At Cincinnati Children’s, Standardization is an Individual Art

frederick-rykmanWhen you’re processing 33,000 inpatients, one million outpatient visits, and 31,000 surgical cases across a 523-bed pediatric medical center with two inpatient sites, numerous neighborhood centers, and 14,000 employees, operational efficiency tends to be a priority. Especially when bed occupancy is well over 90% at times. Dr. Frederick Ryckman has been with Cincinnati Children’s Hospital long enough (33 years) to know that an important part of delivering effective, safe, and affordable care is standardizing best practices.

“I believe that the most important thing we can do to drive down costs in medicine is to eliminate unnecessary work for providers and unnecessary expenses from not following known best practices or treating preventable complications,” he says. “We will achieve more savings and do what is right for patients if we do these things, more so than focusing on renegotiating contracts for supplies, etc.”

As the Senior Vice President of Medical Operations, his job revolves around daily operations management, hospital-wide patient flow, and patient safety. That’s when he’s not busy in one of his other two roles: teaching transplant surgery as a professor at the University of Cincinnati Department of Surgery, or actually conducting surgery.

Achieving Better Care Through Lean Efforts

Using standardized work and daily analytics with run charts, Dr. Ryckman and his team have been able to decrease hospital-acquired infections (blood stream, ventilator acquired, surgical site, and urinary tract) by well over 50%. These are the drivers of a great deal of health care expense and patient morbidity and mortality. Their Lean efforts to decrease costs accounted for a $50 million dollar savings over the past two years because of better analytics and Lean standardization. This leads to what patients want – the best care at a reasonable price.

Most of their future projects will be around standardizing use of supplies, ordering testing, and medications. They are planning to standardize operative procedures and supplies for many of their complex operations, which should lead to even more savings for patients and families.

But Dr. Ryckman is most proud of the work he calls “Operational Excellence.”

“It is a system that’s focused around physician:nurse teams throughout the organization,” he says. “They are on each inpatient unit and significant care location (operating room, radiology, emergency, etc). These defined interdisciplinary teams are empowered to address safety, staffing, daily operations, and regulatory compliance to improve care.”

The Right Mix of Guidance and Guidelines

Dr. Ryckman says the most important ingredients for developing operational efficiency across a large healthcare organization are leadership focus and prioritization; a well-known mechanism or structure for execution; and buy-in at all levels as to the importance of the work.

There’s a long list of other important components that includes:

  • Prioritizing recruitment work
  • Building institutional capability (organizational resources) and capacity (individual knowledge and skill)
  • Teaching improvement to individuals
  • Developing clinical system improvement dashboards to track data
  • Being transparent with outcomes

One of Dr. Ryckman’s transparency guidelines is to generate light, not heat, with data, “which is a way of saying that we are collecting and analyzing data not to be critical or punish bad results, but rather to shine light on the issues that we say are important and allow assessment of a better solution,” he says. “Light to see and disclose, not heat to burn individuals for “bad data.”

Being the Best at Getting Better

The whole organization at Cincinnati Children’s Hospital works on improving care and delivery every day. The ex-Chairman of the Board summarizes it by saying they want to be at all times “the best at getting better.” This is part of the DNA of the organization.

For Dr. Ryckman, he realized early on that the delivery of great post-operative care for his transplant patients could be compromised if he did not improve everything—bed use, availability, nurse staffingand teamwork—that’s needed for greater efficiency and care delivery.

“I realized that by working on these things, as well as my personal practice, I could positively influence the care of many more than just my patients,” he says. “I transitioned my thinking from one person taking care of one person, to building systems of care to improve the care of many.”

For Cincinnati Children’s, being able to tie operational efficiency into the delivery of great care—“what we went into medicine to do”—and great outcomes and experience for the patients and families, helps get the front line involved. This is their passion and tying the initiatives to their passions is important.

“We are lucky in that virtually all people who work here do so by choice,” Dr. Ryckman says, “so they are really mission focused. If part of our mission is to deliver exceptional, safe, and also affordable care, then everyone is on the same page moving forward.”

Join Dr. Ryckman during his presentation titled “Waste Elimination and Cost Efficiency: Re-Inventing Value in Cincinnati Children’s,” one of the dynamic Outcomes Improvement Case Study breakout sessions during the 2015 Healthcare Analytics Summit this September.

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