Case Study | Productivity and Process Improvement

Delivering on Potential: The RTLS Effect on Productivity

Case Study | Productivity and Process Improvement

Delivering on Potential: The RTLS Effect on Productivity

A North Dakota health system has seen positive results in patient wait times and staff productivity by using real-time location system technology.

If the question is one of efficiency, healthcare’s frontline staff likely have a host of answers. After all, they are closer to the productivity bottlenecks and inefficiencies than any CFO. To convert their on-the-ground insights into business intelligence, though, CFOs and other leaders must provide them with the right tools.


Real-time location systems (RTLS) have already led to substantial and timely ROI for hospitals in the area of asset tracking and inventory management. Additional strides leveraging RTLS have been made in other areas as well, most notably in the area of productivity. At the Altru Advanced Orthopedics clinic, part of the Grand Forks, North Dakota-based Altru Health System, the use of such technology has delivered on this promise, yielding actionable information about patient wait times, patient cycle times, staff workflow, and staff productivity.

Quantifying the Hunch

Faced with packed waiting rooms and late evenings working through the backlog, Altru’s clinicians and administrators alike saw the need for change. 

Seeking to quantify their hunches about workflow challenges and solutions, Altru’s leadership sought to distinguish and measure two forms of provider time: value added time (VAT) and non-value added time (NVAT). VAT is the time that the provider spends face to face with the patient, and NVAT covers all of the administrative tasks that take that provider away from patients and their needs. An initial survey of the clinic revealed that providers were spending nearly 50 percent of their time on non-value added tasks while their VAT was quite low—findings that established a common perception of the problem among administrators and providers and set the stage for targeted process improvements. Access to RTLS data about VAT vs. NVAT meant that leaders could track how well any intended process improvement stacked up against historical performance as well as how things were working in real time.

Altru’s clinical and administrative leaders used RTLS-derived business intelligence to achieve a 24 percent increase in annual net income as well as secondary effects on patient and professional satisfaction. 

Removing Bottlenecks to Patient Flow

After the initial survey, the obvious issue facing Altru was how to increase providers’ VAT. The team began its work with obvious, simple changes. For example, after reviewing the amount of time patients were spending in each phase of care, Altru was able to locate the parts of the patient cycle (and the places in the physical clinic) where patients spent the most time waiting. Using RTLS data to contrast these perennial bottlenecks to unexpected spikes in patient wait times, the clinic could take aim at improving both problems of process (over time) and those of coincidence or happenstance (in real time). For example, each step in the evaluation and care process—patient time waiting for a room, patient time waiting for a clinician, time for clinical tests, etc.—was tracked and analyzed. An array of bottlenecks were discovered and addressed.

In just five months, Altru’s insights into patient cycle time bottlenecks improved patient flow and patient satisfaction, successfully reducing the average cycle time per patient by nearly 25 percent. 

Increasing Providers’ Value-Added Time

Bottlenecks are not limited to patient time, however. Missing equipment, room and bed shortages, technology delays, and inappropriate assignments of administrative tasks can all contribute to unnecessarily high NVAT for providers. At Altru, the clinical and administrative leadership made it a priority to find the culprits responsible for their providers’ NVAT. Once those areas were pinpointed and addressed, the team was able to convert over 4,500 minutes each week of NVAT to VAT, ultimately enabling them to add more patient visits per week. The resulting increase in surgical cases also increased the clinic’s revenue. 

Increased surgical cases is one of the most quantifiable outcomes of RTLS-driven business intelligence, but perhaps the most dramatic NVAT to VAT conversion at Altru was in nursing. The gains made in this area allowed nursing staff to be reallocated to other lines of service, maximizing staff utilization, and optimizing resource capacity needs. 

Bridging the Gap Between Clinicians and Administrators

RTLS data certainly gives shape and credibility to providers’ frustrations with process inefficiencies. It also helps close the gap between the administration’s versus providers’ understanding of workflow and performance. 

Put simply, clinicians work at the speed of care, while administrators can only work as fast as the information they receive. Having one group working from past data and the other struggling to keep up with a constant flow of demands can lead to mismatched expectations, miscommunication, and mistrust.

Putting everyone on the same page—giving the administrative team access to real-time operational intelligence alongside clinicians—helps build the trust needed to make systemic, lasting change.


Jill Wilson is director, Altru Health System, Grand Forks, N.D.

Paul Schulz is a consulting manager, Eide Bailly, Fargo, N.D.

Anne M. Bugge is president and CEO, Sonitor Technologies, Inc., Stamford, Conn.

About the Authors

Jill Wilson
Paul Schulz
Anne M. Bugge

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