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Lean helps hospital and its rural medical center standardize processes together

Thursday, October 29 2015

When Pulaski Memorial Hospital established a rural health clinic with recently acquired independent physicians and nurse practitioners, the Winamac, Ind.-based critical access hospital’s administrators began to realize that the hospital and rural medical office building staff needed to work together as a team to standardize processes.

Purdue Healthcare Advisors (PHA) was engaged to initiate a Rapid Improvement Event (RIE) focused on order processing between the hospital and clinic.  PHA spent several days on-site educating the newly formed, ten-member Lean Team on lean principles prior to guiding them in defining their project charter. The team agreed to focus efforts on more complex diagnostic testing orders including magnetic resonance imaging (MRI), computerized tomography (CT), and nuclear medicine. 

“As we discussed what we wanted to achieve from the Lean project, the team agreed to focus on things that brought value to the patient, such as reducing the amount of time patients waited prior to diagnostic testing,” said Patient Administration Director Peg Madsen. “We wanted to eliminate the possibility for insurance precertification errors that would delay testing, and we wanted to improve the process from the time patient arrived at the hospital to the time their testing was complete.”

That meant orders for diagnostic testing needed to be precertifed and those “precerts” needed to match the actual procedure the patients received when they arrived for the test.  If not, this caused test delays for the patient and potential insurance denials of payment.  Patients also needed timely pre-testing prep instructions (what not to eat, what meds to stop, etc.).  Challenges included different computer systems in the hospital and clinic as well as orders not readily accessible to multiple departments.  The team used a lean tool called a SIPOCS to identify suppliers and customers, and to produce baseline measures and goals. A swim lane diagram helped visually distinguish job duties and responsibilities in the process.

As implementation got underway, initial solutions identified the need for the timely sharing of physician orders between departments, which required the purchase of a desktop scanner for the precertification area.  Improving software functionality, however, was not so simple and required significant assistance from the IT administrator, who was added as a permanent member of the team.   The IT administrator worked closely with the providers and clinic patient information system professionals to create system prompts and large fields for free-form text in the clinic’s software order system.  Now the system prompts the physician for contraindications, such as possible allergies associated with test dyes, and physicians were able to add additional comments to clarify their orders for the scheduler and diagnostic lab personnel.

As a result of the improvements, patient registration time at Pulaski Memorial was reduced from 6 to 4.5 minutes on average; wait times in the diagnostic lab dropped from 19 to 5.8 minutes average; and precertification errors went from 36 down to 2 during the revenue cycle. Overall patient satisfaction for the procedures rose from an average of 71% to almost 90%. Since the completion of this lean initiative, process improvements have expanded to diagnostic testing orders involving ultrasounds and mammograms. 

Writer: Jeanine Parsch, 765-337-7047,

Tags: Process & Cost Improvement (LEAN)

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