“Do more with less” is a common healthcare industry directive, but leaders of this Vermont acute care hospital wanted a more tangible, sustainable path to healthcare excellence in challenging times.
North Country Hospital has served its rural Vermont area since its founding in 1919. Like most healthcare organizations, North Country faced significant challenges in the healthcare industry, including unprecedented cuts to reimbursement and a decrease in volume due to patients postponing expensive, elective tests and procedures – all while patients, insurance companies and Medicare/Medicaid began demanding evidence of quality outcomes.
North Country responded to these challenges with investments in its IT infrastructure, cost reductions, service enhancements, and a renewed focus on quality and safety. However, the CEO explained to staff, “I do not believe it is sustainable to simply tell people to ‘work smarter’ and ‘do more with less”. He went on to note that he had convened a Quality Improvement Council from multiple areas of the hospital to explore nationwide best practices in healthcare quality and efficiency improvements. The team’s research concluded that the most successful hospitals had one common characteristic: a Lean methodology for solving problems, reducing errors, eliminating waste and improving efficiency.
Lean Boot Camp Education
QHR consultants conducted on-site education and training on Lean methodology for hospital leaders and managers.
Engagement methods were selected to match the strengths, needs and contributions of each employee group. Physicians were engaged as decision makers on the quality steering team, and later as project champions. Managers were engaged with the tools and measures to ensure departments were meeting daily goals and highlighting process problems early. Front line staff was engaged through participation in two-minute huddles at the start of the shift to clarify the operational plan and the improvement focus for the shift. In addition to the daily improvement focus within departments, the staff selected for rapid improvement teams were able to “learn by doing”, further expediting engagement in a targeted area.
Guided by QHR consultants, North Country restructured its multiple quality oversight committees to become one organizational steering committee, co-chaired by the chief of the medical staff and the CEO. This structure allowed prioritization of select improvement events to meet the hospital’s strategic objectives and to drive crossfunctional process improvements.
Multiple Rapid Improvement Events
Three rapid improvement events have been completed: clinic process for addressing patients who do not keep appointments, inpatient discharge process efficiency, and supply chain improvements. Facilitators and teams identified stakeholder needs, spent time observing the current state, mapped the process, and addressed barriers to achieve outcomes.
Since the adoption of a Lean approach, North Country Hospital has experienced significant, positive changes. “Huddles” take place in departments and among senior leaders to proactively attend to daily operations as well as to plan for incremental improvement. Improvements are tracked on departmental Performance Improvement Boards.
As a result of improvement events, there is now a structured approach to scheduling appointments, confirming appointments and for outreach to patients who miss clinic appointments. In the inpatient area, early nurse/doctor bedside rounds improve communication about patient needs, and structured daily inpatient rounds with the care team facilitate the healing process and increase patient readiness for discharge. Equally important, the North Country Hospital team is learning to lead its own improvement projects as knowledge transfers from QHR facilitators to project champions and leaders.