Long-Term Care Survey Alert

Published on Sun Jan 21, 2007 PDF

These process improvement strategies help you truly work smarter.

If you're tired of doing more with less -- and fear the light at the end of the tunnel is a trainload of more work -- consider putting your facility on a new track.

Lean to the rescue: Many healthcare providers are adopting "Lean" manufacturing principles that eliminate wasted time, effort and resources. Originating with auto manufacturing, Lean techniques can boost productivity and reduce errors in nursing facilities. How so? For one, when you eliminate wasted time from your processes, CNAs and nurses can spend more time with residents, which adds value to residents' experience, says Cindy Oehmigen, with TDO in Syracuse, NY.

To launch Lean practices in your facility, start by selecting a process to make more efficient -- for example, how CNAs do morning care. Then, implement what is known in Lean language as "value-stream mapping," advises Oehmigen. In this example, that simply means you would ask the CNAs to describe step-by-step exactly what they do when providing morning care. "You can actually map how the CNAs do their work, including how far they walk," she adds. Or you can take notes as you observe them in action to develop a "true picture of what's going on."

Next step: A designated "Lean team" reviews the information and "identifies the waste," Oehmigen says.

Key examples of waste: You may see that staff are walking unnecessarily to and from closets to get supplies that you could move closer to their work. Or you may note that staff spends time rummaging through a disorganized closet. In that case, you could implement "visual controls" so they can immediately locate an item.

Lean tip: For supplies, try using a "first in, first out" approach so things don't go out of date, advises Oehmigen. Place a card at a certain level of stock to remind the person to re-order the supply.

To "lean out" the admissions process, look at ways to clarify the admissions information and requirements, as well as the process. Make sure families and residents understand the information. "Part of that can include simplifying the forms" or simplifying language, Oehmigen says.

"Many people in long-term care get used to automatically using acronyms like "ADL," she notes, "but the resident's family doesn't have a clue what that is." And confused or disgruntled family members take more time later and can lead to complaints.

Another major bottleneck is staff having to wait for someone or something before they can do a task. But "understanding the processes will allow for effective pre-planning" to minimize waste, Oehmigen says.

Example: Benedictine Health System has a nursing protocol where nursing supports a rehab plan of care by ensuring the resident is ready to go to therapy at the scheduled time, according to Garry Woessner, MA, MBA, CAS, regional director of rehabilitation for the non-profit chain based in Duluth, MN.

Another big part of Lean involves standardizing work so that everyone does a process the same way. You want to individualize a resident's care. But selecting certain care processes to standardize makes sense -- "for example, administering and documenting medications the same way or taking blood pressure the same way," Oehmigen suggests.

Example: Bordeaux Long-Term Care, a county-owned nursing home in Nashville, TN, has standardized its peri-care and also uses protocols for what staff should do when a resident has a fever or constipation, says Mae Bennett, CEO for the facility.

It pays to standardize even seemingly simple tasks, such as weighing patients, she adds. "If one staff person weighs residents with their shoes on and another staff person doesn't -- or worse, with their prostheses on or off -- the facility will have wide variations in weights."