Operational Assessments: Utilizing
Productivity Standards
Ross Manson
Principal – Eide Bailly
701.239.8634
[email protected]
Mary Klimp
CEO – Queen of Peace Hospital
952.758.8101
[email protected]
www.eidebai lly.com
Agenda
Health Care Industry
reform and the need for
change
Productivity standard principles
Process reviews
“Tools”
The implementation process
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Health Care Industry Trends
Patient Protection and Affordable Care Act
Health Care and Education Reconciliation Act
Bending the cost curve
Utilization rates changing
Technology trends and improvements
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USA Health Expenditures as a % of GDP
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
1960
1970
1980
1990
www.eidebai lly.com
2000
2009
2017
Total Expenditures on Health Care as a
Percentage of GDP
Japan
United Kingdom
Spain
Italy
Netherlands
Greece
Norway
Portugal
Canada
Germany
France
Switzerland
United States
0
2
4
6
8
Percentage of GDP
Source: OECD Health Data 2007
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10
12
14
16
Reform Bill Provisions
Value-based purchasing
Quality reporting
Hospital-acquired
conditions
Readmissions reductions
Independent Medicare Advisory Board
Demonstration projects
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The Need for Change
Industry trends are creating a need for health care organizations to change their operations
and become more efficient and eliminate waste
Demand for
Quality
Increasing
Cost
Demand
Changes
Increasing
Need for
Transparency
Increasing Use
of Technology
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Need for
Change
Why implement productivity standards?
Track progress of strategies
Monitor financial outcomes, operational
efficiencies, and patient quality
Accountability
Commitment
Proactive
Competitive positioning
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Approach to Productivity Management
 Proper decisions and success can only occur by:
Use of benchmarks
Review of current processes
Understanding the reimbursement process
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Step 1: Reimbursement Opportunities
Often overlooked by providers

Coding

Charge capture

Pricing

Physician education
Difficult to hold staff accountable if organization has not
taken every step to capture all earned revenue
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Process Review
Processes established by management are often the
cause of the inefficiencies
However, we tend to hold the staff accountable
for the inefficiencies, without allowing them the
means to become more efficient
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Review of Processes
 Need to individualize to each department
in each facility




What types of patients on each unit?
Where is the work done?
How is the work done?
Who is doing the work?
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Departmental Issues
 Staff mix
 Facility layout
 Staffing patterns



Staggered shifts
Variable staffing plans
Staffing for the situation that “might” occur
 Managing “extra minutes”
 Ordering and stocking supplies
 Physician discharge times
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Benchmarks
 Benchmarks provide guidance as to the
recommended or normal staffing levels of
individual departments
Facility must maintain necessary statistical
information
Staff must understand the benchmark
Benchmarks assume an ability to gather data
consistently
Must assure “apples to apples” comparison
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Benchmarks

Benchmarks are not averages
 Benchmarks ARE best practices
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Productivity Management
 Proper productivity management results in:
Formalizes departmental expectations
Develops consistency across departments
Achieving the necessary financial goals
Creating a positive work environment
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Internal vs. External Benchmarks
•
External – advantages and disadvantages
•
Internal – advantages and disadvantages
•
If you have no productivity standards in place
we recommend you start with Internal
Benchmarks.
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The Value of Lean
•
Reduce cost through improved efficiency and
allocation of resources
•
Reduce time for every day processes; giving time
back to the organization for additional initiatives
and improvements
•
Improve satisfaction of patients and staff as waste
is eliminated from processes and procedures
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What is “Lean”
•
Lean is a continuous improvement and problemsolving approach
•
A work philosophy for achieving rapid progress by
identifying and eliminating waste
•
Lean process involves using tools and team resources to
achieve goals
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Principles of Lean
Implementation of lean processes relies on the following basic principles:
Pursue
Excellence
Allow
Customers to
Drive Services
Eliminate
Waste
Principles
of Lean
Define
Customer
Value
Create Value
Streams
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Lean Terminology
•
Six Sigma Approach: Problem focused with a view that process variation is
waste and that utilizes statistics to understand variation
•
Lean Approach: Focused on process flow and views any activity that does not
add value as waste and utilizes uses visuals to understand the process flow.
•
Kaizan: Continuous, incremental improvement of an activity to create more
value with less waste
•
Non-Value Added Activities : Activities or actions taken that add no real value
to the product or service making such activities or action a form of waste
•
Value Stream: The specific activities required to design, order and provide a
specific product, from concept to launch, order to delivery, and raw materials
into the hands of the customer
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Lean Tools
•
7 Categories of Waste: Used to identify waste within a
current process
•
5 S: A visually oriented system for organizing the
workplace to minimize waste
•
Process Flow Charts: Visual map identifying the steps
and interconnecting points in a process
•
Value Stream Map: Map used to analyze the flow of
materials and information
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Implementing the Operational Assessment
 What do you want to accomplish?
 Where do you start?
 What do you do with all this data?
 How do you maintain momentum?
©2006 Queen of Peace Hospital. Proprietary and Confidential.
What do you want to accomplish?




Improve efficiency
Assess staffing model/needs
Monitor outcomes
Improve financial performance
©2006 Queen of Peace Hospital. Proprietary and Confidential.
24
Where do you start?




Interdisciplinary teams
Setting standards
Process improvement
Data collection
©2006 Queen of Peace Hospital. Proprietary and Confidential.
What do you do with all of the data?
 Benchmarks
 Productivity measures
 Data collection tools
©2006 Queen of Peace Hospital. Proprietary and Confidential.
How do you maintain efficiencies?
 Monthly comparisons
 Commitment
©2006 Queen of Peace Hospital. Proprietary and Confidential.
Staffing Matrix Revised Feb 2010
Census
Staff/shift 9.4
Staff/shift 7.0
Ratio
Charge nurse
Team leaders
HUC/AIDE M-F
HUC PMs
Sat-Sun D& E
15
5.9
4.4
3.8
1
3
2
1
1
9.4
14
5.5
4.1
3.5
1
3
2
1
1
7
13
5.1
3.8
3.3
1
3
*1 or 2
1
1
12
4.7
3.5
3.0
1
3
*1 or 2
1
1
11
4.3
3.2
2.8
1
3-D 2 or 3 -N
*1 or 2
1
1
10
3.9
2.9
2.5
1
2 (look at acuity)
2 if 2 RN's, 1 if 3 RNs
1
1
9
3.5
2.6
2.3
1
2
2 or 1 (house needs)
1
1
8
3.1
2.3
2.0
1
2
2 or 1 (house needs)
1
1
7
2.7
2.0
1.8
1
2
1
1
1
6
2.4
1.8
1.5
1
2
1
1
1
5
2.0
1.5
1.3
1
*2 or 1
1
1
1
4
1.6
1.2
1.0
1
1
1
1
1
3
1.2
0.9
0.8
1
1
1
1
1
2
0.8
0.6
0.5
1
1
*1 or 0
1or 0
1 or 0
1
0.4
0.3
0.3
1
1
* 1 or 0
1or 0
1 or 0
1
1
*1 or 0
1or 0
1 or 0
M/S
0
* Assess the needs housewide
ICU
ER
Census
Charge nurse
RN's
0
na
0
Day shift
Evenings
1
na
2
na
1
0
0
1
HUC for am cares only
0
3
4
na
1 or 2 (acuity/dischg)
1 if only 1 RN (acuity)
acuity
na
2
0
0
5
na
2
acuity
0
7a-7p (7d/wk)
11a-11p (M-Th)
7a-7p 7p-7a (Friday)
9a-9p (Sat/Sun)
7p-7a (7d/wk)
1 RN
1 RN
1RN days/1RN nights
1 RN
1 RN
*this person can go in
on call mix if ER is slow
OB
Census
Charge nurse
7a-7p
7p-7a
0
na
1 (Float or inhouse call)
1 (float or inhouse call)
1+1
na
1
1
2+2
na
1
3+3
na
2
4+4
na
2
2
5+5
na
2 or 3 (acuity)
2 or 3 (acuity)
Outpatients and Labors refer to ACOG guidelines
Highlighted
areasQueen
©2006
are changes for 2010
of Peace Hospital. Proprietary and Confidential.
1
2
Queen of Peace
Quarterly Benchmark Analysis
Period Ending December 31, 2007
Med/Surg/Peds
Qtr Ending
Qtr Ending
Qtr Ending
Qtr Ending
Qtr Ending
Qtr Ending
Qtr Ending
Qtr Ending
6/30/2005
6/30/2006
9/30/2006
12/31/2006
3/31/2007
6/30/2007
9/30/2007
12/31/2007
10.88
13.08
15.89
16.42
14.99
16.65
14.06
13.01
Comments
Benchmark
High but improved
ICCU/CCU
7.00 HPPD
16 to 18 HPPD
Obstetrics
26.29
7.52
Emergency
3.64
2.36
2.91
3.60
3.42
2.60
2.31
2.40
High
1.75 Patients
Surgery
7.68
8.36
9.95
12.30
11.78
9.61
11.05
10.71
High
5.0 to 8.0 Patients
Same Day Surgery
4.59
4.65
7.26
7.30
7.19
7.57
5.80
6.09
High
5.50 Patients
Recovery
1.03
1.03
0.49
0.80
0.54
0.82
1.13
0.89
Below
1.20 Patients
2.20
2.38
2.30
2.18
2.24
2.25
2.14
Core Staffing
2.02
1.29
1.24
1.23
1.16
1.13
1.14
Below
1.60 Patients
1217 Total Worked Hours
Women's Health Center
Outpatient Clinic
1.60
12 to 14 HPPD
Patient Visits
Cardiac Rehab
913
956
1280
1255
1280
1318
1267
1357
High
Respiratory Therapy
0.30
0.80
1.08
0.80
0.75
0.81
0.95
0.99
High
0.086
0.055
0.064
0.061
0.062
0.065
0.067
0.056
Physical Therapy
0.85
0.62
0.64
0.70
0.64
0.65
0.62
0.60
Below
0.65 Procedures
Lab
0.30
0.28
0.29
0.29
0.28
0.27
0.26
0.27
Below
0.35 Procedures
Radiology
1.51
1.49
1.62
1.58
1.71
1.54
1.61
1.68
High
Public Relations/Community Ed
0.15
0.21
0.24
0.24
0.23
0.23
0.29
0.36
Core Staffing
.08 to .10 Adjusted Patient Day
Business Office/Finance
0.50
0.44
0.48
0.50
0.49
0.46
0.45
0.47
Good
.40 to .60 Registrations
Admin
0.64
0.35
0.76
0.70
0.63
0.57
0.53
0.66
None Available
Nursing Admin & Quality
0.95
0.51
0.53
0.91
0.94
0.96
1.57
1.45
None Available
Health Information Service
0.42
0.41
0.42
0.42
0.42
0.42
0.43
0.43
Good
Registration
0.31
0.35
0.37
0.37
0.40
0.39
0.37
0.37
Below
Human Resources
0.14
0.25
0.14
0.26
0.28
0.35
0.45
0.38
Materials Management
0.37
0.35
0.39
0.40
0.39
0.38
0.38
0.46
Good
.35 to .48 Adjusted Patient Day
Dietary
0.51
0.35
0.37
0.35
0.34
0.36
0.41
0.43
High
.17 to .34 Meals
Housekeeping
0.41
0.46
0.49
0.54
0.53
0.50
0.54
0.57
Good
.50 to .65 Hrs/1000 sq ft/day
Laundry
1.85
2.30
2.16
2.28
1.77
2.36
2.60
2.26
Good
1.5 to 3.0 Pounds
Pharmacy
0.37 Procedures
Core Staffing
0.034 Procedures
1.46 Procedures
Adjusted Patient Day
Adjusted Patient Day
.40 to .50 Registrations
.38 to .50 Registrations
None Available
Adjusted Patient Day
©2006 Queen of Peace Hospital. Proprietary and Confidential.
Information Systems
0.28
0.38
0.30
0.38
0.39
0.38
0.36
0.45
High
.25 to .38 Adjusted Patient Day
Engineering
0.14
0.15
0.18
0.19
0.20
0.19
0.19
0.20
Good
.16 to .22 Hrs/1000 sq ft/day
©2006 Queen of Peace Hospital. Proprietary and Confidential.
©2006 Queen of Peace Hospital. Proprietary and Confidential.