Finding more hours in the day
at Yuma Regional Medical Center
In many industries, time is money. In health care, time means so much more. It can determine a patient’s outcome. It can make providers effective, or overstretched.
Caring for a unique population, Yuma Regional Medical Center faced extra pressure to maximize its use of time. Can a process take fewer hours and still lead to better results?
Yuma Regional Medical Center
- Southwest Arizona
- Private not-for-profit
- 406 beds
- 2,400 employees
How do you serve a community that changes every season?
Yuma Regional Medical Center is the region’s primary health care provider, offering the only Level IV trauma center in a 180-mile radius.
They enjoy a one-of-a-kind challenge: Yuma is the sunniest city in the world. Every winter, snowbirds double its population. (Not to mention tourists.) Could YRMC find the balance of resources to serve their community year-round, and into the future?
Overtime was endemic. Expenses were rising faster than revenues. YRMC would need to transform its ways of working long-term, and focus on making the most of every minute of care.
More efficiency, more modernization
YRMC turned to Vizient Advisory Solutions for both transformation expertise, and supply chain opportunities. "We wanted something that was ongoing, sustainable and would become hard wired as part of our operations and business vision," said David Willie, chief financial officer.
Side-by-side coaching was essential to getting all levels on board. As staunch advocates of transformation, the CEO and leadership team supported a comprehensive training program for executives first, then director-level leaders. “We needed resources and coaching from Vizient to successfully accelerate embedding a Lean management system in our organization,” said Justin Farren, vice president, strategy and ambulatory operations.
From the front lines to upper management, YRMC instilled a unified purpose of constant improvement. They would undertake hundreds of project-specific activities, each tied to long-term goals.
Once the successes got underway, the results were dramatic.
Saving hours where time is of the essence
The efforts began in the emergency department (ED) and observation unit. And for good reason.
YRMC has one of the busiest EDs in the state. And yet, they ranked near the bottom among peers for length of stay. This led to staff being overworked, and challenged to keep up with 75,000 patients a year.
The good news? Change was possible, if the opportunities could be identified. A value-stream mapping project revealed physician workflow as the key. But to address it meaningfully, the internal services supporting physicians would have to be streamlined first: nurse triage, radiology and lab turnaround times, transport and others.
Integrating all the elements
Applying measurements to these areas led to improved services, and a more efficient support system. “Physicians gained confidence that adjustments to their workflow also would make a positive difference,” said Farren.
Tangible metrics empowered physicians to fine-tune their own ways of working. Monthly data comparing providers’ patients-per-hour and average lengths of stay provided context. Next, hourly data measuring patient “ins and outs” helped them benchmark themselves against target times.
With everyone involved, length of stay in peak season was reduced by nearly an hour. A further effort focused on sequencing the workflow of physicians and nurses netted two more hours. Average times for patients were cut from almost six hours, to under three. When minutes can make all the difference to a patient’s outcome, this was a proud achievement.
What’s more, a more efficient ED meant far fewer overtime hours for staff. It became a better place to work, and a better place to receive care.
47% reduction in overtime hours
44% drop in agency personnel costs
14% reduction in observation hours
Embedding change throughout the organization
Progress in the ED soon built momentum for efforts in other departments: registration, copay collection, claims processing, supply chain and others.
Standard-setting metrics and team huddles brought together managers and staff to create their own culture of continuous improvement. Directors use scorecards and performance boards to visualize daily progress. Management employs weekly to monthly floor walks to see both successes and challenges with their own eyes.
Redesigning a process sometimes means redesigning the space where it happens. Vizient Facilities Design Services experts assisted in several capital projects to redevelop the endoscopy, bronchoscopy, interventional radiology, and sterilization and supply service areas.
Virtual “waste walks” identified 200 inefficiencies in interventional radiology alone, from technology usage, to location of supplies. Mapping workflow against layout in each area revealed how to optimize the way things were done, then create the ideal space to match.
From just-in-case to just-in-time
An efficient supply chain isn’t simply about sourcing. It’s also about how supplies actually make their way through the facility. This infrastructure can impact care in ways providers may not even realize.
In perioperative services and operating room surgical services, nurses and technicians were filling shelves and stocking case carts themselves, to be sure they had exactly what they needed. The unrecognized cost? Spending valuable time away from patients.
Vizient partnered with YRMC to revamp the system, with redesigned storing and stocking procedures, plus a new approach to filling preference carts and case carts. The reorganization also opened up space for cart staging closer to the operating room.
Now nurses and clinicians could trust that carts had what they needed, the moment they needed it. Minutes spent picking case carts were reduced 75%, and more time could be given to patients.
What’s more, switching to a “just-in-time” approach revolutionized the operating room. Once overstuffed, it now holds a third of the supplies it used to. Everyone can work more smoothly, and turn times have decreased.
Supply chain as a value-added process
The rethinking of supply chain reached every area: leadership and staffing, requisition and procurement, sourcing and contract management, data management, accounts payable, benchmarking, value analysis, inventory management and receiving and logistics.
The Vizient team helped address areas such as stock-outs per day, decreasing from an average of 15 to seven. Changes in the supply process from warehouse-to-hospital reduced monthly overtime hours from 400 to 30, and time required to work a distributor’s truckload of supplies from 18 hours to just two.
Nearly half of all requisitions were still being done manually, time-intensive labor that allowed more errors. The Vizient team helped update the process so that nearly all is now automated, linking in over 100 additional vendors.
E-commerce was further improved by syncing YRMC’s coding with suppliers, manufacturers and distributors, and smoothing the process for invoice processing.
In all, YRMC’s supply chain became far faster and more reliable. And one of the biggest changes created even more possibilities: switching to the Vizient group purchasing organization (GPO).
The potential of group purchasing
Supply chain spend accounted for 16% of YRMC’s total annual expenses. Tapping into the buying power and insights of the Vizient GPO is beginning to change that.
“Changing group purchasing organizations is always a large process, but I couldn’t be happier with the results: high-level cost savings and dramatic increases on service levels,” said Richard Bergmann, administrative director, perioperative services and system supply chain.
The Vizient team has worked with YRMC to analyze all available contract opportunities, implement them at the appropriate tier for maximum savings, and activate them in the system so that purchase orders reflect the correct pricing. “Supply chain operations are now perceived as an asset to the organization,” said Terry Cox, director, supply chain services. “Regular reporting of our results is now reaching the C-suite.”
A brighter future
As it continues serving the sunniest corner of America, YMRC is enjoying positive trends. According to Farren, FY 2017 began $6 million behind budget – and ended $13 million ahead. The 6% operating margin was double the budgeted amount.
In the first year of these efforts with Vizient, YRMC completed 12 improvement projects with an estimated cost savings of $600,000. As the culture of continuous improvement has set in, the impact has multiplied. The organization has now completed over 400, with a cumulative impact of nearly $10 million – $7.6 million in just the last year. Supply chain operations have contributed an additional $3 million.
“Every month that goes by, the organization is achieving more improvements, so that now we are having a hard time keeping up with tracking them all,” Farren said. "Just within the past couple of years, we've positively impacted quality, services, operational efficiency and finances."
Improvements aren’t just about the numbers, however. With more efficiency in every area, the YRMC staff can devote more of their efforts to caring for their community. Whatever the season may bring.
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