‘Lean’ helps to improve long-term care placement process

By Akilah Dressekie

Rouge Valley Health System (RVHS) is one of many hospitals across Ontario that have adopted ‘Lean’, a management philosophy
based on the elimination of waste and respect for people. Kaizen events, four day events where staff and physicians work together to make improvements in certain departments and programs, have been key to identifying waste and finding ways to eliminate it.

Since they were first introduced at RVHS in 2008, 511 staff members and 40 physicians have participated in close to 40 Kaizen events. Thanks to the hard work of Rouge Valley staff, Kaizens have led to a number of successes throughout the hospital.

A Kaizen event is also helping to streamline the referral process for alternate level of care (ALC) patients waiting for placement in a long-term care facility. It is one of our first joint events planned in collaboration with participants from outside RVHS. Patients waiting to be placed in long-term care beds account for a growing number of patients in acute care beds. While there may be limited available space in long-term care facilities accepting new patients, there are still opportunities to improve the referral process by eliminating unnecessary or non-value-added steps.

“At many hospitals, as much as 60 per cent of ALC patients are waiting for longterm care placement,” says Glyn Boatswain, manager, patient flow, relief pool and staffing office. “Due to the limited number of places in many long-term care facilities, many patients are waiting in hospital beds until a long-term care bed becomes available.”

The Kaizen event took place February 8 – 11, and involved staff members of RVHS, The Scarborough Hospital (TSH), the Central East Community Care Access Centre (CE CCAC), and a consumer participant. Representatives from the Central East Local Health Integration Network (CE LHIN) and the provincial Access to Care program were also in attendance.

This unique partnership was formed as a result of a relationship that grew out of the CE LHIN’s ALC Task Group, formed in 2008, co-chaired by Boatswain. The group worked in partnership with the CE LHIN and other health providers to assist in the implementation of the LHIN’s Integrated Health Service Plan (IHSP) concerning long-term care, supportive housing, and home care capacity.

Strong relationships were formed between RVHS, CE CCAC and TSH during the work of the task group. The organizations faced similar issues and challenges in the process of placing ALC patients into long-term care facilities. Boatswain was instrumental in bringing the three organizations together to pool their expertise in order to address a shared challenge.

This Kaizen event was also an opportunity to use Lean principles and tools, which has resulted in many improvements, to help the transitioning of patients designated as ALC. Participants mapped out the current referral process, and identified the non-value added steps. An ideal state referral process with only value added steps for the patients was then mapped out. The ideal state will remain the long-term vision for the three organizations. A future state referral process was also mapped out. From that, a short-term, mid-term and long-term action plan was created.

The three organizations came up with a way of transforming a process that once involved 120 steps to one which can be done in 60 steps!

All three organizations are committed to the new process, which has yielded improvements including:
• A much more collaborative model;
• Reduction of handoffs among the three organizations; and
• A streamlined communication process.

Pre-planning will also take place between the social worker and CCAC case manager to assess the patient’s discharge plans, and jointly determine whether the patient will be going home or to a longterm care facility.

“We look forward to seeing how these improvements will help to make the transition of care much smoother for many of our patients and families,” says Heather Reid, RVHS director of post acute care and patient flow.

“The patient and family will now be discussing options and issues with the hospital social worker and CCAC case manager at the same time. This will be of benefit to our patients and their families, and will cut down on miscommunication,” explains Boatswain. She adds that this new model means that the information patients and families receive will be much more consistent.

As a result of this event, the goals are to:
• Reduce the number of handoffs by 50 per cent;
• Improve communication with the patients and their families;
• Improve communication among the care team; and
• Reduce the number of forms and implement better visual management of this process.

The combination of all of these improvements is expected to significantly reduce the time the referral process takes.

“It’s great to see the how we can apply Lean principles beyond our own hospital to deal with important system issues. We’re looking forward to the benefits that this revised and much more patient-friendly model will bring to our patients,” says Michele Jordan, vice president and chief transformation officer.

For community partners, seeing the benefits of Lean and what it could mean to improving how efficiently patients are referred to long-term care facilities has also made an impact.

“It is so refreshing to work with front line workers who really know the system and can make a difference for the patient and family. I am a believer in the Lean process and hope to participate again with more agencies involved in the continuum of health care and in particular, in driving a senior-friendly environment in our hospitals,” says Randy Filinski, an advocate for senior health care in the community, and a consumer participant in the Kaizen event.

Akilah Dressekie is a Communications Specialist at Rouge Valley Health System.  Reposted with permission from The Rouge Valley Health System.  This article appears in the April 2010 edition of Hospital News.