As its surgical services were nearing capacity, Eisenhower Health needed more effective staff development, better utilized ORs and new scheduling processes to reduce waste and improve efficiency.
With the help of Watson Health Simpler, Eisenhower was able to effectively engage staff, increase OR access for surgeons, fix surgical scheduling issues and put patient care and safety first.
Drastically increases surgical capacityby optimizing OR spaces and improving scheduling processes
USD 9 million increase in contribution marginfrom the OR over 3 years
Greatly improves patient safety and carewith the adoption of a universal protocol through Lean practices
Business challenge story
An underutilized operating room
The healthcare industry is forever evolving, but change is slow because of the complexity of the healthcare system. As facilities compete with one another over patients, top medical talent, low-cost services and optimal care, it's hard to remain a thriving medical center if not open to change.
Eisenhower, a not-for-profit hospital located in Rancho Mirage, California, has provided high-quality care for over 45 years, but the last few years have been stressful for the staff. After leadership turnover in Surgical Services, staff reported communication gaps, inconsistencies within the OR and an inability to reinforce safety and quality best practices.
Dorothy Jones, Administrative Director for Pre-operative Services at Eisenhower, explains: "What kept me up at night was quality. The leadership turnover in Surgical Services led to a loss of institutional knowledge around best practices. The team needed vision and guidance that just wasn’t there.”
Frustration mounted among the staff. Problems arose, including frequent OR scheduling errors, inaccurate supply lists, incomplete patient information and prolonged case turnover times. All of these factors resulted in delayed procedure start times, which in turn delayed subsequent procedures.
Nurses had to balance these process concerns with demands from physicians, who were continually pushing them to fix the inefficiencies and increase turnover. For the surgeons, concern over the lack of organization, scheduling block discrepancies and slow turnover within the surgical units caused high degrees of impatience.
Eisenhower realized it would need to evaluate and improve the entire surgery process, from patient arrival to patient discharge. The hospital also wanted to grow revenue while improving staff retention.
Trusting the process
Many factors are involved in implementing and enforcing change in healthcare, but Eisenhower selected Watson Health Simpler and was ready to embark on a transformation journey that would benefit patients, staff and the overall quality of services offered at the hospital. While Eisenhower Health had experimented with the concepts of Lean in previous years, including leadership training and a few projects, it never really took a footing in the organization until 2016. At that time, with the help of Watson Health Simpler, Eisenhower officially began its formal Lean Journey with the launch of the Surgical Services Value Stream.
Simpler specializes in implementing systemic changes that foster positive transformation and growth by way of Lean methodologies. Simpler consultants got to work right away, training the medical staff on how to be efficient in problem solving and how to utilize the Lean processes while developing the skills and confidence needed to stay atop of the healthcare industry.
Together, Simpler and the Eisenhower team focused on creating a timeline of change, also known as a Transformation Plan of Care, that would promote a better experience for the patient, surgeons and staff by helping to address problems that cause frustration, delays and patient safety issues. Oscar Garcia of the Simpler team offered a steady hand in supporting the Lean transformational change. Through prior experience, Garcia brought deep insight to the table and helped expedite the process improvement work.
Jones explains the immediate transformation: “We identified several needs — the need for scheduling improvements, the need to streamline the 5,000 preference cards that were in place, and others — all while preparing a system-wide electronic medical record change. And while making these organization-wide changes, we had to keep the momentum of Lean thinking going while challenges were happening all around.”
However, despite making strides toward improving OR turnover, Eisenhower encountered a new problem during the transformation process. As more staff came on board to learn and implement Lean methodologies, a challenge emerged with engaging surgeons and physician leadership. Eisenhower’s steering committee looked to Dr. Scott Gering, Vice President of Surgical Services, to lead the charge in getting physicians to attend Lean training. It was no easy task.
“How do you get a surgeon to show up? You recognize that their time and input is valuable and reward their participation,” Dr. Gering emphasizes. “If they’re spending time with you on training or at an event, they’re not in their practice. You have to invest in those physicians because we need them to take ownership of the OR processes.
“That’s what Lean allows them to do. Instead of complaining about why the OR is starting late, they’re now process owners, and they need to figure out how to make the room run on time by tearing it apart and putting it back together in a better and more efficient way.”
Lasting success through growth and innovation
As more physicians became receptive to the Lean process taking place and staff gained confidence in their Lean education, the OR began to transform into an efficient operation. Rooms that were out of commission became fully operational surgical spaces, increasing capacity and bringing in more revenue for the medical center, and the major scheduling issues were worked out.
For Eisenhower’s successful reconstruction projects, credit was due to the implementation of Simpler’s Process Preparation (2P) approach, a digital blueprint of sorts. The 2P method allowed staff who would be working within the space to preview what a possible OR could look like, organize it as they saw fit and add or remove large pieces to enhance efficiency and contribute to a smoother workflow.
Dr. Gering explains: “By thinking out of the box and using a 2P process, we redesigned a space that was not functional and turned it into a hybrid operating room — that’s an amazing feat.”
“With the 2P process, we were able to plan and practice within the space before actually committing to the build,” Jones adds. “We were able to make a simple change like where to put a perfusion machine to more significant adjustments like moving the original scrub sink to a more optimal spot for a smoother workflow.”
By transforming the Surgical Services center using the Lean process methods, Eisenhower significantly reduced its costs and waste and improved quality of care and employee morale. The result has been a financially stable and more efficient medical center. Additionally, the implementation of monthly Rapid Improvement Events (RIEs), with reports going to management on the performance of the Surgical Services team, added value to the overall work environment and fostered growth at all staff levels.
Surgical Services isn’t the only department benefitting from the rollout of Lean processes. The Central Sterile Processing (CSP) department has also volunteered to use the methods in an effort to improve workflows and, since rollout, has experienced tremendous improvements.
Eisenhower has also invested time and resources to begin a value stream focused on ambulatory care. Reimbursement processes are changing as part of healthcare reform, and like the Surgical Services team, the Ambulatory team will need to engage staff and clinicians to improve access and eliminate waste, all while elevating the patient and staff experience.
“It’s a powerful process, and that’s what’s needed,” Dr. Gering says. “We have to keep pushing it from the institutional perspective and draw more people in because you can see the ways things have been fixed already, the evolution of it all, that’s powerful. It’s exciting being able to see a much more efficient operating room that’s safer for patients.”
About Eisenhower Health
Eisenhower Health, a not-for-profit healthcare organization located in Rancho Mirage, California, has been providing high-quality, compassionate care for over 45 years. A 463-bed hospital, the health system is also an accredited teaching hospital, with a School of Graduate Medical Education training new physicians in the specialties of family medicine, internal medicine and emergency medicine. Eisenhower has received a five-star quality rating from the Centers for Medicare & Medicaid Services and has been voted a Top Teaching Hospital by the Leapfrog Group for its full range of state-of-the-art diagnostic, treatment and emergency facilities.
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About Watson Health
Watson Health is a business unit of IBM that is dedicated to the development and implementation of cognitive and data-driven technologies to advance health. Watson Health technologies are tackling a wide range of the world's biggest health care challenges, including cancer, diabetes, drug development and more.