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Yakima Valley Memorial Hospital Realizes $1 million and Dramatically Improves Surgery Flow

Yakima Valley Memorial Hospital, a 300-bed facility located in Yakima Valley, Washington, was facing serious productivity challenges in its perioperative service. The organization exhibited excessive variation in surgical flow, including late first case start times, slow room turnover and lengthy delays in the Pre-Surgical Testing Clinic (PST). This was driving a decline in patient, physician and staff satisfaction. Previous attempts to address these issues yielded limited results and progress was slow.

Yakima Valley Deploys Lean-Six Sigma to Launch a 100-Day Surgery Workout

Yakima Valley's Needs

  • Improve first case start compliance
  • Reduce operating room turnover times
  • Improve the accuracy of case scheduling
  • Increase capacity and productivity
  • Improve surgeon satisfaction

Yakima Valley engaged Caldwell Butler & Associates (CBA) to support its initiative through the application of Lean-Six Sigma and its 100-Day Workout Productivity Series. CBA assisted senior management in identifying potential strategies to yield significant improvements in surgical patient flow. The stated goal was to create efficiency and predictability in case scheduling, first case starts and room turnover in order to improve surgeon satisfaction. A secondary goal was to generate gains in financial performance by reducing worked hours per case and creating additional capacity for expanding volumes. During implementation, CBA employed proven methods to validate the effectiveness of each change proposed by the teams.

Process Flow and Statistical Analysis: CBA deployed its expertise in Lean-Six Sigma methodologies to identify and quantify potential opportunities for improving surgery flow and productivity. The statistical analysis revealed that only 33% of 0730 cases were wheeled in by 0735 , average room turnover was more than 24 minutes, and fewer than 39% of overall cases started within 15 minutes of their scheduled start time. Research also indicated significant patient dissatisfaction with the pre-operative assessment process and lengthy delays in PACU and Same Day discharges. Caldwell & Associates used its extensive healthcare experience to identify opportunities for improving surgical process flow. Analysis revealed this change would yield significant gains in satisfaction, capacity and financial performance.

Change Concepts Deployed

  • Eliminating non-value added steps in Day Surgery pre-op flow
  • Creating turnover teams with standardized roles
  • Computer-based scheduling grounded on historical data
  • Matching staffing to demand in post-operative care

Strategy Development: With the support of CBA, Yakima Valley organized three multi-disciplinary, sub-process work teams to identify solutions. Each team focused on different areas including on-time starts, to-follow cases and pre-admission/scheduling. The teams began assessing a multitude of possible improvement strategies. Caldwell Butler & Associates provided the expertise in process flow analysis to assist each team in determining which Change Concepts would produce the most dramatic improvements.

Implementation of Rapid Cycle Testing: CBA provided its expertise to test and implement each of the identified Change Concepts. Methods of Rapid Cycle Testing were utilized to accelerate the achievement of sustainable improvements. The results of each project were analyzed using advanced statistical techniques to quantify effectiveness and ROI.

Demonstrated Statistically Significant Results of Yakima Valley Implementation

  • First case start compliance increased from 33% to 64%
  • Average room turnover time fell from 24.4 minutes to 15.9 minutes
  • Scheduling accuracy (case started +/- 15 minutes of scheduled time) improved from 38.7% to 58.2%
  • The % of case cancellations due to an unavailable H&P declined from 3.3% to 0.7%
  • The pre-op assessment clinic shaved 4.7 minutes off the RN assessment time and 6.2 minutes off the EKG/lab time
  • A rapid cycle test reduced the average Day Surgery discharge time by 18.6 minutes

Room Turnover Initial RCT

Financial Benefits Verified by the CFO

  • Cost savings from improved first case starts and reduced room turnover equal $975,438 per year
  • Net revenue opportunity from increased case capacity equals $1,335,600 per year