Phase II
Operational metrics to establish quality indicators, organizational effectiveness, monitoring of process improvement activities, and compliance of governmental standards must be established to provide organizational focus on resource allocation and establishment of organizational strategies.
System metrics are necessary to establish baseline practice and must be valid and acquired from a single reliable source. Hospital metrics from a system perspective need to have an ability to drill down to the individual provider level to determine areas of opportunity for improvement. The following metrics are a guide to operational efficiency:
Hospital length of stay preference would be in hours Discharges before noon 30-day readmissions Patient satisfaction
Each of these components link to quality, efficiency, finance, and service. Additional metrics used for operational assessment include:
Governmental Metrics: This includes core measures, reports on hospital utilization, Program for Evaluating Payment Patterns Electronic Report (PEPPER), Hospital Consumer Assessment of Healthcare Providers and Systems(HCHAPS) hospital acquired infections, and others Quality Metrics: Includes “never” events, hospital errors- meds, blood draws, wrong patient studies, falls, and others
Financial Metrics: Days cash on hand, debt level, collection rates, bad debt, and others Efficiency Metrics: Includes patient movement—ED to admit time, admit to bed placement time, ED to ICU transfer time, PACU to floor time, and others
The importance of a centralized storehouse of metrics is mandatory. As drill downs occur and departments develop effective methods to gauge their efficiency, linkage must be maintained to the overall system metrics which determine optimal operational efficiency.
Phase III: Process Redesign
Process redesign brings focus and resources to areas of opportunity defined by metrics. Areas of opportunity may be defined by comparisons to similar organizations, best practice, or complete redesign strategies using industry accepted methodologies and include:
An organizational and operational effectiveness assessment using Lean Six-Sigma methodologies The development of an efficiency improvement plan that aligns with the organizations strategic needs and design elements specified in phase I.
The design and structuring of a process improvement strategy includes the following:
An internal training and capability development plan for process improvement (Lean Sigma) expertise The development of standards and escalation processes to ensure sustainment of improvements The development of standard work for leadership at all levels: This supports their role in leading through the use of continuous improvement methodologies and processes (Lean Sigma)
A financial improvement plan based on the tactical deployment of Lean Sigma methodologies targeting patient flow and throughput improvements
Process Redesign has multiple components to it. Primary areas of focus would be as follows:
Non-Care Delivery Process improvement: Primary focus is on accuracy of non-clinical components which begin at the point of patient registration and end at the point of clean claims billing. This includes evaluation using Lean to look at the entire non-patient care delivery process and would evolve:
Patient Access and Registration Clinical Documentation (provider)
Enhanced Clinical Documentation Review and Education Optimal Coding and Educational Formats Optimal Billing with high percentages of Clean Claims and minimal discharge to dropped bill days Impact of process on denials management
