Improving the patient experience tops lean goals for Indiana's Critical Access and Rural Hospitals

Wednesday, August 31 2016

Mark Clare, PHA's Principal Advisor, presenting at the Aug. 18 eventThe day-long "RIEs in Review" presentation and networking event on Aug. 18th at the Ivy Tech Corporate College and Culinary Center was hosted by Purdue Healthcare Advisors (PHA) and the Indiana State Office of Rural Health (INSORH), the latter of which provides funding for the initiative through the Medicare Rural Hospital Flex Grant Program. From 2015 until 2018, PHA is charged with working with each hospital to develop "lean-thinking" leadership; utilize value streams for a systematic approach to improvement; and improve care delivery while reducing cost.

"The Critical Access and Rural Hospitals in Indiana aren’t afraid to do what it takes to ensure a better overall patient experience," said PHA Director Randy Hountz. "Each hospital lean team has worked aggressively to make the first year of the three-year Lean Healthcare Transformation Initiative count." During the event, PHA's Senior Advisor for Process Improvement Brian Hudson who oversees the initiative's quality-improvement training, coaching and project facilitation, explained that each improvement effort began with a Value Stream (VS) Session; then trained hospital staff to run Rapid Improvement Events (RIEs); and continued by initiating Lean Daily Improvement (LDI) activity at the front line of care.

Members of the lean teams involved in the work presented their findings and key takeways, which included the following comments from team members:

  • During the communication huddle, I was surprised to hear information that I otherwise would not be aware of to better care for our patients.
  • It was very interesting to see with better communication and a few quick fixes this issue could be improved drastically or even eliminated.
  • We learned that many people are involved in the process to insure precertification is obtained  (for an outpatient procedure) and that it begins before the patient arrives on the day of service.
  • During the lean sessions, having input from other departments looking at things a different way helped to improve flow of the emergency department.
  • Keeping an open mind and be able to look ‘outside the box’ was important. We learned not blame staff/ people because more times than not the issue is with the process. When variation is identified it is not to the fault of any one individual, but rather a breakdown of the system.
  • I initially felt it was nursing that should have the most say in developing a workflow for these infusion patients.  However, not long into the process I began to realize how much different disciplines effect each other during every stage of the outpatient infusion therapy. We found that registration either effected, or was effected by, every decision we were faced with making.
  • We appreciated the simple visualization of the process map as there are many steps that we just do automatically and we do not always think about these little pieces of the puzzle because we just do them every day
  • The value stream session helped unify the hospital in its mission for this project and the related strategic goals. Specifically, it helped to create accountability to individual departments (including front line staff) on how they directly impact the revenue cycle.

Value Stream Mapping at Putnam County HospitalSt. Vincent, Jennings Lean Team Huddle    Harrison County Hospital  LDI board


Many of the projects chosen involved the desire to improve the patient experience, and included efforts to reduce patient wait times from registration through to discharge. The following table lists the focus area chosen by each hospital during its Value Stream session:

Value Stream Focus Areas
Hospital Location Focus Area
Cameron Memorial Community Hospital  Angola, Ind. Process from Emergency Department (ED) arrival to discharge from Med/Surg for inpatients
Decatur County Memorial Hospital  Greensburg, Ind. Improving the patient experience in both hospital and medical practice registration areas
Fayette Regional Health System  Connersville, Ind. Improving the prior authorization process in the Geri psychiatric unit
Franciscan Health Rensselaer  Rensselaer, Ind. Decreasing the time from the ‘decision to admit’ until the time the patient was admitted to a bed in the inpatient unit
Greene County General Hospital  Linton, Ind. Improving the workflow associated with the revenue cycle from the time of physician order through payment of the account
Harrison County Hospital  Corydon, Ind. Improving patient flow, volume, and improve timeliness of care in the ED
Pulaski Memorial Hospital Winamac, Ind. Improving the medication reconciliation process for patient safety; improving patient and associate satisfaction and reducing errors during the registration process.
Putnam County Hospital  Greencastle, Ind. Increasing the number of patients who were contacted prior to arrival as part of the workflow processes in central scheduling/registration
Rush Memorial Hospital  Rushville, Ind.

Increasing the volume, reducing the denial rate, and improving departmental productivity through the Infusion Clinic

St. Vincent Jennings Hospital North Vernon, Ind. Improving patient wait times in the Immediate Care/Occupational Health department
St. Vincent Mercy Hospital Elwood, Ind. Improving the patient experience as they move from presentation to discharge for infusion therapy
St. Vincent Salem Hospital Salem, Ind. Improving patient throughput in the ED
Woodlawn Hospital Rochester, Ind. Improving the patient overall experience to improve satisfaction scores


Indiana State Seal

Photo caption / above right:  Mark Clare, Purdue Healthcare Advisors' Principal Advisor for Strategic Initiatives, introduces PHA's new coaching/training options at the Aug. 18th "RIEs in Review" event.
Photo caption / middle row left:  Value Stream mapping by lean team at Putnam County Hospital.
Photo  caption / middle row middle:  The lean team at St. Vincent Mercy Hospital huddles during an RIE.
Photo  caption / middle row right:  The Lean Daily Improvement Board at Harrison County Hospital.

Writer: Jeanine Parsch, 765-337-7047,

Tags: Process & Cost Improvement (Lean)

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

© 2019 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