Reducing Blood Wastage
At Hopkins Hospital, more than 4.4 percent of packed red blood cells had to be discarded before they could be delivered to patients. The vast majority of the time, this was due to units leaving the blood bank for more than 30 minutes without being administered or going beyond maximum allowed temperatures. Using Lean Sigma methodology, a team with backgrounds in anesthesiology, transfusion medicine and nursing identified major factors affecting blood product wastage—such as units being improperly packed in coolers so that they became too warm—and made changes to reduce wastage by more than 50 percent. Over its first four years, this effort saved the hospital $800,000 and ensured that more of this life-saving resource was available.
Improving Patient Flow
Long lines at registration, crowded waiting rooms and late-starting appointments were common at the Otolaryngology-Head and Neck Surgery clinic at the Johns Hopkins Outpatient Center. Using Lean methodology, a team facilitated by the Center for Innovation used process mapping and other tools to understand where the sources of waste existed, and then worked to wring waste out of the system. For instance, the clinic changed front-desk staffing patterns so that they were more aligned with patient flow. The changes resulted in a 44 percent increase in on-time examinations.
Phlebotomy Wait Times
At the Johns Hopkins Kimmel Comprehensive Cancer Center, the Weinberg phlebotomy area reduced patient wait time by 45 percent and overall patient visit time by 42 percent by improving workflow in the patient staging process. Now, cancer patients needing blood work can get to their treatment areas more quickly, thanks to the reduced turnaround time for blood draws.
Cutting Triage Times
The increasingly busy labor and delivery unit at Johns Hopkins Bayview Medical Center faced a dilemma: While the number of deliveries had increased by 50 percent over five years, the unit had no room to expand its physical space. To improve patient flow, the team targeted its triage process using Lean Sigma principles. Working with the Center for Innovation, the group identified several small changes that combined to make a big impact. For instance, rather than have nurses make several trips down the hallway to gather the materials they needed for a patient, they found a bedside supply cart that could securely store these items in the triage exam rooms. In less than a year, triage wait times decreased by nearly 25 percent, despite a near-doubling in the average daily patient census.
Kidney Transplant Throughput
In 2008, despite ever-increasing referrals, Johns Hopkins’ kidney transplant program was performing fewer procedures and adding fewer patients to the waiting list for new organs than in previous years. Seeking to reverse the trend, the transplant program teamed up with the Center for Innovation and the Quality Improvement department to improve how it handles patient referrals. By mapping the referral process and calculating the time taken to complete each step, the team identified where patient referrals were getting delayed, as well as the processes that had marginal value. With a more streamlined referral process, the lead time to patient evaluations was reduced by 54 percent. The improved referral-to-evaluation throughput was among several changes that the program credits for boosting its evaluations (39 percent), patients placed on the wait list (22 percent) and transplants (44 percent) in 2009. Revenue from kidney transplants that year was $11 million greater than in 2008. Read more about this Lean Sigma project.
At the Johns Hopkins Outpatient Chemotherapy pharmacy, the 55-minute average wait for chemotherapy preparation was causing dissatisfaction among cancer patients and their nurses. With patient volumes expected to surge by 40 percent in the subsequent five years, change was needed. So a multidisciplinary group decided use a process known as Lean Kaizen to make sweeping changes over several days. The solutions were straightforward but profound. For example, a reorganization of the workspace reduced the distance that technicians needed to walk to obtain materials from 223 feet to 53 feet. These and other changes resulted in a 40-percent reduction in preparation time.
Dermatology Clinic Scheduling
Patients who wanted to see a dermatologist at the Johns Hopkins Outpatient Center often had to wait 40 days—sometimes even 60—for their first appointment. The situation resulted not just from high patient demand, but also from complicated, uncoordinated scheduling practices. With guidance from the Center for Innovation, the clinic revamped its scheduling process, resulting in a 47 percent reduction in the number of days that patients waited for a first appointment. Meanwhile, visit volume increased by 15 percent.