• Eliminating Waste Without Hurting Quality

    May 25, 2012

    By Katharine Luther Luther, Kathy 

    Through its Impacting Cost + Quality initiative, IHI is helping health systems identify and remove waste from their operations.

    When Northeast Health set out to reduce blood transfusions among critical care patients, the primary goal was to improve patient care. Blood transfusions can lead to complications, from mild fevers to uncommon but serious infections.

    However, in reducing blood use, the Troy, N.Y., health system also saved big money. By introducing clinical guidelines for blood transfusions, two Northeast hospitals are saving more than $400,000 a year on the cost of red blood cells alone. "More important, patient outcomes have improved, and morbidity and mortality rates continue to decline," says Dan Silverman, MD, chief medical officer for Albany Memorial Hospital and Samaritan Hospital.

    That is the kind of result that the Institute for Healthcare Improvement (IHI) wants to see from its Impacting Cost + Quality initiative, a learning collaborative designed to help health systems save money while also improving quality. IHI is challenging health systems to remove 1 percent of operating costs per year without hurting quality.

    Accepting the Challenge

    The initiative's goal is to harness the ideas of clinicians to help hospitals improve the value-defined as quality divided by cost-of care. It's one thing when an edict comes down from on high that says, "Everybody, take X percent out of your budget." It's another thing when clinicians sit down together and say, "I think we could improve the flow in our ICU."

    To date, more than 40 hospitals have accepted the Impacting Cost + Quality challenge and are on the search for ways to ferret out waste and document "dark green dollar" savings, or savings that are reflected on the bottom line.

    Achieving Savings

    Like many other participants in the initiative, Northeast Health used IHI's Hospital Inpatient Waste Identification Tool to engage staff (Resar, R.K., et al., Hospital Inpatient Waste Identification Tool, IHI Innovation Series White Paper, Cambridge, Mass.: IHI, 2011).

    "It's a sheet of paper with examples of waste that we distributed to staff throughout the hospitals," says CEO Norm Dascher. "We asked staff to give us examples of things that they thought, in their day-to-day work life, represented waste-and we received more than 300 suggestions."

    Some suggestions paid off. Based on staff input, insulin management and outpatient pharmacy practices were changed, saving Northeast Health $70,000 during the last two quarters of 2011. Another staff suggestion prompted Samaritan Hospital's physical therapy department to reduce inappropriate consultations, which boosted the department's productivity.

    In a related initiative, Northeast Health eliminated waste by changing the way sedation is used for patients who are on ventilators. Inspired by information on the IHI Ventilator Bundle, the medical director of Northeast Health's critical care units developed a new protocol that decreases patients' sedation and increases their mobility (How-to Guide: Prevent Ventilator-Associated Pneumonia, Cambridge, Mass: IHI, 2012). 

    The result: The average length of stay (LOS) for ICU patients decreased by 0.9 days in the last six months of 2012, and the overall LOS for those patients decreased by 0.7 days. "We're getting people out of the critical care unit faster and getting them home quicker," says Silverman.

    That, of course, translates into savings. "Just in the last six months of the year, dark green dollar savings have reached more than $50,000," says Susan Vitolins, RN, director of performance improvement for the two hospitals. "That is a great example of front-line staff-with physician leadership and involvement-improving the care that we give to the patients and showing dollar savings, too."  

    Katharine Luther, RN, is vice president of hospital portfolio planning and administration, Institute for Healthcare Improvement (kluther@ihi.org).