Three Hidden Problems in Your Hospital That Are Reducing Efficiency and Costing You Money

Connex Staff |

In a fast-moving, ever-changing hospital environment, there is inefficiency lurking in your processes and this is costing you money. Hospital Executives often know it exists in some capacity, but struggle with where to look and often under estimate the magnitude and cost of it to your hospital. The truth, is that it is likely hiding within the scurry of fast-paced activity. Healthcare leaders generally lack the luxury of having the time to spend multiple hours observing their employees’ processes to uncover this hidden lost time. In our experience, based on thousands of hours observing the execution of work processes with healthcare employees on the hospital floor, 30 to 50% of the typical work-day is not adding value to the business. While employees are working, often very hard, they are doing tasks in a less-than-effective manner, regularly expending excess time and resources to get the job done.

Healthcare leaders usually recognize that operational issues exist, but without the ability to observe and evaluate the process over many hours, they are unaware of the magnitude of the problem or what it costs in terms of patient satisfaction, quality of care and efficiency. That’s because it’s hard and time-consuming to see the waste. They often mis-translate the buzz of activity in their department into productivity. Often, however, masked inefficiencies lead to ineffective processes, which compromise the quality of care, patient satisfaction and result in higher costs.

So in the dynamic world of hospital operations, where does the waste typically hide? In over two-decades of assessing hospital operations both large and small institutions we generally find it consistently in:

  1. Organizational Misalignment,
  2. Process Breakdowns, and
  3. Ineffective Management Behaviors.

1. Organizational Misalignment due to a Breakdown in Planning and Frontline Management Tools

Too often, hospital executives struggle to translate their vision for the organization into the planning mechanisms and point-of-care management tools. A properly integrated management performance system is the most important tool that a CEO has for aligning an organization and creating a culture of accountability and continuous improvement. Management performance systems help managers at all levels to plan, execute, report and improve their area of responsibility in accordance with the direction of the CEO.

Unfortunately, almost all management performance systems suffer from one or more of the following fundamental problems:

Planning Does Not Integrate Directly with Execution

Key planning tools include budgets, forecasts, resource plans and departmental schedules. One of the causes of this disconnect between vision and plan implementation is the lack of tools to gauge how long tasks take and the absence of reasonable mathematical relationships between revenue dollars, forecasted volume and the time required for activities. Without rigorous time standards, it is impossible to execute a plan efficiently. After all, how can you create work schedules for a radiology clinic if you do not know how long each procedure takes or how many procedures you need to do in a month to hit your revenue requirements? Without this information, you are gambling with resources when you predict the number of patients you can see, as well as the rooms, equipment, and labor needed. That’s because you are forced to base planning on gut feelings rather than facts.

Execution Tools Are Missing

Demand fluctuations add to the complexity. When 80 or 120 patients show up instead of the expected 100, the radiology department manager needs to adjust labor and resources accordingly. The risk of not flexing operations to meet demand is to know that volume will be increasing as it happens, not the next day, at which point it is too late to realign resources to meet the changes in volume. that costs rise, and the patient experience declines as wait-
times stretch out. The problem, however, is that execution control tools at the point of care are noticeably absent from many work areas. Managers need tools during the day that reflect real- time activity levels and performance. Such feedback lets them know whether they are on schedule or not, empowering them to follow up and correct variances to plan.

Reports Are Disconnected from Frontline Activity

It’s important to note that the problem is usually not the lack of metrics. Most hospitals have many of them, but leaders cannot see the forest for the trees. So, it’s essential to boil down metrics to those that are critical for managing the business in the day, for the day. Also, make sure your numbers are accurate, visible and easy to understand, giving managers the feedback, they need to improve performance. For example, metrics that do not provide guidance for running the business and driving financial performance are not helpful. Likewise, if a manager needs to act as variances occur, neither are those metrics that are reported after the fact. If for instance, a car pileup on a local highway causes an influx of patients into the emergency room, the manager needs to know that volume will be increasing as it happens, not the next day, at which point it is too late to realign resources to meet the changes in volume.

Make sure your numbers are accurate, visible and easy to understand.

There Is No Systematic Way to Improve Performance


The right metrics—at the right time—help managers proactively identify and address variances to plan, enabling them to solve and prevent problems rather than fight fires. Variance identification requires accurate planning parameters, which unfortunately are often lacking or weak in their linkage to the hospital’s financial requirements. Without a formal feedback loop, solutions to problems tend to be temporary, and leaders spend most time firefighting problems in a reactive manner.


2. Process Breakdowns

To address process breakdowns, you first need to understand the steps or activities within the process. Process mapping is a good way to visually represent each step and the hand-offs and touch points between steps.

Once you have the process mapped and good understanding of the steps involved in the process, the second step is to break down the process into the components of volume and rate. Volume is the number of times someone in the organization performs a task or the steps, as defined by your process activities. Rate refers to the cost per unit of output.

Once you have defined your process and determined the volume and rate of each task, you can dig deeper to uncover the breakdowns or variabilities that are creating redundancies, inefficiencies and compromising care. To do so, observe processes at the frontline and ask the following questions:

Is the Task Necessary?

If you have not optimized workflow, your staff may be doing unnecessary tasks. For instance, if you poorly schedule surgery in operating rooms, staff may have to move surgical equipment from one room to the next. This activity would be unnecessary if room scheduling planned, as much as possible, similar surgeries back-to-back in the same room or considered cross-room equipment requirements. Doing so would facilitate the block scheduling of operations that use the same equipment, thus reducing redundant equipment moves which add employee touch points and extend room turn-time.

Is the Task Redundant?

Tasks tend to reproduce in multiple departments, and inefficiencies in one department can affect the outcomes of upstream and downstream departments. Common causes of redundancies are inaccuracies in physician surgical equipment procedure cards. If the information on the cards is wrong or incomplete, doctors will not have the supplies they need during the procedure. Consequently, their support staff make last-minute calls to the sterile supply department to attain what they need, causing sterile supply staff to scramble collecting and delivering supplies, while the entire operating room staff wait for the procedure to begin, thus, elongating procedure time. The net behavioral outcome of this issue is the tendency to overstock to accommodate last minute, unpredictable demand. Also, when doctors return the supplies they do not use, it results in transporting, handling and managing these items multiple times.

Inefficiencies in one department can affect the outcomes of upstream and downstream departments.

Does the Task Take Too Long?


There is a certain amount of variability is inherent in every surgical process, some of this is unplanned, but some of this in build into your existing process. Perhaps you want to find ways to fit more procedures into the OR schedule? To do so, you might review room turnover time to pinpoint the tasks and activities you can do concurrently rather than sequentially, compressing the total time associated with each surgical turn to free up rooms more rapidly. For example, by establishing which nursing preparation work can be done in parallel alongside anesthesia set-up activities, we can reduce case turnaround time.


Are Employees Adhering to the Process?

Sometimes hospital staff members do not follow processes. In straying from the process, they may have the best of intentions, like proactively trying to solve a process breakdown. In many cases, employees have created workarounds because of process barriers. For instance, if the specified equipment and supplies have not been ordered and are in short supply, hospital cleaning staff may substitute something they have on hand, but if those products do not work as well, efficiency and cleanliness suffers. Managers first need to be aware the problem exists and then ensure that cleaning staff have the tools they need for the job. This requires that Mangers first gain visibility to the issue. Usually, it’s by observing processes first-hand that manager spots the workarounds.


Are Communications Effective?

If one link is broken in the communication chain, the process falls apart, causing inefficiencies and service gaps. When patients need X-rays, for example, many moving parts must come together. If all goes well, a doctor orders an x-ray procedure, a nurse schedules the procedure with radiology and a personal care worker prepares the patient for transport. Then, a patient transporter picks them up. Once the patient arrives in radiology, a department administrator ensures they have an appointment and that their medical information is on hand. Finally, a radiology technician performs the x-ray. Following the procedure, the transportation process happens in reverse and the patient finally returns to their room to be greeted by a nurse on the floor. When all the pieces of the puzzle do not come together, it increases patient waiting time and employee inefficiency. So, look for the breakdowns in communication that lead to lapses in handoffs between employees as they move through process steps.

Are There Workload Imbalances?

Volume in any clinic is not at a steady state; there are ebbs and flows. There are times during the day when a clinic may be teeming with activity and others when it’s slower. The same type of fluctuations can occur on different days of the week—perhaps Monday is busier than Friday. Unless hospitals adjust their staffing to meet demand variances, workload imbalances are going to occur, leading to service gaps and long wait times for patients during busy periods and under- utilized capital and employee resources during slower periods.

To make the necessary modifications and synchronize the moving parts, find out how long activities take and assign equivalent workload based on forecasted demand. To accomplish this, you need frontline management tools—metrics that highlight the plan and variances to it. If you know how many minutes, on average, it takes for an endoscopy technician to care for each patient during a procedure, you can adjust the number of technicians you bring in on a heavy versus a light day. Similarly, if you are aware of how long, on average, each procedure takes, you will try to smooth out your volume, considering forecasted cancellation rates, emergencies and average procedure durations. By doing so, you ensure high service levels, reduced wait times and increased patient satisfaction.


3. Lack of “Active Management” at the Frontline

To help solve problems related to operational variances and ensure adherence to plan activities, managers need to be visibly managing staff on the hospital floor. Management activities include setting schedule and work-plan expectations with staff, following up with employees throughout the day on the status of that plan, and removing obstacles as necessary. The nature of hospitals, however, is such that leaders spend a considerable amount of time in policy-related meetings and engaged in administrative tasks. Due to their administrative workload, they are often confined to their offices, behind closed doors. Thus, because of other demands on their time, they are often physically absent from the front lines.

In light of this, it is critical that every hospital organization and each department tailor their own management profile that defines how managers should be spending their time.

Again, stepping back and evaluating where managers spend their time is extremely eye opening. Observation is a powerful way to illuminate the many tasks and requirements that take managers away from physically managing their teams.

Good hospital management addresses process problems, organizational misalignment and lack of active management on the front lines. One significant benefit of this is that it enables hospitals to increase patient throughput, which in turn leads to increased capacity, reduced wait times and improved patient flow.

About Carpedia

For healthcare providers faced with revenue compression and bottom line pressure, Carpedia has a proven record of implementing healthcare performance improvement and clinical integration strategies that result in improved patient care, greater cost containment, and more predictable patient volumes.

Our consulting team works with your management team to improve clinical quality, patient safety, and demand management. Together we can improve the patient experience by transforming patient care models for better quality of care, greater patient safety, and higher overall patient satisfaction.

Along with improving patient care, we also deliver healthcare performance improvement across all areas of hospital operations from clinical units to ancillary support departments, as well as administrative offices.

See for more information.

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