A California hospital recently earned recognition for reaching the highest level of information technology adoption. Part of the operation’s success involved implementation of Lean Six Sigma.
The success at Martin Luther King Jr. Community Hospital in Los Angeles shows the potential of Lean Six Sigma methodology and health IT, as well as the importance of having buy-in from the top levels of management.
The community hospital achieved Stage 7 on the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM). This essentially means the hospital is using electronic health records (EHR) as efficiently and effectively as currently possible.
Only 6.4% of all hospitals in the United States have reached Stage 7 status.
What is Stage 7?
HIMSS – the Healthcare Information and Management Systems Society – is an organization that provides advice and thought leadership on improving healthcare organizations through the use of health information and technology.
EMRAM is an eight-stage measurement, from zero to seven, that indicates how well a medical operation has adopted and used EHR functions. The goal is to run a near-paperless operation that makes the best use of healthcare information technology to improve patient outcomes.
Martin Luther King Jr. Community Hospital focuses on using technology and implementing Lean Six Sigma. That level of commitment reaches the top of the organization. For example, Susan Burrows, the hospital’s vice president of human resources, is certified in Lean Six Sigma.
The community hospital opened in May 2015. It’s a 131-bed, acute care hospital that serves about 1.3 million people in south Los Angeles regardless of their insurance status or whether they can afford medical services.
From its inception, hospital leaders have been dedicated to leveraging health IT strategy and process improvement to become a model hospital for healthcare innovation and collaborative community healthcare.
That includes key components such as the EHR operating environment, interoperability, clinical intelligence and bio-med device integration.
From the start, the community hospital treated reaching Stage 7 as a project. The hospital designated a project leader and created a multi-disciplinary prep team focused on achieving Stage 7.
If that sounds like a Lean Six Sigma approach, that’s because it was. Martin Luther King Jr. Community Hospital leaders and employees have a wealth of experience in the methodology, Tracy Donegan, chief information and innovation officer at the hospital, told Healthcare IT News. She said the hospital had already performed or were working on 15 Lean Six Sigma projects when the Stage 7 project began.
One such Lean Six Sigma project included improving the flow of new patients through the hospital after admission. In February 2016, the median time from admission to department from the emergency department was 471 minutes.
A multi-disciplinary Lean Six Sigma team managed to cut that time by 22%. They did so with the following steps:
- Implementing a centralized bed control process overseen by case management that improved care transition out of the emergency department
- Creation of a standard checklist used between the inpatient charge nurse and the emergency department care manager when reporting on a newly admitted patient
- Use of a patient’s call light by the transport team to notify the inpatient nursing staff of a new patient’s arrival in their unit
A Step-By-Step Approach
On the EHR project, once the project manager and Stage 7 prep team were in place, the community hospital took the following steps.
- Quantified the impact of the current EHR design
- Used existing resources and projects to prepare for the HIMSS Analytics site visit in which the system would be evaluated
- Engaged the hospital’s EHR vendor to help guide prep efforts
- Held several meetings between the Stage 7 prep team and the vendor to review the requirements of the EMRAM Stage 7 guide
- The vendor also gave a sample client presentation “so the hospital team could have a sense for the level of detail required for the reviewers on the day of the evaluation site visit,” Donegan said.
- A shell of the client presentation was created to help the prep team focus
- Weekly prep team meetings focused on going through the proposed presentation deck, which helped the team continually refine sections
- The vendor attended a mock presentation 45 days before the HIMSS Analytics visit, which led to further refinements
As part of the process, the prep team also sought information on success stories within the hospital in the use of EHR. They ultimately settled on three areas that improved patient safety: medication management, population health and proactive intervention in critical patient care.
The success of both health IT and Lean Six Sigma at Martin Luther King Jr. Community Hospital shows the possibilities when the two are combined. It also provides an excellent example of the impact having executive buy-in can have on the success of process improvement.