Client Successes The following brief examples illustrate the concrete safety, quality and financial gains that Value Capture partners capture using values-driven operating principles. For additional information about any of these cases or other Value Capture partners and references, please contact Ken Segel, Principal Allegheny General Hospital (AGH), Pittsburgh, PA - At Allegheny General Hospital, Value Capture's principal staff supported the use of Toyota/Lean principles to eliminate/reduce three classes of infections. This work produced direct bottom line benefits to the health system totaling over $8 million over three years and was the earliest demonstration in American hospitals that the elimination of nosocomial infections is possible. This work has now been sustained for 6 years and published in several academic, improvement, and business journals, including: Using real-time problem solving to eliminate central line infections. Jt Comm J Qual Patient Saf. 2006 Sept; 32(9):479-87; and Economics of Central-Line Associate Blood Stream Infections, American Journal of Medical Quality November/December 2006 vol. 21 no. 6 suppl 7S-16S. University of Pennsylvania Health System (UPHS), Philadelphia, PA - The University of Pennsylvania Health System aimed for the elimination of Central Line Associated Bloodstream infections starting on four units and then spreading the improvements system-wide using Toyota/Lean principles. Incorporating Value Capture teaching, Penn created an 80% reduction in their infection rate within 30 days and then increased and sustained the improvement for more than three years to date. This accounted for 66 fewer deaths in the health system during Value Capture's 18-month engagement, a $2.9 million increase in revenues (new patients due to increased throughput) and a $3.6 million reduction in actual bottom line costs, accounting for a $6.5 million direct benefit to the bottom line from work in just one infection area. Penn also gained the capability to sustain these results and apply the ideas and skills to other problems and opportunities. CNN highlighted this work as the ideal model for true health care reform. But the real impact of this work is best measured not by national headlines, but by the feelings of front line staff and managers in addition to the concrete results. Here is how a front-line nurse described this work in successfully nominating it for a prestigious internal prize: "The value capture project was initiated in April of 2008 by the medical director Dr. Shannon. At that time [our unit's] BSI rate was 3.44 (per 1,000 catheter days). Our overall BSI rate in 2007 was what now seems astronomical at 7.5%. After completion of the project, the hospital has been able to maintain a BSI rate of zero for over a year now. What at the time seemed unbelievable to [our unit's] nurses has now become reality. We too found that our BSI rate dropped to zero in the first month..." Wellmont Holston Valley Medical Center, Kingsport, TN - With Value Capture teaching, staff working to improve the medication use process reduced stock-outs by 84% and reduced medication inventory purchasing by more than $1.3 million. This $1.3 million savings in the first year was achieved by reducing the gap between purchases and actual consumption by patients - an important discipline Value Capture teaches that can produce increased safety and dramatic reductions in waste across the enterprise. These savings are only part of the total story. Creating less wasteful inventory means that fewer drugs expire on the shelves or have to be sent back to the manufacturer - high expenses for most hospitals. And time is saved across the organization - from the ordering process itself to the endless "rework" occasioned by the need to look for and then reorder and reprocess medications that the patient is missing. Wellmont Bristol Medical Center, Bristol, TN - A revamp of the environmental services process using lean principles produced a direct cost savings of $112,000 and reduced the space needed for these supplies by 75%. Dramatic savings in square footage as a consequence of process improvement and waste elimination is a Value Capture specialty. Additionally, the creation of a reliable pull-based equipment resupply process - using simple ideas and no expensive technology -- was able to free up 11 RN FTEs and apply this time to direct patient care. This improvement was by cited by the nursing staff as by far the most positive change at the hospital in years in the annual human resources survey. The successful equipment supply redesign allowed nurses to spend measurably longer at the bedside. Using the same Value Capture principles, Bristol's staff drove other major improvements including a 75% reduction in falls across the hospital. LifeCare Hospitals of Pittsburgh, PA - Value Capture helped this 125 bed Long Term Acute Care Hospital (LTAC) implement a house-wide real time problem solving system toward their goal of eliminating all harm. In support of this work Value Capture helped the hospital redesign the medication use pathway to first create a direct connection between customers and suppliers (including MDs). This simple change based on a core principle of the Toyota Production System reduced illegibility and incompleteness by 77% in just 60 days without Computerized Physician Order Entry. Value Capture then helped LifeCare create stability for all elements of the medication use pathway and streamlined purchasing, eliminating virtually all stock outs while freeing up two days per week of a technician's time to do value-added instead of non-value added work. The bottom line savings were achieved in the medication inventory, where a simple Toyota-based signaling system eliminated the need to purchase $401,000 (20%) in purchases in the first year, with an ongoing minimum yearly value of $119,000 in eliminated, unnecessary purchases (6% of budget). LifeCare also solved dozens of previously recurring problems to their root causes, further stabilizing their care processes and reducing waste. International Hospital Corporation (IHC), Dallas, TX (hospitals in Mexico, Costa Rica, and Brazil) - Cliff Orme, the CEO who led the full engagement at LifeCare Hospitals of Pittsburgh (see below), became the COO of IHC as his subsequent role. Orme had already led the implementation of a real time problem solving system and used tools including Kanbans (simple, specific reorder cards) to reduce medication errors by more than 50% house-wide at LifeCare. He used these same leadership skills at IHC to increase error reporting while reducing patient and worker injury by 69% and increasing profitability by 37%. University of Pittsburgh Medical Center Northwest, Franklin, PA - UPMC Northwest's goal was non-financial, to eliminate harm for patients and workers. Value Capture's work with them produced the most successful safety model in American healthcare to date. By instituting a 'real-time' safety problem solving system house wide and by training each level of the organization the principles they would need "just-in-time" to solve a specific problem or business need, UPMC Northwest was able to increase reporting of safety events by over 500% (a sign of the professional safety needed to surface errors so that they can be investigated and solved) while reducing the number of events that reached a patient by 66% in the first year. This is the fastest and broadest increase in hospital safety that has occurred to date in the nation. The focus on safety led to substantial cost improvements that were not quantified due to the CEO's desire to signal the importance of doing safety work for safety's sake (following Alcoa's approach). However, the pharmacy and nursing units did institute a simple Toyota-based stabilization system for medications and supplies, respectively, that we have reason to believe produced similar results to those at LifeCare Hospitals of Pittsburgh. (See above) New England Baptist Hospital (NEB), Boston, MA - Value Capture supported NEB in the creation of a real time problem solving system and made numerous system improvements toward the goal of eliminating medication errors. Hospital leaders discovered nearly one-third of each pharmacist's time, or 2.5 hours of each 8-hour shift, was devoted to resolving problems related to incomplete, unclear or illegible medication orders. The result: the Hospital was spending $155,000 a year on clarifying such orders. The staff used lean principles to connect pharmacists to physicians to produce results. On the medical unit, for example, the median time to process a medication order fell rapidly, to less than five minutes today. Only 38 orders per month, or 0.02%, on average are put on hold for further clarification; about 2%, or 200 orders, are put on hold each month for the same reason hospital wide. When a redeployed satellite pharmacist was introduced in the Post-Anesthesia Care Unit (PACU) in late 2008, the number of problems with post-op orders that pharmacists encountered dropped from 34% to 10%. This is notable as 70% of medication orders at NEBH are immediate post-op medication orders. A goal here was to see how quickly a patient in immediate need, following surgery, gets his or her medicine. Meanwhile, the number of post-operative medication orders placed on hold by nurses for unclear orders dropped by 42%. The number of pages to the ordering practitioner to clarify an order has plummeted by 85%. BlueCross BlueShield of Tennessee (BCBST) - BCBST has significantly redesigned their medical management model using Value Capture system principles to eliminate error and waste and developed a plan to capture $1.5 million in value. Value Capture also helped BCBST and two pilot hospitals see the opportunity to eliminate large amounts of waste and error in the authorization process which crosses insurer and hospital boundaries.