VHA Southeast Bright Ideas by chenboying


									                                                VHA Southeast Bright Ideas
                                          Improving Organizational Strength through Collaboration
                                                        2003 - 2004 Awards Edition

                                                           Congratulations to the winners of the VHA
 VHA Southeast Bright Ideas is a
                                                         Southeast Bright Ideas Awards for outstanding
 newsletter to foster sharing of
                                                         performance within their respective categories.
 improvement ideas within VHA

 Southeast member organizations.
                                                                         Financial/Operational Improvement
                  In This Issue                          Quantifiable change to improve the efficiency, cost structure, or revenue generation of
                                                                                           the organization
                                                                Lee Memorial Health System: Catching the W.A.V.E.
 The Special Edition of VHA
                                                                                           July 2004 Edition
 Southeast Bright Ideas features the

 winners of the VHA Southeast                                                             New Services
                                                         Quantifiable change to improve the revenue generation of the organization through the
 Bright Ideas Awards in each of the                                                    offering of a new service
                                                                         Baptist Healthcare Corporation: Efileshare
 following categories:
                                                                                         January 2004 Edition

         Financial/Operational Improvement                                          Quality Improvement
                                                                         Quantifiable or qualitative change to improve patient
         New Services                                                                outcomes and/or satisfaction
         Quality Improvement
                                                                       Sarasota Memorial Hospital: Coumadin Clinic
                                                                                           May 2004 Edition
         Safety Improvement

         Supply Chain                                                                Safety Improvement
                                                          Quantifiable or qualitative change to improve the safety of patients and/or employees
         Management/Utilization                                        Lee Memorial Health System: “On-Boarding”
                                                                                           July 2003 Edition

         Workforce Improvement
                                                             Supply Chain Management/Utilization Improvement
                                                         Quantifiable savings resulting from standardization and utilization within supply chain
                                                                                     management of the organization
 Entries were evaluated and scored                             University Community Hospital: Teamwork Saves Millions
 by members of the VHA Southeast                                                           May 2004 Edition

 Executive Committee of the Board
                                                                                 Workforce Improvement
 of Directors.                                           Quantifiable or qualitative change to improve the satisfaction of current employees and
                                                                                         attract new employees
                                                                      Sarasota Memorial Hospital: Physician Behavior
VHA improves members’ economic strength through better                                     July 2003 Edition
Patient care, operations and supply management
                                                VHA Southeast Bright Ideas

                                                                                               Award Recipient
                Lee Memorial Health System
                             Catching the W.A.V.E.
    Lee Memorial Health System applies the concepts of lean production to

    healthcare delivery in order to reduce waste and improve patient care.
    The aging of the population, labor           departments; Accounts Receivable,          Emergency Department, which
    shortages, growth of the underinsured        Orthopedics, Emergency Department          contributed to the reduction in
    and uninsured population, reduced or         and Medical/Telemetry.                     admission cycle time by 30 minutes.

    flat reimbursement, unregulated              Employees were trained in “waste           The Medical/Telemetry Department at
                                                 walks” and challenged to identify and      Cape Coral Hospital streamlined the
    operating expenses, and economic
                                                 eliminate wasteful processes,              processing of admission orders from
    instability, are just some of the surges
2                                                practices, and procedures within their     45 minutes to 24 minutes. The efforts
    in a sea of problems threatening the
                                                 work areas. Employees were                 produced savings of $3,909,630,
    healthcare system and the consumers
                                                 empowered to redesign their own            exceeding the system-wide goal for
    who access it. Lee Memorial Health
                                                 work processes, focusing on rapid          Fiscal Year 2003 of $1 million dollars.
    System (LMHS), located in Southwest
                                                 cycles of change that would yield          Several lessons were learned
    Florida has found a way to weather           immediate results. The categories of       throughout implementation. First, the
    the storm by applying the principles of      waste identified fit into one of eight     initiatives must be employee-driven,
    lean production to healthcare delivery       categories; Inventory, Correction,         where they had been largely driven by
    at LMHS through the Waste                    Overproduction, Material or                consultants in the past. Second, the
    Annihilated/Value Enhanced                   Information Movement, Processing,          process begins at the front line and all
    (W.A.V.E.) Program.                          Motion, Waiting, and Capital. (tbl. 1:1)   employees must be involved. The
    In the beginning, LMHS partnered             The efforts yielded incredible results.    teams must be facilitated by dedicated
    with General Motors in their                 Accounts Receivable decreased              coaches who are experienced in
    aggressive quality improvement               system-wide Accounts Receivable            implementation. Facilitation begins
    program, PICOS, to provide training          days from 82.9 to 63 days within one       only after determining the value
    on the concepts surrounding waste            year. The Orthopedics Department at        stream. Most important, organizational
    elimination. Later on, a dedicated           Lee Memorial Hospital streamlined          dedication to continuous improvement
    continuous improvement department            the process of moving post                 is absolutely imperative. For more
    was established. Dedicated W.A.V.E.          anesthesia care patients to an             information, please contact Atil
    coaches use LeanSigma philosophy             orthopedic bed from 33 steps to 22,        Koyuncu, Director of Wave Services
    and tools to focus on identifying and        saving 20 hours of productive              Continuous Improvement Resources
    eliminating waste, non-value added           Post-Anesthesia Care Unit (PACU)           Officer at
    activities, removing artificial variance,    staff time per week. The Emergency         atil.koyuncu@leememorial.org .
    smoothing natural variance and               Department reduced diversion hours,
    striving for continuous improvement in       recovering annualized system-wide
    processes and services. The initial          lost net revenue of $930,800. Bedside
    roll-out of W.A.V.E. included four           registration was implemented in the
                                           VHA Southeast Bright Ideas

                                                                                   Award Recipient
          Baptist Health Care Corporation
    Baptist Health Care Corporation uses Efileshare to streamline the

    patient referral process.

                                                                                                     New Service
    The new referral system at Baptist      of time physician office staff

    Health Care has streamlined the         spends on the phone or faxing

    patient referral process, saved         documents, increasing the overall
    money and produced additional           efficiency of the patient referral

    revenue. The system is hosted           process.

    and provided by Efileshare, a local     Using the referral system has also

    web-based development company           saved Baptist Health Care

    in Pensacola, Florida. Efileshare       thousands of dollars on front-end

    has automated what was                  medical necessity checking of

    traditionally a paper-oriented          claims. An added benefit is the

    process by placing patient              increase in referrals to the

    information such as diagnosis           hospital. The new referrals bring

    codes, needed for referrals on a        more revenue by promoting

    secure server that uses the             outpatient services referrals to the

    Internet for access. Physician          connected physicians. For more

    offices are able to access the          information, please contact David

    information at their leisure when       Garrett, CIO at

    referring patients to other             dgarrett@bhcpns.org.

    physicians or specialty clinics. The

    system has decreased the amount
                                              VHA Southeast Bright Ideas

                 Sarasota Memorial Hospital

                                                                                               Award Recipient
                                     Coumadin Clinic
    Sarasota Memorial Hospital provides convenient care to patients

    receiving coumadin.
    The Coumadin Clinic at Sarasota           finger-stick test to assess the patient’s   complications arise, the patient’s

    Memorial Hospital is a success for        Prothrombin Time (PT) and                   physician is contacted.

    patients and physicians. The clinic,      International Normalized Ratio (INR).        Follow-up care plans and monthly
    under the leadership of Medical           While the patient is waiting for test       results of lab tests are sent to the

    Director Patrick Delmastro, M.D. and      results to return from the lab, an          patients’ physicians so that the most

    Debra Lorshbough, ARNP, has grown         educational video regarding                 current medical information is

    to over 1,500 patient visits per month.   anticoagulation therapy is shown.           available upon visiting their primary

    The staff includes one Registered         Once the lab results have been              care physician or cardiologist. The

    Nurse (RN), two Licensed Practical        returned, the Nurse Practitioner            clinic is very well received by patients

    Nurses (LPN), and one front office        reviews the chart and uses the clinic’s     because it is quick and convenient.

    personnel.                                Coumadin treatment protocols to             The clinic has been popular with

    The patient’s first visit to the clinic   make necessary adjustments to the           physicians due to reduced visits and

    includes an interview and assessment      Coumadin dosage. The frequency of           improved outcomes. Frequent

    performed by Debra Lorshbough,            the patient’s visits to the clinic is       monitoring of the patient’s INR

    ARNP, who is responsible for patient      dependant on the patient’s INR.             through regularly scheduled visits

    care delivered at the clinic. The         Subsequent visits to the clinic include     improves patient compliance with

    patient’s health history and recent       the finger stick test to determine the      anticoagulation therapy. Adjustments

    anticoagulation therapy are reviewed.     current PT and INR. The results are         to medications can be made in a

    Lifestyle issues and the importance of    returned from the lab within minutes        timely manner in order to prevent

    adhering to prescribed therapy and        and placed in the chart for the Nurse       complications leading to hospital

    follow-up care are also discussed.        Practitioner to review. Once the chart      admissions. For more information,

    Once the initial assessment is            has been reviewed, any necessary            please contact April Mason at

    complete, a RN or LPN performs a          adjustments to therapy are made. If         April-Mason@SMH.com.
                                            VHA Southeast Bright Ideas

               Lee Memorial Health System

                                                                                       Award Recipient
                                  “On – Boarding”
    Lee Memorial Health System takes a creative approach in the provision

    of new-hire orientation and employee relationship building resulting in a

    reduction of voluntary turnover rate.                                                                   Safety
    Lee Memorial Health System’s new-        the six Joint Commission Patient

    hire orientation program, “On-           Safety Standards. The program relies
    Boarding” plays a large part in the      on 30 and 90 day surveys of new-

    process of creating a Patient Safety     hires to provide critical feedback

    culture where reporting errors is the    essential to the revision of the

    norm and every event is viewed as a      program to better suit new-hire needs.

    great opportunity to improve. In         Surveys reveal that the environment

    seeking a blameless culture, Lee         Is more conducive to learning and the

    Memorial’s Katie Elkins has found a      nature of the stories allows for better

    creative way of infusing the Joint       retention of the information. New

    Commission’s Six Patient                 employees reported a greater level of

    Safety Standards into the minds of       support with mentoring for longer

    new hires. The program is also           periods of time compared to previous

    credited with an improvement in the      experiences. For more information on

    voluntary turnover rate from 18.4% to    the program, contact Katie Elkins at

    4.9%. The nautical-themed program        Lee Memorial Health System; (239)

    uses creative vignettes and light        335-7260. Additional information

    humor to “navigate” through the          concerning this program as well as

    system, learning and “embarking” on      other work-force strategy materials

    the six adventure islands which are      can be found on CKM.
                                            VHA Southeast Bright Ideas

      University Community Health System

                                                                                           Award Recipient
                       Teamwork Saves Millions
    The Value Analysis Team at University Community Health System improves the

    process by which products are evaluated and purchased, saving the System
                                                                                               Supply Chain
    millions in supply cost expenditures.
    In November of 2003, University         establish a single point of entry for the   trained specifically for participation on

    Community Health System sought the      consideration of new expenditures to        the Value Analysis Team.
    assistance of VHA Consulting            be incurred by the organization; to         One member of each subcommittee

    Services in designing a process for     evaluate changes in products or             also sits on the Oversight Committee

    product selection with the hopes of     procedures resulting in a supply            which meets quarterly to review the

    identifying potential savings           expense increase or decrease; and to        reports from each subcommittee. The

    opportunities. University Community     analyze, evaluate and monitor all trials    Oversight Committee also assists

    Health System contracted with VHA       and evaluations of products leading to      teams with roadblocks and physician

    Consulting Services to facilitate the   the selection of the best product in        issues.

    project, which included all four        terms of clinical and economic value.       The Value Analysis Team has been a

    hospitals in the network; University    The Value Analysis Team includes            success in terms of providing product

    Community Hospital in Tampa,            nine subcommittees and one                  standardization, contract

    Carrollwood Hospital in Tampa, Helen    Oversight Committee. Surgery was            maximization, product utilization

    Ellis Hospital in Tarpon Springs, and   the first of the subcommittees to be        reviews, cost effectiveness review,

    Suncoast Hospital in Largo.             formed, followed by Cardiology,             and review and monitoring of

    The project lead to the formation of    Documentation Management,                   disposable and reusable products.

    the Value Analysis Team. The team       Laboratory, Medical/Surgical,               The University Community Health

    was tasked with establishing a          Pharmacy, Radiology, Respiratory            System has realized $6,115,043 in

    procedure and environment for the       and Support Services. The                   savings to date as a result of this

    timely and appropriate acquisition of   subcommittees are multidisciplinary         project. For more information, please

    supplies, materials and services that   teams whose members have had                contact Debi Martoccio, Vice

    provide the most value in terms of      previous experience in developing,          President of Patient Services at

    clinical effectiveness and economic     implementing and maintaining                dmartoccio@mail.uch.org .

    value. The objectives were to           organization-wide teams and/or are
                                          VHA Southeast Bright Ideas

               Sarasota Memorial Hospital

                                                                                Award Recipient
    Sarasota Memorial enforces a “three strikes and you are out” policy

    when dealing with disruptive physician behavior

    Sarasota Memorial has effectively      demonstrated by the fact that they
    dealt with the issue of disruptive     do not have any physicians

    physician behavior. Dr. Bill           with “second strikes”. For more
    Morgan states that the hospital        information, contact Dr. Bill

    has established a “three strikes       Morgan, at

    and you are out” policy regarding      bill-morgan@smh.com .

    physicians’ behavior that is

    inappropriate, unprofessional or

    disruptive. The policy requires

    that each physician sign a

    document describing the

    behavioral standards expected

    when practicing at Sarasota

    Memorial. If a physician violates

    the policy, then he/she receives

    counseling. After three violations

    of the policy, the physician looses

    his/her privileges. Dr. Bill Morgan

    indicates that their success is
                              VHA Southeast Bright Ideas

                        2003 – 2004 Bright Ideas Awards
                              Honorable Mention
                       The facilities listed below are recognized for their
                         contribution/s to VHA Southeast Bright Ideas.

                        Financial/Operational Improvement
        Baptist Hospital, Inc: Better Pricing on Pharmaceuticals Using the 340B Program, March 2004

8                             Bay Medical Center: SempraCare, March 2004
                         Bay Medical Center: “When Letting Go Works”, May 2004
              Cullman Regional Medical Center: Medical Records Completion, November 2003
                      DCH Regional Medical Center: “Direct Admit” Unit, July 2003
        Lakeland Regional Medical Center: Restructuring Patient Transport Services, November 2003
                    Lee Memorial Health System: Improving Patient Flow, January 2004
               Marshall Medical Center South: Emergency Department Redesign, March 2004
                 St. Luke’s Hospital: Readmit and Mortality Tracking Tool, September 2003

                                          New Services
                       Bethesda Healthcare System: Benefactor’s Pavilion, July 2004
                             Health Central: School Nurse Program, July 2004

                                    Quality Improvement
                      Eliza Coffee Health Group: Over Bed Light Fixtures, May 2004
    Marshall Medical Center: Improved Emergency Department Patient Satisfaction Scores, September 2003
                Mobile Infirmary Medical Center: “Crash Cesarean Section”, November 2003
         Munroe Regional Medical Center: “Protecting Patients One Shot at a Time”, November 2003
            Northeast Alabama Regional Medical Center: Quality Initiative Prompters, May 2004
                             St. Luke’s Hospital: Coumadin Clinic, March 2004
                                VHA Southeast Bright Ideas

                          2003 – 2004 Bright Ideas Awards
                                Honorable Mention
                        The facilities listed below are recognized for their
                          contribution/s to VHA Southeast Bright Ideas.

                                    Safety Improvement
       Baptist Health System, Montclair and Princeton: Improving Medication Accuracy, July 2003
9                   Bay Medical Center: “Alarms: Can You Hear Me?”, January 2004
    Orlando Regional Healthcare System: Improving Emergent Blood Administration Process, July 2003
                                Suncoast Hospital: Alarms, January 2004
    The Villages Regional Hospital: Distribution and Control of Anesthesia Medications, September 2003

          Supply Chain Management/Utilization Improvement
                     Bay Medical Center: Reducing Pharmacy Costs, September 2003
                 Munroe Regional Medical Center: Vendor Standardization, March 2004
             Parrish Medical Center: Reduction in Surgical Stapler Expense, November 2003
                 Parrish Medical Center: Reprocessing of Durable Disposables, May 2004
      University Community Hospital: Standardize Custom Procedural Tray Vendor, July 2004

                                Workforce Improvement
               DCH Medical Center: Planning for Tomorrow’s Workforce Today, July 2004
                  Lakeland Regional Medical Center: Shoebox Brigade, November 2003
           Martin Memorial Health System: S.T.A.R.S. over Martin Memorial, September 2003
                  Munroe Regional Medical Center: CNO/CMO Relationship, July 2003

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