And what’s even more remarkable about this class is that the employees who were dealing with these issues every day got to fix them.
In March, 30 employees graduated from the inaugural A3 program, a component of the Center for Operations Excellence (COE) Lean Six Sigma initiative.
“A3 projects are identified by frontline staff who are enrolled in or have completed the eight-week A3 training program,” said Trauda Gilbert, a COE Lean Six Sigma project leader. “Participants use continuous process improvement skills aimed at reducing and eliminating waste to define and resolve problems that affect their daily work activities.”
The following is a sampling of the 28 A3 program success stories.
A plumb of a problem
Akron Children’s Engineering department is responsible for all the plumbing repairs in patient rooms, offices and public areas throughout the Children’s system. However, tracking thousands of plumbing parts can be difficult.
“I was working on a Saturday and came down to get a showerhead for a patient room and I couldn’t find one,” said Mike Cooper, of Engineering. “Eventually I decided it would be faster to replace it with one from an empty patient room.”
Cooper and coworker Matt Hirsch decided to put their A3 skills to the test and created a system to reduce the time it takes to find plumbing fixtures. They started by organizing fixtures into categories for showers, toilets and sinks. Next, they separated the parts and put similar pieces together in storage bins with a bar code label. The label includes the part number and shows a maximum and minimum number of parts permitted in the bin. “You see pretty quickly if you’re down to two parts and it needs to be reordered,” Hirsch said. “A rep from the company that supplies our plumbing fixtures comes in, scans the bar codes for the parts we need, and then sends the order to Engineering for approval.” The duo also created an inventory parts book to help simplify the process of finding parts.
To measure their success, Cooper and Hirsch had employees punch a timer at the start of looking for a part and again when they found it. Under the old system, it took 15 minutes to find one part. In the new system, it took just over three-and-a-half minutes to find 11 parts for one repair job.
Reducing patient cancellations
Julie Renner, RN, CNP, of Developmental-Behavioral Pediatrics, tackled patient cancellations and no-shows for her A3 project. “Patient cancellations create challenges for every physician’s office,” Renner said. “Although late cancellations are sometimes unavoidable, we were concerned that our average of seven open appointments per day was too high.”
Renner took the issue to task and conducted a survey that found most new patients kept their appointments, while followup patients had a 21 percent cancellation rate. The survey showed that weather, lack of transportation and a conflict with a parent’s work schedule were the primary reasons patients canceled an appointment.
Renner also evaluated the center’s scheduling process. Office staff made reminder calls to patients two days before their appointment. The next day cancellations would start to come in, leaving little time to fill an open appointment.
“We evaluated how much time we really needed to schedule an appointment and decided to move the reminder calls to seven days prior to an appointment,” said Renner. “We also asked patients to call us back within 48 hours if they needed to reschedule an appointment.”
This new process gave the scheduling staff five days to fill the schedule if an appointment was canceled.
The department’s A3 team also created an electronic cancellation list so staff could quickly see which patients had canceled and who needed to move into an available time slot. “After one week, the office went from an average of seven open time slots down to three in a day,” Renner said. The estimated net revenue increase of Renner’s project is $104,000 a year.
Accounting for faxes
Like many departments, Patient Accounts has a central fax machine and they receive high volumes of faxes daily from insurance companies, physicians, patients and internal departments.
“Faxes would stack up quickly and they weren’t always distributed to the correct person in a timely manner,” said Deborah DePree, of Patient Accounts. “The backlog of faxes could cause a delay in claims processing and sometimes even lost faxes.”
Problems were caused when no cover sheet accompanied the fax, no one distributed the faxes, or employees didn’t know when faxes were arriving or they forgot that a fax was waiting for them. Using her newly acquired A3 skills, DePree discovered that 60 percent of the faxes received were for billing and customer service.
As part of her plan, DePree created a fax distribution team rotation schedule, assigning each employee to a week when they pick up, sort and distribute faxes to coworkers’ mailboxes.
“We clearly labeled each employee’s name on the inside and outside of their mailbox,” DePree said. “We also moved the staff mailboxes closer to the fax machine, making it easier to distribute faxes.”
This project reduced the number of faxes waiting to be distributed by 48 percent and saved an estimated $3,433 in staff time spent searching for faxes.
PICU procedure cart receives makeover
Shortly after A3 classes started, Jean Christopher, RN, MSN, CNS, of the pediatric intensive care unit (PICU), received an e-mail from her director, Helen Raub, regarding problems with restocking the PICU procedure cart.
“The PICU procedure cart is supposed to contain all of the items we need to start a central line, arterial line, lumbar puncture and other procedures,” said Christopher. “We use the cart on an average of 10 times per day and it was only getting restocked once per shift, which meant sometimes it didn’t get restocked for 12 hours and then we’d run out of things.”
Christopher organized a group of coworkers to evaluate the contents of the eight-drawer cart. They discovered that some items were overstocked or unnecessary while other items were missing.
“We had the wrong amounts of some things. For instance, 10 pairs of each size of gloves were reduced to five of each size,” said Christopher. “We were missing catheters as well as sterile drapes, which are required for most procedures.”
In the end, they made one and- a-half drawers available, providing enough space to include one of each size drape and catheter. “Now nurses don’t have to leave the room to go and get these items. They’re right on the cart,” Christopher said.
To make sure the cart is restocked on a timely basis, Christopher and her team added a small basket and a flag to the cart. “The flag works like the flag on a mailbox. If the flag is up, the cart needs restocked,” Christopher said. “Within 30 minutes, the PICU resource employee checks the basket for any used wrappers, restocks the items, empties the basket and puts the flag down.”
The PICU project saves an estimated seven minutes per procedure, which results in a projected yearly savings of $4,368 in staff time.
Heart Center streamlines patient moves
Sarah McGuire, CVT, of the Heart Center, often lends a hand to move patients and families throughout the center.
“The flow of patients and families who need an electrocardiogram (EKG) and echocardiogram (echo) required them to move to different exam and procedure rooms an average of five times during one visit,” McGuire said.
After patients checked in, they went to the EKG room where a nurse took vitals. Then they moved to an exam room to meet with the physician. Next, they went to the echo room and then back to the exam room for results, followed by check out.
“During winter months, parents are lugging kids with boots, coats, hats, diaper bags and usually young siblings,” McGuire said.
“On average these visits took 107 minutes and it would be hard on the kids and parents to move from room to room.”
McGuire’s A3 project focused on reducing the movements of EKG and echo patients and families from five moves to three. This was done by moving equipment, combining testing, and changing the routines of echo technicians and C.R. Patel, MBBS, director of maternal-fetal cardiology.
McGuire and her team shortened patient visits by an average of 32 minutes.
“Patients may wait up to four weeks to see Dr. Patel for this type of appointment,” McGuire said. “With these results, we have the potential to add patients to Dr. Patel’s schedule.”
This A3 project has an estimated potential net revenue increase of $96,000 per year.
Talk to your supervisor if you are interested in participating in the A3 performance improvement program, or call 330-543-4771 for more information.