Hospitals, Health IT

Florida’s Health First streamlines patient flow with Lean management

IT helped enable Lean methodology at Health First, a four-hospital IDN with a health plan in Brevard County, Florida.

When new leadership came on board in 2011 and 2012 at Health First, a four-hospital integrated delivery system and health plan in Brevard County, Florida, the organization suffered from low quality scores, low patient satisfaction and financial difficulties. That changed within three years because the new CEO and COO each came from health systems that had employed “Lean” management principles, which they quickly implemented at Health First.

IT helped enable Lean methodology at Health First. Lean is the philosophy based on the Toyota Production System of continuously striving to improve the customer experience, reduce waste and avoid duplication.

“By using the Lean methodologies or principles, you can do something great,” said Michael Gallup, president of TeleTracking Technologies, a Pittsburgh-based maker of healthcare operations management software. Health First, a TeleTracking customer, did do some great things by streamlining bed management and patient flow.

As reported in a recent Rand Corp. study that TeleTracking sponsored, Health First was, in a three-year period, able to: reduce mean inpatient length of stay by 0.75 days; cut time between admission and inpatient bed occupancy by 37 percent; and halve the time between the emergency department requesting a bed and processing of the bed assignment, from 90 to 45 minutes at its flagship Holmes Regional Medical Center in Melbourne, Florida. This happened despite the fact that Holmes saw a 27 percent increase in admissions, 12 percent higher ED volume and a 300 percent increase in adult patient transfers during the study period, 2012-14.

CEO Steven Johnson, who came on board in 2011, hired Lean expert Bill Griffith to be the first executive director of operational excellence at Health First. “Griffith quickly identified patient flow processes as a key opportunity,” the Rand study noted.

“Individual hospitals within Health First operated as separate units, often transferring patients outside the system. Within each of the four hospitals, nurses had to manually find and assign beds and were not always motivated to take new patients. Busy times, such as changes of shift, resulted in bottlenecks and led to prolonged wait times for inpatient beds for patients admitted from the ED,” the report continued.

Environmental services had a manual process for identifying recently vacated beds in need of cleaning. Patient transport was decentralized. Both slowed turnaround times, leading to ED overcrowding and safety issues, as well as patient diversions that resulted in lost revenue.

“There is a lot of wasted time, a lot of wasted resources,” Gallup said. “There are efficiencies to be found in the system, and they’re game-changing.” (Gallup estimated that the U.S. could save $100 billion or more a year if every hospital in the country made similar changes.)

Health First did have TeleTracking software installed prior to 2012, but it wasn’t implemented properly, according to the Rand review. For example, even though the system could manage bed assignments Health First still had nurses assign beds manually. That changed starting in early 2013. By October of that year, the health system had automated most processes related to patient flow.

Health First created a department called Central Patient Logistics, with nurses overseeing nonclinical employees who manage bed assignments. The center keeps real-time inventory of available beds and beds in need of cleaning, and knows the status of all incoming transfers and admissions at all four hospitals. Management regularly reviews Central Patient Logistics’ performance based on specific metrics and can adjust staffing accordingly.

TeleTracking is interfaced with the Allscripts electronic health record, so admission orders go right into the bed management system. It’s also interfaced with scheduling and ICU systems. “Without these interfaces, the operators would need to spend more time looking for information in other systems to make bed assignment decisions, which might also require that they have additional clinical knowledge,” Rand reported.

Image: Rand Corp.

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