1) The document discusses how hospitals can improve performance by applying Lean methodology and Genpact's proprietary Smart Enterprise Processes (SEPSM) framework to clinical and non-clinical processes. 2) SEPSM enables continuous process improvement through tools like Lean and prior knowledge from benchmarks. It provides end-to-end mapping and granular process improvements. 3) Applying SEPSM has led to reductions in patient wait times, medical stock levels, billing errors and other improvements across the "Visit to Cash" cycle.

1. Driving Hospital Performance to the Next Level
White Paper
HealthcareProviderServices
Driving Hospital Performance to the Next Level
Tajinder Vohra, Senior Vice President, Genpact and Abi Karun, Vice President, Genpact
Introduction
While the first two waves of improvements in the healthcare industry were
led by technology and pharmaceutical development, the third wave has
largely been focused on using technology to manage and use information.
Healthcare providers have embraced these changes, albeit slower than in
most industries, but have yet to realize the full potential of the ‘Process’
dimension.
Hospital processes, both clinical and non clinical, have remained relatively
untouched by the advances in tools and techniques which are used
successfully in other industries to drive efficiency and effectiveness.
However, there is now a gradual movement towards incorporating practices
from other industries. While healthcare has many unique operational
nuances, there are significant functional processes that overlap across
industries e.g. insurance and financial services.
Lean and Six Sigma are methodologies, which until recently, were practiced
primarily in the manufacturing industry but are now being implemented
in the service industry as well. However, application of Lean Six Sigma
tools in service industries like Healthcare is not as straightforward as it is in
manufacturing. Healthcare has different levels of complexities and non-
deterministic flows which makes process optimization tougher. Lean and
other such frameworks when adapted to Healthcare, have the potential to
fully unleash the power of the processes within hospitals.
Genpact, a global leader in managing business processes for companies
around the world, has introduced a new, proprietary methodology called
Smart Enterprise Processes (SEPSM
). This methodology enables continuous
improvements in specific business processes in different industries by
leveraging multiple tools like Lean and an accumulated pool of knowledge
and benchmarks. It makes the improvement process very deterministic
instead of a discovery exercise.
This paper presents Genpact’s findings from applying Lean using SEPSM
to
specific processes in hospitals.
Challenges faced by Hospitals
The healthcare system globally is struggling with some significant
challenges: Infrastructure and capacity constraints, rising costs, service
quality and staff shortages.
Traditionally, most of these challenges have been addressed by solutions
that include heavy capital expenditure, expensive IT implementations,
surplus supplies and just-in-time training for medical staff.
Key Issues facing the global healthcare system include:
• Insufficient Capacity: Hospitals are experiencing severe capacity
constraints which affects service quality and physician and patient
satisfaction. The problems range from a lack of available beds, to
Emergency Room (ER) overcrowding, to an increasing nursing shortage
and delays in patient care. These problems constrain a hospitals’
ability to develop new patient services and enhance revenue streams.
• Sub-optimal Operational Performance: Hospitals are siloed in their
approach to delivering patient care. This siloed approach leads to multiple
hand offs, inefficient use of infrastructure and drives potential patient
safety challenges.

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• In-effective Cost and Material Management: Issues such as
overstocking and high stock of expiring and unused medicines, multiple
points of storage and inability to track actual consumption add to a
hospital’s challenges.
• Sustaining Performance: The lack of standard measurement systems
to track performance of hospitals also impacts efficiency levels. Even in
the best run hospitals, data and metrics are used only to diagnose past
issues and not to predict and proactively tackle potential issues related to
patient experience and safety.
Lean in Hospitals using SEPSM
(Smart Enterprise
Processes)
In most hospitals, clinical processes encompass only 10-30% of total
processes. Non-clinical or back office processes make up the balance.
Within this area lies an opportunity to dramatically decrease costs and
increase efficiency through the adoption of alternative business models.
Hospitals are unable to leverage their full potential and true value which can
be unlocked by applying the correct tools and methods to their individual
processes.
Hospitals can unlock this hidden value by deploying lean using SEPSM
(See Fig 1 ) - the means to enhance safety and quality by managing
SEPSM
enabled Hospital Processes
• Primary Care Physician to Pre-Registration
• Door to Diagnosis
• Lab - Order to results
• Radiology - Order to results
• Diagnosis to disposition
• ICU transfer to completion of care
• Med prescription to administration
• Intent to admit to Patient roomed
• Intent to discharge to Room readiness
• Pre-operation to Transfer Out (OR)
• Warehouse/ Pharmacy to Point of Use (Medication/Medical Supplies)
• Patient access and on-boarding
• Utilization review
• Administrative processes (billing, AR, AP)
Door to
Doctor
Patient Arrival
to first MD
Consult
Doctor to
Diagnosis
Radiology/
Patient
work up for
Diagnosis
Diagnosis to
Disposition
Diagnosis to
Patient Admit/
Discharge
Cut to
Stitch
Surgery Start
to Finish
- Including
Patient Prep
Stitch to
Cut
Surgery
complete to
start of next
surgery -
including room
turnover
Bed to
Care
Patient
Admission
and Medical
Administration
Care to
Transfer
Patient
Discharge and
transfer to
step down
LEVEL 2
Sub-Process
LEVEL 1
SEP
VISIT TO PAY
1. Improved Capacity 2. Reduced Cost / Adj Patient day 3. Customer Satisfaction
EMERGENCY DEPARTMENT OPERATING ROOM ICU
Fig 1 – Lean using SEPSM
provides End-to-End, Granular Level Mapping and Continuous Improvements
Key Benefits
• Delivers PL identifiable impact using a tested and non-intrusive diagnostic and delivery mechanism
• Identifies and builds a roadmap to best in class for granular level process linked to critical few business outcomes
• Provides measureable improvements in a short time span by simple yet scientific tools and methods - SEPSM
changes and creating continuous improvement. This enables a hospital to
consistently deliver safe and high-quality healthcare.
Lean along with SEPSM
has provided an approach that cuts across
departments, hierarchies and the operational complexities of hospitals.

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Supply Management
• Pharmaceutical and non-pharmaceutical stock levels can be reduced
within the first 90 days to prevent overstocking without impacting
care-giving processes. This can be done by deploying Lean tools
– similar to those used in other industries like manufacturing.
• Overall supply costs can be further optimized by 8-12% by moving
from physician preference items to standardized supplies.
• Expiration of medication and obsolescence of supplies contribute
1-3% of total operating costs of wards and can be reduced by 30%
within 90 days.
Payments/Cash Management
• Potential exists to improve First Time Right in Billing by up-to 25-30%
each by fixing avoidable and manageable root causes.
The Road Ahead
SEPSM
has proved to be an effective tool in improving processes in hospitals’
emergency rooms. V2C SEPSM
is ideal for developing and implementing
a blueprint of key processes. This allows hospitals to focus on clinical
excellence while being able to get maximum efficiency from support
functions. It shifts the focus from managing in silos to managing processes
that can be resilient and delivering sustained results.
Processes Improvements in the Visit to Cash Cycle
Genpact aggressively deploys Six Sigma/Lean tools to cut waste and
standardize processes and procedures. Through its proprietary scientific
methodology approach, Smart Enterprise Processes (SEPSM
), Genpact has
mapped 140 core processes that constitute 80 percent of the repeatable
activities within a hospital. These processes cover the entire cycle of
patients visiting for a treatment and hospitals getting the payment—called
Visit-to-Cash (V2C).
Genpact has worked with multiple hospitals to improve their business
outcomes - time to provide faster care to patients, improve patient flow
and equipment utilization. Genpact has developed best practices and
a deep knowledge base which enables it to drive best-in-class hospital
performance.
Some examples of how process can be improved across the V2C cycle
include:
Patient Experience
• Stitch-to-Cut cycle times impacting surgical suite availability can be
improved by 4-6% in 90 days by improving the patient flow process.
• Patient walk times can be reduced by 20% by optimizing process flow
and ergonomics.
FOR MORE INFORMATION:
Tajinder Vohra, Senior Vice President, Healthcare Services
Tajinder.vohra1@genpact.com
Abi Karun, Vice President, Healthcare Services
a.karun@genpact.com
Visit us at www.genpact.com/healthcare

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About Genpact
Genpact is a global leader in business process and technology management, offering a
broad portfolio of enterprise GA and industry specific services, coupled with strong IT,
analytics and reengineering capabilities.
For more information, visit: www.genpact.com
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