How do you serve a community that changes every season?
Yuma Regional Medical Center is the region’s primary healthcare provider, offering the only Level IV trauma center in a 180-mile radius. They faced a one-of-a-kind challenge: Yuma is the sunniest city in the world. Every winter, snowbirds and tourists double its population.
Could YRMC find the balance of resources to serve its community year-round despite fluctuations, and into the future? Current state included high amounts of overtime. Expenses were rising faster than revenues. Yuma Regional needed to transform how it worked long-term and focus on making the most of every minute of care.
Treating the emergency department first
The transformation efforts began in the emergency department (ED) and observation unit
Yuma Regional has one of the busiest EDs in the state, but the department 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. To address it, other physician support services needed streamlining, including nurse triage, radiology and lab, patient transport and others.
Saving hours where time is of the essence
Integrating all the elements to improve workflow leads to quicker care
Applying measurements to clinical workflow processes led to improved services and a more efficient support system. Physicians gained confidence that adjustments to their workflow would make a positive difference.
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 fewer overtime hours. Yuma Regional became a better place to work and a better place to receive care.
After the success in the ED, Yuma Regional transformed other areas including patient registration, collection, claims processing, supply chain and others. Scorecards and performance boards were built to visualize daily progress. Leadership uses regular floor walks to see both successes and challenges with their own eyes. 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.
Reduction in overtime hours
Drop in agency personnel costs
Reduction in observation hours
Unlocking the supply chain
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 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 Yuma Regional to revamp the system, with redesigned storing and stocking procedures, plus a new approach to filling preference and case carts. The reorganization also opened up space for cart staging closer to the operating room.
Now clinicians could trust that carts had what they needed the moment they needed it. Minutes spent picking case carts were reduced 75%, leaving more time for patient care. What’s more, switching to a “just-in-time” approach revolutionized the operating room (OR). Once overstuffed, it now holds a third of the supplies it used to. As a result, OR turn times have decreased.
A brighter future
YMRC is enjoying positive trends. In FY 2017 the medical center 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, Yuma Regional 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.