Building Efficiency Into Care Delivery

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Proprietary & Confidential CreatingaSustainableFuturefor HealthcareOrganizations
Building Efficiency
into Care Delivery
Roger Gruneisen, MS LSSBB
Senior Manager, Operations and
Performance Improvement

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Proprietary & Confidential
• Efficiency:
NOUN - the ratio of the useful
work performed in a process to
the total energy expended
• Care:
VERB - Look after and provide for
the needs of
NOUN - the provision of what is
necessary for the health, welfare,
maintenance, and protection of
someone or something
What Are We Talking About?

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Where Is Care Delivered?

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The First Law of Improvement
Every system is perfectly
designed to achieve exactly
the results it gets.
Help!

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• Leadership:
 Process of influence by providing
purpose, direction, and motivation
• Management:
 Process of working with people and
resources to accomplish organizational
goals
Leaders Will Seek Better Ways to Deliver Care
ControllingLeadingOrganizingPlanning

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So, How Do We Bring More Efficiency to Care Delivery?

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Objectives
Let’s discuss…
Let’s keep it simple: focus
on what matters
Let’s get started

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Let’s Discuss…

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• Situations:
 We work together, when we are working
and see that supplies are low, we replace
them…
 I write it down on paper; then I go chart it
for the nurses; then I make a copy for them,
because they can’t easily see what I
documented
Let’s discuss…

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Let’s Discuss?
• Situations:
 In this department, we can have no
customers or 10, it just depends…
 Well, I like to do things this way; she likes to
have everything that way; and he likes to eat
his dinner while doing this another way…

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• Situations:
 You have to realize that my staff make
more money than nurses, so it makes better financial sense for
nurses to bring me the equipment…
 Our radiologist was concerned that
information was not transferring
between systems, so we had a leader
meeting to discuss. We then made it a
weekly meeting…
Let’s Discuss?

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Let’s Discuss?
• Situations:
 We had an architect come look at our
layouts and come up with some new ways
to make our unit better…
 Well, our priorities are that we improve
all of our patient satisfaction scores, hit
our new productivity targets, cut back on
our inventory, reduce readmissions,
improve outcomes of care, etc….

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Let’s Keep It Simple

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• Create your common language to
explain problems
• Create your organization’s way for
problem solving at all levels
• Create your organization’s way to
engage the front line
• Now you created your organization’s
“common sense” approach
Create Your “Common Sense” Approach to Efficiency

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Focus Efforts Where Care Is Delivered
• Patient-centered care is the
front line
 What are all the wastes in that
work?
 What are all the non care tasks we
have shifted or asked front lines to
do
 Study the “logistics” behind care

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Shifting waste from one department or step in the process
to another department or step in the process is truly not
eliminating the waste

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Cut Out All Other Inefficient Uses of Front Line Leaders
• Go to where the work is instead
• Meetings, committees, councils
are good if they are good use of
time
 Information provided that cannot be
provided another way
 Decisions made
 Need specific voice

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• Processes for elevating identified
wastes, barriers, quality, safety,
dissatisfaction
• On average, organizations with
“engaged staff” do better – no
kidding!
Engage All Staff – Give the Choice

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• Question:
 In medical science, there are labs,
diagnostic imaging, subjective
assessments, objective
assessments, etc…
 Why do we feel that the same is
not needed for management
science?
Use Diagnostics, Yes, Data and Visuals
Patient pulled to
Open Room
RN Triage/
Assessment
Physician Exam
Diagnostics
Ordered
Patient pulled to
Open Room
RN Triage/
Assessment
initiate protocols
as appropriate
Physician Exam
Further
Diagnostics
Ordered as
Needed
Current Practice
Recommended Practice
Not
consistent
practice
Not all
providers
support
protocols
Delayed by
provider
waiting on
patient to be
triaged
No ED order
sets/ templates;
some providers
slow to build
EMR skill set
Step Description Time Takt Time Keeps Up Value Added % of Value
1 Registration 2 20 10% N 5%
w Patient waits for nurse 5 20 25% N 12%
2 Nurse pulls to room 1 20 5% N 2%
3 Nurse runs diagnostics 5 20 25% Y 12%
w Patient waits for doctor 4 20 20% N 10%
4 Doctor assessment 22 20 110% Y 54%
5 Check-out 2 20 10% N 5%
Total Time 66%41

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• If everything is a priority,
then how much of
anything gets done well?
• Select and reinforce those priorities that influence
behavior across the board
• Be an umbrella for the rest
Prioritize and Pick Those Key Habit Changing Measures

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At Some Point, We Have to Start Doing It
• In order to actually make change
or make something more efficient,
we actually have to do things
make changes and make things
more efficient
• What stops us?

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Where Can You
Start?

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• Identify employees, direct reports,
colleagues who you can work with to free up
his/her time
• Generally, they will feel overwhelmed
• Free up 1, 5, 10 hours of his/her time per
week: unnecessary meetings or committees,
painful reports, general inefficiencies…
• Request that they pay at least half of that
time forward to making further
improvements
The “Lead by Example” Challenge

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• Track progress
• Report the good, bad, and ugly (to a group – not in it
alone)
• Collaborate, take those great lessons learned, run with it
The “Lead by Example” Challenge

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CreatingaSustainableFuturefor HealthcareOrganizations
Intended for internal guidance only, and
not as recommendations for specific
situations. Readers should consult a
qualified attorney for specific legal
guidance.

Building Efficiency Into Care Delivery

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