Lean Results at Harbor-UCLA
Summary of Key Improvements
Updated June 2018
Saving time is saving lives in healthcare…
Eliminating waste saves time. Harbor-UCLA was recognized at the Los Angeles County 30th Annual Productivity & Quality Awards (PQA) Program for the following time study findings after completing 5S in 22 supply areas in patient care units:
$561, 779.63 in cost avoidance
$62,010.91 in cost savings
Improving Patient & Staff Experience:
- Achieved an 18% improvement in the percent of patients who rate the hospital as a 9 or 10. This has been sustained (March 2018)
- Achieved a 12% improvement in the percent of patients who would recommend the hospital
- Achieved a 19% improvement in nurse communication with patients from 69% 2014 baseline to 82% (March 2017).
- Unfortunately, the most recent data shows a drop to 77.4% (June 2018) but we anticipate with improvement efforts underway to see a re-bounding of these data
- Physician Communication with patients has been sustained at 80% (March 2017) to 83.2% (June 2018)
- Performed electronic, anonymous survey of 5-S line staff who participated in a 5-S Event. The results indicated a 19% improvement over baseline response to the statement: “It is easy to find everything I need to do my job”.
- Additionally, 85% of the staff agreed or strongly agreed that 5-S has saved them time- time that they can now spend doing other work that aides the patients
- A hospital-wide survey was conducted asking the following (3) questions**:
- “I feel respected by the people I work with”
- November 2016 baseline results = 32% agreed or strongly agreed
- Improved to 70%- a 119% improvement (February 2017; sustained these results for 2017- a current study is underway)
- “I am given the tools I need to contribute to Harbor-UCLA in a way that makes my job meaningful”
- November 2016 baseline results 30% agreed or strongly agreed
- Improved to 54%- a 80% improvement (February 2017. A current survey is underway to assess progress)
- “Someone at Harbor-UCLA gives me recognition for what I do”
- November 2016 baseline 36% agreed or strongly agreed
- Improved to 52%- a 44% improvement (February 2017). A current survey is underway to assess progress.
- “I feel respected by the people I work with”
- Implementing Staff Improvement Ideas:
- As of June 2018 (6 months), there have already been over 250 staff improvement ideas implemented (more than the full 12 months submitted last year). This speaks to improved staff engagement.
Emergency Care Domain (Value Stream):
- Emergency Care: Reduced the number of non-eligible patients referred to the Continuing Care Clinic (CCC) from a high of 36% to 15%– a 58% improvement
- Active visual management boards with weekly meetings has spread from the Rapid Medical Evaluation (RME) to Acute Emergency Dept. (AED) & Pediatrics ED (total of 3).
- Achieved a 40% reduction in cycle time for patients who are discharged home from the ED (from 6 hours to 3.6 hours. This improvement has been sustained (3.7) through 2018.
- Achieved a 53% reduction in the time of arrival to EKG for emergent “cardiac” patients from 15 minutes, to 7 minutes for last year– and an 84% improvement over baseline of 45 minutes
- Achieved a 40% decrease of patients who left without being seen (before triage) from 2017 (1.5% to 0.9%) and an 83% decrease over baseline of 5.3%.
- Achieved an 18% decrease in left before treatment completed (before discharge) from 2017 (11.2% to 9.2%) and a 32% improvement over baseline of 13.5.
- Rapid Medical Evaluation Model Cell:
- Improved compliance to pain reassessment from 16% to 93% – achieved a 481% improvement in compliance to pain reassessment over baseline which has been sustained for over 1 year.
Inpatient Domain (Value Stream):
- Through 5-S Events in Inpatient units, we have experienced a cost savings of over $35,000 (less supplies [overstock] on shelves (as of 2/2016)
- Improved inpatient satisfaction (percent of patients who rate hospital as a 9 or 10) from 63% to 74.4% – an 18% improvement
- Reduced the denied days from 19% to 10%- a 44% improvement
- Performed electronic, anonymous survey of 56 line staff who participated in a 5-S Event. The results indicated a 19% improvement over baseline to the question: “It is easy to find everything I need to do my job”
- Active visual management boards with weekly meetings has spread from the Trauma-Surgical Intensive Care Unit (ICU) to 4 East Orthopaedic/Medical-Surgical Unit (total of 2).
Outpatient Domain (Value Stream):
- Overall Outpatient: Improved patient perception of access to appointment (Did you receive an appointment as soon as you wanted?) from 46% to 88%- a 91% improvement
- Improve the percent of pre-financially screened clinic appointments from 90% to 98.5%- a 9% improvement
- Standardized work has spread to (3) of the Primary Care Clinics: OB-GYN, Pediatrics, and Women’s Clinic
- Active visual management boards with weekly meetings has spread from the General Internal Medicine Clinic to Women’s and Pediatrics’ Clinics (total of 3).
- Eye Clinic:
- Reduced the clinic cycle time in the Eye Clinic from over 4 hours to just over 2 hours; cut surgical wait times for eye surgeries from several months to one month or less)
- Waiting time to be scheduled for eye surgery has been reduced from greater than 6 months to less than 1 month
- Cataract Surgery is less than 2 weeks (improved from 1 month in 2016) – a 50% improvement
- Achieved a 94% decrease; sustained for 2 years
- Retina Surgery is less than 2 weeks (improved from 1 month in 2016) – a 50% improvement
- Retina Surgery: Achieved a 96% decrease, sustained for 2 years.
- Oculoplastic is less than 4 weeks-sustained improvement
- Oculoplastic: Achieved a 94% decrease and has been sustained for 2 years.
- General Internal Medicine (GIM) Clinic:
- Cycle Time has been reduced from 160 min (baseline) to 89 minutes- a 44% decrease, sustained for 2 years.
- The clinic “no show” rate has decrease from the baseline of 40% to 32% for new patients- a 20% improvement; from 30% to 21%- a 30% improvement which has been sustained
- Of note, the same “Paul O’Neill” survey was repeated specifically for GIM and the results were even higher than the hospital-wide post survey which was felt to be due to the implementation of their weekly meetings and visual management board: 1) 70%- 119% improvement; 2) 60%- a 100% improvement; and 3) 80%- a 122% improvement.
Perioperative Domain (Value Stream):
- Through 5-S Event in the Post Anesthesia Recovery Area (part of the OR Service Line) we returned (2) private post-anesthesia recovery rooms back into service for patient care through collating supplies and wheelchairs in another location
- Achieved a 35% reduction in surgery cancellations which occur in Pre-Op from 60/month (June 2017) to 39/month (June 2018) over baseline (Access to care)
- Achieved a 59% reduction in the number of preventable quality issues in Central Sterile over baseline.
- Active visual management boards with weekly meetings has spread from the Central Sterile Processing Dept. to the Perioperative (Pre-Op, Intra-Op, and Post Anesthesia Care Areas) Domain (total of 2).