Improvements Across the Continuum of Care at a National Top 10 Academic Medical Center

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1 Improvements Across the Continuum of Care at a National Top 10 Academic Medical Center A national top 10 academic medical center and leader in healthcare innovation engaged Tefen to improve the efficiency and effectiveness of patient care delivery for neuroscience and orthopedic inpatients by optimizing patient placement and flow throughout the hospital and to improve safety, compliance and service levels throughout their medication management process. Challenge Similar to many academic medical centers, the hospital was faced with a variety of challenges including: Decreasing patient satisfaction and staff satisfaction Increasing costs with a high cost per case structure and decreased third party reimbursement Facility and capacity constraints combined with increasing patient volume Increasing medication errors with long unacceptable turnaround times for orders How Tefen Helped Tefen utilized a hands-on participatory and phased approach to addressing our client s operational challenges. This phased approach consisted of a diagnostic and implementation. The diagnostic phase focused on the detailed analysis of the Current State of the operations and the root causes impacting performance. Throughout the diagnostic, Tefen partnered and facilitated cross functional work groups in operational analysis of the Medication Management processes and the Neuroscience and Orthopedic departments. These core work groups observed activities throughout the pharmacies, nursing units, physician and interdisciplinary rounds, conducted surveys, interviewed employees, and performed key data analysis to support and quantify opportunities.

2 Upon completion, Tefen found hidden capacity in the hospital s current systems and processes including, inefficient use of resources, gaps in communication, lack of standardization in care provided, and poor data integrity. Once the key opportunities were identified and quantified, Tefen worked with key client stakeholders to develop a detailed implementation plan. To maximize the quality of patient care and the hospital s investment, Tefen prioritized these improvements and partnered with the hospital to develop and lead cross functional improvement teams focusing on implementing solutions in 3 key areas: patient management, patient placement, and medication management. Patient Management: Coverage and Communication: Tefen shadowed and quantified the coverage patterns and inpatient time contributions of all orthopedic and neuroscience patient staff. Recommendations were implemented to eliminate communication gaps around patient planning and restructure the communications between Physicians/Surgeons, Hospitalists, Residents and other Physician Extenders, Nursing, Case Management, Ancillary Services and Support Staff. Active Discharge Management: Tefen worked with physicians and staff to identify the critical path of the patient stays for high-volume diagnoses and standardize best practices. Solutions were developed and implemented to manage the patient Length of Stay prior to admission, increasing interdepartmental communication and setting patient expectations throughout the hospital stay aimed to reduce the length of stay (LOS) for neuroscience and orthopedic inpatients. The improvement teams developed and implemented user-friendly visual management tools to track LOS performance and improve coordination for more effective and informed decision making. Highlights of the work included: scripting the patient experience, defining agreed upon roles and responsibilities, streamlining the discharge process, and tracking metrics for auditing progress and identifying additional improvement opportunities. Ancillary Services: Tefen prioritized services for improvement which would have the greatest impact. Pilots were completed to restructure the services offered and prioritization guidelines were implemented to maximize the quality of patient care, optimize resource utilization and minimize discharge delays. Tefen also worked with the hospital s IT department to streamline data entry actions and create automated metrics used to pro-actively drive performance and continuous improvement long after project completion.

3 Patient Placement: Room Turnover: Diagnostic analysis found that the average room turnover process lasted 3-4 hours from patient wheels out to wheels in. The improvement team developed a new communication pattern with oversight and accountability to significantly reduce downtime between patients. Room cleaning procedures were developed and standardized in accordance with infection control requirements. Staffing was restructured to promote flexibility and allow for transportation and cleaning to be completed simultaneously. Centralized Placement Kaizen Events: Tefen designed and facilitated a powerful series of kaizen events to streamline the patient flow process prior to the implementation of a new bed management software system. Key players throughout the hospital took part in creating a new centralized patient placement process which eliminated redundant decision steps, minimized competing interests, and utilized a pull system to bring patients to the units. Bed Management Software Selection: Tefen participated in the development of an RFP to assist the hospital in the selection of a new bed management software system. Tefen s expertise assisted with the objective evaluation and selection of the most appropriate system to meet the hospital s individual needs. Medication Management: Order Fulfillment: Tefen began by performing a cost-benefit analysis of the vendor managed inventory system used by the hospital and found the current rate of order fulfillment was not in line with the hospital pharmacy service level goals. In its place, Tefen recommended using in-house picking which eliminated batching and was more cost effective. Additionally, communication channels were renewed between the vendor and the hospital pharmacy with on-site visits and the service level to patients and staff increased. The improvement team optimized the use and application of the institutions Pyxis System and optimized the Medication Management process from order to drug administration. This included the frequency of deliveries and centralized drop-off locations for all patient medications in addition to implementing a simple visual medication delivery signal to reduce inefficiencies and eliminate errors in the medication administration.

4 Inventory Management: In the main pharmacy, Tefen created a list of fast-pick drugs, defined par levels according to usage, removed unnecessary inventory to increase capacity and sorted equipment and supplies. These implementations increased service, compliance, and lowered cost. Within the main pharmacy and across the multiple satellite pharmacy locations which required inventory optimization, Tefen revised the drug list, set Pyxis par levels according to usage and implemented a kanban system to signal appropriate inventory replenishment quantities. Staffing/Resource Management: Tefen performed time studies along with statistical data analysis of demand trends by hour of day, day of week to complete a comprehensive staffing gap analysis. New shift patterns were developed, eliminating unnecessary shifts and creating a floater coverage pattern to meet the hospital s needs for flexibility. Results Achieved Tefen s participatory, phased and data driven approach which partnered with client personnel including Sr. Management, clinical, non-clinical staff and physician leadership resulted in achieving significant results in inpatient flow and medication management. Inpatient Flow: Discharge before noon nearly doubled from 19.2% to 37.2% of Neuroscience inpatients Patient satisfaction scores for Nursing improved from the 20th 30th percentile to 80th 90th percentile Room turnover delays decreased by 45 minutes Orthopedic average LOS decreased by 0.82 days Spine average LOS decreased by 1.4 days Total capacity improvements equated to an increase of $3.6 million in annual revenue

5 Medication Management: Technician order fill time was reduced by 30% Reduced inventory in satellite locations by 30% Improved service levels and reduced sorting time by 40% Pharmacy improvements totaled $510K in annual cost savings Tefen s expertise across the continuum of care increased capacity and decreased costs, while improving patient satisfaction and developing a culture of sustainable continuous improvement. About Tefen Tefen is an international management consulting firm, committed to improving overall operational effectiveness for Fortune 500 companies around the world. The firm s main areas of focus include operations excellence, manufacturing, quality, customer service, research and development and supply chain management. With its hands-on approach philosophy, the company has achieved tremendous success in delivering quantifiable and value-driven results for its clients in a variety of industries, including healthcare, life sciences, general manufacturing, high-tech and financial services. All of Tefen s support programs are ISO 9001 certified. Tefen currently employs over 300 professionals worldwide. For additional information, please contact: Cristina Priamo, Marketing Associate Tefen USA (646) cpriamo@tefen.com