Process Redesign

HealthLeaders Media Council members discuss their organizations' experience with process redesign efforts.

This article first appeared in the December 2016 issue of HealthLeaders magazine.

Emilio Vazquez, MD
Chief Medical Officer
Dekalb Health
Auburn, Indiana

Process redesign has encompassed many different things at DeKalb Health. One aspect we are looking at in particular is our charge-capture process, which we hadn't really examined in a number of years.

We aren't only looking to see that the charges are correct, but we're examining the way we capture charges, especially on the floor. We're making it easier for nurses to scan in supplies as they are used for patient care, and for materials management to figure out where stuff has gone. That is all in process now, so I can't say for sure whether we've received any benefit from it at this point—it's something we've just started.

Another area we're redesigning is our admissions process, especially for patients who don't have coverage. We've involved a company that works with individuals who come into the hospital without insurance. They work with these patients to help them apply for health insurance or grants. It's not-for-profit, and it helped us find a way to get those applications for coverage in through someone outside the hospital. This helped us to recover $90,000 in payments through these patients that we otherwise would not have received. For a hospital of our size, that is not a drop in the bucket.

Jack Kolosky
Executive Vice President and Chief Operating Officer
Moffitt Cancer Center
Tampa, Florida

From my point of view, our process redesign efforts have been spread throughout the organization. I've seen them in clinical, research, and administrative areas. There really isn't a part of the organization that has not been involved in process redesign.

Probably the most notable of those efforts currently is what's going on with our outpatient clinical design. Moffitt is about 70% outpatient, and that percentage is growing.

We've asked everyone in the organization to participate in these initiatives, and we received over 400 different ideas that workers think we should explore, or that are immediate opportunities to better manage our costs or processes.

People are an amazing resource. So far, we have successfully avoided doing layoffs. I think that's for two reasons: We've been able to redeploy workers into different areas, but also, the growth of our organization has been steady. The opportunities for us have more to do with efficiency rather than downsizing or layoffs.

Keith Alexander
Regional President
Memorial Hermann Health System
Houston

I think this issue hits home for many healthcare leaders; challenges face them in the emergency department, including long wait times to get patients into the ER, and then long waits once a decision to admit patients to the hospital has been made. This combination often leads to lengthy turnaround times, patient dissatisfaction, and quality and patient safety issues.

We've done a significant redesign around those processes, including appointing a "bed czar" to oversee bed management functions throughout the hospital. This person is connected to our emergency department as well as operating rooms, which are the other areas that tend to drive inpatient admissions. Potentially, if you have long lengths of stay in all of your inpatient units, it's key to work on that problem in order to create more bed capacity in a more expedient fashion.

ED throughput is one of our core measures in terms of CMS quality standards for value-based purchasing. It also drives patient satisfaction and our ability to have patients seen more quickly in the emergency department. Our focus on shortened inpatient length-of-stay, ED admission throughput, and reduced ED waiting time is paying dividends. The entire system is much more efficient and benefits both patients and staff.

This process redesign has been fairly transformative for a few of our hospitals, and we're trying to replicate that redesign in other hospitals across the Memorial Hermann system.

Jack O'Connor
Vice President for Cardiovascular Service
McLeod Health
Florence, South Carolina

At McLeod Health, we have a value analysis committee, which regularly examines our products. If a product is adding cost, there needs to be some sort of benefit down the road or in the global picture. For example, it might reduce readmissions. We've expanded on that further to look at existing procedures we currently do and new procedures.

If a device or procedure is a money loser for us, the committee will look into finding ways to make those procedures cost-neutral, or even money-earners. They also analyze new procedures before we get started on them to ensure we've got that process streamlined and have reduced variation as much as is possible.

On controlling labor costs: For us, the biggest cost is the training and hiring of new staff. We have some entry-level units where nurses begin their careers, and as they progress, they want to grow within the organization. There are some units that are more popular destinations; we're happy to move up good workers, but this can cause turnover in some of the entry-level units to be quite high.

The cost of hiring, recruitment, and training additional staff is probably our biggest expenditure from a cost standpoint. It requires paying additional staff to do training, education, and orientation. But we do a lot of work to try to retain workers and reduce turnover, and generally try to maintain employee satisfaction.