Improving Home Care Financials with Lean Six Sigma

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Improving Home Care Financials with Lean Six Sigma

  1. 1. Improving Home Care Financials with Lean Six Sigma Rebecca Kjonegaard, MSN, RN, CIC Lean Six Sigma Black Belt
  2. 2. Integrated Delivery System 79,674 annual discharges 2,060 licensed beds 14,749 employees 2,600 physicians 2,764 volunteers $2.1 billion in annual revenues
  3. 3. • Problem Statement – In 2008, 474 patients were outsourced – Lost net revenue over $1.2 million annually • Goal – Improve efficiencies in intake and scheduling process – Increase number of patients admitted to service – Decrease number of patients outsourced narrowing the gap by 50% – Improve Home Health operational performance by $627,000 Define
  4. 4. Key Project Metrics • Outsourced – 69,237 DPMO – 2.9 sigma – 7% of our business is outsourced – Goal: Reduce by 50% • Not seen within 48 hours – 194,594 DPMO – 2.3 sigma – 19.5% non-compliant – Goal: Reduce by 50%
  5. 5. Measure Intake-Scheduling Process Current State Excessive delay due to clerk placing worksheet in bin and intake staff selectively working referrals Overall time 42 hrs
  6. 6. 18% of our patients are not seen within the 48 hour state requirement Measure 48 hour Target 0 2 4 6 8 10 12 14 16 18 20 48 hour PercentofCases Exceeding48hour 18% (23/130) Good
  7. 7. Analyze Delay in Intake – Scheduling process Scheduling Workflow Referrals Fax not taken off of Fax immediately Inappropriate referral Incomplete referrals Too many different forms/worksheets that intake/liaison has to fill out, etc. Nurse does not have the skills so cannot see patient Not syncing timely, schedules not showing up Schedules not entered, not current Too many different computer program sources that intake/liaison has to look through Not getting back to a patient I’ve seen before, someone else is starting from scratch Not enough staff later in the week
  8. 8. 21% of referrals are not admitted which are determined at the end of the intake process – accounts for 14% hours spent on non-admitted cases Analyze Not Admitted During Intake in the Office March 2009 0 5 10 15 20 25 Not Admitted During Intake Process percentnotadmitted 21% (27/130) Good
  9. 9. Analyze 5% not admitted when the clinician visits the patient to admit for Home Health services – accounts for 5.6% hours spent on non- admitted cases Not Admitted in the Field March 2009 0 1 2 3 4 5 6 Not Admitted in Field PercentNotAdmitted 5% (7/130) Good
  10. 10. The Home Health Intake Department receive the highest number of referrals on Wednesday Day of Week Referral Received in March 2009 0 5 10 15 20 25 30 35 40 Sun Mon Tue Wed Thur Fri Sat Day of Week Numberofreferrals Analyze
  11. 11. Schedule of Nurse and PT March 2009 More staff scheduled at beginning of week inconsistent with referrals and patients being admitted Analyze
  12. 12. Both Nursing and Physical Therapist have low compliance with syncing twice a day Percent Sync in February 2009 0% 10% 20% 30% 40% 50% 60% Nurse and PT PercentSync %Nurse sync %PT sync 39% (104/265) 49% (237/484) Good Analyze
  13. 13. Improve New Intake-Scheduling Process Most significant decrease is between receiving the referral and the initiation of worksheet (from 17.2 to 6.7 hours) Forms, documentation Scheduling improved, skills and competencies addressed, work expectation clarified Scripting Overall time 29 hr
  14. 14. Total Time for Intake Process Comparing the baseline and remeasure the Mann-Whitney Test indicated statistical significance with a p value .0033 Baseline March 2009 Remeasure April 2009 Improve
  15. 15. Not statistically significant between March and April Comparing March and June the Two Proportions test indicated statistical significance with a p value <0.05 48 hour Target March, April, June 0 5 10 15 20 25 30 March April June Month Pecentoutsideof48hour 18% (23/130) 24% (13/55) 6% ( 4/65) Good Improve
  16. 16. Not statistically significant between March and April Not statistically significant between March and June but trending in the right direction Not Admitted To Service During Intake March, April, June 2009 0 5 10 15 20 25 30 March April June Month Percentnotadmitted 21% (27/130) 22% (12/55) 23% (15/65) Good Improve
  17. 17. Not statistically significant between March and April Not statistically significant between March and June but trending in the right direction Not Admit in the Field March, April, June 2009 0 5 10 15 20 25 30 March April June Month Percentnotadmit 5% (7/130) 9% (5/55) 3% (2/65) Good Improve
  18. 18. Sponsor Improves • Staffing patterns • Staff skills and competency • Education for referring agencies
  19. 19. In March the most referrals received on Wednesday In June the most referrals received on Thursday Both are inconsistent with staff schedule Week Day Referral Received March and June 2009 0 10 20 30 40 50 Mon Tue Wed Thu Fri Sat Sun Day of the week Numberofreferrals March June Referrals Received
  20. 20. In both March and June most admissions on Thursday which is inconsistent with staff schedule Day of Week Admissions March and June 2009 0 10 20 30 40 50 Mon Tue Wed Thu Fri Sat Sun Day of Week NumberofAdmissions March June Patient Admissions
  21. 21. Schedule of Nurse and PT RN & PT Schedule for June 09 0 20 40 60 80 100 120 140 160 180 200 Mon Tue Wed Thu Fri Sat Sun NumberofRNandPT RN PT More staff scheduled in beginning of week which is inconsistent with referrals and admissions
  22. 22. Continued low compliance by Nurses and Physical Therapists with syncing twice a day resulting in schedule conflicts Synchronization Feb and June 2009 0 10 20 30 40 50 60 70 80 90 100 Nursing PT PercentSync Feb June 49% (237/484) 40% (204/517) 39% (104/265) 39% (100/255) Good Field Staff Synchronization
  23. 23. Key Project Metrics Outsourced: Baseline (CY 2008) Remeasure (Apr – Jun 2009) • 69,237 DPMO • 32,088 DPMO • 2.9 Sigma • 3.3 Sigma • 7% business outsourced • 3.2% business outsourced Benefit: $677,672 increase in revenue (annualized) Not seen within 48 hours: Baseline (Mar 2009) Remeasure (Jun 2009) • 194,594 DPMO • 62,500 DPMO • 2.3 sigma • 3.1 sigma • 19.5% non-compliant • 6% non-compliant Benefit: Increased compliance with regulation
  24. 24. Key Project Metrics Field staff synchronization: Baseline (Feb 2009) Remeasure (Jun 2009) • 544,726 DPMO • 606,218 DPMO • 1.3 Sigma • 1.2 Sigma • 45.5% synching • 39% synching Takeaway: More effort focused on understanding root cause of problem and developing solutions to change behavior
  25. 25. Lessons Learned • Progress made – not so easy • Identified resistance in key stakeholders • Staff lack of knowledge on Six Sigma methodology slowed the progress • Addition of new team member changed group dynamic • Large team difficult to manage • Limited champion involvement impacts overall follow through
  26. 26. Questions & Discussion

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