Little more than five years after launching an ambitious, system-wide Six Sigma improvement initiative, Virtua Health in New Jersey, USA, is now considered a high-performing healthcare organization and a model for others to follow.

With a multitude of measurable results in key areas such as the surgical suite, emergency department and cardiovascular services, this four-hospital system in New Jersey has shown that it has what it takes to transform the organization’s culture, keep the momentum going and make change stick.

Virtua Health Today

  • Four hospitals in southern New Jersey
  • Two long-term care facilities
  • Two home health agencies
  • Two free-standing surgical centers
  • Two medical staffs (currently merging)
  • Ambulatory care
  • Fitness center
  • 8,000 employees plus 2,000 physicians
  • 7,752 babies delivered annually
  • 8 percent operating margin (tops in the state)
  • STAR culture

Six Sigma and Change

The leadership team at Virtua Health has taken its commitment to process improvement and error reduction very seriously. Every Virtua manager has been trained in Six Sigma at least to the Yellow Belt level, and there are 56 Green Belts, 22 Black Belts and five Master Black Belts working on projects and delivering results for the organization on a daily basis.

Change management tools such as Change Acceleration Process and Work-Out also were adopted in 2000, and Virtua has since trained numerous change agents within the organization.

“Change in healthcare is hard no matter what area you are focusing on,” noted Carol Mullin, registered nurse and Master Black Belt. “It is especially difficult with respect to patient safety issues and projects, because you’re talking about a huge cultural shift for everyone involved. You can’t begin to come up with workable solutions until people first admit there’s a problem.”

Through the use of Six Sigma for statistical process control, Virtua has added in excess of $9 million in new revenue. The healthcare system also has made significant improvements in clinical and operational processes throughout the organization, receiving continued recognition and accolades for its efforts.

Here are just a few of the project results Virtua has seen during the course of this initiative:

  • A patient safety project to reduce the incidence of surgical site infections improved the administration of antibiotics within one hour of incision from 90 percent to 97 percent.
  • An operational project to improve the accuracy of the home health coding process by the clinical staff led to the system’s overall Home Health Resource Group case weight mix increasing to 1.33 for Virtua’s West Jersey Hospital and 1.36 for Virtua Memorial Hospital, resulting in an increase of $615,000 in Medicare revenues within just six months.
  • Another project to increase insurance reimbursement for surgically implanted devices such as artificial joints saved the hospitals more than $2 million.

Leveraging a variety of management tools and techniques, Virtua Health has become transparent and accountable as an organization. The management team seeks solutions instead of excuses, and constantly raises the bar in terms of performance. Dr. Mark Van Kooy, another Master Black Belt and chief medical information officer at Virtua, described it this way: “We’re more forward looking now than backward looking. Everyone understands the concept of accountability – there is no excuse-making or finger-pointing anymore.”

With multiple projects reaching Six Sigma levels of excellence, the team continues to aim even higher for that next opportunity to excel. The achievements have been driven in large part with the vision, leadership and support of Rich Miller, the president and CEO at Virtua Health. “We’ve adopted measurement, rigor and accountability to make Virtua a very special place and a very successful one,” Miller said.

Virtua Health 2006 Strategic Imperatives

  • Continue to improve and sustain patient safety and clinical quality through evidence-based practices.
  • Improve and sustain patient satisfaction scores with an increased emphasis on customer service.
  • Two home health agencies
  • Recognize and continuously develop best people and monitor employee satisfaction, with emphasis on leadership and management learning.
  • Advance Virtua’s programs of excellence development.
  • Continue implementation of medical staff development plan and consolidation of the Memorial and West Jersey staffs, with a drive toward standardization of practice.
  • Continue rigor in expense management, revenue enhancement and reduced length of stay.
  • Begin facilities development of ambulatory sites and regional medical centers.

Lean Healthcare

Adding Lean methods to its toolkit is the latest phase in Virtua’s ongoing journey. Lean is a traditional manufacturing process that eliminates waste in a process, and it is being successfully applied within healthcare.

In March, Virtua co-sponsored a week-long International Lean Healthcare Seminar at its facilities. Attendees came for classroom sessions and to participate in real-time Kaizen events in collaboration with Virtua staff.

Five Kaizen teams included healthcare professionals from 18 hospitals and health systems and four countries, along with Virtua and other process improvement leaders. Within a week’s time, participants had not only been introduced to basic Lean concepts and their applicability to healthcare, but they had actually been able to take part in a Kaizen “learning lab” – rolling up their sleeves and working as a team to create meaningful change.

For example, the Kaizen teams:

  • Reduced emergency department care giver travel by 96 percent
  • Reclaimed 107 square feet in emergency department
  • Eliminated need to restock 57,000 central sterile processing items
  • Reduced lab specimen wait time by 70 percent
  • Reduced lead time for surgical materials requests from 10 days to four days
  • Reduced cycle time to stock surgical case cart by 90 percent

The results demonstrated the level of change that is achievable in healthcare, through focused efforts and the application of appropriate tools.

One participant, Jason Lebsack of the Nebraska Medical Center, offered his impressions of the week: “The Lean seminar was terrific. “You see so much happening at once. And to be able to come to Virtua Health and see this live is really an advantage. There’s a flurry of activity and it’s energizing to see five Kaizen events happening at once.”

One of the nurses at Virtua remarked that the Kaizen events had generated lots of enthusiasm and ideas, actually creating a domino effect where one good idea or activity was leading to another. “It’s a new way to learn and an exciting way to make change happen quickly,” said registered nurse Sue McGann, another Master Black Belt at Virtua and the system’s director of strategic partnerships.

Leadership and Accountability

To help drive strategic alignment and accountability, Virtua Health also has adapted a number of GE management processes. Currently, Virtua’s programs of excellence in cardiology, maternal/child health, cancer, neurosciences, orthopedics and surgery are utilizing these operating mechanisms to develop a business framework, standardize measurements and create focused growth.

Virtua Health Star Management System 2006
Virtua Health Star Management System 2006

The changes are having a positive effect on the people who work and deliver care at Virtua Health. Overall employee satisfaction is at 84 percent. Employees know they are empowered with the tools, training and management support to make things better within the organization.

Virtua measures the results of its initiatives using several benchmarking tools. Most notably, Virtua has achieved the following in the last two years:

  • First in profitability among New Jersey health systems with an 8-percent operating margin.
  • Honored with a 2005 New Jersey Governor’s Award for Performance Excellence.
  • Honored in 2006 by Voluntary Hospitals of America with its Leadership Award for Clinical Excellence.
  • One of 12 hospitals in the nation to be recognized by Medicare as a best practice hospital for pneumonia care.
  • The first organization in the northeastern United States to earn Joint Council on Accreditation of Healthcare Organizations (JCAHO) accreditation for its total joint replacement program.
  • The only provider in the region to offer technology for the non-invasive treatment of uterine fibroids.
  • The first in southern New Jersey to earn JCAHO accreditation as a primary stroke center.
  • Among the top three “best places to work” in the Delaware Valley as recognized by the Philadelphia Business Journal.
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