Operational Assessments: Utilizing Productivity … Assessments: Utilizing Productivity Standards ... from concept to launch, order to delivery, ... Visual map identifying the steps

www.eidebai l ly.com

Ross Manson

Principal – Eide Bailly

701.239.8634

[email protected]

Operational Assessments: Utilizing

Productivity Standards

Mary Klimp

CEO – Queen of Peace Hospital

952.758.8101

[email protected]


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

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

1960 1970 1980 1990 2000 2009 2017


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


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

Increasing Use of Technology

Need for Change


Why implement productivity standards?

Track progress of strategies

Monitor financial outcomes, operational efficiencies, and patient quality

Accountability

Commitment

Proactive

Competitive positioning


Proper decisions and success can only occur by:

Use of benchmarks

Review of current processes

Understanding the reimbursement process

Approach to Productivity Management


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


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


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 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

Benchmarks


Proper productivity management results in:

Formalizes departmental expectations

Develops consistency across departments

Achieving the necessary financial goals

Creating a positive work environment

Productivity Management


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 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


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


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

©2006 Queen of Peace Hospital. Proprietary and Confidential.

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?


What do you want to accomplish?

Improve efficiency

Assess staffing model/needs

Monitor outcomes

Improve financial performance

24


Where do you start?

Interdisciplinary teams

Setting standards

Process improvement

Data collection


What do you do with all of the data?

Benchmarks

Productivity measures

Data collection tools


How do you maintain efficiencies?

Monthly comparisons

Commitment


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


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



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Operational Assessments: Utilizing Productivity … Assessments: Utilizing Productivity Standards ... from concept to launch, order to delivery, ... Visual map identifying the steps