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Matthew Smith

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Transformation at the Frontline--A Nurse’s Perspective on Enablers of Outcomes-Based PI: Value Stream Mapping

Posted by Matthew Smith on Jun 27, 2018 5:55:50 PM

By Tina Hallberg, RN, Senior Consultant, GE Healthcare Partners

The Value Proposition for Value Stream Mapping in Healthcare

Those who are well-versed in Six Sigma and DMAIS are familiar with using process maps to define borders and high-level steps. A process map visually describes the flow, sequence, and interactions of related activities from the beginning to the end. From a manufacturing perspective, this makes sense. However, in healthcare every process is patient-centric, including non-clinical processes, and must be viewed from the lens of keeping and creating value for the patient. To identify steps as value added, non-value added, or non-value added but necessary, the clear choice is to utilize a value stream map (VSM).

To keep the focus on the true customer, every process must be viewed from the patient lens, including non-clinical processes. In the laboratory, for example, we must view the widget as the patient’s specimen; in surgery, the patient’s case cart; in records, the patient’s chart; in housekeeping, the patient’s room. Keeping the patient front of mind, ensures everything we do has their best interestsat heart.

Many people interchange a VSM with a process map or even a flow chart, but they are immensely different. A VSM is more than just borders and high-level steps, a VSM:

  • Is a visual tool with real-time data to see and understand the flow from the patient’s perspective.
  • Places a focus on improving the whole process rather than isolated task optimization.
  • Is a road map to improvement--helping to see and eliminate waste while adding value.

Traditional v Value Stream Mapping: Where to Optimize?

In traditional work flows, the focus lies on optimizing what’s directly in front of us; our environment. We rarely consider what happens in preceding processes that directly affect us, or in succeeding processes that our work may impact. Graphically, business as usual can be represented as the following:

processactivityfunction1

A VSM approach has us remove the blinders to look both upstream and downstream. What processes are inputs or are feeding our work? What effect do we have on the next set of processes downstream? Where can we remove waste and add value for the patient? How is my work adding value? Is it something the patient is willing to pay for?

processactivityfunction2

Not all our work may be 100 percent value added, but we must ask what value is derived from each step of the process. Some activities may seem repetitive or non-value added, such as asking the patient about his or her allergies or having another nurse double check the insulin dosage. In this case, there is a safety component incorporated, so these steps may be determined to be either value added or non-value added but necessary.

To enable the patient to see the value, we must set clear expectations, such as: “I’m sure you’ve already discussed your allergies with other staff, however I want to be sure I have them listed correctly” or, “From a safety standpoint, Mrs. Jones, we have all our insulin dosages double checked to ensure you are getting the accurate dose.”

Why Value Stream Mapping?

  • Identifying your current state allows you to see flow.
  • Analyzing your current state allows you see opportunities for improvements in quality, cycle time, lead time, and patient satisfaction.
  • Understanding your current state allows you to develop a vision for improved flow.
  • Displaying your current state in your area allows for transparency of the flow and planned improvement work.

Consider that every process has, at a minimum, three versions:

PerceptionRealityIdeal

The objective is to get everyone to embrace reality before moving to the ideal. Value stream improvement is primarily a management responsibility. Management must be able to see the overall flow, develop a vision of improvement for the future, and lead the improvement implementation. A current-state map and the effort required to create it are pure waste unless you use it to create and implement a future-state map depicting where the process will be (realistically) in 12 months.

Choose a process

Mapping for the Future

While creating a VSM requires more time investment up front, the information it yields is of far greater value than a process map, particularly because its utilization sets the stage for the future state. Your future state VSM is:

  • a vision of the health care experience, process, or service flow without waits, stopping, batching, mistakes, or other waste.
  • a document used to drive detailed implementation plans.
  • an improved design so the patient can pull the product or service when they want it.
  • a process that meets your patient’s value expectations:
    • Quality – no defects.
    • Reliable delivery – right time, right product.
    • Rapid response to changing needs.

Once the future state VSM is drafted, planning commences for the implementation work. Planning and discipline are required for success with reaching the future state. Examples of future state improvement targets:

  • Reduce the lead time for the patient’s experience.
  • Reduce the number of patients waiting.
  • Increase the percentage of patient touch-time by staff.
  • Increase capacity to provide service.
  • Decrease the area footprint.
  • Eliminate defects and mistake-proof the process.

The point of value stream mapping is not the maps, but to understand the flow of the patient through the healthcare experience to drive improvements. The map is a tool created from real-time direct observation and measurement of the actual process. The future state VSM shows the vision of the process without waits, stopping, batching, mistakes, or other waste 12 months into the future. Many lean practitioners see value stream mapping as the fundamental tool to identify waste, reduce process cycle times, and implement process improvement, all creating value for the patient, who is the focus of the process.


HallbergTina Hallberg, RN, is a highly experienced registered nurse and senior consultant at GE Healthcare Partners. Her leadership and managerial skills are coupled with 20 years of nursing experience in acute hospital settings, including transplant and flight trauma, long-term care, and clinic settings including the roles of Chief Nursing Officer, Director of Nursing, Case Mix Manager, Staff Development Coordinator, and Operations Supervisor. Tina maintains sensei-level expertise in the application of Kaizen methodology to healthcare. She obtained her training under the tutelage of Taichii Ohno’s protégés through multiple missions to Japan. She may be reached at kristina.hallberg@ge.com.

The CFO’s Role in Accelerating Systemwide Performance Improvement

Posted by Matthew Smith on Jun 21, 2018 1:59:15 PM

FINANCE LEADERS CAN LEVERAGE THEIR OPERATIONAL EXPERTISE TO SERVE AS CATALYSTS FOR COMPREHENSIVE PERFORMANCE IMPROVEMENT—A SYSTEMATIC APPROACH TO INCREASING OVERALL VALUE.

Most hospital executive teams today are focused on the same goals—rapidly improving quality, increasing efficiency, and reducing costs. Everyone knows how important these objectives are, but executing on them can be difficult.

One of the main challenges is leadership. Effective change management requires a top-down, bottom-up approach based on formal performance improvement tools and methodologies. In many health systems, however, it is difficult to find an executive who has the knowledge set, professional relationships, and authority to effectively lead comprehensive performance improvement while demonstrating and documenting ROI.

To read this article in its entirety on the HFMA website, please click the button below:

Robert Green, Darryl Greene, John Orsini

Authors

Green_Greene_Orsini
 
Robert Green, MBA, FACHE, CHFP
Senior Vice President, GE Healthcare Partners
 
Darryl Greene, MS
Vice President, GE Healthcare Partners

John Orsini, CPA
Senior Vice President and CFO, Northwestern Memorial HealthCare, Chicago

 

 

Aligning Payroll Practices to Policies

Posted by Matthew Smith on Jun 18, 2018 2:11:22 PM

In the Summer 2018 issue of the American Society for Healthcare Human Resources Administration's (ASHHRA) HR Pulse magazine, Theresa Brandon, vice president at GE Healthcare Partners, writes about how HR leaders can champion compensation reviews that reduce excess and unnecessary expense in light of hospitals tightening operating budgets.

Theresa breaks the process down into three crucial steps that will provide results in improvement opportunities or provide assurances that payments are in order.

To download a PDF of this article in its entirety, please click the button below:

Aligning Payroll Practices to Policy

Join Our Team and Change Healthcare! A Variety of Positions Now Available With GE Healthcare Partners

Posted by Matthew Smith on Jun 15, 2018 11:45:08 AM

The GE Healthcare Partners team is hiring! Because of our rapid growth in Command Centers and Performance Partnerships, there has a never been a more exciting time to join the team.

Be a part of changing healthcare! Learn more about us at https://lnkd.in/dHAMs8m and then review our current open positions here: https://lnkd.in/ezeZ4Cx or by clicking on a specific link below.

Vote Jeff Terry for Modern Healthcare's "100 Most Influential People in Healthcare (Supplier Category)"

Posted by Matthew Smith on Jun 8, 2018 9:40:49 AM

Jeff Terry has been named as a finalist for Modern Healthcare’s 2018 list of 100 Most Influential People in Healthcare (Supplier Category). We need your vote to see that Jeff makes the top 100.

A vote for Jeff is a vote for the GE Healthcare team and the transformational work that is underway to improve patient care through advanced data analytics, AI, and Command Center technology.

Jeff_Terry_FortuneIf you’re unfamiliar with the work that Jeff and the team are doing, this video interview with Fortune magazine highlights how the Johns Hopkins Command Center continually examines data that recommends actions to reduce delays in patient progression, predict and prevent risk, and balance staff workload. 

Please click the button below to vote for up to five finalists on the Modern Healthcare survey site. You may vote once from each of your devices (laptop, phone, tablet). Please share this email with your network as you see fit.

All votes must be cast by June 12. 

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Friday Fun Video: The Dream Hospital of Tomorrow (as Imagined in the 1950s)

Posted by Matthew Smith on Jun 1, 2018 10:14:04 AM

This video, circa 1957, showcases a medical dream come true from Henry Kaiser and Dr. Sidney Garfield of the Kaiser Foundation.

While many of these "dream" hospital features are now staples in every modern facility, you can't help but wonder whatever became of the sliding baby drawers (not to mention the waiting room father and unprotected X-Ray technician).

What part of the current hospital patient experience will remain 60 years from now? Our own Dr. David DiLoreto opines that, "Sixty years from now people might be amused that patients had to actually travel to facilities for consultations, physical exams, and lab services."

Topics: Trends

Florida Hospital and GE Healthcare Partners to Build 'Command Center' to Guide Clinical Operations

Posted by Matthew Smith on Jun 1, 2018 9:17:28 AM

The center, the first of its kind in the region, will use predictive analytics to guide decisions on patient care, staffing, and more. 

ORLANDO, Fla., May 31, 2018 — Florida Hospital and GE Healthcare Partners are working together to design and build a command center that will transform clinical operations at Florida Hospital locations across Central Florida. The high-tech center, the first of its kind in the region, will use predictive analytics to help hospital staff working to deliver quality, safe, and optimized clinical operations. 

The command center will function like NASA’s mission control, but focused on constantly orchestrating patient care at nine Florida Hospital campuses in Orange, Seminole, and Osceola counties. Together, these hospitals handle more than 2,000,000 patient visits per year, making Florida Hospital one of the nation’s largest nonprofit health systems.

The command center’s Wall of Analytics leverages existing IT systems. The platform takes data from multiple systems and applies artificial intelligence algorithms to spot the “needle in the haystack” so staff can act to prioritize patient-care activities and discharges, make short-term staffing decisions, and mitigate potential bottlenecks before they occur.

Command-center technology has also been shown to reduce wait times, expediting needed patient care. And by using near real-time data, providers can streamline their processes in time-sensitive clinical situations.    

Florida Hospital joins a growing ecosystem of such centers which includes The Johns Hopkins Hospital in Baltimore and Humber River Hospital in Toronto.  Florida Hospital’s Command Center (FHCC) will achieve the distinction of being the largest health-care command center (square footage) supporting the largest number of beds and hospital campuses.  Analytic “tiles” in the FHCC will leverage learning from the other centers and break new ground in using artificial intelligence to constantly help caregivers.

“Florida Hospital prides itself on utilizing innovative technology to provide the best possible care for our patients. Our goal is to improve the patient experience, enabling caregivers to spend more time with their patients while making care decisions more easily and quickly,” said Daryl Tol, president & CEO of Florida Hospital and Adventist Health System’s Central Florida Division. “We are excited to partner with GE Healthcare Partners to bring this innovative concept to our care network.”

“Command Center staff using advanced analytics in a purpose-built space will help caregivers help patients, all the time. The combination of human and artificial intelligence is what’s so powerful,” added Jeff Terry, CEO of Command Centers for GE Healthcare. “Florida Hospital is so advanced in many ways. We’re honored for them to join GE’s command center community.”

The command center will be built in a centralized location to serve Florida Hospital operations across the region. It is expected to open in 2019.

For media inquiries only, call Florida Hospital Corporate Communications at 407-303-5950.

Topics: Command Center

Two Women Turn Data Into Action--Help Doctors Save a Patient's Kidney

Posted by Matthew Smith on May 31, 2018 3:19:25 PM

Inside a busy acute care hospital, it’s not uncommon for several hours to pass between the moment a patient is cleared for a procedure and the moment that procedure occurs.

When Tom Parker* arrived at the hospital with abdominal pain and a pre-existing kidney condition, before doctors could diagnose and treat him, they needed to know that his body could tolerate the kidney-sensitive contrast agent needed to perform a CT scan which would allow them to see inside his body. A thorough evaluation and blood work revealed Tom’s kidneys could withstand the contrast needed for the scan. However, between the time the CT was ordered, and Tom was to begin prepping for the exam, his condition and kidney function had seriously deteriorated. If administered, the contrast injection could have caused kidney failure, a discovery not made by the doctor or nurse, but flagged by artificial intelligence (AI).

AI helped detect Tom’s kidney condition, flagged it to staff, who subsequently called off the scan that could have put him into kidney failure.

Debbie Harkins and Ann Cole are part of the GE Healthcare team who developed the AI, or what they call “tiles,” that pull data from a variety of sources to feed information to GE Healthcare’s mission control-style command centers. At the heart of the command center lies a centrally located hub that houses a Wall of Analytics (WOA), displayed on a bank of monitors in the center and accessible on mobile devices. The WOA processes real-time data from multiple sources across the hospital and triggers staff to act.

In Tom’s case, the tiles helped identify the risk while the hospital’s command center staff mitigated and responded in real-time. But for consistent outcomes to occur day to day, minute by minute, across an entire system, it takes more than a wall of monitors and responders. “All elements of the Command Center came together for the benefit of the patient in this instance,” said Debbie. “This included a pre-defined protocol for this type of situation, an empowered expediter, a data model that looks across IT systems and modules in real-time, a tile that visualizes the alert, a central dedicated hub within the hospital where such oversight takes place and immediate action occurs.”

Debbie, a practicing nurse, brings an MBA and more than 25 years of practical healthcare expertise to the GE Healthcare team, a combination of skills that helps her recommend the roles and responsibilities of the staff that works inside the Command Center along with the actions needed to come out of the data to affect change. “The reason the Command Center is successful is the analytics, but it’s enhanced when the right people are in the room working as one team. It’s critical to have people accountable for driving actions as an output of the analytics,” said Debbie.

Ann focuses on the data that comes into the Command Center, maps out the workflow for hospital employees and applies data to that workflow to create analytics.  Her background in imaging, women’s health and hospital administration has given her the experience where she can bring data to life. “The experience that Debbie and I have had in hospitals working on the frontlines and being able to relay that to non-clinical people is a very important piece to this project,” said Ann. “It’s not about the equipment as much as it’s about the components within the analytics that can drive change and improve patient care in an effective manner.”

Both women agree that one of the biggest challenges when building the Command Center was data integration. “You’re trying to meld a variety of source systems into one,” said Debbie. After figuring out how to get the systems integrated, the team then turned their efforts to the people. “Data is data; it doesn’t lie. What was hard was to get people to look at the data in a different way,” commented Ann. “Change management is a big focus for the team when collaborating with the teams,” according to Debbie.

“I’ve been in the [healthcare] field for 40 years,” comments Ann. “When I think about caring for patients, I think about the triad of health: quality, access, and cost. I’m always thinking of health as a product of an individual. ‘How can I make a better product of that patient’s health?’ I can make their health product better quality and can also save money by helping hospitals operate more efficiently. We’re approaching health in such a different way and I have a passion to work to affect the health of patients.”

“I feel passionately that [the Command Center] is a game changer in Healthcare,” said Debbie. “We can now have transparency across organizations so we can make really good decisions. In the future, this can allow us to be proactive rather than reactive. It’s really exciting.”

*Tom Parker’s name was changed to protect the identity of the patient. 

Topics: Command Center

Command Centers in the News

Posted by Matthew Smith on May 30, 2018 1:21:20 PM

As Command Centers continue to gain traction with hospitals and health systems, GE Healthcare remains at the forefront of the conversation. Read more about GE Healthcare's involvement in Command Center development via the links below:

Command Centers

Tampa General Hospital and GE Healthcare Partner for Next-Level Care Coordination

Posted by Matthew Smith on May 29, 2018 1:48:48 PM

Tampa - Tampa General Hospital (TGH) and GE Healthcare are partnering to advance care coordination, help enhance patient safety and quality, and improve efficiency with a new care coordination center. The center will harness predictive analytics to help improve the experience and outcomes for patients, families and hospital staff.

Tampa General Hospital joins a growing ecosystem of such artificial-intelligence-based centers including The Johns Hopkins Hospital in Baltimore and Humber River Hospital in Toronto. TGH has set aside 9,000-square feet for the Center, which will open in 2019.

The center will be powered by GE’s Wall of Analytics, which continually examines data that recommends actions to reduce delays in patient progression, predict and prevent risk, and balance staff workload. The magic of the center is the combination of artificial and human intelligence to help caregivers achieve more efficient hospital operations.  

The center will house staff members from different hospital departments that will use the artificial intelligence data to improve patient transports, reduce patient wait times, enhance the coordination of services and speed up the discharge process.

 “We want to leverage this system to improve efficiency and shorten the time patients are in the hospital by better managing their care,” said John Couris, president and CEO of Tampa General. “This technology will help to reach our goal of providing coordinated patient care after they leave the hospital. We are excited to be working with GE on this project. We believe in GE.”

“Tampa General will be a great partner. They are a highly aligned and focused organization. We expect that will translate to both speed to patient impact and innovation,” adds Jeff Terry of GE Healthcare. “We’re honored to have Tampa General Hospital join GE’s command center community.”

Tampa General Hospital, a 1010-bed non-profit academic medical center, delivers world-class care as the region’s only center for Level l trauma and comprehensive burn care. It is one of the nation’s busiest adult solid organ transplant centers and is the primary teaching hospital for the USF Health Morsani College of Medicine. Advancing medicine through innovation, Tampa General houses a nationally accredited comprehensive stroke center, an 82-bed Level IV neonatal intensive care unit, and a state-certified spinal cord and brain injury rehabilitation center. For more information, go to www.tgh.org.

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