Lean Health Application
for
Small Rural Facilities
Based on the
Experience of First Care Medical Services
Fosston, Minnesota
by
Patricia Wangler
Chief Executive Officer
Produced by: Joey Johnson, Administrative Assistant
“We Are “Small” Demographics”
 206 Employees
 168 FTE’s
 $15,000,000 Annual Expenses
 640 Admissions
 600 Surgical Procedures
 45 Births
 17,000 Nursing Home Days
 590 Home Health/Hospice Admissions
 9000 Service Area Population
So Why Did We Invest?
 Building project and new services were putting a lot of
pressure on staff work volumes
 Processes seemed to be getting more complex
 We were not achieving goals for customer satisfaction
 Patients
 Staff
 A great opportunity presented itself that provided the education
through Northland Community and Technical College
 We made a commitment of staff time to the value of $50,000
which turned into higher real numbers due to overtime and
replacement of staff
Where Are We  The first cohort of 24 management staff have completed 96 hours
of:
TPS (A-3’s)
Kaizen (5-S)
PI (Performance Improvement Methodology)
Six Sigma – One staff member has Greenbelt
 The second cohort of staff training is nearly completed
 We are in the second year of LEAN
What Have We Accomplished:
1. 37 A-3 projects completed
2. Potential savings of
$100,000
3. Both soft and hard savings are included
• Soft saving of time and supply reduction
• Hard savings are actual recoupment of revenue
/ loss charges / lost visits
4. Time reduced from projects 5,798 hours
Strategic Goal:
First Care Medical Services leadership and staff
work together to become a premier employer achieving
staff turnover below 17%.
Strategy:
Simplify work processes through “LEAN” to
achieve 10% more staff time with patients as measured
time saved
by
total hours
How Will Staff Be
Rewarded For Commitment:
Intrinsic:
1. Work processes will flow smoother
2. Process points bridging two departments will unite staff
rather than divide.
Extrinsic:
$100,000
1. Performance Bonus
Award Winning Projects
Processing of Bills
Business Office
$13,081.00
hard savings.
Processing of Bills
Business Office
Situation:
Current processes were
not changed with the
implementation of new
electronic billing
systems. We continued
to do manual process
steps that were required
under previous system.
Processing of Bills (continued)
What we did:
• Mapped out the current flow of work.
• Mapped flow as it should go with the new technology.
• Identified several routine, manual processes that added no value.
• Eliminated:
1. Bills being printed and filed by patient name for every
date of service.
2. Bills being pulled from patient files each time a payment
is made on that bill. (This happened each month until the bill was
paid in full.
3. Bills being pulled from patient files each time an
insurance company is called.
Processing of Bills (continued)
Initiated:
1. Communications on patient accounts
being completed on the information
system, which enables individuals to
search account information from their
desk.
Processing of Bills (continued)
What we achieved:
• $13,081.00 of hard
savings in time.
• Enabled reallocating
saved time to the upfront
collections process being
implemented
Elimination of
Manual Duplication
in Radiology
$19,000.00
combination of soft
and hard savings.
Elimination of Manual Duplication in Radiology
History:
• Development and Implementation of Digital
Radiology, PACS and Teleradiology Network.
• Became filmless with exception of
Mammography Voice Recognition Software
enabled interpretation to be joined to the image
and stored in PACS.
Elimination of Manual Duplication in Radiology (continued)
Situation:
Manual processes of
printing interpretations
and placing in a film
jacket continued as in the
past.
Elimination of Manual Duplication in Radiology (continued)
What we did:
• Completed Value Stream Mapping
• Value of manual steps timed, cost and
questioned
• Process revised to use digital report as the
only archive – Takes trust in automation!!!
Elimination of Manual Duplication in Radiology (continued)
What we achieved:
• $19,000.00 soft saving of time.
• $700.00 hard savings of jackets and
paper.
• Value of space saved – Not quantified.
Pharmacy Inventory Management
• $17,300 Reduced in Soft Costs of Time
and Outdates.
• Reduced Inventory on Hand by $16,000.
• Total Impact of Over $33,000.
Pharmacy Inventory Management (continued)
History:
1. Pharmacy Inventory
creep evident.
(Benchmark for facilities
our size = $50,000)
2. All Pharmacy processes
manual and time
consuming.
Pharmacy Inventory Management (continued)
What we did:
• Mapped out current flow of work.
• Value of manual steps timed, cost and
questioned.
• Process re-mapped with expiration date
coding done at time of entering drug into
inventory.
Pharmacy Inventory Management (continued)
What we achieved:
• Reduced the number of steps in the process from
seven to two and reduced time spent by 145 minutes
per month. Value of time saved is $1,400 per year.
• Implemented system of flagging outdates on entry
to inventory at a cost of $100.00 for stickers.
Stickers are coded by month allowing visual
inspection for outdates versus reading every
container for expiration.
• Net savings of $1,300.
Pharmacy Inventory Management (continued)
What we achieved:
Reduced outdates from $19,000 annually to $3,000
in one year for immediate soft cost savings of
$16,000.
• Implemented tracking system to develop database
of drugs that expired.
• Pharmacy and Therapeutics committee reviewed
list of drugs and removed from inventory.
• Reduced inventory on hand from $72,000 to
$56,000. For a total hard cash savings of $16,000.
Pharmacy Inventory Management (continued)
Sustain Improvements In Inventory Management:
• Installed Pharmacy software package to further
automate and improve inventory management. The
value of the software package is too new to be
measured, however, continued improvement are
expected.
• Goal: Having the right drugs on hand in the right
amounts to ensure quality care of patients while
continuing to eliminate and/or reduce supply of
drugs that outdate. Continue to work toward $50,000
inventory benchmark.
Misrouted Phone Calls
Current Situation:
• Phone calls enter through the switchboard/reception area.
• Departments reporting receiving calls for other
departments/staff.
• Hospital patient services decided to track the calls and the
amount of interference into their patient care delivery.
• Study showed a projected 207 hours spent on misrouted
phone calls annually.
• Switchboard receiving so many calls that they were
answering and transferring hurriedly.
Misrouted Phone Calls
(continued)
What we did:
• Worked with switchboard staff on phone
answering protocols.
• In process of installing more DID lines with the
expectations that staff will share their number
with persons who call them.
Misrouted Phone Calls
(continued)
What we accomplished:
• Reduce up to 207 hours worth of
nursing interruption annually.
• Soft value is over $5000.00.
• Reduce number of calls going
through switchboard by DID lines.
• Soft costs of DID lines not known
as been measured at this time.
First Care and Lean –
Are we best buds yet?
• We’re just starting.
• Staff are seeing the potential.
• Peers nominated two of the project champions
for Excellence Awards in Innovation.
• Discussion at Department, leadership and All
Staff Meetings is increasingly Performance
Improvement focused.
Where Are We Going With Lean?
• We’re going to harness the processes and use them
to help make work life easier.
• We’re in it for the long haul.
• Staff are beginning to get excited.
• Excited staff are great!!!