Today, many hospitals and health systems find their emergency rooms consistently over capacity, and this will only be exacerbated as tens of millions of Americans gain access via the Affordable Care Act. But a packed ED doesn’t necessarily mean the problem starts there.

“Many organizations are good at looking at the efficiency of their processes within a particular department, but fail to look at efficiency across the entire patient journey. That’s where the real opportunity is,” said Don McCall, partner and director of Kurt Salmon’s Operations and Performance Improvement.

Kurt Salmon and Vanderbilt University Medical Center partnered to tackle this problem with a unique approach.

Issue: Vanderbilt University Medical Center was faced with a significant capacity problem. The system’s emergency department was on diversion a significant amount of time and, even on the eve of opening a new, 70-bed tower, Vanderbilt was concerned that it did not have enough beds to handle future increases in demand related to the Affordable Care Act. So, Vanderbilt turned to Kurt Salmon for help improving capacity and throughput system-wide.

Solution: We helped Vanderbilt look at capacity and throughput from the patient’s point of view. Instead of focusing on improving performance within specific departments, we examined how each department interacts with each other and impacts patient experience.

We applied classic Lean principles in a new and innovative way, creating the concept of care streams. The goal of care streams are to measure non-value time throughout the entire patient care journey—not just within one department—and teach staff and physicians how to eliminate non-value time and improve patient satisfaction and throughput in care processes.

After taking a close look at processes from the patient’s point of view, the hospital was astounded at the amount of non-value time. In fact, for surgical patients, 49% of the day of admission and 85% of the day of discharge were non-value-added time. The numbers were even more surprising for medical patients: 80% of the day of admission and 86% of the day of discharge were non-value.

To tackle this significant process challenge, we started by addressing the most complex and hard-to-fix issues with patient flow. Instead of just working on one department at a time, we addressed the holistic problem and helped reduce the number of handoffs, and with it, the amount of unnecessary time patients experienced. We also included input from patients and family into the process to help make sure whatever changes we implemented were done with the patient’s best interest in mind.

Finally, we helped change the mindsets of staff and physicians, increasing their knowledge of the impact of their actions on those upstream and downstream and relying on a strong change management program to show them the value of working together to improve care and throughput.

Results: Vanderbilt has a goal of reducing non-value time by 50%. When they successfully reach this goal, they will be able to see 5,000 additional patients a year without building additional space, and increase patient admissions by 10%. This translates to an approximately $32 million annual boost to their bottom line.