Operational Assessments: Utilizing Productivity Standards Mary Klimp CEO Queen of Peace Hospital 952.758.8101 mklimp@qofp.org Ross Manson Principal Eide Bailly 701.239.8634 rmanson@eidebailly.com
Agenda Health Care Industry reform and the need for change Productivity standard principles Process reviews Tools The implementation process
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
USA Health Expenditures as a % of GDP 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% 1960 1970 1980 1990 2000 2009 2017
Total Expenditures on Health Care as a Percentage of GDP Japan United Kingdom Spain Italy Netherlands Greece Norway Portugal Canada Germany France Switzerland United States 0 2 4 6 8 10 12 14 16 Percentage of GDP Source: OECD Health Data 2007
Reform Bill Provisions Value-based purchasing Quality reporting Hospital-acquired conditions Readmissions reductions Independent Medicare Advisory Board Demonstration projects
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 Need for Change Increasing Use of Technology
Why implement productivity standards? Track progress of strategies Monitor financial outcomes, operational efficiencies, and patient quality Accountability Commitment Proactive Competitive positioning
Approach to Productivity Management Proper decisions and success can only occur by: Use of benchmarks Review of current processes Understanding the reimbursement process
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
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
Review of Processes 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?
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
Benchmarks 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 Benchmarks are not averages Benchmarks ARE best practices
Productivity Management Proper productivity management results in: Formalizes departmental expectations Develops consistency across departments Achieving the necessary financial goals Creating a positive work environment
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.
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
What is Lean Lean is a continuous improvement and problemsolving approach A work philosophy for achieving rapid progress by identifying and eliminating waste Lean process involves using tools and team resources to achieve goals
Principles of Lean Implementation of lean processes relies on the following basic principles: Pursue Excellence Allow Customers to Drive Services Principles of Lean Define Customer Value Eliminate Waste Create Value Streams
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
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
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 2006 Queen of Peace Hospital. Proprietary and Confidential. 24
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 2006 areas Queen of Peace Hospital. Proprietary and Confidential. are changes for 2010
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 7.00HPPD 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 1217Total Worked Hours Respiratory Therapy 0.30 0.80 1.08 0.80 0.75 0.81 0.95 0.99 High 0.37Procedures Pharmacy 0.086 0.055 0.064 0.061 0.062 0.065 0.067 0.056 Core Staffing 0.034Procedures 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.10adjusted 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.50registrations 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.65hrs/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 2006 Queen of Peace Hospital. Proprietary and Confidential. 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.22hrs/1000 sq ft/day
2006 Queen of Peace Hospital. Proprietary and Confidential.
2006 Queen of Peace Hospital. Proprietary and Confidential.