GSA #:   GS-10F-0306V
DUNS #:   034239942
Cage Code:   58SR1
 
Corporate:   877-496-8811
Sales: 214-533-8571
Case Studies
Hospital District Operational Improvement

Project This project was directed at improving overall operations of a California Rural Hospital District. This client provides a wide variety of services to a mountain resort community and surrounding areas. In addition to its Emergency and Acute Care facilities, it also provides Long Term Care, Home Health, Hospice, Wellness Center, Oncology Center, and patient clinics.
Objectives The objectives for this project were to :
  • Improve Customer Satisfaction
  • Increase throughput
  • Reduce Errors
  • Improve Inventory Management
  • Establish a Strategic Plan for Future Systems Development and Continued Improvement
  • Improve Billing and Cash Flow
  • Improve Humans Resources Operations
Unique Issues This hospital district contains many business units in order to serve the health care needs of an entire mountain resort community and surrounding areas. The hospital employs numerous part time and contract personnel since employees’ desire to be in the ski area for winter sports. Recruiting is difficult because of the cost of living in this area.
Results Improvements were widespread due to the size and complexity of the operation but are summarized as:
  • Insight 1, Inc. facilitated this group from an informal management style to a process management system style of management.
  • In consideration of the above, a complete system of process diagrams was developed – typically one for each Business Unit and Service Department Area. These served as the basis for identifying and incorporating operational improvements and for developing a new set of Operational Procedures and Work Instructions. Many Improvement Projects were conceived from this activity.
  • Implemented a Performance Monitoring System
    Insight 1, Inc. led the hospital management team in the development and implementation of a system of visible performance measurement boards at the department level as well as establishment of a summary performance measurement “dashboard” for use by the hospital Administrative Council in monitoring overall hospital performance against established goals and objectives established in the hospital’s business plan.
  • Established a Formal Hospital Census Management System
    Although the acute care hospital was licensed for a maximum number of inpatients at any given time, no formal method for monitoring the current census as admissions, transfers and discharges were transacted throughout each day existed. No pre-defined management actions and responsibilities for assuring compliance to the regulatory mandated maximum population level were documented. Insight 1 facilitated the development and documentation of formal census management processes, assignment of management responsibilities and completion of documented Standard Operating Procedures for assuring the hospital’s compliance. This lowered the hospital’s risk and potential liability.
  • Improved Medical Charts
    We found that many problems with coding of patient expenses and billing denials were rooted in poor medical chart maintenance on the hospital floor. Insight 1, Inc. facilitated the Nursing staff leadership in developing and implementing a standard outline and color coded format for all patient charts.
  • Medical Coding and Billing Improved
    Successfully transformed the Medical Records coding and analysis activity to a standardized approach utilizing improved accessibility of medical records via an electronic imaging system and standardizing patient charts throughout the hospital. This reduced billing errors and contributes to increased cash flow.
  • Registration Improved
    The system used multiple approaches and systems for patient registration. These were standardized and Insight 1 facilitated the IT department in simplifying the registration activity by simplifying the complex screens required and eliminating the need to re enter common data. This reduced registration time with the patient and reduced registration entry errors. A tracking database was developed and implemented for tracking and verifying registration data entry errors.
  • Emergency Department Improved
    We completely documented the operational processes in the ED for the first time. These increased compliance to standard protocols in emergency patient situations. This led to the implementation of standard treatment protocols (T-Sheets) developed for each type of patient symptom. These both simplified and increased standardization of ED patient charts. Patient wait times were reduced by simplification of registration requirements in the emergency department. We also better integrated the transition of patients moving from the Ed to other acute care department including Surgery, ICU and inpatient treatment areas.
  • Surgery Center Improved
    Pre Registration for surgery was stream lined and surgery scheduling improved along with improved methods for reception and management of incoming surgical patients resulting in a seamless flow that improved the patient’s hospital experience resulting in reduced patient complaints and improved patient satisfaction.
  • Long Term Care Improved
    Improvements were achieved for patient admission to LTC through streamlining of documentation and by better coordination between acute care personnel and LTC personnel. Patient charge gathering and billing preparations improved with improved processes. Introduction of increased Case Management improved patient access to needed multi-disciplined care. Discharge processes improved speeding discharge process and subsequent billing.
  • Home Health and Hospice
    Both of these functions benefited from improved documented procedures that focused and coordinated care providers to better communicate patient status and progress through better forms control and better scheduling of home visits.
  • Purchasing and Inventory Systems Improvements
    By developing new process definitions and procedures for the overall acquisition, supply chain management and inventory management systems, this organization became much more efficient. Inventory was initially out of control. Insight 1, Inc. facilitated the modification of the inventory management module by the OEM to implement needed functionality for managing procurement, receiving, inspection, and inventory systems. Inventory definitions were simplified improving visibility and accuracy.
  • Establishment of a Capital Planning and Asset Management System
    No formal processes existed for capital asset planning, capital budget establishment and control or for adequate tracking of assets through their life cycle. Formal process developments for this function were facilitated with the management team and implemented with the first successful capital planning and approval cycle and through the establishment of a new capital tracking process.
  • Successful Integration of New Oncology Center
    When the opportunity came for establishing a new Oncology Center to meet community needs, Insight 1, Inc. facilitated the definition of the operational processes and integrated them with the rest of the hospital functional area processes. This was important because of the resulting increased demand on the Pharmacy, Radiology, Laboratory and Surgical departments. This addition grew rapidly because of local demand producing an overall increase in revenues.
  • Reorganized Information Technology Department
    Recognizing that the IT department was the key factor in future improvements (since nearly all improvements involve new or modified systems and applications), Insight 1, Inc. led the management team in:
    • Clearly redefining key IT Staff responsibilities.
    • No formal processes existed for dealing with the heavy demand on the small staff for meeting these advancing needs for survival over time. Insight 1, Inc. utilized its experience in IT management to establish formal processes for IT Systems Development, Production Operations and Maintenance. These were documented into 38 Standard Operating Procedures, implemented and all personnel trained.
    • Led the Implementation of a Help Desk System and staffing for it. This provided the means to measure IT response to customer complaints and service requests. A response tracking methodology was implemented resulting in working down a significant backlog of customer requests. Overall response time was significantly reduced and customer satisfaction improved because customers knew what to expect from their IT Requests.
    • A Strategic planning methodology was developed to provide the identification, prioritization and migration of IT infrastructure, systems and applications to bring the district in line with new technology and emerging systems that will lower cost through automation and integration in the future. This was very complex given the advancing technology needs and budgets in the coming years. Using our prior experience, we also led the IT department in developing a process and procedures for the development, testing and maintenance of a comprehensive business continuity plan and its implementation.
  • Laboratory Operation Improved
    Applied Lean Practices and principles in reorganizing and structuring the lab workflow to a more production like operation. This resulted in a significant operational improvement and transition of the culture to a production environment with increased management oversight and improved lab capacity with minimal increase in costs. This was the subject of a separate case study.
  • Maintenance and Engineering
    • We found that the maintenance operation was experiencing significant demand but possessed no current era systems for managing this vital operation. Insight 1, Inc. has had broad experience in establishing and improving maintenance systems in many industries. We relied on this experience in leading a team of Engineering Management members and IT representatives in the analysis and selection of a state of the art maintenance management system for procurement and implementation. This organization is well on its way to making significant gains in preventive (scheduled), predictive and unscheduled maintenance and equipment calibration. Records were strengthened to reduce risk and liability for regulatory compliance audits.
    • This hospital district had just completed a successful bond election in the community to raise approximately $100M for expansion and addition to the hospital district capabilities and facilities. This required embarking on the complex path from strategic planning, architectural planning, contractor selection and management throughout the construction phase as well as compliance with multiple state, city and other regulatory requirements, inspections, certifications, licensing requirements and occupancy. We developed a comprehensive set of processes to define this lengthy process and embarked on documenting them with new procedures. This was quite timely and was stated by the client as their best hope and method for successfully managing the many contractors and participants through this maze of complex processes.
  • Reorganized and Improved Human Resources
    The HR department had been in a state of disarray in terms of standard process. The quality of hires was below expectations. Insight 1, Inc. began work with this department just as a new Director was assigned. This afforded both parties the opportunity for completely redefining the HR Process. AN extensive set of HR functional processes was developed as facilitated with the new director. Ultimately 63 Standard Operating Procedures were identified including those covering the Volunteer Program (including volunteer qualifications and training) for the hospital which had never been documented. Following this activity, the quality and timeliness of new hires improved.
Description of Services As part of our overall project to improve operations for the Hospital District, Insight 1, Inc. performed the following tasks in support of the Laboratory operational improvement:
  • Developed a set of process diagrams for the each Business Unit within the Hospital District. This included 10 major hierarchical process diagrams and one Infrastructure and support Process Diagram. New operating Procedures were developed and implemented in each Business Unit or functional service area.
  • An assessment of all operations was conducted and improvement initiatives were identified and then prioritized based on the impact to overall operational performance as well as with respect to key organizational goals.
  • Process Improvement Plans and Approaches were developed and these executed to obtain widespread improvements.
Methodologies Utilized Insight 1, Inc.’s unique methodologies for facilitation and documentation of hierarchical business processes as well as application of lean practices to eliminate waste, improve product flow and reduce errors.