By Bill Griffith, Vice President of Business Process/Operational Improvement for Jackson Health System, Miami
One year ago, Jackson Health System in Miami realized a cultural shift was necessary in order to move forward. An integrated, nonprofit academic medical system deeply committed to offering the highest quality care to the people of Miami-Dade County regardless of their ability to pay, the health system was facing high patient volumes and high lengths of stay, hindering its ability to admit and treat new patients.
With staff working at capacity to serve the flood of patients in need of care, the health system was experiencing patient wait times as high as 728 minutes — the time between room request and patient occupying room. Patients ready for discharge were also delayed, with an average wait time window of nearly 12 hours, and patient transport delays of more than an hour. Contributing factors including time lost in communicating the need to turn around empty rooms, and delays in alerting staff on the availability of ready rooms.
A systemic change was needed to address these challenges, one that fully embraced and employed the implementation of technology to streamline operations, while simultaneously providing supportive, comprehensive training for hospital staff.
With a goal of moving the hospital to the top 10 percent of health systems nationally while remaining steadfast in its mission to provide outstanding care to every patient, our team of nursing, case management, lab, radiology, patient transport, and senior executives launched an in-depth gap analysis of patient experience from arrival to discharge. Collaboration and communication with multiple departments, along with strong buy-in from executive management, was key to this process, as well as to creating a comprehensive picture of operational issues and the roadblocks that were causing systemic delays.
Our findings determined Jackson Health’s success would require changes to our processes, the adoption of technology, and an openness to change among staff at multiple levels. Key action steps identified included the need to:
- integrate the operational platform and Electronic Medical Record system
- expedite Environmental Services (EVS) response times to clean vacated rooms
- implement a centralized patient transport system to reduce wait times, cancellations, and improve discharge compliance
- implement a centralized patient placement model to assign rooms to incoming patients
- utilize patient discharge milestones to reduce delays when patients are ready to leave
- coach and train staff in LEAN techniques and increase understanding of the broad-reaching impact of wasted time as it relates to the delivery of patient care
- utilize daily metrics to track performance across the health system
With these gaps identified, Jackson Health took action to make patient flow a priority, creating interfaces between its operational and EMR provider systems and implementing a centralized patient logistics center that manages and monitors all patient movements into and out of the system. A patient flow dashboard now provides metrics by unit, generating immediate notifications of the location of available beds for incoming patients.
Jackson Health also adopted an automated patient transport system equipped with dispatch logic that provides the exact location for each transporter and enables an automatic page to be sent to the individual located closest to the patient. This system has increased productivity from 2.2 to 3.3 trips per hour, with the resulting drop in wait times positively impacting patient experience.
Having identified the need for improving room turnover, and knowing that new patients cannot be admitted if patients are not being efficiently discharged, the team met with EVS staff to discuss procedures, identify the challenges causing delays, gained buy in for implementing new procedures, and increased accountability. After monitoring bed turn times by the minute and hour, the team worked together to modify zones to optimize productivity and streamline processes.
Further recognizing the importance of bringing all employees together in a mission to improve efficiency, training sessions on patient flow processes were and are being conducted on an ongoing basis. A patient flow steering team was created that meets daily to evaluate success and identify concerns or challenges. Standardized workflows were created to eliminate communication silos, an issue common among large health systems, and employees were coached on key highlights of Lean Six Sigma Tools.
To better ensure staffing aligned with patient volume cycles, staffing shifts were modified, allowing for rolling start times that provide more coverage during high demand time. While process changes continue, the outcomes experienced at Jackson Health one year from deploying a dedicated focus on patient flow are notable and include:
- increase in-patient admissions of more than 30 percent
- cost savings of more than $5 million per year
- reduction in patient length of stay at Jackson Memorial Hospital by 1.5 days
- reduction in dead bed time of 25% (the time a bed sits empty when it could be occupied)
- a drop in time from Clean Bed Assignment (room is ready and assigned) to Pending Transport (patient waiting for transporter in the emergency department) from 118 minutes to +/- 57 minutes
- a post pull time reduction from an average of 48 minutes to +/- 13 minutes (units ‘pulling’ patients vs. waiting for assignment of a new patient)
- increased volume of transports by 115 percent while reducing patient wait times for a transporter by 50 percent
- reduction of Request to Occupy by 32 percent (from the time a room request is made for a patient until the time the patient physically occupies the room)
And these numbers are just the beginning. The staff at Jackson is continuing its focus on Length of Stay reduction by empowering the ICUs to dig in on clinical resource utilization. There is a discharge process in place for placement issues and most notably, Jackson is building a robust transfer center and direct admit process. The team is proud of what has been accomplished but looking forward to continuing to use data to drive process improvement and enhance the patient experience.
About The Author
Bill Griffith started his career in manufacturing, implementing Lean strategies at Pella Windows, Tyson Foods, and Rain Bird Irrigation. Believing that the same efficiency principles could be applied to healthcare, he worked for Ascension and Health First. He is a Certified Six Sigma Black Belt and Quality Auditor through the American Society of Quality. He has a BA in finance and economics and an MBA in management.