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LEAN HEALTHCARE PROCESSES at

PELLA REGIONAL HEALTH CENTER

The staff at Pella Regional Health Center, like the employees of healthcare providers

everywhere, is searching constantly for a better way to workto be efficient andeffective while still providing compassionate care. The difference at Pella Regional,

though, is that they must do it with a small staff and a limited budget. But they are

doing itand have become the example that Lean Healthcare is possible anywhere.

Pella Regional Health Center, a 25-bed Critical Access Hospital in Iowa, has

implemented Lean Healthcare Processes that:

Functions without consultants, except for an initial 8-week training session.

Use front-line staff on the job as opposed to the 5-day event model.

Have provided staff with tools to structure and organize their problem-solving.

Have empowered front-line staff to form their own multi-disciplinary teams

and take the lead as the Resident Experts, exemplifying the pull theory ofLean.

Have become engrained in the culture of working at Pella Regional;employees of all levels regularly use lean tools to solve problems and deal

with issues.

Lean Healthcare Processes at Pella Regional Health Center are coordinated by

Sarah Cottington, BS, CPHQ, RHIT

scottington@pellahealth.org

641.628.6781

mailto:scottington@pellahealth.orgmailto:scottington@pellahealth.orgmailto:scottington@pellahealth.org

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Lean Healthcare Case Study #1(As featured in The Joint Commissions: The Source June, 2007)

The Issue: Patient care may be delayed due to nurse to nurse report taking longer than 30 minutesat end of shift. This problem was identified by frontline staff nurses at Pella Regional Health Center.The nurses worked on the above A3 and created a handoff communication tool to format their reportgiving, and other countermeasures to help minimize interruptions. The time they save each day indelivering report to the next shift equates to dollars saved by the hospital and more time for patientcare at the bedside.Countermeasures:1. Able to arrange coverage for RNs due to schedule specified for when RN will report to oncoming staff.Off-going staff will be aware of when expected for report and will be available.2. Clear guidelines established for when report is in session -sign posted on door and enforced by requiringknocking if absolutely necessary to enter room, otherwise no intrusions allowed.3. New Report -change of shift communication plan re-designed.

Cost Benefit/Waste Recognition ~ *Total Estimated Cost Savings (Annual) = $59,130*

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Lean Healthcare Case Study #2

The Issue: Increased spread of germs due to poor handwashing practices by PRHC personnel.Healthcare Associated Infections (HAI) affect nearly 2 million individuals annually in the UnitedStates and are responsible for approximately 80,000 deaths each year (IHI). Initial directobservations of handwashing at PRHC were low and variable at 20-100% (Feb, 2008). This problemwas facility-wide and addressed by the Shared Governance Quality Council which is comprised of frontline staff nurses from every discipline of PRHC.The Quality Council worked on the above A3 and created a formal monitoring system to monitor handhygiene throughout the Pella Medical Clinic, Outreach Clinics, Hospice, Home Health and all levels ofPella Regional Health Center. There is no way to know a hard dollar return on investment but eachhealthcare associated infection prevented is PRICELESS.Countermeasures:1. Handwashing readily available.2. Education to all Pella Regional Health Center staff.

3. Establish a hand hygiene monitoring system for Pella Regional Health Center.4. Establish a culture of safety at Pella Regional Health Center.Cost Benefit/Waste Recognition~*Total Estimated Cost Savings per patient = $35,000*Reference:CDC. Retrieved from the web December 3, 2008. http://www.cdc.gov/ncidod/eid/vol5no1/rubin.htm

http://www.cdc.gov/ncidod/eid/vol5no1/rubin.htmhttp://www.cdc.gov/ncidod/eid/vol5no1/rubin.htm

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Lean Healthcare Case Study #3

The Issue: Cannot easily identify outdates on sample medications in the clinic. Sample meds werestored in cabinets in the clinics and outdates were checked monthly. This process used to take anadditional 8 hours/mo. to be completed by a nurse. A nurse was scheduled to come in specifically todo sample medication outdates and re-ordering.The Pella Medical Clinic nurses worked on the above A3 to create a defined system to manage samplemedications. This has resulted in the sample medications being managed during the course of workand kept current with no outdates dispensed.Countermeasures:1. 5S sample med cabinet to create and maintain organized and clean cabinets.2. Label sample meds with sticker method used by PRHC pharmacy.3. Sample med cabinet responsibilities completed by three clinic schedulers.4. Each doctor/nurse team set par levels of sample meds they use to guide re-ordering and upkeep ofcabinet.

Cost Benefit/Waste Recognition~*Total Estimated Cost Savings (Annual) = $3,054.59*