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Employees' ideas improve efficiency
Sometimes the best ideas for improving your efficiency might be right under your nose. At two surgery programs, staff members have suggested ideas that, when implemented, resulted in better patient flow and reduced costs.
At San Luis Valley Regional Medical Center in Alamosa, CO, the front office person sits within an office that is separated from the pre-op area by a door. "It is a fire door, so it cannot be left open," says Angela Blankinship, RN, CASC, director of surgical services.
When patients checked in, staff attempted calling the pre-op nurse to notify her that she had a patient, she says. "If they are busy with other patients, the nurse can't answer the phone, Blankinship says. The staff considered pagers, but the nurses didn't like that idea. "The front desk person can't leave her desk to run and tell them they have a patient," she adds.
The solution? One of the nurses went to a local discount store and bought a wireless doorbell. The cost of this item is about $15. The staff selected the doorbell tone. "Occasionally, one of the anesthesia providers changes the tone just to keep things lively," Blankinship says.
The staff simply plugged the doorbell into a wall socket in the pre-op area, Blankinship says. "We placed the actual door bell button on the receptionist's keyboard with double-sided sticky tape," she says. When the receptionist completes her registration process, she rings the doorbell. The nurses know there is a patient, and they come and pick them up, Blankinship says.
"It has really helped by keeping the receptionist in her office and improved timely patient flow," she says.
At Bald Mountain Surgical Center in Lake Orion, MI, the staff regularly meet at the end of busy days to determine what they can change to boost efficiency, says Annette Bak-Lopez, MSN, administrator.
"It keeps everyone engaged in process, looking to always improve processes," she says.
As a group, staffers determine the most effective time frame for bringing in patients to start the pre-op process so there wasn't a too-long wait, she says. Another potential problem is that the center has a small waiting room that they don't want overflowing with visitors, Bak-Lopez adds. The staff determined that with minor procedures such as cataracts and colonoscopies, the patient immediately could go back to the recovery room, where the surgeon could speak with them, she says. "That improved the flow process," Bak-Lopez says.
Other changes included making up linen packs ahead of time and using recliner chairs as much as possible in order to free up patient carts for transport.
Another dilemma solved by staff at San Luis Valley involved overstocking of surgical screws, with a corresponding rise in costs.
To ensure that there were enough screws, materials management received an order for the screws from the central supply department (CS), and the CS technician opened the packages and placed the screws in a special compartment, Blankinship says. The screws were then available for restocking, she says. "As you can imagine, we accumulated more screws that we could possible use," she says. There were no par levels, and the overstocking continued, she says. "The techs just didn't consider that the screws were an investment," Blankinship says.
With tighter reimbursement margins, this overstocking created a dilemma, she says. "We need to save every possible penny," she explains.
The materials management staffer came up with a solution, Blankinship says. After reviewing the financial reports with the materials management staff person, she developed a system using a large file box; index cards; and a two-copy, no-carbon-required (NCR) sheet that she uses when ordering and restocking screws.
In the file box, screws are filed by their part number, Blankinship says. Screws are filed without removing them from their package prior to being restocked in trays. "The CS tech can look into the filing system, remove the screw they need, and both the CS tech and materials management can visualize their stock quantities," Blankinship says. "This also helps her if she does find that she is overstocked, as now we can return the screws if needed," because they are in the original package, she says.
"We have saved to date about $3,000, and we have been using the system about three months," Blankinship reports.
The NCR form is organized, comprehensive, and clear, Blankinship says. The second copy goes to the billing department, she says. The form is organized to not only help her control stock, but provide the billing person a legible accounting of the particular screws used," Blankinship says. It is not part of the medical record, Blankinship says. (Editor's note: An implant log also could be used to be certain that the costs of chargeable items are captured every time.)
Will they always choose to use the NCR form? Probably not, Blankinship says. "It is an added expense," she says. However, it was value-added in that it allowed materials management to gain control of this small particular problem, Blankinship says.
"It was delightful from a director's point of view to see her take pride in her actions, come up with a plan, execute the plan and she now is re-evaluating her processes with her entire department, developing a true 'Lean Six Sigma' [performance improvement] style of thinking," she says.
The end result? "She is excited, and that is contagious to all other aspects of our team," Blankinship says. Now, employees volunteer ideas, she adds. "It usually starts with, 'Hey, I was thinking. . . it may not work . . . but, could we . . .?' How very cool is that?"