operational assessments: utilizing productivity … assessments: utilizing productivity standards...
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Ross Manson
Principal – Eide Bailly
701.239.8634
Operational Assessments: Utilizing
Productivity Standards
Mary Klimp
CEO – Queen of Peace Hospital
952.758.8101
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Agenda
Health Care Industry reform and the need for change
Productivity standard principles
Process reviews
“Tools”
The implementation process
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Health Care Industry Trends
Patient Protection and Affordable Care Act
Health Care and Education Reconciliation Act
Bending the cost curve
Utilization rates changing
Technology trends and improvements
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USA Health Expenditures as a % of GDP
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
1960 1970 1980 1990 2000 2009 2017
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Total Expenditures on Health Care as a
Percentage of GDP
0 2 4 6 8 10 12 14 16
United States
Switzerland
France
Germany
Canada
Portugal
Norway
Greece
Netherlands
Italy
Spain
United Kingdom
Japan
Percentage of GDP
Source: OECD Health Data 2007
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Reform Bill Provisions
Value-based purchasing
Quality reporting
Hospital-acquired conditions
Readmissions reductions
Independent Medicare Advisory Board
Demonstration projects
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The Need for Change
Industry trends are creating a need for health care organizations to change their operations and become more efficient and eliminate waste
Demand for Quality
Increasing Cost
Demand Changes
Increasing Need for
Transparency
Increasing Use of Technology
Need for Change
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Why implement productivity standards?
Track progress of strategies
Monitor financial outcomes, operational efficiencies, and patient quality
Accountability
Commitment
Proactive
Competitive positioning
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Proper decisions and success can only occur by:
Use of benchmarks
Review of current processes
Understanding the reimbursement process
Approach to Productivity Management
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Step 1: Reimbursement Opportunities
Often overlooked by providers
Coding
Charge capture
Pricing
Physician education
Difficult to hold staff accountable if organization has not taken every step to capture all earned revenue
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Process Review
Processes established by management are often the cause of the inefficiencies
However, we tend to hold the staff accountable for the inefficiencies, without allowing them the means to become more efficient
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Need to individualize to each department in each facility
What types of patients on each unit? Where is the work done? How is the work done? Who is doing the work?
Review of Processes
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Departmental Issues
Staff mix
Facility layout
Staffing patterns
Staggered shifts
Variable staffing plans
Staffing for the situation that “might” occur
Managing “extra minutes”
Ordering and stocking supplies
Physician discharge times
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Benchmarks provide guidance as to the recommended or normal staffing levels of individual departments
Facility must maintain necessary statistical information
Staff must understand the benchmark
Benchmarks assume an ability to gather data consistently
Must assure “apples to apples” comparison
Benchmarks
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Benchmarks are not averages
Benchmarks ARE best practices
Benchmarks
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Proper productivity management results in:
Formalizes departmental expectations
Develops consistency across departments
Achieving the necessary financial goals
Creating a positive work environment
Productivity Management
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Internal vs. External Benchmarks
• External – advantages and disadvantages
• Internal – advantages and disadvantages
• If you have no productivity standards in place
we recommend you start with Internal
Benchmarks.
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The Value of Lean
• Reduce cost through improved efficiency and allocation of resources
• Reduce time for every day processes; giving time back to the organization for additional initiatives and improvements
• Improve satisfaction of patients and staff as waste is eliminated from processes and procedures
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What is “Lean”
• Lean is a continuous improvement and problem-solving approach
• A work philosophy for achieving rapid progress by identifying and eliminating waste
• Lean process involves using tools and team resources to achieve goals
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Principles of Lean
Pursue Excellence
Define Customer
Value
Create Value Streams
Eliminate Waste
Allow Customers to Drive Services
Implementation of lean processes relies on the following basic principles:
Principles of Lean
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Lean Terminology
• Six Sigma Approach: Problem focused with a view that process variation is waste and that utilizes statistics to understand variation
• Lean Approach: Focused on process flow and views any activity that does not add value as waste and utilizes uses visuals to understand the process flow.
• Kaizan: Continuous, incremental improvement of an activity to create more value with less waste
• Non-Value Added Activities : Activities or actions taken that add no real value to the product or service making such activities or action a form of waste
• Value Stream: The specific activities required to design, order and provide a specific product, from concept to launch, order to delivery, and raw materials into the hands of the customer
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Lean Tools
• 7 Categories of Waste: Used to identify waste within a current process
• 5 S: A visually oriented system for organizing the workplace to minimize waste
• Process Flow Charts: Visual map identifying the steps and interconnecting points in a process
• Value Stream Map: Map used to analyze the flow of materials and information
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Implementing the Operational Assessment
What do you want to accomplish?
Where do you start?
What do you do with all this data?
How do you maintain momentum?
©2006 Queen of Peace Hospital. Proprietary and Confidential.
What do you want to accomplish?
Improve efficiency
Assess staffing model/needs
Monitor outcomes
Improve financial performance
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©2006 Queen of Peace Hospital. Proprietary and Confidential.
Where do you start?
Interdisciplinary teams
Setting standards
Process improvement
Data collection
©2006 Queen of Peace Hospital. Proprietary and Confidential.
What do you do with all of the data?
Benchmarks
Productivity measures
Data collection tools
©2006 Queen of Peace Hospital. Proprietary and Confidential.
How do you maintain efficiencies?
Monthly comparisons
Commitment
©2006 Queen of Peace Hospital. Proprietary and Confidential.
Staffing Matrix Revised Feb 2010
Census Staff/shift 9.4 Staff/shift 7.0 Ratio Charge nurse Team leaders HUC/AIDE M-F HUC PMs Sat-Sun D& E
M/S 15 5.9 4.4 3.8 1 3 2 1 1
9.4 14 5.5 4.1 3.5 1 3 2 1 1
7 13 5.1 3.8 3.3 1 3 *1 or 2 1 1
12 4.7 3.5 3.0 1 3 *1 or 2 1 1
11 4.3 3.2 2.8 1 3-D 2 or 3 -N *1 or 2 1 1
10 3.9 2.9 2.5 1 2 (look at acuity) 2 if 2 RN's, 1 if 3 RNs 1 1
9 3.5 2.6 2.3 1 2 2 or 1 (house needs) 1 1
8 3.1 2.3 2.0 1 2 2 or 1 (house needs) 1 1
7 2.7 2.0 1.8 1 2 1 1 1
6 2.4 1.8 1.5 1 2 1 1 1
5 2.0 1.5 1.3 1 *2 or 1 1 1 1
4 1.6 1.2 1.0 1 1 1 1 1
3 1.2 0.9 0.8 1 1 1 1 1
2 0.8 0.6 0.5 1 1 *1 or 0 1or 0 1 or 0
1 0.4 0.3 0.3 1 1 * 1 or 0 1or 0 1 or 0
0 1 1 *1 or 0 1or 0 1 or 0
* Assess the needs housewide
Census Charge nurse RN's Day shift Evenings
ICU 0 na 0
1 na 1 0 0
2 na 1 HUC for am cares only 0
3 na 1 or 2 (acuity/dischg) 1 if only 1 RN (acuity) acuity
4 na 2 0 0
5 na 2 acuity 0
7a-7p (7d/wk) 11a-11p (M-Th) 7a-7p 7p-7a (Friday) 9a-9p (Sat/Sun) 7p-7a (7d/wk)
ER 1 RN 1 RN 1RN days/1RN nights 1 RN 1 RN
*this person can go in
on call mix if ER is slow
Census Charge nurse 7a-7p 7p-7a
OB 0 na 1 (Float or inhouse call) 1 (float or inhouse call)
1+1 na 1 1
2+2 na 1 1
3+3 na 2 2
4+4 na 2 2
5+5 na 2 or 3 (acuity) 2 or 3 (acuity)
Outpatients and Labors refer to ACOG guidelines
Highlighted areas
are changes for 2010
©2006 Queen of Peace Hospital. Proprietary and Confidential.
Queen of Peace
Quarterly Benchmark Analysis
Period Ending December 31, 2007
Qtr Ending Qtr Ending Qtr Ending Qtr Ending Qtr Ending Qtr Ending Qtr Ending Qtr Ending
6/30/2005 6/30/2006 9/30/2006 12/31/2006 3/31/2007 6/30/2007 9/30/2007 12/31/2007 Comments Benchmark
Med/Surg/Peds 10.88 13.08 15.89 16.42 14.99 16.65 14.06 13.01 High but improved 7.00 HPPD
ICCU/CCU 16 to 18 HPPD
Obstetrics 26.29 7.52 12 to 14 HPPD
Emergency 3.64 2.36 2.91 3.60 3.42 2.60 2.31 2.40 High 1.75 Patients
Surgery 7.68 8.36 9.95 12.30 11.78 9.61 11.05 10.71 High 5.0 to 8.0 Patients
Same Day Surgery 4.59 4.65 7.26 7.30 7.19 7.57 5.80 6.09 High 5.50 Patients
Recovery 1.03 1.03 0.49 0.80 0.54 0.82 1.13 0.89 Below 1.20 Patients
Women's Health Center 2.20 2.38 2.30 2.18 2.24 2.25 2.14 Core Staffing Patient Visits
Outpatient Clinic 1.60 2.02 1.29 1.24 1.23 1.16 1.13 1.14 Below 1.60 Patients
Cardiac Rehab 913 956 1280 1255 1280 1318 1267 1357 High 1217 Total Worked Hours
Respiratory Therapy 0.30 0.80 1.08 0.80 0.75 0.81 0.95 0.99 High 0.37 Procedures
Pharmacy 0.086 0.055 0.064 0.061 0.062 0.065 0.067 0.056 Core Staffing 0.034 Procedures
Physical Therapy 0.85 0.62 0.64 0.70 0.64 0.65 0.62 0.60 Below 0.65 Procedures
Lab 0.30 0.28 0.29 0.29 0.28 0.27 0.26 0.27 Below 0.35 Procedures
Radiology 1.51 1.49 1.62 1.58 1.71 1.54 1.61 1.68 High 1.46 Procedures
Public Relations/Community Ed 0.15 0.21 0.24 0.24 0.23 0.23 0.29 0.36 Core Staffing .08 to .10 Adjusted Patient Day
Business Office/Finance 0.50 0.44 0.48 0.50 0.49 0.46 0.45 0.47 Good .40 to .60 Registrations
Admin 0.64 0.35 0.76 0.70 0.63 0.57 0.53 0.66 None Available Adjusted Patient Day
Nursing Admin & Quality 0.95 0.51 0.53 0.91 0.94 0.96 1.57 1.45 None Available Adjusted Patient Day
Health Information Service 0.42 0.41 0.42 0.42 0.42 0.42 0.43 0.43 Good .40 to .50 Registrations
Registration 0.31 0.35 0.37 0.37 0.40 0.39 0.37 0.37 Below .38 to .50 Registrations
Human Resources 0.14 0.25 0.14 0.26 0.28 0.35 0.45 0.38 None Available Adjusted Patient Day
Materials Management 0.37 0.35 0.39 0.40 0.39 0.38 0.38 0.46 Good .35 to .48 Adjusted Patient Day
Dietary 0.51 0.35 0.37 0.35 0.34 0.36 0.41 0.43 High .17 to .34 Meals
Housekeeping 0.41 0.46 0.49 0.54 0.53 0.50 0.54 0.57 Good .50 to .65 Hrs/1000 sq ft/day
Laundry 1.85 2.30 2.16 2.28 1.77 2.36 2.60 2.26 Good 1.5 to 3.0 Pounds
Information Systems 0.28 0.38 0.30 0.38 0.39 0.38 0.36 0.45 High .25 to .38 Adjusted Patient Day
Engineering 0.14 0.15 0.18 0.19 0.20 0.19 0.19 0.20 Good .16 to .22 Hrs/1000 sq ft/day
©2006 Queen of Peace Hospital. Proprietary and Confidential.
©2006 Queen of Peace Hospital. Proprietary and Confidential.