Improving OB Quality through Operations Excellence

Challenge

As a result of increasing rates of scheduled caesarean section procedures and labor inductions, the obstetrics department of one of New England’s largest and most active hospitals has often exceeded capacity at peak times. 
To accommodate this increased patient load, the hospital would normally double patients in rooms or keep postpartum patients in labor & delivery rooms. 
These actions would, inevitably, lead to decreased patient satisfaction and lowered quality of patient care. To improve the overall quality of the OB services department, the client contracted Tefen Management Consulting (Tefen) to spearhead an operations excellence program. 
The primary focus of this program was to identify and implement improvements pertinent to the way patients receive care in the delivery process as well as the postpartum stage. The OB services department needed to:

• Increase efficiency and patient processing to accomodate for traffic spikes during peak times
• Increase patient satisfaction
• Standardize patient lengths of stay
• Improve maternal discharge times
• Improve operations for patient service, schedule forecasting, and patient discharges

How Tefen Helped

In order to ensure optimal results, Tefen worked with the client in a typical two-phase project that included an in-depth diagnostic to identify the root causes of the facility’s concerns and hands-on implementation. 
Upon completion of the diagnostic, thorough implementation was conducted, during which time Tefen worked with hospital employees to customize the required changes in order to meet their needs.

Eight-Week Diagnostic

Tefen analyzed the organization’s “current state” processes, identified potential improvement opportunities, and quantified potential benefits, which included four main goals for the implementation phase: 1. Decrease the length of stay targeting the use of interventions in the labor and delivery suite and the care process for postpartum patients 2. Decrease use of semi-private rooms during postpartum 3. Increase bed capacity by using evidence-based practices for labor and delivery admissions 4. Decrease amount of time the nurse spends chasing information or gathering equipment so that he or she can spend more time with the patient.

16-Week Implementation

Tefen’s team guided the OB services department staff through training, trials, and successful set-up of:

• Daily discharge monitoring
• 5S organizational system
• Room turnover improvements
• Enhanced mother-baby care model (care for mother and baby done in patient room; reducing movement & waste)
• Key Performance Indicators (KPI’s)
• A forecasting model for delivery spikes
• Elimination of redundant or inefficient activities for OB staff
• Establishing 5 provider practice pattern guidelines:
  • Indication for induction - Method for induction
  • Diagnosis or r/o labor
  • Diagnosis or r/o preeclampsia
  • Treatment of pre-term labor

Performance Excellence Delivered

Upon successful diagnostic and implementation of the project, early results included reduced recovery and discharge time, increased bed capacity by 10%, 75% decrease in circumcisions performed on the day of infant discharge and a decrease in unnecessary nurse’s time spent searching for needed medical supplies and materials, leading to a 20% increase of nurse’s time spent with the patient. Key Performance Indicators (KPI’s) also showed initial improvement in the applied patient discharge metrics. The main objectives of this program produced long-term sustainable results, due to a commitment by the hospital’s OB services department employees to alter their attitude and behavior as well as willingness to learn and maximize on Tefen’s operations excellence program. 
This program was a complete success, ensuring great improvement of the medical center’s OB services department’s overall operations and quality of service.