AHRA: Process improvement transforms the imaging enterprise

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DALLAS—Real-life Lean management tactics can produce real outcomes, confirmed James T. Timpe, MS, RT, and Airica Steed, RN, MBA, both of Advocate Condell Medical Center, Libertyville, Ill., during an educational session Aug. 14 at the annual AHRA meeting.

Timpe and Steed opened by clarifying the four drivers prompting the need for transformational change in healthcare: escalating costs, quality and safety concerns, funding and reimbursement cutbacks and consumerism.

In the midst of a precarious macro climate, Timpe and Steed were confronted with the challenge of righting an imaging department and hospital contending with tough competitive and service issues.

Advocate Condell Medical Center is a 350-bed level 1 trauma center located in the competitive north Chicago market. Its imaging business includes a hospital-based practice and five outpatient imaging centers.

When Timpe and Steed were charged with the process improvement undertaking, the hospital had already undergone several unsuccessful endeavors. They faced hefty challenges, including: ranking in the bottom quartile of patient satisfaction; a report turn-around time in excess of 16 hours; a high percentage of denials and bad debt; a 6 percent no-show rate; negative growth; a high percentage of abandoned or lost appointments; a cumbersome registration process; elongated patient wait times; and low staff and physician morale.

They turned to Lean and the Malcolm Baldridge framework and coined operations excellence as the overarching strategy.

The basics of Lean, shared Timpe, include improving process flow and eliminating waste by involving front line staff, identifying and eliminating wasteful steps, streamlining processes to focus on what’s important to customers and creating standard work and transparent accountability.

The approach yielded multiple solutions, including:

  • Streamlined registration and intake, dubbed “reguling,” a single call for scheduling and pre-registration prior to service;
  • Decentralized access points for lab, radiology, women’s imaging, cardiology, surgery and registration at point of service;
  • Patient reminder calls 24 to 48 hours prior to service;
  • Voice recognition with 100 percent self-editing;
  • A pull system to schedule to demand;
  • A strong emphasis on customer service;
  • Inpatient scheduling;
  • Aligned schedule capacity and hours to expected volume and time;
  • Electronic transport requests; and
  • Standard work for all modalities.

One year after the launch of the project, the hospital reported:

  • Greater than top quartile in customer satisfaction;
  • Reduced report turn around to less than four hours;
  • Reduced no shows from 6 percent to less than 2 percent;
  • Greater than 8 percent year-over-year profitable growth;
  • Reduced abandoned/lost calls from 30 percent to less than 8 percent;
  • Reduced patient wait time from more than 30 minutes to less than 10 minutes;
  • Greater than 50 percent improvement in staff and physician satisfaction; and
  • Confirmed year-over-year return on investment of $1.75 million.

The project, concluded, Timpe and Steed, is continuous.