UHHS unveils Operational Excellence program to reduce waste, increase quality
By Bruce Coleman
Whether trimming waste from the supply chain or eliminating redundancies of effort among the workforce, in corporate America today, thin is most definitely in.
That concept is crucial for organizations as robust as University Hospitals and Health System, which functions on a razor-thin margin in a challenging health-care climate. Add a layer of complicated governmental requirements from a national health-care law with an uncertain future, and the prospects for an economically viable enterprise become all the more difficult.
A new program launched by UHHS administrators this spring promises to keep the institution ahead of the curve in waste-reduction strategies.
Operational Excellence is a bare-bones training program modeled after lean initiatives which have become widely popular in the country’s manufacturing industry, especially during the recent economic downturn. Born out of the automobile industry’s efforts to streamline operations during the 1950s, the program seeks to increase efficiency and profit margin.
According to Michael Korpiel, UHHS chief operating officer, Operational Excellence is the right initiative at the right time for the organization.
“In an era of health care when we have decreasing revenues from the private sector and from government programs, more uninsured patients and continually rising costs for services, we have got to eliminate waste out of our system,” Korpiel said. “That’s what this program is designed to do: deliver the greatest product to our patients at the best price that we can.”
But translating a manufacturing paradigm to a health-care organization is not always a perfect fit. Korpiel is quick to point out that Operational Excellence is intended for UHHS’ operational side only.
“Lean is not the answer to everything in the hospital,” he said. “Dr. (Michael) Baumann, our chief quality officer, does a great job of looking at clinical quality and clinical outcomes to gain performance improvement on the clinical side.
“We want Operational Excellence to develop improvement on the operational side: patient flow, how we handle supplies, how we register patients, how we move things from Point A to Point B. The idea is to mirror what we’re doing in performance improvement on the clinical side.”
To that end, Korpiel selected a team of hospital educators and operations staff trained in lean principles to tailor the Operational Excellence program specifically for the institution. The critical element was how best to introduce the concept to UHHS employees.
“Our challenge was to change the way our employees think about cost savings and efficiency,” Korpiel said. “Historically, employees think it means people will lose their jobs, that we’re only interested in cutting costs and that we’re not as interested in outcomes.
“With our program, we’re making sure outcomes are better than they were. We’re not getting rid of people. We’re improving the process, improving the system to make things better for the patient.”
After meeting success with initial pilot programs in the adult emergency room at University Hospital-Lexington and in Interventional Radiology – where inventory in the supply storage rooms was streamlined so effectively that the department didn’t have to replenish them for two full months – the lean initiative was officially launched.
Cindy Hartman, information technology solutions consultant in the Division of Information Systems, spearheaded the effort to educate employees about lean processing, and three groups were selected to go through OPX training to learn the methodology and apply it to their respective units.
“We asked people to submit their ideas for performance improvement in their units,” Korpiel said. “We selected people we felt were most committed to going through the eight-week training program and, after training was over, were willing to be advocates for lean processing.”
One such advocate is Cissy Bailey, nurse manager on 5 North, who brought together a team from 5 North and the Supply Chain to conduct an audit of supply areas to decrease PAR levels and eliminate rarely used items.
As a result, she said the project allows more space for needed items and decreases the likelihood of supplies expiring before they are used.
“More education has been provided to staff in addition to educating the physicians on using the system,” Bailey said. “Our compliance rate with charges started at 38 percent and has increased to 48 percent since implementation of the program.
“I feel Operational Excellence is a valuable tool to decrease waste within our facility. With this program, we use the ‘5 Why Analysis,’ which makes us all stop and think why we are being wasteful.”
Cindye Fava, technical supervisor in clinical lab administration, led a lean initiative that focused on making the lab’s Point of Care Area more cost-effective while ensuring compliance with required guidelines.
“We are in the process of developing a system to follow the entire (Point of Care Area) process, from requisitioning the product to testing performance to reporting and billing,” Fava said. “There were breakdowns in each of these procedures.
“By using this as a project in the Operational Excellence program, we have had cooperation from departments and individuals involved in the Point of Care Program. This program can be a great asset to the hospital as we focus on providing quality patient care and operating under budgetary guidelines.”
Sharon Poyadou, nurse manager on 2 North, is leading an OPX team that is looking to introduce a new staffing initiative.
“We are looking at ways to change how we assign our nurses to patients by utilizing one nurse that will not take a patient load, but will be available to assist the other nurses with some of the more routine tasks that must be completed,” Poyadou said. “The ‘floater’ would also have a set of tasks to be completed in addition to helping the other nursing personnel.”
Although this staffing arrangement has not yet been implemented, Poyadou anticipates it will help nurses who have patient assignments complete their duties in a timelier manner. She said that will increase patient and employee satisfaction and decrease the amount of overtime nurses need to catch up on documentation.
“Operational Excellence is simply a common-sense approach to solving a problem,” Poyadou said. “You define the issue, drill down to the root of the problem and develop a process for improvement.
“It also gives staff ownership by allowing them to come up with a solution or process that will best meet the needs of their unit, and it will be a useful tool when working through process issues that involve several different departments.”
Staff ownership of OPX is one of the program’s greatest strengths, according to Korpiel.
“Once they go through training and do a project, then they’re sold,” he said. “They recognize how much easier their lives are by doing this.”
UHHS leaders are hopeful that recognition is contagious enough to make a substantial impact on UHHS operations.
“Our goal is that, over the next four years, we have a significant amount of people who have gone through training, understand the methodology and are certified as having some level of training so we can change the culture and become a more efficient organization,” Korpiel said. “Ultimately, we want to be recognized as a lean facility within (that time).
“My expectation is that we’ve got to reduce cost, improve revenue and improve both patient and staff satisfaction. That’s really what our main focus is. We’ve just got to be able to do things in a big, bureaucratic system much more efficiently so people aren’t going to have to work so hard to get things done.”