counties
Goals

To achieve Patient-Centered Medical Home (PCMH) Level 2 recognition.

Results

Purdue University’s Family Health Clinics in Carroll and White counties became the first nurse-managed clinics in Indiana to be recognized by the National Committee for Quality Assurance as Patient-Centered Medical Homes (PCMH). Daniel J. “Jim” Layman, executive director of both clinics said PHA was instrumental in working with clinic leadership to ensure a patient-centric approach.  See full story.

Customer
Harrison County Hospital
Goals

Administrators at Harrison County Hospital, a Critical Access Hospital in Corydon, Ind., had a problem with supply delivery to nursing departments. They had been grappling with a new software system and the way it generated re-order lists for items charged to patients, such as feeding tubes, IV fluids, needles, catheters,  wound dressings and the like. Bad weather was exacerbating the problem by causing issues with supply delivery, so Purdue Healthcare Advisors (PHA) was called in to help the hospital in early 2014 to better understand why supplies kept getting depleted.

A Lean Team was formed at the hospital consisting of the materials manager, three nursing managers (from the ER, ICU/TCU, and Med-Surg), two floor nurses, and two central supply techs. PHA guided the team in creating their project charter, educated the team on Lean philosophy, explained 5S, and helped them work through their current-to-future state workflow. Team Leader Denise Mathes, the hospital’s Materials Manager, said, “Having the floor nurses on the team made all the difference because we got to see their point of view and they began to understand the challenges we were facing in getting them the supplies they needed.”

The team focused its efforts on three departments and also added the Respiratory Therapy and the PICC cart. They discovered that the re-ordering process in the new system depended on the 100% accuracy by the person ordering. Delays in receiving supplies forced the central storage staff to make multiple trips to the units and to adjust the orders manually with paper lists; and it led to hoarding/hiding supplies by each of the nursing departments for fear they would not be there when needed.

 

Results

Implementation of the Lean Team plan began in May and by July the positive feedback was overwhelming.  The plan started with a 5S organization project in which they filled ten tables with supplies that the floor staff had shoved in cabinets throughout the units. Using Lean tools such as color-coding and item separation, the team made the supplies easier for nurses to find, and was able to reduce the steps necessary to re-stock the units from 11 to 5. Central storage has not had to make any further manual adjustments but continues to monitor the supply flow through documentation of how often nurses request additional supplies on nights and weekends as well as a call log for daytime requests. Trust between the nursing staff and central storage has been restored.

 Because the changes are working so well, the hospital plans to expand their Lean initiative to three other departments: the OB unit, Surgery and Wound Care. Central storage also has taken over the ordering of much of the non-chargeable supplies (i.e. soap, lotion, toothbrushes, tissues, etc.), which has lessened the workload of nurses so they can spend more time with patients.

Narrow your results

Improvement Areas:
Organization Types:

 

 Linkedin Icon  PHA eNews sign-up  

 

Purdue University, West Lafayette, IN 47907 (765) 496-1911

© 2014 Purdue University | An equal access/equal opportunity university | Copyright Complaints

If you have trouble accessing this page because of a disability, please contact Purdue Technical Assistance Program taphelp@purdue.edu.