TOCICO

This presentation demonstrates what management principles were applied in a general hospital that improved the quality of care and decreased the workload on nurses and doctors, while the same amount of patients was treated. This implementation took place in a Dutch hospital and is still in the process of completion. The implementation strategy is used in several hospitals in The Netherlands and abroad and delivers similar results over and over again. The problem is: Clinical wards in most hospitals, at least in The Netherlands, are usually occupied for more than 90% on average on a yearly basis. This average occupation means that from time to time wards are fully occupied, resulting in some major negative effects: patients cannot be admitted, operations are cancelled, patients are admitted on the wrong ward, nurses and doctors experience a lot of stress. Before our implementation started, the average occupation in this particular hospital was well over 90% and the amount of patients admitted on wrong wards was almost 1000 per year on a total of 8000 admissions for the concerning wards (5 in total in this case). On top of that, 10 to 15 times a year the hospital was completely full, resulting in patients being sent through to other hospitals in the region. The average length of stay was at the time of the beginning of the project (2010) 7.3 days per patient. What had to be changed? The goal of the implementation was to eliminate guest-admissions and to prevent a full-house situation during normal market demand (i.e. not taking into account winter crises or disasters). The way to achieve this was to reduce the length of stay for each patient by eliminating non-medical waiting times. These non-medical waiting times are often caused by mis-synchronization of resources inside and outside the hospital: diagnostic departments, such as Radiology, Physiotherapy and the like, also suffer from fully planned schedules, resulting in not being available at the right time for clinically admitted patients. But also nursing homes and rehab clinics tend to be occupied for almost 100%, also resulting in blocking patients to be discharged from the hospital. Implementation results include: Occupation of beds decreased by 20%. The occupation of beds throughout the 5 wards has decreased below 80%; the length of stay decreased by 15%; no more full-houses occur, almost no wrong admissions anymore and the overall average length of stay has decreased by almost 15% and is still going down. Ongoing improvement is on daily basis. The hospital has a process of continuous improvement installed, by using buffer management system during a daily stand-up meeting in which delayed patients will get the appropriate management attention in order to move forward again. Decisions are based on performance. On a monthly basis every ward measures the performance and decides where to improve even more, based on the delay-data derived from the buffer management system. Management focuses on improvement. On a board level the management observes hospital wide obstacles and decides where to improve on a hospital level.