Evergreen Hospital: Obstetrics Operational Excellence

Evergreen Hospital engaged Tefen to conduct an Operations Excellence Project in their Inpatient Obstetrical Services unit. The project focused on improving the Family Maternity Center (FMC), which has 36 Labor-Delivery-Recovery-Postpartum (LDR) suites with additional swing rooms to use as needed. Evergreen’s objective was to increase capacity and overall throughput to accommodate additional birth volume.

Challenge

In the early stages of Tefen’s relationship with Evergreen, a scoping assessment of the OB Services was performed to establish a baseline for the performance of the hospital. The assessment included preliminary data analysis, observations, and interviews with key personnel to gain an initial understanding of the historical performance and the major operational constraints limiting the FMC from achieving its goals. After the assessment, Tefen was able to understand Evergreen’s challenges, and the results that they could expect from the operational improvement effort.
The current-state challenges identified during the assessment included:

• Inefficiencies in the current discharge process and communication tools
• Inefficient scheduling practice causing high census levels later in the week
• Access to slots and timely performance of scheduled procedures contributing to providers and patients dissatisfaction
• Misalignment of staffing with daily census levels across the unit
• High Provider Practice variation contributing to high length of stays 

How Tefen Helped

Tefen developed a two-phased process to transform Evergreen’s OB operations, starting with a diagnostic phase. The diagnostic focused on the root causes and underlying issues limiting Evergreen’s performance. It established a clear baseline from which recommendations were developed to close performance gaps and realize an optimized “Future-state.”

After the diagnostic, a roadmap was created to detail the activities to be completed across key work-streams during the implementation. These work streams included: Discharge Planning, Procedure Scheduling, Resource Utilization, Room Turnaround, Materials Management, and Provider Practice Patterns. The Implementation phase focused on the tactical execution of the necessary activities to achieve the desired “Future state” and operational benefits.

• Discharge Planning: Key discharge activities were mapped to define sequence, responsibilities, and tracking tools to achieve the timely discharge of patients.
• Procedure Scheduling: Tefen explored alternatives to the current procedure scheduling practices to reduce census peaks and to level demand for the entire unit.
• Resource Utilization: Tefen studied the staffing of RN patterns across the OB units and aligned these patterns with patient demand for nursing services.
• Room Turnaroundt: Tefen observed the room turnaround process within the LDRP & OR Suites. Opportunities were identified to reduce turnaround time, increase room availability and utilization, and improve communication/notification issues.
• Materials Management: The current Material management practices on the unit was evaluated and improved upon.
• Provider Practice Patterns: Tefen mapped and analyzed provider practice pattern variations and worked with Physician staff to identify and implement “Best in Class” practices between providers.

Performance Excellence Delivered

Working together, the Tefen/Evergreen team successfully developed and implemented changes leading to significant improvements in Evergreen’s OB department.

Discharge Planning: Tefen developed discharge activity posters in all of the patient rooms to standardize nurse communication and patient education, while setting expectations and actively managing the discharge process. A Newborn Discharge form and a chalkboard to support real-time charting and pro-active management of discharges was developed. These activities led to improvements in patient throughput, capacity, and LOS. 

Procedure Scheduling: Identified opportunities from current procedure scheduling practice, and recommended distribution of C-Sections and Inductions schedule by day of week to level census and support staff leveling. This resulted in greater schedule adherence, staff satisfaction, and resource balancing across the unit.

Room Turnaround: Implemented new room turnaround process and reduced communication delays.

Material Management: Improved material management practices including storage locations, material flow, and replenishment processes.

Resource Utilization: Developed staffing tool and recommended staffing schedule that aligns resources with overall unit census.

Provider Practice Patterns: Developed a Best Practices bundle, which included practice/patient educational tools to improve provider-nurse communication and reduce the Provider practice variation. This increased not only the provider’s satisfaction levels but also contributed to an overall reduction in length of stay.

As a result of this initiative, Evergreen Hospital was able to;

• Increase capacity by 12% to accommodate 574 additional deliveries per year
• Improve Length of Stay by 11%
• Increase Schedule Adherence from 52% to 92%
• Add additional service offerings while increasing staff satisfaction by 22%
• Achieve an annualized savings benefit of $900k
• Increase potential annual revenue by $4.1M

Client Testimonial

We’ve been working with Tefen…and not only their skills and talents have been incredible, but just working with them has been awesome... I think we have done some amazing work... and I think it’s obvious for you all to see what they have done for us. We have seen a significant reduction in our Length of Stay for C-section [and] the LOS decrease is a result of all of our work and increased awareness of the discharge process. It’s really kind of blown me out of the water.