Operational Improvements Lead to Top Line Revenue
Background
A community hospital in North Carolina was struggling with excessive delays in getting the patient to see the provider, a high walk out rate, low patient satisfaction and a lack of sustainable department leadership. The emergency department sees approximately 53,000 annual visits and serves as the only hospital in the community. Blue Jay Consulting was retained to provide a combination of performance optimization and interim department leadership services.
Approach
Blue Jay Consulting performed an assessment to examine the challenges and understand the culture at this state of the art facility. A dual approach was utilized to turn the department around. The first approach consisted of providing stable and consistent departmental leadership. As a result, staff performance expectations were established and staff was held accountable to the expectations. Additionally, a core staffing pattern was created and changes were made to staffing skill mix and scheduling practices.
The second approach, performance optimization, was initiated by establishing a steering committee and oversight team. These teams were responsible to design, implement and communicate the needed changes. The team identified the following process improvement projects:
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Redesign of the triage process |
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Implementation of ESI 5 level triage |
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Immediate bedding |
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Redesign of the registration process to include bedside registration and a quick registration process |
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Standing orders/protocols |
Critical to the success of the project was communication, transparency and the development of metrics. Communication was emphasized through monthly staff meetings, the implementation of shift huddles and the creation of project newsletters and postings. In an effort to be transparent to the community, a written communication was sent to all community providers and flyers explaining the new processes were made available to all patients. Metrics, relative to the process improvement projects, were developed and goals established. The metrics were monitored daily and shared with all ED staff. Blue Jay Consulting served as a facilitator and project manager for the performance optimization project and provided onsite assistance and guidance.
Results
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Arrival to triage times were reduced from 19 minutes to 6 minutes (68% improvement) |
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Arrival to room times went from 82 minutes to 29 minutes (64% improvement) |
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Arrival to provider from 104 minutes to 45 minutes (57% improvement) |
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Walk out rates from 6.4% to 3.1% (52% improvement) |
These improvements allowed the hospital to treat 4.69 additional patients per day, with 0.77 additional admissions per day. Financially the organization will realize over $2,000,000 in additional annualized revenue because of these initiatives.
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