$300,000 Leaner and 97% Happy

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At Portsmouth Regional Hospital in New Hampshire, a team that included members of the radiology department, centralized scheduling, a floor nurse, and the COO entered a room with the goal of improving the satisfaction of customers (including patients, physicians, and nurses). The team emerged, five days later, with a plan to implement eight different kaizen (improvement) events that resulted in savings of $350,000 and in soaring customer- and employee-satisfaction scores. Robert WhiteElizabeth VierraRobert White, MBA, CRA, and Elizabeth Vierra, both of Portsmouth Regional Hospital, described the process on August 23, 2010, in “How Lean Methodology Can Improve Customer and Employee Satisfaction” at the annual meeting of AHRA: The Association for Medical Imaging Management in Washington, DC. What sent the team into action was the fact that overall, 75% of patients were getting into the imaging rooms within 10 minutes. With CT, the figure was 33%. Contending with physicians, nurses, and patients who always seemed upset, the team began by observing the department’s processes by using a stopwatch and writing down the number of steps that it was taking to perform each one. Processes were categorized as direct patient care, indirect care (preparing a room), regulatory (required by the Joint Commission), or one of eight kinds of waste: defects, overproduction (such as preparing contrast for patients not on the schedule), waiting, transporting, inventory, motion, confusion/lack of clarity, and excess processing. The team made use of four kinds of lean tools: applying the five S process (see Getting Started, page 24); drawing spaghetti diagrams, making value-stream maps, and asking the five whys (to find out why someone does something the way that he or she does, ask why, then why, then why, then why, and then why). After making observations (including the fact that the average technologist walked 7.5 miles each day) and collecting data, the team constructed pie charts for each modality to calculate how much of the process was categorized as waste. The team created a value-stream map that identified problems in scheduling, in transporting patients, in the availability of supplies, in name bands that technologists had to scan repeatedly, and in a confusing questionnaire. Next followed a period of idea generation, and each person was asked to illustrate four ideas using crayons and paper. This process resulted in six action plans. Problem 1: Patients were required to fill out a confusing and lengthy questionnaire upon entering. Impact: This took five to 15 minutes to complete, seriously limiting the department’s ability to get patients into an exam room within 10 minutes of arrival. Countermeasures: The questionnaire was condensed to two sides of one piece of paper, and the questions were rewritten for clarity. Problem 2: Supplies were scattered, particularly in the CT area and special areas.
Impact: Technologists (particularly per-diem workers) were forced to rummage through cabinets looking for what they needed, and patients lost confidence in the process. Countermeasures: Managers spent several hundred dollars (the only capital cost for the improvements) on replacing the cabinet doors’ wooden inserts with glass, labeled each shelf, gave each item a place, put someone in charge, and made the staff accountable for order. Problem 3: Name bands were scanned multiple times in exam rooms. Impact: Technologists were spending 30 minutes per month rescanning name bands; this was not just an imaging problem, but a problem affecting the entire hospital. Countermeasure: The department called in the vendor, who did hospitalwide training on how to use the name bands. Problem 4: Many orders were inaccurate. Impact: Of CT exam orders, 70% were inaccurate, resulting in excess work (with an impact on nursing staff of 10 minutes per defect). Countermeasures: An imaging-services reference guide was created and distributed to all referring physicians; the guide was also added to the internal website. “Did You Know” cards were created and were distributed to the relevant departments. Problem 5: There were errors/difficulties in patient transport. Impact: The department experienced delayed turnaround time from order to report; downtime was expressed in empty tables and idle equipment; patients were being transferred in wheelchairs instead of on stretchers, resulting in staff injuries; excess work was created; and patients were being left alone. Countermeasure: A team was developed to find solutions, which are still being developed. Problem 6: In scheduling, the next available exam did not reflect actual availability, exams were scheduled in clusters, and resources for exams did not match appointment times. Impact: Referring physicians were sending patients to competitors, and CT volumes were dramatically higher at 8 and 9 am. Countermeasure: Appointment templates were reviewed and updated, improving the percentage of patients who were delivered to an exam room within 10 minutes of arrival from 33% to 72%. Results, to date, have been impressive. Customer satisfaction, which began at an anemic 47%, soared to 85%, exceeding the goal of 69%. Overall employee satisfaction is 97%, up from 60%.