Performance Improvement in Obstetrics – Case Study

This medium sized community healthcare system in the mid-west believes in setting the bar high when it comes to the quality of care it provides for its patients. The system consistently receives high quality marks and was ranked among just four percent of hospitals to earn the “Magnet” status from the American Nurse Association, the organization’s highest honors in nursing excellence.  With a focused commitment on improvement, hospital leaders decided to formally engage in a Lean improvement initiative. They received formal coaching and training in the application of Lean management to relieve overburdened employees, improve patient care and reduce cost by applying a hospital-wide strategy that seeks improvement across the network. The first service line was OB.

Improving Patient Care in the Obstetrics Department

One department that has experienced breakthrough results is the Obstetrics (OB) service line. Lean management coaches began the Lean transformation by helping hospital staff identify which parts of the treatment process were of greatest value from the patient’s perspective. From checking in with the receptionist, to delivering the baby, to leaving the hospital with the baby, each step in the patient’s experience was closely defined and examined.

The Problem

The Obstetrics ( OB ) service line delivered more than 18,000 infants the previous year with a staff of more than 110 employees. With increasing demand, the OB department was confronted with capacity issues. Staff often had to push back a scheduled C-section or induction for a later time in the day or have two mothers share postpartum rooms to meet the demand. There were even capital plans to meet the increased demand with an $80 million construction project that included the $50 million construction of an expanded OB department along with $30 million budgeted for an energy plant expansion and new parking garage for the OB department in addition to a potential staffing increase of up to 20 percent.

Current State

Discharge Efficiency: OB nurses worked with four to five patients each. When a patient needed to be discharged, they had to juggle the process of discharging a patient while caring for other patients. Only 40 percent of patients ready for discharge were released by the hospital by 1:00 p.m.– patients who no longer needed care were occupying beds that could be used to treat new patients.

Obstetrics Scheduling: At this community hospital more than 40 percent of births are scheduled inductions and C-sections. In the past, the OB department would schedule these based on the physician’s preferred schedule. This resulted in various peaks in the schedule each week, which was hard to balance when an influx of non-scheduled mothers was ready to deliver. An automated scheduling system was in place but not being used.

Length of Stay: New mothers often want to stay in the hospital longer even though they are ready to be discharged. In fact, patients recover faster at home.

Solutions

Discharge Efficiency: Assigned a dedicated discharge nurse who only works on discharges, conducts education to mothers the day before discharge and schedules procedures like conducting additional tests that need to take place before discharge. By ensuring more patients were discharged by 1:00 p.m., mothers who delivered the night before or that morning would not have to wait for a postpartum room.

OB Scheduling: Schedule cases more evenly. The OB department evened out the number of scheduled cases each day. The automated scheduling system is in place and functioning as needed. If a patient scheduled for delivery goes into labor early, they are automatically removed from the schedule.

Length of Stay: The OB staff developed speaking points and educational materials that physicians and nurses use to properly speak to new mothers about length of stay.

The results

• Added 15% bed access and capacity with existing facility and staffing postponing a planned expansion.
• Year to date, 89.5 percent of patients who were ready to leave by 1:00 p.m., left by 1:00 p.m.
• Decreased length of stay by nearly 3 hours from 2.8 days (67.2 hours) – now at 2.69 days (64.56 hours).

To find out more about how Group50 can help your healthcare system significantly increase productivity and asset management, call us at (909) 949-9083, drop us a line at info@group50.com or request more information here and read more articles from the Group50 Healthcare Consulting Practice here.

About the Author:  Vincent Polito is Group50’s Healthcare Practice leader with over thirty years of experience as an executive and healthcare consultant in the design and delivery of Lean, Lean Transformation and Operational Excellence in the Healthcare, Medical Device, Industrial Manufacturing, Aerospace, Textile and Oil and Gas industries.  He has held senior management roles in operations, materials, quality, and business development.

Vinnie pioneered Lean techniques in Healthcare. At the forefront of Lean in Healthcare since 2003 he has provided guidance to over 100 hospitals, physician/specialty practices, insurance health plans and home health systems in North America. He has a grasp and appreciates of the mission and complexity of Healthcare. He translates Lean principles and techniques into effective delivery strategies and execution specifically meeting the critical needs and culture of Healthcare. Some his more notable Healthcare clients include, Thedacare, Denver Health, Beth Israel Deaconess, Barnes Jewish, New York Health and Hospitals, and Priority Health. His Lean support of Healthcare has included initiatives for non-clinical organizations including the Institute of Medicine (IOM), the Institute for Healthcare Improvement (IHI) and National Quality Forum (NQF).

Vinnie has led and executed Lean transformation in a diverse range of industries with a client list of Fortune 500 organizations including Boeing, Alcoa, Lockheed Martin, Rockwell-Collins, Duracell, Owens-Corning, Sandia Labs and Hanes Brands. #group50, #healthcareconsulting, healthcare consulting firm, healthcare consulting, #healthcare, healthcare consultant

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