Year 2: Value Stream Management

Lean teams from participating Indiana Critical Access Hospitals (CAHs) and Rural Hospitals (RHs) gathered in Indianapolis on August 17th for an event showcasing their progress during the second year of the three-year Lean Healthcare Transformation Initiative. The initiative, which began in 2015 under funding from Indiana State Office of Rural Health (INSORH) through the Medicare Rural Hospital Flex Grant Program, pairs Purdue Healthcare Advisors (PHA) lean coaches with hospitals to improve care delivery while systematically reducing cost.

Entitled “Walking Along the Value Stream,” the event kicked off with praise for Indiana’s CAHs and RHs, which were named 8th best in the country by the U.S. Department of Health and Human Services (HHS) in 2017. PHA Director Randy Hountz said, “For the rankings, HHS looked hard at progress on quality improvement projects supported by Federal Office of Rural Health Policy funds. From patient safety to patient wait times to patient satisfaction, the process-improvement projects our Indiana hospitals continue to generate show a high level of commitment to improving the patient experience.” Anne Alley, director of the Indiana State Department of Health’s Chronic Disease, Primary Care and Rural Health Division, agreed, “This is really not too surprising as we take stock of their forward thinking leaders, their dedicated staff, their contribution to community, and their progress in the lean process improvement program.”

Following the initiative's first-year focus on the foundations of improvement management, Year 2 turned its attention to Value Stream Management (VSM), which utilizes value streams for a systematic approach to improvement. With guidance from PHA lean experts, each hospital’s lean team took ownership of their selected value stream(s) (i.e. revenue cycle, patient satisfaction, ED throughput, etc.), identifying opportunities that lead to Rapid Improvement Events (RIEs) and “Just Do It” projects with the goal of maximizing the value created for the customers of each stream.

Cameron Memorial Hospital, Decatur County Memorial Hospital, and Pulaski Memorial Hospital presented for 40 minutes each on the results of their VSAs, which included reduction in the urgent care mean length of stay, improvements in scheduling optimization, and reductions in claim write-offs, respectively. A panel discussion with Putnam County Hospital, St. Vincent Randolph Hospital, Woodlawn Hospital, and Franciscan Health Rensselaer briefly outlined project results and the year’s challenges.

Comments from hospital team members were as follows: 

  • The idea of ownership of a value stream is a major shift for the organization.
  • The tools available to visually see the process from the time our patient calls for an appointment to the time the bill is sent, and to measure the outputs, have been incredible.
  • The arsenal of tools in our toolbox increased significantly through the Value Stream Analysis process.
  • Team members have expressed that reviewing data on paper only tells one side of the story, but actually seeing the data in action gives meaning to those metrics.
  • We are making the commitment to take the time needed for the prep, RIE, and through follow-up so gains are sustained. We actively are looking for opportunities to make improvements rather than waiting for problems to occur and then react.
Lean Team at Cameron Memorial Community Hospital

Lean Team at Cameron Memorial Community Hospital

Lean Team at St. Vincent Randolph Hospital

Lean Team at St. Vincent Randolph Hospital

Improving the revenue cycle was a popular theme for hospitals participating in Year 2, with four hospitals — Cameron Memorial, Pulaski Memorial, Putnam County Hospital and Woodlawn Hospital — concerned about reducing the claim errors that lead to delayed reimbursement and even write-offs. Focus areas selected by the hospitals were as follows:

  • Cameron Memorial Community Hospital – Revenue Cycle and Urgent Care
  • Decatur County Memorial Hospital – Patient Throughput and Experience in Hospital’s Medical Practices
  • Fayette Regional Health System –
  • Franciscan Health Rensselaer – Patient Safety / Discharge Planning & Outpatient Scheduling
  • Greene County General Hospital – Operating Room (OR) Throughput
  • Harrison County Hospital – Laboratory Turnaround Times
  • Pulaski Memorial Hospital – Revenue Cycle
  • Putnam County Hospital – Revenue Cycle for Outpatient Surgical Services
  • Rush Memorial Hospital – Emergency Department (ED) Throughput
  • Vincent Jennings Hospital – Emergency Department (ED) Throughput
  • Vincent Mercy Hospital – Supply Chain
  • Vincent Randolph Hospital – Patient Satisfaction / Outpatient Services
  • Vincent Salem Hospital – Associate Satisfaction Through Addressing Pain Points
  • Woodlawn Hospital – Revenue Cycle

Looking ahead to Year 3, which will focus on Operational Excellence, PHA’s goals involve improving Value Stream Management (VSM) for these hospitals as well as assuring their competency for change-management and their depth of lean expertise. During this final year of the initiative, PHA aims to guide skill development at the enterprise and the value-stream level to build the infrastructure and competency necessary to drive and sustain operational improvement. PHA also wants to assure that participating hospitals build competency to initiate and sustain change management efforts at the enterprise level; and that they have a full complement of developing lean expertise to execute an enterprise lean plan. Year 3 will involve Lean Leadership training, remote coaching and onsite gemba coaching as well as optional PHA-facilitated Rapid Improvement Events (RIEs) and Advanced Lean Practitioner (ALP) training.

Participating hospitals are urged to register their teams before the October 1 deadline.

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