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River Region Faced Unfavorable Management Care Contract

River Region Medical Center, a multi-hospital system located in Vicksburg, Mississippi, faced significant cost issues resulting from aggressive renegotiation from their largest payor. In addition, the Emergency Department found patients were frequently "Leaving Without Treatment" (LWOTs) and ED patient satisfaction fell below the 5th percentile. River Region's senior management acknowledged they needed to achieve immediate gains in their cost structure. In addition, there was a strong desire to optimize ED patient flow, thereby reducing LWOTs, and to improve ED patient satisfaction.

River Region engaged Caldwell Butler & Associates (CBA) to critically examine operations' waste, productivity and work flow of its emergency department.

River Region's Needs

  • Improve the Medical Center’s cost position
  • Reduce the number of ED LWOT’s below 3.2%
  • Improve patient satisfaction scores

Caldwell Butler & Associates applied its skill in Lean-Six Sigma methodology to assist senior management in isolating the changes with the potential to yield the most significant improvements in patient care and productivity. Caldwell Butler & Associates' expert staff employed the 100 Day Operations Waste Workout, techniques for enhancing accountability and its Accelerated DMAI2C method (Define-Measure-Analyze-Improve-Control) to systematically produce the desired results while placing a premium on speed to results.

Identification of Waste

  • Over production
  • Correction
  • Processing
  • Inventory
  • Waiting Time
  • Motion
  • Materials & Information

Change Concepts Deployed

  • Reduce time for patient to be seen by physician
  • Decrease wait times for diagnostic results
  • Accelerate the speed of acquiring an inpatient bed
  • Reduce fast-track patient treatment times

Non negotiable Goal-Setting Workshop: To assure the year-long process remained focused, CBA led managers in a three hour Non Negotiable Goal-Setting Workshop 30 days prior to 100 Day Operations Waste Workout. Each manager's goals were set at benchmark levels resulting in 39 FTE reduction target on a 1002 FTE base, plus a 3% non-salary cost target.

100 Day Operations Waste Workout: CBA provided managers with the tools and support required to achieve their goals. Support included the services of a Master Black Belt in Lean-Six Sigma methodologies to identify opportunities for improving workflow. Training also included workshops in the seven categories of waste and the Waste Walk Methodology. As part of the 100 Day Workout, CBA assisted managers in creating 100 Day Action Plans and deploying a system for monitoring progress.

Lean-Six Sigma Deployed in ED / DMAIC: CBA then used its extensive healthcare experience to complete a thorough analysis of River Region Medical Center's workflow. This information was transformed into specific categories for improving the performance of the Emergency Department. The team had targeted three key areas of focus and designed specific strategies to realize the opportunity contained in each area.

Demonstrated Results of River Region Implementation

Through two cycles of 100 Day Operation Waste Workouts and the ED DMAIC project facilitated by CBA, River Region Medical Center gained:

Reduction in ED LOS for River Regional Medical CenterMeasurable Benefits:

  • 35% reduction in LOS, thereby achieving the worldclass benchmark of 1.9 ED LOS
  • Patient Satisfaction Scores increased from 2nd percentile to 77th percentile
  • River Region realized $1 million improvement in cost position
  • ROI of investment in Caldwell Butler & Associates services of 5:1

Intangible Benefits:

As a result of deploying CBA’s expertise, River Region achieved:

  • Staff acceptance of non-negotiable goals
  • Rapid deployment of proven methods and techniques for improving productivity and performance
  • Apprenticed in Lean-Six Sigma Design Techniques and 100 Day Workout method to ensure sustainability