Sheridan Memorial Hospital (SMH) sought to build a pervasive culture of problem-solving and launch a daily management system to help enable teams reach strategic goals, such as more timely patient access.
The organization teamed with Simpler in a multiyear lean transformation engagement. The approach involved engaging employees, who used lean tools and methodologies, to deliver excellent healthcare.
76% increase in daily patient visitsand boost in provider rating from 15th to 72nd percentile
> 220% improvement in point-of-service collectionsand 62% reduction in revenue cycle deficiencies
18% increase in sepsis guideline complianceand 14.5% increase in congestive heart failure mortality score
Business challenge story
An all-in approach to lean management
SMH aspires to always be the first choice for Sheridan County residents who need medical attention. “When people think of exceptional healthcare, we want them to think of SMH over other regional healthcare providers,” says Mike McCafferty, the organization’s Chief Executive Officer.
The rural community hospital is well prepared to carry out its mission of providing excellent, patient-centered care. In addition to inpatient and outpatient services, SMH encompasses a wide range of primary and specialty practices, including oncology and radiation therapy at the Welch Cancer Center.
As part of its vision to deliver even greater patient value, the executive team sought to improve clinical and functional support services. For instance, it needed to tackle patient wait times. In some cases, patients waited up to 45 days to see their preferred clinician within the Internal Medicine Group at the SMH Outpatient Center.
“The group had grown from one provider to 15 over just a few years. Providers were dealing with space and process challenges, and their workdays were hectic. They were really frustrated,” explains Dr. John Addlesperger, Chief Medical Officer and Chief Transformation Officer (CTO) at SMH.
Furthermore, rapid growth across the organization led to inconsistent billing practices and delayed documentation of clinical services rendered. These inefficiencies reduced productivity and contributed to revenue write-offs.
Executives sought to develop a problem-solving culture that permeated the entire workforce and drove continuous improvement everywhere. Overseeing quality across SMH, Dr. Addlesperger championed adoption of lean management practices and recommended engaging professionals who used a comprehensive approach.
“Ultimately, we recognized that if we weren’t all in culturally and if our partner wasn’t providing a total package, we weren’t going to get sustainable results across the organization,” explains McCafferty.
Accelerating daily process improvements
SMH set off on a three-year lean journey with Simpler, selected by executives over several other consultancy companies and strategies for its extensive industry expertise.
In workshops led by Simpler, the leadership team defined its targets based on the hospital’s strategic pillars of excellence. They also launched a leadership coaching program to help executives build the necessary skills to propel a lean transformation forward. The Simpler team also led lean thinking workshops and created collaborative environments to inspire engagement among mid-level managers, frontline staff and other employees.
During this initial period, the team experienced firsthand the lean concept of respect for people. “The Simpler team role modeled that idea. We learned the importance of patience in allowing people to speak up and express themselves in meetings. Building that trust helped us move forward,” says Dr. Addlesperger.
The leadership team chose the Internal Medicine outpatient clinic as the first focus area, working to accelerate change using Simpler tools for value stream analyses (VSAs), rapid improvement events (RIEs) and high-priority projects that complemented the lean intervention plan. Once a VSA was mapped, small multifunctional groups of stakeholders from all levels engaged in multiple RIEs to identify process waste and then develop and implement improvement solutions.
The RIEs revealed that physicians were burdened by excessive administrative tasks associated with medical referrals, reducing their availability for patient visits. Rework — which occurred whenever one staff member incorrectly performed a task and then passed it on to another — was also a problem.
“Now that we’ve made improvements in these areas, we’re looking at seriously redesigning the clinic’s workflows. It lends the opportunity to really bring forward efficiency, cost savings and improvements in quality and safety,” explains Dr. Addlesperger.
As its second focus area, SMH took advantage of Simpler revenue cycle management consulting services to reduce waste in the hospital’s revenue cycle. Most recently, teams have begun analyzing value streams in the SMH’s medical-surgical unit and supply chain.
In addition to this work, SMH rolled out the Simpler Managing for Daily Improvement (MDI) system, a framework that facilitates strategy deployment and engagement down to frontline workers. Using the system, SMH standardized job tasks and processes to guide individuals in performing the appropriate work needed to attain strategic objectives.
It also adopted tiered daily huddles and metrics to help ensure problem-solving and accountability at all levels. MDI proved particularly useful in driving incident management and operational agility during the initial stages of the COVID-19 outbreak in the region. MDI has improved communication and been the key driver in moving strategy into operations.
“Before our MDI with the tiered daily huddles, leaders would evaluate processes and look for improvement strategies to meet metrics. There was a disconnect between senior leadership and front-line staff regarding continuous improvement; we are working to close this gap with our MDI system,” says Barbara Hespen, Chief Nursing Officer at SMH.
Improved patient access and revenue cycle
SMH has achieved several positive results as a result of its Simper engagement: daily patient visits to internal medicine providers have risen 76%, from 67 to 118 patients daily. In addition, patient satisfaction surveys indicate significantly improved outpatient experiences, increasing SMH’s provider rating from the 15th to 72nd percentile.
“Patient complaints about not being able to get in to see a provider have gone away,” says Dr. Addlesperger.
For the organization’s revenue cycle, monthly point-of-service collections increased more than 220%. SMH also reduced its cost-to-collect to 1.95% and its revenue cycle deficiencies by 62%. Additionally, SMH anticipates ongoing value stream improvements to further optimize operating margins.
Process improvements at SMH have led to other notable clinical outcomes:
- Improved congestive heart failure mortality score by 14.5%
- Increased sepsis guideline compliance by 18%
- Maintained extremely low rate of patient falls with injury
Also, SMH has increased engagement and morale among staff members. “Employees see MDI as very valuable and a real positive. It is helping drive some of our employee engagement,” says McCafferty. Lean leadership, as demonstrated by Dr. Addlesperger as the CTO and other executives who remain actively involved in lean initiatives, also propels engagement.
“This transformation has inundated our lives every single day since we kicked it off three years ago,” comments McCafferty. “Through the process, we’ve learned a lot and recognized that we want to change behaviors and get people heading in the same direction. We’re well on our way.”
Sheridan Memorial Hospital
Based in Sheridan, Wyoming, near the Bighorn National Forest, SMH (external link) serves the immediate community and surrounding areas in north central Wyoming, southeast Montana and western South Dakota. It offers advanced medical services, including an 88-bed hospital and cutting-edge technologies, to 30,000 county residents. Founded more than 100 years ago, SMH has approximately 700 employees, including more than 60 physicians who provide primary medical and specialty care in more than 20 areas.
About Watson Health
IBM Watson Health is a data, analytics and technology partner for the health industry. Supported by the innovation of IBM and intelligence of Watson, we are committed to helping build smarter health ecosystems. Through the combination of our deep industry expertise in health, data and analytics, actionable insights, and reputation for security and trust, Watson Health is working together with its clients and partners to help them achieve simpler processes, better care insights, faster breakthroughs and improved experiences for people around the world. Learn more at ibm.com/watson/health.
About Simpler Consulting, an IBM Company
Simpler is part of Watson Health. For nearly 30 years, the Simpler team has worked with clients to collaborate, coach and enable them to achieve rapid improvement across financial and nonfinancial performance indicators. Simpler’s value lies in its ability to work with clients to develop a business system and implement systematic improvements that facilitate long-term performance and sustainable growth.
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