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Lean means success for North Carolina rural hospitals

Five rural hospitals in western North Carolina that formed a collaborative designed to eliminate waste have found success.

The Rural Hospital Lean Culture Transformation Collaboration is comprised of Ashe Memorial Hospital in Jefferson, Blue Ridge Regional Hospital in Spruce Pine, Caldwell Memorial Hospital in Lenoir, Charles A. Cannon Jr. Memorial Hospital in Linville and McDowell Hospital in Marion.

The hospitals have worked with Pittsburgh, Pa.-based Simpler Healthcare to apply the Toyota Production System to identify waste in their processes.

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"Each hospital has a strategy for improvement, but they also share a philosophy with the rest," said Mike Chamberlain, president of Simpler North America and General Manager of Simpler Healthcare.

Each hospital targeted two "care streams" in their waste-reduction efforts. Some are focusing on imaging and turn-around to patients, while others are targeting the emergency room and operating rooms.

"We've already seen significant improvement in patient satisfaction in all five hospitals," said Chamberlain. "We've been working together for two years and we're just beginning to uncover the layers of waste."

Lean management techniques look to improve clinical quality, access and productivity, said Chamberlain, as well as "working in a productive and respectful manner so the patient is cared for above all else."

R.D. Williams, Ashe Memorial's CEO, helped acquire grants to fund the North Carolina collaborative, including a donation from the Golden Leaf Foundation.
According to Williams, Ashe Memorial has seen an 85 percent reduction in patient wait times and a 25 percent increase in the department's capacity since applying Lean management techniques.

The hospital then targeted acute care and inpatient nursing, implementing team-based nursing and revamping the way that nurses and aides care for patients. Williams said the changes, which included a required bedside report when changing shifts, resulted in an increase in patient satisfaction and a reduction in overtime.

"We've identified about 22 value streams and have been doing work in three of them," said Williams, who noted the hospital would next target its revenue cycle and emergency department value streams. "Our pace of transformation is increasing and we're finding more and more applications for this process."

Caldwell Memorial Hospital first focused its Lean strategies on inpatient and operating room flow value streams.

Tim Palmer, the hospital's Lean director, said turn-around times improved and there was a significant reduction in patient preoperative time without the need for additional staff or extra rooms. For example, surgery preparation used to take an hour, but has been reduced to 20 minutes through the implementation of a pre-op interview.

"The hospital was able to increase its surgery volume with the extra efficiencies," said Rebecca Smith, Caldwell's chief operating officer.

"It is of critical importance that if you start this journey, that it starts with the top, the administration. If you don't hardwire Lean thinking into your routine, then it will just become a 'flavor of the month,'" she said.

Smith said close to 30 percent of the hospital's employees are involved in Lean events, which were assigned to departments based on priority to the value stream.

The collaboration's results have had a statewide effect. Recently, five hospitals in the eastern end of the state – Bladen County Hospital in Elizabethtown, the Columbus Regional Healthcare System in Whiteville, J. Arthur Dosher Memorial Hospital in Southport, Duplin General Hospital in Kenansville and Sampson Regional Medical Center in Clinton – have formed their own collaborative and will be looking to apply Lean management techniques as well.