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Cost of Waste/Poor Quality
Lucy A. Savitz, Ph.D., MBALucy A. Savitz, Ph.D., MBASenior Associate, Abt AssociatesSenior Associate, Abt Associates
[email protected][email protected]
Senior Scientist, Intermountain HealthcareSenior Scientist, Intermountain Healthcare
[email protected]@intermountainmail.org
AHRQ Annual Meeting AHRQ Annual Meeting September 27, 2007September 27, 2007
Bethesda, MarylandBethesda, Maryland
Purpose
Reducing waste in health Reducing waste in health care is key to affordable, care is key to affordable, high quality health care. high quality health care.
Nearly half of consumed Nearly half of consumed resources represent resources represent potentially recoverable potentially recoverable waste in hospitals (44%)waste in hospitals (44%)
Framework for Estimating the Cost of Waste and Poor Quality in Health Care
AHRQ IDSRN Contract 290-00-0018, Task Order AHRQ IDSRN Contract 290-00-0018, Task Order 11 to RTI International11 to RTI International
Task Order Officer, Cynthia PalmerTask Order Officer, Cynthia Palmer Lead InvestigatorsLead Investigators
Lucy A. SavitzLucy A. Savitz Brent James, Intermountain HealthcareBrent James, Intermountain Healthcare K. Bruce Bayley, Providence Health SystemK. Bruce Bayley, Providence Health System Jane Wallace, Intermountain HealthcareJane Wallace, Intermountain Healthcare
Deciding on Approach to Estimate Waste
Analysis LevelAnalysis Level ApproachApproach TargetTarget
PopulationPopulation Dartmouth Atlas, Dartmouth Atlas, WennbergWennberg
Supply-induced Supply-induced demanddemand
EpisodeEpisode Six Sigma & ATP Six Sigma & ATP QI ProjectsQI Projects
Selected Selected opportunitiesopportunities
Patient Care Patient Care TPS/LeanTPS/Lean Inefficiency of Inefficiency of front-line workers front-line workers
Scope of Observations
61 workers61 workers 72 observation hours (36 morning, 36 afternoon)72 observation hours (36 morning, 36 afternoon) Staff role/functionsStaff role/functions
PhysiciansPhysicians NursesNurses Other clinical (lab techs, pharmacists)Other clinical (lab techs, pharmacists)
Years of experienceYears of experience 8% less than 1 year8% less than 1 year 72% more than 3 years72% more than 3 years
How Evaluated Standard set of activity categories and definitions Standard set of activity categories and definitions
(6 categories with 12 sub-category clarifications)(6 categories with 12 sub-category clarifications) OperationsOperations ClarifyingClarifying Defect/ErrorDefect/Error ProcessingProcessing MotionMotion OtherOther
Trained observerTrained observer Developed toolset for structured observation and Developed toolset for structured observation and
data capturedata capture Replication of approach at an academic centerReplication of approach at an academic center
ResultsCost of waste for frontline health care worker activities is substantial
Overall, 35% waste observedOverall, 35% waste observed Non-operational activities were almost Non-operational activities were almost
evenly split across 3 major categoriesevenly split across 3 major categories 20% clarifying20% clarifying 19% processing19% processing 17% motion17% motion
Waste on a single 12-hour shift, 46-bed Waste on a single 12-hour shift, 46-bed medical unit = $2,309medical unit = $2,309
Lessons Learned Waste at the patient care level is primarily related Waste at the patient care level is primarily related
to inefficient systems, wide variability in work to inefficient systems, wide variability in work processes, and “work around” culture processes, and “work around” culture
Key to waste reduction is developing the capacity Key to waste reduction is developing the capacity to recognize and eliminate waste—developed to recognize and eliminate waste—developed toolsettoolset
Front line ownership & support of their role in Front line ownership & support of their role in problem solving is essentialproblem solving is essential
Leadership must help remove constraints so a Leadership must help remove constraints so a range of solutions can be tested range of solutions can be tested
Culture change required to support the will to Culture change required to support the will to eliminate wasteeliminate waste
Knowledge TransferStaff training at UNC Health CareStaff training at UNC Health Care
RTI International. Cost of Poor Quality or Waste in RTI International. Cost of Poor Quality or Waste in Integrated Delivery System Settings, AHRQ Final Report Integrated Delivery System Settings, AHRQ Final Report submitted to Cynthia Palmer, AHRQ TOO, Contract No. submitted to Cynthia Palmer, AHRQ TOO, Contract No. 290-00-0018, RTI Project No. 0207897.011; August 2006290-00-0018, RTI Project No. 0207897.011; August 2006
Wallace, J, LA Savitz. Estimating Waste in Frontline Wallace, J, LA Savitz. Estimating Waste in Frontline Health Care Workers. Health Care Workers. Journal of Evaluation in Clinical Journal of Evaluation in Clinical PracticePractice, forthcoming 2007, forthcoming 2007
Automating toolset on a notebook at IntermountainAutomating toolset on a notebook at Intermountain
Next Steps
Spread Spread RICU Supply/Material RICU Supply/Material
Waste ReductionWaste Reduction MRSA ProjectMRSA Project Women’s & NewbornWomen’s & Newborn
Increasing observations for Increasing observations for improved role/function improved role/function estimatesestimates
Apply in outpatient settingApply in outpatient setting
