This document discusses how outsourcing mandatory compliance training to Cascade Training Solutions can provide significant savings and efficiencies to healthcare organizations compared to managing training in-house. Cascade's centralized approach eliminates waste like excessive resources, waiting time, and defects through a standardized process with consistent instructors and flexible scheduling. Outsourcing to Cascade achieves the benefits of a Lean project without the time and cost associated with extensive process improvement initiatives.

1. Abstract
Managing your own mandatory
compliance training is costing you much
more than you realize. See how Cascade
Training Solutions dovetail with Lean
methodologies and offer significant
savings to your organization.
JUMP START YOUR
NEXT LEAN PROJECT
All the gain without the pain

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Training and Lean Healthcare
At Cascade, we see the changing world of healthcare like you do. Sweeping changes from the Affordable
Care Act, hospital consolidations and staffing shortages to name a few. Many factors complicate efforts
to maintain sustained profitability. With over a decade of experience working directly with the education
departments of medical facilities, we’ve learned first-hand how to identify and eliminate waste for our
clients.
Cascade has a simple solution that you can easily implement and realize immediate and sustained
improvements in your organization.
The Pain
To level set, Lean Methodology is a process of transformation which is very personal and involved and it
requires buy-in from the organization (very hard to do) and is expensive. But the payoffs are huge when
applied to the right process.
A Lean project will result in an “ideal state” that you desire which feeds into a “wish list” that will be
used to create a “future state” mapping exercise that will ultimately yield a “gap analysis” between
current state and future state.
In the end you end up with one of three possible solutions to close the identified gaps:
1) JDI (just do it) complete within a week, few resources, etc.,
2) Project that will take significant coordination, often across Organizational boundaries, and
3) KAIZEN event, a formal 4-day event to develop a 90-day plan to take care of the requirements.
At Cascade, we believe the outcome of a Lean initiative described above is going to end at the same
conclusion. Outsourcing.
Your organization gets the benefit of proven processes developed over 10 years in hospitals just like
yours. The decision is fairly simple, a Lean Project or just outsource to Cascade.
Value Stream Metrics
Figure 1 on the next page is a depiction of cascading metrics created by Philips Healthcare Consulting
showing how process metrics roll-up to critical value stream metrics and then up to the primary healthcare
objective of sustained profitability. The lower, “Asset efficiency” value stream in Figure 1 is where the
Cascade Solutions live.

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Figure 1 – Cascading metrics: Successfully deploying Lean in healthcare, Philips Healthcare, 2011 ©
Cascade is more than an outsource vendor to our clients. We are a true partner that has the capability to
dynamically expand and contract based upon your needs. This flexibility in this “pull vs. push system”
allows our clients to realize measurable improvement in their mandatory compliance training efforts.
These gains in efficiency have tentacles that reach far beyond the classroom and into the mission of the
organization.
Cascade has a long history with Seattle’s Medic One organization which has some of the highest
resuscitation rates in the US. The size of our organization and our geographic footprint allows us to work
closely with credentialing organizations and keeps us on the cutting edge of the newest training and
regulatory changes.
The Gain - Genuine Value Added Services
Cascade does one thing, and we do it really well. Training management. In the world of Lean there are
either comprehensive process improvement projects using Lean tools or there are “just do it” efforts
that yield immediate results. The ROI on these “low hanging fruit” initiatives can be impressive.
Outsourcing to Cascade Training Center is one of those “just do it” decisions.
• Cascade is a partner that sees and understands your challenges from a healthcare provider
perspective.
• One of our goals is to keep your organization “inspection ready” by always being up-to-date and
ensuring critical changes are communicated to those that need it in support of improved patient
outcomes.
• We are nimble. As the world of healthcare changes, Cascade provides significant value because
we can customize training much faster than a large organization's ability to flex.
• Cascade is up to date. Our clinical medicine and our business model is current. We adapt quickly
so that our customers can have a competitive advantage in the healthcare market.
• Cascade provides best in class service and implements our solution it in the least amount of time.
• Lessons learned. Cascade takes lessons learned from within the industry and uses that
information to create additional value for our customers.

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• No cost until we train. In Lean terminology, Cascade is a “pull system” meaning we provide classes
7 days a week, in the evenings and locations across your region. No matter when or where your
staff takes a class, Cascade tracks the student and you receive a monthly invoice (or more often if
you prefer) for training services. There is no “set up or onboarding” fee to engage Cascade. You
pay for students trained.
• Guarantee – Cascade is so confident in our solution that our client engagements have no contract
term. We can do this because we have never lost a client. We deliver what we say we will and
when we make a mistake we fix it. And more importantly, when you get thrown a curve ball, we
have your back. (See the addendum labeled “Curve Balls”)
SECTION 1 – Lean Concepts
Below are some common Lean definitions that will bring clarity to what Lean is trying to solve in your
organization.
• Lean is a customer-centric methodology focused on continuously identifying improvement
opportunities by eliminating “non-value added” or (wasteful) activities and creating value.
• In a Lean process, a customer is any individual or entity that benefits from the Lean Program.
• Value is defined as any activity within a process that is essential to delivering what a customer will
pay for.
Successfully deploying Lean in healthcare, Philips Healthcare, 2011 ©
Lean concepts:
• Defining "value" from a customer and patient perspective
• Identifying "waste" and non-value-added activity
• Identifying and improving "value-streams"
• Creating better "flow" for patients and processes
• Preventing errors and improving quality in a systematic way
• Creating an environment of true "kaizen" (continuous improvement)
http://www.lean.org/
“Value-Added” Activities defined:*
• Transforms patient, material, information, decisions, or risks
• And the customer wants it (or would if they understood it…)
• And it’s done right the first time (or as right as possible...)
“Non Value-Added” Activities defined:*
• Consumes resources but creates no value to the customer
• Pure waste - if this activity is removed, can the process continue?
• Waiting, Inventory, Movement, Excessive/defective processing...
*McManus - Lean Healthcare - March 2012 – © LAI EdNet
By focusing efforts on reducing wasteful activities, healthcare organizations can more effectively attain
organizational objectives.

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Seven Wastes (Lean) - Potential causes of waste
Excessive motion • Unnecessary movement by employees
• Incorrect floor layout (e.g., inefficient emergency department patient flow)
• “Searching” for information (e.g., lack of operability of EMR)
Waiting time • Waiting for the next event to occur or the next work activity
• Waiting for paper work
• Waiting for response/approvals/beds
Over-production • Doing more than is needed by the customer or doing it before it is needed
• Planning full utilization of assets/labor
• Large batches of material and supplies inventory
Unnecessary
processing time
(Over-processing)
• Doing work that is not valued by the customer, or caused by definitions of
quality not aligned with the patient needs
• Fragmented workflow
• Unnecessary processing steps
Defects • Time spent doing something incorrectly, inspecting errors, or fixing errors
• Cost of patient readmissions
• Hospital acquired conditions
Excessive
resources
(Inventory)
• Excess inventory cost through financial costs, storage and movement costs,
wastage
• Non-optimized resource leveling
• Redundant activities (e.g., excess administrative costs)
Unnecessary/
ineffective
handoffs
(Transportation)
• Unnecessary movement of the product in the system (patient, specimen,
materials)
• Verification loops
• Unnecessary approvals
Table 1 - Seven critical wastes in healthcare addressed by Lean. Ref: Mark Graban, Lean Hospitals (CRC Press, 2009)
SECTION 2 - Common challenges for healthcare training departments
The table below outlines some of the common inefficiencies identified by Cascade in our client’s education
programs along with one or more of the 7 corresponding Lean “mudas” (muda = waste). Areas of waste
vary by client and can be impacted by number of variables including the location and number of campuses,
complexity of operations (e.g., military hospitals), or recent mergers or acquisitions.
Training problem and the associated Lean waste
Problem/Opportunity Identified Waste
Inefficient use of facility staff to administer in-house
programs means administrative oversight cost to
manage the program coupled with the high cost of
in-house nurse educators.
Excessive resources (Inventory)
Course scheduling logistics for instructors and
students - finding rooms over multiple campuses
and making courses available nights and weekends
to fit your staffing schedules. Poor class turnout.
Excessive resources (Inventory)

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Problem/Opportunity - continued Identified Waste - continued
Skipped classes (low turnout causing over-staffed
class instructors)
Waiting time, excessive motion, defects, Excessive
resources (Inventory)
Insufficient number of class offerings to ensure
certifications don’t lapse - are there enough courses
on the schedule that staff can find multiple times to
secure their certifications?
Excessive resources (Inventory), excessive motion,
waiting
Reimbursements for classes taken outside of the
hospital when expiring certifications are at risk.
Defects, waiting time, unnecessary/ineffective
handoffs
Overtime pay for classes taken after a 40 hour work
week.
Excessive resources (Inventory)
Backfilling shifts for staff taking training classes
because of expired certifications.
Unnecessary processing time
Providing adequate customer service by hospital
staff is a challenge. Are medical staff inquiries
responded to promptly? Are phones answered and
emails returned with urgency?
Excessive resources, unnecessary processing time
Instructor/Educator turnover - what is the cost to
onboard and ensure that a new instructor is
delivering the required level of instruction?
Excessive resources (Inventory)
Inconsistent Instructor quality across hospital
facilities - Do you know when an instructor is not
delivering world class training? How do you fix the
problem when it does occur?
Defects
Lack of, or availability of adequate space on the
hospital campus.
Excessive resources (Inventory)
Risk – “Colleague Factor” = card issued without
completing the full course is a real problem and
exposes the hospital to significant risk.
Defects
CME compliance for medical staff Excessive motion
Table 2 – Common inefficiencies in healthcare Education departments

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Section 3 - How Cascade delivers Lean results without the Lean pain
Cascade brings over a decade of specialized experience in designing, implementing and improving
resuscitation training programs for each client we serve. The unique ability for Cascade to bring a
national perspective from multiple regions, some of which have the highest resuscitation rates in the
nation, to other geographic regions allows us to truly leverage best practices in all we do.
Table 3 below overlays the Lean “Identified Waste” with the “Cascade Solution” that we bring to your
organization. Think of it as a “Button Push” solution that gives you the same benefits you would receive
from an expensive and time consuming Kaizen (take apart and make good) project.
The biggest challenge you will likely encounter is getting internal stakeholder approval and Cascade has
ways to assist you in getting buy in from the people impacted.
Training problem and associated Cascade Solution
Problem/Opportunity Cascade Solution
Inefficient use of facility staff to administer in-house
programs means administrative oversight cost to
manage the program coupled with the cost for in-
house instructors when they are not actually
teaching a class.
Cascade administers the entire program while working
closely with your team to ensure we are executing courses
that meet your requirements.
Course scheduling logistics for instructors and
students - finding rooms over multiple campuses
and making courses available nights and weekends
to fit your staffing schedules.
Cascade offers classes 7 days a week including nights
across all of the campuses made available to us as well as
at our Training Center and at other facilities across your
local area.
Skipped classes (causing over-staffed class
instructors)
Automated class reminders with a very liberal
rescheduling policy makes it easy for staff to make their
classes. When they do skip a class they must pay for the
reschedule out of pocket.
Insufficient class offerings to ensure certifications
don’t lapse - are there enough courses on the
schedule that staff can find multiple times to secure
their certifications?
Cascade’s unique registration software reserves a portion
of classes offered at Advocate and other facilities for
outside attendees (optional). This allows your staff to find
open courses off-campus, at Cascade Training facilities
and allows Advocate Healthcare to showcase your facility
to healthcare provider prospects.
Reimbursements for classes taken outside of the
hospital when expiring certifications are at risk.
Courses are offered in sufficient quantity on days of the
week and at hours necessary to accommodate all shifts.
Overtime pay for classes taken after a 40 hour work
week.
The cadence of courses offered by Cascade eliminates the
need to take classes outside of scheduled shifts.
Backfilling shifts for staff taking training classes
because of expired certifications.
Cascade’s class schedule ensures that certifications do not
lapse which prevents staff from being pulled from the
schedule until they can get certified.

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Problem/Opportunity - continued Solution - continued
Providing adequate customer service by hospital
staff is a challenge. Are medical staff inquiries
responded to promptly? Are phones answered and
emails returned with urgency?
Cascade has Customer Support Specialists that are
available during business hours and available by phone
and email for registrations, reschedules and questions.
Instructor/Educator turnover - what is the cost to
onboard and ensure that a new instructor is
delivering the required level of instruction?
Training and retaining top instructor talent is a cost that
Cascade absorbs.
Inconsistent Instructor quality across hospital
facilities - Do you know when an instructor is not
delivering world class training? How do you fix the
problem when it does occur?
Cascade is centralized solution and our instructors are all
trained the same way, are evaluated after each class, and
because they are contractors, only the best retain their
status with Cascade. Low instructor evaluations result in
removal from the schedule.
Lack of or availability of adequate space on the
hospital campus.
Cascade classes are offered off campus and at locations
closer to where staff live which allows hospitals to
repurpose space for competing needs.
Risk – “Colleague Factor” = card issued without
completing the full course is a real problem and
exposes the hospital to significant risk.
Cascade eliminates short-cuts or favors. All training is
delivered to accredited standards and a consistent process
is applied everywhere.
CME compliance for medical staff Cascade can build custom courses that bundle CAT 1 CME
Credit™ with typical resuscitation training and can offer
classes just for physicians.
Table 3 – Cascade’s solutions to waste
Included Features and Benefits
Cascade acts as a third party supplier/partner to many healthcare organizations. We have contractual
obligations to furnish training and management services to our clients. The Cascade Solution includes:
Custom Website Portal An online registration portal hosted by Cascade that has your hospital pricing and
information specific to your organization.
Cloud based system access Allows access to real-time updates on the status of your employee certifications.
Document Retention Forget about audits. Everything is documented for each student and available
when they come looking.
Customer Service Someone else to answer phones and emails for registrations, cancellations,
reschedules and questions. Yes, we really do answer the phones.
Dedicate Account Manager Not only will you have a point of contact for emergencies, that person is backed
up by a team that can also take care of your needs.
Course reminders Staff get class reminders at 15, 7 and 1 day prior to their class. Great for those
MD’s that can’t seem to manage their schedule.
Multiple Certifications In addition to AHA, we offer ENA, ACL, AAFP and AAP certifications.

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CAT 1 CME Credit™ We can create custom curriculums for your physicians.
Manager notification Configuration setting allows the employee’s manager to receive an enrollment
notification at class registration.
Expiring Certification notice 90, 60, 30, 15, 1 day expiration reminders sent until the employee enrolls.
Custom Web Portal Branded web portal allows employees to register online (phone and email
registration is still supported)
Document retention All certification documentation is maintained by Cascade and is available online
by your administrative staff.
No contract term You are not locked into an agreement with Cascade (unless you want to be). You
contact can be terminated with 30 days’ notice. This is our guarantee that you
will like partnering with our company.
Conclusion
Whether your hospital is just beginning to look for opportunities to implement Lean initiatives or is in the
middle of Lean project, your mandatory National standard compliance training is a prime opportunity for
you to get a quick win that will have immediate impacts in your organization.
Whether you have an in-house Six Sigma/Lean Program Office or utilize outside consultants to identify
areas to realize cost and operational efficiencies, Cascade has the proven infrastructure to quickly and
seamlessly deploy an outsourced resuscitation training solution that we guarantee will work.
Deployment of Cascade
Implementing the Cascade Solution is easier than you might think. The engagement is simple and
flexible.
1. Analyze your current process and identify any special requirements unique to your organization
including how your accounts payable team wants billing setup.
2. We create a custom proposal and recommendations based upon volume, mix of certifications
and your desired implementation date.
3. A revised plan is presented and approved.
4. We meet with stakeholders to set expectations and establish timelines and communications.
5. Cascade builds a custom web based registration portal and ensures your education team is
trained on how to access it.
6. Courses and pricing are set up for your organization.
7. We go live. Cascade has the flexibility to soft launch which enables existing courses on the books
to be completed or we can do a hard cut-over.
8. Your organization is invoiced based upon the agreed upon billing cycle.
Consulting
Phase
Accept
Phase
Alignment
Phase
Launch
Phase
Build-out
Phase

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It is important to note that no money exchanges hands until students have been trained.
Hospital Consolidations
Just a final word on hospital consolidations. As the trend continues, project teams tasked with bringing
two disparate organizations together with multiple campus, training departments, different procedures
and often with no idea of the true cost of delivering this type of training. Outsourcing to Cascade during
this transition can reduce your list of 100 things-to- do down to 99.
Cascade brings a best practices, national perspective solution that allows both organizations to simply
point their staff to Cascade for their National standards compliance training. Management can rest
assured that adequate classes will be available and all employees will receive certifications to maintain
their right to work status. Management has full visibility to current certification status as well as real-
time access to credentials.
Certifications Offered
• CPR/BLS for Healthcare Provider: AHA BLS CPR
• Advanced Cardiac Life Support: AHA ACLS
• Pediatric Advanced Life Support: AHA PALS
• Intro to ECG & Pharmacology: AHA ACLS Prep Course
• 12-Lead ECG Interpretation
• Airway Management: AHA
• Emergency Nursing Pediatric Course: ENA ENPC
• Trauma Nursing Core Course: ENA TNCC
• Pre-hospital Trauma Life Support: NAEMT PHTLS
• Advanced Medical Life Support: NAEMT AMLS
• Neonatal Resuscitation Program: AAP NRP
• S.T.A.B.L.E.
• ACLS - Experienced Provider: AHA ACLS - EP
• Advanced Life Support in Obstetrics: AAFP ALSO
• Advanced Trauma Life Support: ACS ATLS
• Pediatric Emergency Assessment
• Recognition and Stabilization: AHA PEARS
• Heartsaver CPR & AED: AHA
• Heartsaver First Aid Only: AHA
• First Aid, CPR & AED Training: AHA
• Emergency Medical Responder

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Addendum – Curve Balls
• November 2015, David Grand Medical Center had training vendor walk off the job during an
ACLS class. Cascade responded the same day by getting boots on the ground to complete the 2-
day class. A delighted 5-year client.
• October 2014, Sacramento Metro Fire received board approval to get their all 530 of their staff
trained in BLS and ACLS...in 30 days! With only 2 weeks’ notice, Cascade delivered…in 27 days.
Happy client.
• September 2051, Kaiser Permanente, Portland. An early morning class is scheduled by hospital
in hospital conference room. Students and instructor show up and conference rooms are taken
and squatters were not budging. Instructor commanders the pharmacy, gets introductions done,
and got shared stories going until help arrived to sort out the room. Course evals were all 5 out
of 5.
• 2014 the VA Northern California called us after they realized their database had failed to identify
approximately 150 staff due to expire within 2 weeks, in December no less. We added 10 BLS
HCP classes to our system for them and made it happen. Some classes were really small but we
did not cancel them as the staff credentials would have expired. Delighted client.
All in a day’s work. Returning patients home to their loved ones through world class training. It’s all we
do. And we are the best. Contact us!

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www.CascadeTraining.com