When LincolnHealth hospital patients reported it was too noisy to sleep at night, it was a medical problem because too little sleep means slower recoveries.

Because reimbursements from both private insurers and government insurers like Medicare are increasingly tied to surveys that measure, among other things, how well patients sleep, it was potentially a financial problem.

Solving it was not easy. Hospitals are busy places, with lots of noisy machines, including beepers, diagnostic equipment and floor cleaners operating around the clock to keep patients safe and the environment clean. The way staff solved the problem had a lot to do with the management processes used by Japanese car manufacturers to improve quality after World War II.

Those processes, developed by electrical engineer and management consultant W. Edwards Deming, are designed to break down barriers within organizations and involve front-line employees in identifying problems and developing ways to improve processes.

In November of 2014, those principles came to LincolnHealth as Operation Excellence and since then, employees have used the program to make hallways quieter at night, get hot meals to patients faster, reduce waste and save money for both LincolnHealth and patients.

How it works

As part of Operation Excellence, employees in each department identify problems or processes that can be improved and then identify a goal – a Key Performance Indicator (KPI) – that will serve as a measuring stick to determine when the problem is solved. They then gather data each day and use that data to home in on a solution.

Every morning, teams of managers, including top leadership, visit each department in the hospital checking in with staff on their progress toward achieving KPIs. At each stop along the morning walks, the managers ask staff if they can offer any help.

When patients were having trouble sleeping, nurses and certified nursing assistants adopted a KPI that patients will report that it is quiet 100 percent of the time at night. Each day, nurses surveyed patients. After several days of failing to meet the goal, three problems stood out: the use of phones, a floor buffer and a noisy ventilation system.

The floor buffer was rescheduled to daylight hours. The use of phones was restricted, but the noise persisted. A filter on the ventilation system was replaced and still it continued. Finally, a maintenance person tracked the noise to its source and discovered a dried label had come unstuck and was caught in the vents.

When the label was removed, the number of patients reporting that it was quiet enough to sleep rose significantly.

Another issue solved

Another initiative ensured that every department that should be notified when a patient is about to be discharged is notified, including the medical/surgical floor, pharmacy department, dietary services, cardiopulmonary and environmental services departments.

That change lowered the time that patients wait for rooms by alerting environmental services that they would soon need to prepare an empty room for the next patient. It gave pharmacists time to make sure each patient goes home with not only the medications they were prescribed in the hospital, but also everything they came to the hospital with, which can potentially save hundreds of dollars per patient.

The cardiopulmonary department had time to insure that if the patient was prescribed an inhaler, they understood how and when to use it, and dietary services knew not to send any more meals to the room.

That one change could save thousands of dollars in medication costs and perhaps even tens of thousands of dollars a month. Even more importantly, it will help keep patients safe by insuring that when they leave the hospital they have the medicine they should have and know how to use it.

Engaging employees

As important as patient safety and keeping costs down are, however, they aren’t the reason the hospital adopted Operation Excellence, said Cindy Wade, RN, LincolnHealth’s chief operations officer.

“We didn’t start this to have a return on investment or eliminate waste. We wanted people to feel ownership in what they were doing and we wanted employees to be more engaged,” said Wade.

LincolnHealth has a national reputation for quality. In four of the past five years, it has won the prestigious Top Rural Hospital award from The Leapfrog Group as well as a host of other quality awards, but Wade said Operation Excellence is really about making sure the small rural healthcare system is a great place to work, one in which every employee feels their contribution is valued.

“It is really about empowering the staff to do what they need to do to get the job done the best way possible,” she said.

Front line employees are closest to the day-to-day work processes. They understand the weaknesses and how those weaknesses can be improved, she said.

The idea behind Operation Excellence is to give front-line staff more freedom to suggest improvements and in the process make LincolnHealth a better place to work.

“They are problem solving. They are engaging in their work at a different level, which is improving their experience as employees. Ultimately, we are improving the care provided to our patients and residents through continuous daily improvements that are driven by the staff,” said Wade.

Another result of Operation Excellence is that because senior leadership and managers, including President Jim Donovan and Wade, visit departments during the walks, they have become familiar faces and employees are much more comfortable talking to them.

Wade said that has made it easier for people to walk up to her in the parking lot and share ideas.

“It is about relationship building, connections and helping everyone understand across the full continuum that we are all here working together,” said Wade.

Food delivery improves

In dietary services, Chris Botelho admits that she wasn’t originally sold on Operation Excellence but after taking part in more than 20 KPI’s, she is a believer.

“It is work but it is worth it,” said Botelho. “Having the whole KPI thing has made it easier to say ‘This is a problem and we need to fix it.’”

A lot of the issues that dietary services has addressed through Operation Excellence boil down to delivering the wrong meal to a patient or delivering the right meal at the wrong time.

Because the team at the Miles Campus of LincolnHealth has to produce up to 60 meals a day for patients, another 100 or so for staff and others who eat at the Milestone Café, and a variety of special orders, the kitchen is more or less constantly in assembly line mode. Fitting in a special meal, or replacing a meal that was ordered incorrectly can be a problem.

For instance, if a diabetic patient received the wrong meal, the patient would then have to wait for a replacement meal. Or, if a patient was being put through a diagnostic test during meal time, their meal would be cold by the time they were ready to eat it.

Miscommunication not only means waste, it means a patient might receive a cold meal or might not get the meal they ordered at all.

Operation Excellence provided an opportunity for dietary staff to open a dialogue with different departments to resolve those issues in way that kept the focus on the data.

Once everybody understood the problem, the issues were easy to resolve.

“They didn’t realize we had this problem,” said Botelho. “They jumped on board with it because they realize that if their patient is getting good hot food, their patient is happier.”

And dietary staff is also happy because they take pride in delivering meals that patients want to eat.

“They are getting fresh food, not food that has been held, and they get what they want, what they had ordered,” said Sarah Eugley.

Tom Schwarz, Director of LincolnHealth Dietary Services, said he has also seen the interaction between his department and other hospital departments improve. And everyone seems more comfortable taking the initiative when there is an issue, he said.

“If there is a problem, you fix it now, you don’t wait for somebody else to do it,” said Eugley.