The benefits of improving patient flow go way beyond reducing wait times. While most healthcare administrators tend to focus on reduced diversions (in the ED), elopments, elective surgery cancellations, improving flow can positively impact quality of worklife for physicians, nurses and staff . This can in turn have a very positive impact on patient satisfaction and quality of care.
Here are top 5 tried and tested strategies used to improve flow.
1. Evaluate and monitor bed status in Med surg and Intermediate care units continuously – Don’t sweat the small stuff, the biggest bottleneck for patient flow is mainly in these units. In any acute care hospital, when you hear ‘we don’t have beds’ that usually means there are no monitored beds. So focussing on these units instead of the rest of the house helps. Also, these are the units where there are lots of activity during the day (usually not captured in midnight census which is used to measure occupancy usually). Increasing bed capacity in these units will help flow greatly.
2. Minimize transfers: Again this is counter intuitive but if you actually observe data you will see that transfer consume the most resources (beds, staff, environmental services etc). So do it right the first time and put patients in the right level of care. This can also reduce your insurance denials and impact finances positively.
3. Create an admissions unit to reduce stress on your ED: If your diversion hours in the Emergency Department and admission times are hitting the roof, you know you are in crisis. For quick relief create and admissions unit to keep the ED rooms/beds turning over quicker than usual. The admissions unit can focus on tracking and expedite flow to different units while the ED focuses on providing emergency care and evaluation.
4. Create a discharge lounge : Add a checkout lounge with a coffee bar and flat panel tvs to move patients waiting for a ride, so the valuable beds can be turned over to accomodate other patients. This will also impact patient satisfaction positively.
5. Airlines style surge staffing with demand: Use the airline model when it comes to staffing. Airlines tend to staff proactively during peak hours (and don’t worry about productivity in the short run).Also rememeber this does not only mean nursing staff. This applies to support staff as well. If you don’t have adequate environmental services staff for instance, there is not chance of beds opening up quickly on discharge. Moreover, support staff don’t cost much but are an asset in opening up beds.
British Healthcare system
The National Health System(NHS) is the publicly funded healthcare system in the UK. The NHS provides the majority of healthcare in England, including primary care (such as general practitioners), in-patient care and long-term healthcare. NHS hospitals are increasingly competing with other private health systems and facing financial difficulties.
Lean applied in Birmingham Heartlands hospital
Recently, the NHS health system and other health systems have adopted ‘lean principles’ that evovled from the Toyota production system to reduce waste. They are primarily focussing on clinical areas such as emergency departments but plan to use it ancillary areas, pharamcy and other support functions.
They have also come up with innovative solutions such as using Nurse practicioners in the ED to treat low acuity patients . They have been able to reduce the number of patients waiting from over 40 to less than 10.
5s is a methodology developed in the toyota production system from which lean thinking derived. The 5s system is perhaps the most easily applicable and adaptable tool of lean in healthcare setting. It’s also a tool that can deliver real results impacting both quality of care and the bottomline quite dramatically. If you are not convinced yet, let us consider this…
Benefits of 5s
If we had applied 5s to all of america’s Inpatient units in 2005, and reduced just 5 minutes from a patient’s length of stay. that would amount to approximately 135,985 days of care reduced. I am not going to venture a guess on the amount of lives saved . But it would be easier to do the math on the financials and if you are so inclined you will see a obscene amount of dollar savings.
When done well, it can deliver even better results. Let us examine the methodology and then we will look at the ‘done well’ part.
The 5s method has 5 steps to implement Sort (Seiri): This refers to the sorting through all the charts, supplies, equipment and meds etc., in the work area and keeping only essential items. Everything else is stored or discarded. This leads to fewer hazards and less clutter to interfere with productive work. Straighten (Seiton): Focuses on the need for an orderly workstation. Charts,Forms and other equipment must be systematically arranged for the easiest and most efficient access. There must be a place for everything, and everything must be in its place. Shine (Seiso): Indicates the need to keep the workplace clean as well as neat. This is a daily activity. At the end of each shift, the work area should be cleaned up and everything is restored to its place. Standardize (Seiketsu): Allows for control and consistency. Basic housekeeping standards apply everywhere in the facility. Everyone knows exactly what his or her responsibilities are. House keeping duties are part of regular work routines. Sustain (Shitsuke): Refers to maintaining standards and keeping the area safe and efficient order day after day, year after year
Where to start?
Start looking at your most busy areas and just take pictures, you will be amazed at the amount of clutter you find around you. Specifically take a look at your Nurse’s station, Physician work areas, Operating rooms, Triage, Registration and Patient bedsides. Start a 5s program today and reap it’s rich benefits.