Saving Clinicians 12,585 Hours per Year at Mahaska Health

As part of their Signature Learning Series, The American Hospital Association (AHA) recently featured a presentation from Mahaska Health Partnership, “Secure PHI and Ensure Clinician Productivity Using Lean.”

Through the use of Lean practices, the team at Mahaska Health Partnership, a 25-bed critical access hospital, applied Lean time savings study practices to determine the true impact that securing PHI would have on clinician productivity—in terms of real minutes translated into cost. 

The results proved that implementing secure access management equates to more time for doctors, nurses and support staff to care for patients – more specifically 12,585 hours per year (the equivalent of six full time employees!) giving real value to clinicians. 

Kristi Roose, Information Technology Director and Dan Nikkel, Continuous Improvement Director at Mahaska, explained how they improved processes by implementing fingerprint recognition and single sign-on (SSO) technology as well as remote access tokens, allowing physicians easier access to patient records.

The on-demand version of the webinar is now available on the AHA website. Below is the summary of the live Q&A from their presentation.

What drove Mahaska to undertake and launch the Lean initiative? And when you began the Lean project did you find other healthcare organizations who had also adopted the Lean approach from which you could learn?

Dan Nikkel, Mahaska: Our director of support services here at Mahaska Health four years ago came from the same manufacturing facility, which we both had worked for. He had witnessed a lot of the Lean transformation in manufacturing. He started hearing about a lot of the healthcare organizations using the same concepts and he recognized that Lean would be a good application for healthcare. Our director of materials came from a manufacturing facility as well and has a lot of exposure to Lean and like I’ve said Kristi has been exposed to a lot of the same concepts. So a lot of these things come very naturally when managers have worked in that kind of an atmosphere. I read as much as I can, from a healthcare prospective. There are a number of really great books out there that you can read, a number of really great learning organizations out there that have done very well with Lean on a larger scale than what we’re doing. So I would say if you have a lot of interest just Google “Lean healthcare” and see how far it takes you.

Why was single sign-on (SSO) selected as a key initiative in your Lean implementation?

Kristi Roose, Mahaska: Through our Lean initiatives, we identified that our biggest waste was in authentication. We did research on what technologies were out there that could reduce that authentication waste, which led us to Imprivata.

In the presentation you identified the ROI in authenticated savings amounting to annual savings of nearly $400,000 per year. How did you track log-ins to feed that savings ROI calculation?

Dan: I went back to our IT department and asked our network administrator to give me a report of some actual numbers. Then we went back and used the same cost unit of measure to calculate cost justification as well as an ROI.

Now, we use this very carefully because I think you can cost justify about anything you want to. I’m always very careful of how I use numbers. Our CEO has an accounting background and he likes to see things a certain way. He likes to have a comfort level when the hospital is going to invest in something. So we try to ask what are the apprehensions here, what are the concerns and try to direct it that way.

Now what we do to understand effectiveness is try to go beyond just the financial aspects, we have an evaluation. We take a look at different areas, like for example we evaluate people: did it simplify the work, did it improve the work area, anything like that under service, and did it have a positive impact on the patient, those kinds of things.

And we do a rating system. Financially: what were the financial gains here? So we have a little bit broader evaluation system than just this ROI sheet. So we used it very carefully because this looks like you’re saving roughly six full time employees a year. Well that doesn’t calculate into hard savings unless you’re able to reduce your FTEs by six people and, like in manufacturing, we had ways of doing that.

We haven’t really gotten to that point; we try to use it to reduce waste. If you do half a dozen projects like this and you’re starting to add those together you should be able to make some scheduling changes based on that, but there are ways to really dial in on the amount of scheduled people you need in a unit.

With the savings of these hours per week, has the nursing and care team staff model changed? Did you or the organization fill that time with other work or was it real savings because of a reduction in overtime, staff to patient ratios, changes, etc.? Can you speak to that?

Kristi: The results of the initial project were that time wasted logging in and out no longer occurred. When we went to implement these changes we took a look at how this change would impact our staff. So if we didn’t do this project, if we didn’t apply Lean in the forefront, it certainly would have had to have been staff additions because of that increase in demand of time spent on the computer and the authentication process. So fortunately for us, it was waste we did not realize but were able to justify preventing it in the front end.

How did you train the staff on the single sign-on technology? What was the initial and current adoption rate for the technology?

Kristi: For the training, we took that unit by unit and it was really surprising how it kind of spread like wildfire, quite frankly. We started in our med-surg area, the area with most impact in our time studies.

We spent a couple days on the floor and staff by staff they would rotate in and we would train them hands on, every one of them, being a small facility that is much more realistic than in a larger facility but took it unit by unit.

It was really neat to see how those clinicians would talk about the technology to other clinicians. “Oh my goodness, I just got trained on this, watch how this works and what this is going to mean in my day.” It was neat to see how that spread and the technology really sold itself across the organization as it expanded it.

At the time we were getting requests, “When does our unit get Imprivata? When are you bringing that to our unit?” So the demand and adoption was there quicker than we could fill it.

What is your current SSO adoption rate, do you know that?

Kristi: We have Imprivata single sign-on in place organization wide, in all of our clinical areas, 100%. In a lot of our financial areas as well, for example our business office has a great use for that due to the amount of insurance websites they have to log into, external third party software that they have to use for claims. Our materials area is a user as well for procurement, the amount of vendor sites that they use and different applications.

The only areas where we don’t use the product are more of our accounting and folks that log into their computer and that’s really about the only system they use because everything is local. So from an adoption prospective, everyone that has it uses it.

How efficient are the current single sign-on solutions that were deployed at Mahaska? What’s the security of log-ins using tokens and are you in fact using tokens within your single sign-on solution?

Kristi: As far as the tokens go, we use that two factor authentication for external log-ins. So from remote access prospective they’re very efficient. We moved away from the key tokens to the smartphone tokens because, really by physician request, they may not always have their keys on them these days but they do always have their smartphone on them. So providing that access in the device that they have is beneficial for us.

As far as efficiency, literally what this looks like is our clinicians walk up to a device they put their finger on a reader and, boom, they’re in immediately to the session that they opened at the start of their day and it leaves off right where they left off. What’s really neat is say a physician leaves a patient chart open for one of his clinic visits, then he needs to run up, or in the middle of his day to do rounds on our med-surg floor then he or she walks up to the med-surg floor put their finger on a reader on a device up there and it pulls up exactly where they left off in their clinic. So for us it’s almost like desktop virtualization just a little bit more inexpensive for a facility our size using those terminal servers combined with single sign-on.

One last question, how well did Imprivata utilize the Lean project for single sign-on?

Dan: One of the concepts in Lean is you’re always looking at flow whether it’s flow of products, flow of services, flow of patients, that kind of thing. I believe this is a great example—if you don’t have flow what has a tendency to happen is things get batched, so things are grouped up.

I think what we avoided here is pretty common practice for nurses to sit down at the end of the day and do all their charting. We’ve created more flow with this and gotten them to do things as they occur, in real time, do their charting in real time and that’s what we’ve been encouraging. From spending some time doing nurse observations and doing time studies and those things this was pretty easy to see how this would create more flow within a nurse’s day. It gets hard to always, like I said, to put a dollar value on that as to how much better patient care is doing something like this.