St. James Parish Hospital’s Lean Project Success

December 2014
National Rural Health Resource Center (The Center)

St. James Parish Hospital, located in Lutcher, Louisiana, is a non-profit, 25-bed Critical Access Hospital. Services include a Level II Emergency Department, inpatient and outpatient surgery, 20 acute care and skilled rehab/swing beds, 5 progressive care beds, full service lab and imaging services, and comprehensive outpatient therapy. St. James Parish Hospital prides itself on being "Large enough to serve, Small enough to care."

Ravi Lote, Global Operations Manager and Principal Consultant with PMC Engineering, worked with St. James Parish Hospital in 2012 on a Lean Process Planning & Value Stream Mapping Project. The team chose to focus on two particular areas: medication management and medical necessity. RHPI spoke with Mary Ellen Pratt, CEO, Geri Abadie, Director of Quality, and Tracy George, CFO, team leader for the project, in June of this year concerning their progress.

Q: Why did you choose to focus on Lean process for your RHPI project?

A: St. James Parish Hospital is very results-oriented and places much importance on driving performance improvement through a balanced management system. For many years, we have recognized Lean as an effective technique for improving processes and increasing efficiency and we invested in training hospital leaders back in 2004. Because many leaders had changed, we wanted to teach the new leaders the principles and tools as well as "refresh" the rest of the leadership team. I knew PMC Engineering was working with a CAH that I had worked at prior to St. James and were getting good results.

Q: What is your hospital's current status with regard to implementing the recommendations made during this project?

A: For medication management, standardization in the process has been fully implemented. Staff had been making lots of trips to medication room which took a lot of time. Now they pull meds at the beginning of their shifts which saves time and they can do medication verification, 91% of med verification is done at the bedside. There is a new flagging process for physician orders and they now have CPOE which is helping with timely orders. IV piggybacks are now color-coded and really reduced errors. The team is able to quickly identify issues to be addressed when there is a spike in numbers. For the medical necessity portion of the Lean project, the team redesigned the outpatient order form to highlight tests that require additional documentation. Almost all physicians are using it and they worked with their office staff to provide education. Advance Beneficiary Notice of Noncoverage (ABN) are signed in advance which has improved Medicare compliance.

Q: What were the expected outcomes of this project? Has your hospital been able to document any of these outcomes?

A: The goals for the medication management were to: reduce turnaround time, reduce medication errors, and establish a universal process. Creating a set process has saved time and physical effort involved in medication management. Medication verification has saved the hospital $5000. Medication errors have moved from 1.2 per 1000 to 0.8 per 1000. For the medical necessity portion, medical necessity write-offs were reduced from $997 to $964. Orders requiring rework were reduced 50%, resulting in a cost savings of $5000.

Q: What are the expected next steps towards adopting your consultants' recommendations? Is there a sustainability plan?

A: Measures continue to be watched and acted on. The hospital quickly responds to spikes in measures.

Q: Is there anything your hospital would do differently if you were able to repeat this experience?

A: To make the Kaizen event and on-site consulting time more productive, we would have identified the necessary data elements and collected this information to be used by the team during the event. Secondly, trying to do two distinct projects at once, was probably asking too much. We should have focused on one at a time.

Q: Aside from the measurable outcomes, what has been the impact of this project on your community?

A: There were a number of ways this project impacted the hospital:

  • Quick course correction when numbers spike and when they see trends
  • Using lean process to handle other issues
  • Save time in nursing practice
  • Better collaboration among departments - nursing, respiratory therapy
  • Helped everyone develop ownership for impact on project
  • Staff felt more included in improving process
  • Improved morale due to less rework
  • Better staff understanding about improvement to processes and not being blamed
Hospital Spotlight

Uvalde Memorial Hospital Strategizes SRHT Implementation

June 2018

UMH successfully incorporated the ten action items recommended in their 2017 FOA strategic plan. The teams modified time frame goals to coincide with the strategic plan to stay focused on the implementation.

Hospital Spotlight

Delta Memorial Hospital’s SEAL Team

May 2018

Delta Memorial Hospital was spotlighted in November 2017 for the progress on their QI project. Read this next spotlight which talks about their SEAL team, charged with the task of impacting patient experience.

Hospital Spotlight

Delta Memorial Hospital: SRHT Project Well Under Way

November 2017

After only six months of their SRHT QI Project implementation, DMH is reporting successes including the start of a chronic care management program, creation of a patient satisfaction committee and an innovative approach to leadership rounds.

Hospital Spotlight

Coteau des Prairies Keeping Services Close to Home

August 2017

CDP staff is more aware of the ways they impact the financial success of the hospital. There is increased trust of the new leadership team, as well as, improved communication and problem solving.

Hospital Spotlight

Monroe County Hospital Achieving Outcomes

April 2017

Monroe County Hospital completed a Quality of Care and Transition of Care SHRT Project in 2016. Read about their progress on this project.

Hospital Spotlight

Pender Community Hospital Surpassing Project Goals

May 2016

Melissa Kelly, CEO of Pender Community Hospital in Nebraska shares ways they utilized the recommendations from a Financial Operational Assessment to “jump to new system of delivery and payment.” They describe how they are setting goals around preventative services and trying to change the community’s view by changing communication with the community about prevention.

Hospital Spotlight

Spotlight on Cibola General Hospital

February 2016

CGH completed a QI and TOC Project in 2015. Bob Phillips, CEO and co-CNOs share how they used the recommendations to prepare to be a part of an ACO and creating processes to support population health.

Hospital Spotlight

Spotlight on Missouri Delta Medical Center

June 2015

MDMC shares successes and lessons learned from an RHPI FOA in preparing for a new payment and care delivery model and discusses next steps for participation in a shared savings plan and/or ACO.

Hospital Spotlight

Spotlight on Tallahatchie General Hospital

April 2015

Jim Blackwood, Administrator of TGH, discusses ways they used an RHPI FOA to focus on developing leadership abilities, especially regarding handling the “business” end of their departments.

Hospital Spotlight

St. James Parish Hospital’s Lean Project Success

December 2014

St. James Parish Hospital worked on a Lean Process Planning & Value Stream Mapping RHPI Project. The team chose to focus on medication management and medical necessity.

Hospital Spotlight

LaSalle General Hospital Improves Clinical Processes and Revenue Cycle

February 2012

This project helped to provide assistance with evaluating clinical processes that impact the revenue cycle, prioritize needs, develop action plans based on the identified needs and implement a plan to improve clinical processes and thus the revenue cycle.