Provincial Healthcare System Improves Patient Access Through Lean/Six Sigma Implementation

Serving all the provincial residents within an Eastern Province

$20M

Forecasted Overall Savings

50%

Reduction in Overall Length of Stay

Challenge

The client requested guidance on how to achieve their strategic goals that would address the quality, accessibility, and efficiency of the provincial healthcare system. The two main hurdles to overcome were how to improve patient, client and resident access to all services and to improve population health outcomes. The goal was to reduce the Overall Average Length of Stay (OALoS) by 50%. This required a focus on the extra time spent in the hospital above the expected stay length to address improving patient flow through Acute Care (hospitals). The first phase of the program was affectionately known as “reducing the hospitals’ reasons for poor patient flow”. Phase one was designed to identify the ‘External to Acute’ care reasons for excessive admissions and discharge delays. This would address blocked beds in emergencies; patients that had no assigned primary care providers; missed communications for sending patients home with home care; and hospital admissions from long-term care to name a few.

Our healthcare experts were engaged to design and guide a province-wide health system transformation using Lean Six Sigma and quality management implementation and training techniques. This included leadership training and consultation, as well as a training and mentorship program to create Yellow, Green, and Black Belt-level personnel that would manage quality improvement projects across the province. The focus on training health system staff was to build their internal quality improvement capacity, leading to long-term sustainability after the consulting engagement was completed.

Discovery

The team developed a two-phase approach to reduce the OALoS in Acute Care.

Phase l:

The team focused on the areas external to the Acute Care system that could contribute to increased acute care patient flow, including Public Health, Primary Care, Home Care, Long-Term Care, and Extended Care. The following projects outline some of the changes initiated:

Long-Term Care: Identified root causes of preventable hospital admissions: falls, pressure ulcers, UTIs, etc, and implemented measures to eliminate these causes and reduce hospital admissions. This was managed through a multi-home collaborative approach. Each Long-term care home would lead one initiative, like eliminating UTI’s. Once each had created and proved a change model with sustainable results, it was shared with other homes. This collaborative model accelerated the health system change, increased buy-in through active participation by the stakeholders and improved Resident outcomes for all long-term care Homes.
Two Rural Acute Healthcare facilities: It was found that the length of the initial hospital stay was a predictor of readmission (either longer or shorter than the expected length of stay). To reduce instances of readmission, an Expected Date of Discharge (EDD) was implemented upon admission to engage the patient, family and care providers to focus on completing tests, patient activities, and care plans so the patient could leave sooner. This collaborative approach with a shared discharge goal created better predictable outcomes and reduced readmissions.
Extended Care: Patient discharge was often delayed due to a lack of resources. Implementing EDD upon admission improved ‘plan of care’ visibility for the entire care team (primary care providers, the patient, and the patient’s family) to ensure adequate planning and preparation allowing the patient to return home on their specified date.
Primary Care: This focus on identifying the panel size for family physicians was to reduce patient wait times to a maximum of one week. The Advanced Clinical Access (ACA) tool created by Dr. Mark Murry was used to support clinical spaces and Doctors’ offices to reduce the workload for Doctors, Nurses, and support staff. The tool is comprised of ten modules that are implemented over two months. Upon completion, many office schedules were freed up to allow for same-day appointments and panel sizes could be increased with reduced staff workload.
Home Care: The team identified opportunities to free up capacity for homecare staff in high-volume areas. This resulted in reduced disparity in services across different counties. In addition to this, the team introduced tools to track visits without increasing administrative load, enabling the department to make data-driven decisions.
Public Health: The focus was to reduce duplicate tasks and review current preventative care policies to increase nursing capacity and high-risk population visits and immunizations. The Public Health team achieved access to the full vulnerable population, and reduced flu outbreaks, and hospital admissions.

Phase ll:

Once these Acute Care external factors had been addressed, Phase II focused directly on solutions for the two primary hospitals. This included:

Acute Care: EDD was implemented in medical and surgery units to reduce OALoS as well improvements were made lessen the burden on the ED by improving flow from the emergency department (ED) to inpatient units.
Panel Group: This project involved coordination between all facilities in the province to create a standard, predictable flow for patients between facilities and services across the province. This resulted in an environment where patients, clients, and residents received the appropriate care in the appropriate environment at the appropriate time.
Community Mental Health and Addictions: We worked with physicians to reduce psychiatry wait times using the Advanced Clinical Access model implemented in Primary Care during Phase I.
Inpatient Mental Health and Addiction Services: EDD was implemented for mental health inpatients reducing barriers to patient flow allowing those that needed a bed in the Mental Health ward instead of being treated elsewhere.

Value Created

As a result of this Quality Management System transformation, our client was equipped with the foundation, trained staff, infrastructure, and systems to continue its quality improvement journey independently. Realized benefits through this engagement included:

A 50% reduction in OALoS
Creation of a system wide Value Stream Map that senior leaders used to identify health system hotspots using real time data
A 25% reduction in emergency room visits
200+ Lean projects, enabling $20M of savings
50% of physicians were now able to offer same day appointments
Public health reaching the full vulnerable population and preventing outbreaks in LTC for almost two years

Provincial Healthcare System Improves Patient Access Through Lean/Six Sigma Implementation

Challenge

Discovery

Value Created

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