Health First’s Lean methods focus on meeting financial goals while also addressing new quality guidelines established by the Affordable Care Act.


What processes or outcomes is your department, organization, or team trying to improve?
Health First is using Lean methods to improve efficiencies in various departments. The integrated delivery network, headquartered in Rockledge, Fla., has four hospitals, a large multispecialty medical group, outpatient and wellness services, and health insurance plans.Bill Griffith, Health First

One specific initiative at Health First’s Holmes Regional Medical Center, a 514-bed, level 2 trauma center located in Melbourne, Fla., is improving operational efficiency and eliminating waste to improve its financial status. Holmes identified the pre-admit process and the discharge process as the first areas to evaluate based on Lean methods. New efficiencies in those areas would have the most immediate impact, as those are traditionally areas where logjams occur.

Holmes uses an operations management system to monitor daily hospital functions in real time and captures performance data on pull time—the length of time it takes for patients to occupy assigned beds—number of transfers, and total length of stay (LOS), as well as turnaround time for all ancillary support services, such as transport, environmental services work, lab work, and radiology. The data are available on demand, with the goal of eliminating wasted time and resources.

For example, when monitoring LOS, it is critical to know when and why patients are being hospitalized beyond DRG guidelines because longer LOS can affect payment. In addition, bed turnaround time is monitored to ensure the patient admittance process is starting in a timely manner and care and discharge are being performed efficiently so new patients aren’t waiting for a bed.

What was the impetus for this project?
Health First saw an opportunity to use Lean methods to meet financial goals while also meeting new quality guidelines established by the Affordable Care Act. For example, Health First is using Lean methods to improve value-based purchasing—Medicare’s initiative to link payment to quality of care, including the patient experience. We focus heavily on those metrics that drive customer safety and satisfaction, including staff responsiveness, staff communication with patients, cleanliness of the hospital environment, pain management, and discharge information.

What organizations, departments, or other groups are centrally involved in this project?
Health First created a leadership position responsible for operational excellence and hired me based on my Lean Six Sigma experience in the manufacturing sector. The operational excellence department is tasked with determining ways to reduce costs without eliminating jobs. We help virtually every department analyze existing processes to determine how Lean principles and operational technology can enhance efficiency and eliminate wasted time. Utilizing value stream analysis, all key stakeholders—physicians, staff, and patients—are involved from the beginning to the end of any process.

What results have you achieved to date?
We have reduced LOS by an average of 26 percent, and we have 80 additional patient beds available per day. Emergency department (ED) wait times have decreased by 70 percent, even though ED visits have increased 12 percent. Our transfer volume has increased by 30 percent because of more bed availability and smoother operations. We’ve cut the discharge window from nine hours to just 1.7 hours and reduced the cost per adjusted discharge by 12 percent.

What one or two important lessons learned from this project might help other healthcare leaders?
First, the leadership of Health First made operational excellence a priority and created a special position to oversee it. Second, they looked to expertise from the manufacturing sector and invested in the technology to facilitate better operational management. Ultimately, they looked at the problem, said it’s not unique to health care, and took bold steps to fix it.


Bill Griffith, CSSBB, CQA, is executive director of operational excellence, Health First, Rockledge, Fla.


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Publication Date: Wednesday, July 15, 2015