With a fundamental drive to excel in place, the management and staff of Good Samaritan Hospital in Los Angeles have taken this quest to a higher level during the last few years through the application of Six Sigma, Lean and change management techniques.

By Carolyn Pexton

The brightly colored posters in the main lobby of Good Samaritan Hospital in Los Angeles proclaim the hospital’s mantra: “Good isn’t Good Enough at Good Samaritan Hospital. Aim Higher, Work Smarter and Do it Better.” This fundamental drive to excel is the underpinning of the hospital’s quality and process improvement efforts. During the last few years, hospital management and staff have taken this quest to a higher level through the application of Six Sigma, Lean and change management techniques.

Andy Leeka, president and CEO at Good Samaritan Hospital, first brought Six Sigma to the attention of the hospital’s board in 2001 and has continued to demonstrate his ongoing commitment to the hospital’s improvement initiatives. He tapped strong leaders within the organization for roles as Black Belts, Master Black Belts and change agents, and he regularly attends the project report-outs. The hospital’s management team worked to align their patient-focused mission and organizational goals with the new process improvement methods.

About Good Samaritan
Hospital in Los Angeles

Located in downtown Los Angeles, Good Samaritan Hospital is a 408-bed not-for-profit facility founded in 1885. The hospital supports eight “centers of excellence” that advance the science of medicine while providing outstanding patient care.

Good Samaritan admits nearly 17,000 patients each year and handles more than 91,600 outpatient visits. More than 8,000 surgeries are performed annually.

A Level II trauma center, Good Samaritan’s emergency room handles more than 26,000 visits annually, with physicians on duty and a full-specialist panel on call.

Good Samaritan has 1,500 employees and more than 825 physicians on its medical staff. Reflecting the rich diversity of the area, together the medical staff and employees speak almost 60 languages and dialects.

The first wave of projects focused on the following six areas for improvement:

            • Pacemaker billing and reimbursement
            • Length of stay for percutaneous coronary intervention (PCI)
            • Use of Omnicell non-narcotic
            • Medical record retrieval
            • Room availability cycle time
            • Lab supply management

“When we began this program,” said Alan Ino, chief financial officer at the hospital, “we selected projects we felt would have a good success rate, including those that would deliver benefits beyond financial returns. We not only wanted to improve our bottom line, but we also sought to raise satisfaction for staff and patients. Strong leadership, teamwork and a solid approach are helping us to achieve these goals and make sure the results are sustainable.”

Since the program began, the hospital has trained 18 Green Belts and two Black Belts in Six Sigma and change management methodologies, and collectively completed more than 20 projects and numerous Work-Outs. The two original Black Belts have since moved into Master Black Belt roles in the organization.

“Those involved with Six Sigma at Good Samaritan feel that in many ways they are able to make a much bigger impact than when they were directly involved with patient care,” said Shauna Pearce, RN and Black Belt at Good Samaritan. “As a nurse, for example, they may be able to impact only one area or unit. As a Black Belt or Master Black Belt, that person now has a chance to impact every patient that comes through the hospital by improving processes involved with healthcare delivery.”

Acquisition of Durable Medical Equipment (DME)

One early project involved the acquisition of durable medical equipment, such as IV pumps, walkers and wheelchairs. According to CFO Ino, this project seemed to hit all the right parameters in terms of quantitative and qualitative benefits. At Good Samaritan, much of the durable medical equipment is outsourced, and nurses are primarily responsible for initiating its use. Over time, process inefficiencies had created dissatisfaction among nurses and made it difficult to control costs.

“We put a team together to scope the project,” Ino said, “focusing on IV pumps since they comprise the bulk of our outsourcing. The project team gathered VOC (voice of the customer) from nurses and other stakeholders. This gave us different perspectives to look at what we’re using, whether it moves with the census, and if so, whether that movement is seasonal. The project allowed us to obtain reliable data to help strike a solid business deal.”

It took just five weeks to complete the DME project, which involved a diverse cross section from the hospital, including nurses, billing, accounting and materials management. Ensuring acceptance required not only a valid technical solution, but also attention to unique concerns from each constituency. The positive outcome proved that the project hit on all cylinders, and the team at Good Samaritan was able to address the specific needs of key stakeholders.

It was critical that nurses had input from the beginning, given their usage of the equipment and sensitivity to the environment of care. Before the project, nurses frequently ordered the pumps as “stat” simply because it took so long for equipment to arrive. They were not used to receiving equipment in a timely fashion and would sometimes store away extra pumps so they would be available when needed.

Change acceleration techniques and the Six Sigma DMAIC approach helped to identify key factors in the acquisition process and point the team to viable solutions. “The bottom line,” said Ino, “is that our DME project translated to a contract savings of $10,000 per month, plus we were able to bring on four additional FTEs, move to 24/7 coverage and raise nursing satisfaction.”

Improving the Utilization of Linens

One of the projects completed in 2004 focused on identifying opportunities to improve linen utilization (sheets, pads, bedspreads, towels, warming blankets, etc.) without compromising quality or patient care. Data analysis revealed that the hospital’s linen usage was higher than expected for a facility of a similar size and with a similar acuity level among patients. Since hospitals spend a significant amount on linen usage, this appeared to be a good opportunity for improvement.

A project team was assembled and included the director of environmental services, director of the medical/surgical unit, three nurse managers, infection control, certified nurse assistants and the linen lead technician. The project was scoped to focus only on the use of linen for inpatients.

To improve supply utilization, the goal was set at reducing linens from 20 pounds per patient per day to between 14 and 16 pounds. Data sources used included the linen distribution program already in place throughout the hospital, as well as national benchmark data for comparison.

“Using process maps and gathering VOC, we found the factors causing the majority of variation included differences in staff usage, procedures and training,” said John Rubin, director of environmental services. “We put changes in place including the development of standard operating procedures based on patient acuity and other considerations. The hospital now provides training for 550 employees and a department orientation for new aides to educate staff on the new procedures.”

Another change involved putting linen that was not usable (due to manufacturing or other defects) into a reject bag on the cart, instead of adding it to the laundry. The hospital receives vendor credits for any items that are defective on arrival.

Elements of Lean were brought in to eliminate waste in the process steps, and Lean techniques also were used with linen carts. For final distribution of linens to patient rooms, smaller carts were used and brought to the wing, reducing wasted effort and time. Instead of one large cart that carries linen, staff members now take two carts and restock as necessary. Such changes have measurably improved staff satisfaction and efficiency.

The project was ultimately successful, and the per-patient-day costs for linen have decreased by 20 percent from the level of expense in 2002. Linen usage is down from the average of 20 pounds to an average of 14 to 16 pounds. Savings for fiscal year 2002-03 were calculated at $174,918, and for 2003-04 at $78,818. Perhaps even more importantly, efforts by the team have generated a new awareness of cost and efficiency among the staff.

“With appropriate supplies readily available, the nurses no longer feel the need to hoard linens in order to meet patient needs,” Rubin noted. New processes have been put in place and progress will be tracked through reports given to the units, the project’s executive sponsor, and oversight from a linen utilization committee. As part of the monitoring process in the Control phase, all data is collected manually on a daily basis and carts are weighed regularly. Continued education and focus on ancillary usage will contribute to maintaining the improvements.

Figure 1: Laundry Usage in Pounds Per Patient-Day

Summary: Achieving Savings and Building Skills

Other Improvement
Projects at Good Samaritan

  • Call hotline response for bio-med equipment problem
  • Stat Lab TAT
  • Non-stock supplies order process
  • Omnicell supply stockouts
  • PCI procedure LOS
  • Pre-admission patient wait time (for OP procedures)
  • Preventative maintenance of bio-med equipment (JCAHO compliance project which also turned into a containment project)
  • Chart retrieval cycle
  • Nursing registry expenses

In addition to achieving impressive and sustainable results through a variety of individual projects, the team at Good Samaritan Hospital in Los Angeles also has acquired valuable skills that can be applied to address any challenge they may face in the future.

According to Bonnie Gorges, physical therapist and Black Belt at Good Samaritan Hospital, the most significant thing has been learning the tools and realizing they can be adapted to resolve issues in virtually any area of the hospital. “Having knowledge in Six Sigma, Lean and change management techniques has given us a very valuable and flexible toolkit to solve any problem we might face,” she said. “We initially started with enthusiasm for Six Sigma, but realized we weren’t ready to apply this type of rigor in every situation. In some cases, we first needed to get some basic processes in place. The great thing is that whatever level you and the organization are at – the tools really work.”

Good Samaritan’s comprehensive approach to performance improvement has allowed the organization to gather widespread input, create a common language, and provide a sense of structure around quality and process improvement. In addition, despite significant challenges in today’s complex environment, the viable process improvement methods help raise satisfaction and provide high quality patient care in a more cost-effective manner.

About the Author: Carolyn Pexton has more than 17 years experience in communications and healthcare and is the director of communications for Performance Solutions at GE Healthcare. She is Green Belt-certified and has presented and published on topics including Six Sigma and change management within the healthcare industry. She can be reached by email at [email protected].

About the Author