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St. Louis hospital focuses on efficiency

By MARY JO FELDSTEIN
St. Louis Post-Dispatch

Monday, September 22, 2008

ST. LOUIS (AP) — When executives at St. John’s Mercy Medical Center in Creve Coeur noticed patients in wheelchairs lining the halls as they waited for physical and occupational therapy, they thought there must be a better way.

They were right.

Hospitals across the St. Louis area — and the country — are employing the concepts and tools used for decades by manufacturing companies to make operations more efficient and quality more consistent. Lean manufacturing and Six Sigma are overlapping process-improvement strategies that aim to take the waste out of a process while standardizing the process itself.

“The benefits there are many,” said Kendall Cobb, leader of the health care practice at Missouri Enterprise, an organization that leverages federal, state and private programs to help companies become more efficient.

“You’re going to see improved quality. You’re going to see reduced waiting times, shorter lengths of stay for patients, improved outcomes but there’s a lot of other secondary effects,” including possibly improved staff attitudes, Cobb said.

The staff at St. John’s had some training in these principles before, but felt help from outside experts could help it accomplish more.

As part of a community service project, Boeing Co. stepped in to lend expertise to the task at no charge.

Teams from St. John’s and Boeing decided to focus on the inpatient rehabilitation center, where patients recovering from strokes and car accidents go to regain strength and relearn daily tasks.

The teams found areas where the rehab center could work more efficiently, where waste could be eliminated and where patients’ experience could be improved.

“Part of this is to change the culture and the mind-set,” said Vince Tappel, director of lean manufacturing for Boeing.

A first step was eliminating the long line of patients in the hallways waiting for appointments.

“Everybody had a ’time’ that nobody really paid attention to,” said Joan Frost, a registered nurse who focuses on quality improvement at Boeing.

Before the change, whether the therapist was available or not, transport staff took patients from their rooms to the hallway near the therapy center.

And there was no way for nurses from the floor who know the patients’ challenges best to easily communicate the patients’ needs to the therapists.

It was a classic assembly line system, substituting patients for widgets. There were 31 steps from the time the order for the therapy was written to the point where the patient returned to the room.

The process needed to move to batch system, a classic Six Sigma shift. The new system moves patients in as needed. And each patient’s nurse talks to the therapist through an internal communication system. The process is down to 17 steps.

Still, there were concerns: For instance, would therapists waste time waiting for patients?

“We were concerned about loss of productivity,” Frost said.

The solution has been for therapists to signal the transport staff to bring down the next patient shortly before they’re finished with the current patient.

There’s the occasional delay, “but overall the new system is working more smoothly,” said Kandi McClellan, a physical therapist at St. John’s.

The rehab center itself then was redesigned so the therapists would be closer to needed equipment and paperwork.

St. John’s and Boeing’s next goal will be to expand the concepts throughout the hospital. They are selecting 20 projects on which to work. A team of staff involved with the problem, including a trained consultant from St. John’s, will be assigned to fix each problem. -Boeing will continue to help as well.

Continuous improvement is a major tenet of all Six Sigma processes. “You continuously have a new baseline that you need to work from,” said John Wood, a Six Sigma expert at St. John’s.

As the hospital and its physicians continue to implement an electronic health records system, the technology will improve communication, pushing the process even further, Frost said.

“It will be huge,” Frost said.

Related to therapy, a nurse could make notes in an electronic medical record. Those notes could be accessed by the physical or occupational therapist, eliminating the need for communication through the internal system.