Process Improvement for the Long Haul

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 - Process Improvement

It's easy, or at least relatively so, to uncover an anecdotally successful imaging project. We've all heard a fair share of impressive success stories about departments that increased patient satisfaction or reduced MRI wait time. All too often, the data associated with these stories are soft, unsustained or unmeasured. Or the project simply fizzles after six months. In contrast, Health Imaging presents a collection of truly successful data-driven process improvement case studies.

Genuine process improvement, and the variety every organization demands, is data-driven, sustained and measurable. Process improvement success stories are flush with metrics, such as:

  • A revised coronary CT angiography (CTA) protocol at Gundersen Lutheran Health System in La Crosse, Wis., trimmed radiation exposure from 21 to 15 mSv for 260 patients annually;
  • A CT turnaround project slashed room turnaround time at Columbus Regional Hospital in Columbus, Ind., from 22 to 13 minutes and maintained the new standard for four years (and counting); and
  • Advocate Condell Medical Center in Libertyville, Ill., increased patient satisfaction from the bottom quartile to the top quartile, and sustained the gain.

Despite the varied results, a number of common factors pervadet these success stories, including a solid grasp of data, committed leadership, organizational coherence and consistency, staff engagement and solid metrics and assessment. Many embrace Lean, a system of process improvement that originated in manufacturing, which seeks to eliminate waste by involving frontline staff, identifying wasteful steps, focusing on customer priorities and standardizing processes.

The first step in any process improvement project is data gathering. Without data, it's nearly impossible to accurately assess current operations and set meaningful goals. "You don't know what you don't know [without data]," says Deanna Welch, system director imaging services at Intermountain Healthcare in Salt Lake City.

In 2009, Intermountain completed an organization-wide strategic plan and imaging services has used those data as a springboard to drive 13 strategic initiatives, each of which have multiple improvement projects. "The strategic plan highlighted a number of areas where performance could be improved, or were not measured regularly or effectively. The data analysis gave us our marching orders," says Dave Monaghan, assistant vice president.  

Rocket science…or not?

"If this were easy, every hospital would do it," shares Airica Steed, RN, MBA, EdD, vice president of professional services at Advocate Condell Medical Center. Steed and her colleagues spearheaded a downright transformation, nurturing impressive gains in an array of metrics including patient satisfaction, report turnaround, profitability, no-show rates and much more.

Everyone, observes Steed, loves to see positive results. She and her team have amassed more than a few, including reducing report turnaround time by more than 75 percent, cutting patient wait time by more than 65 percent and increasing staff and physician satisfaction by more than 50 percent. "The simplest part of process improvement is identifying what's broken and identifying the best practice to fix it. The difficult part is selling that change throughout the organization."

The challenges originate on multiple fronts. The sheer volume of data at Intermountain illustrates the complexity of the planning and improvement processes. The extensive strategic plan analyzed 2.7 million data lines, entailed 500 interviews and surveys and required more than 2,000 man-hours.

Data gathering and analysis, however, are the mere starting point. Every organization is comprised of multiple players who will question and resist the need for change. "Getting everyone to share the same vision is the most complex aspect of a Lean program," Steed asserts.

In fact, Advocate Condell struggled in its initial process improvement efforts because the medical center had not thoroughly established the infrastructure for change. "We had a lot of starts and stops and actually experienced breakthrough success in many respects, but we didn't have the leadership strength to sustain the new and improved level of performance. It was very easy to fall back on what we had always done, which was to operate with a lot of weight, redundancies and inefficiencies," Steed says.

For example, an early process improvement project in the ambulatory surgery program focused on integrating