Community Hospitals have a long tradition of providing quality care regardless of an individual patient's ability to pay. However, with rising healthcare costs and larger volumes of unreimbursed services, many community hospitals have been forced to close their doors. Read how one senior leader at a community hospital rallied employees to confront the business challenge of keeping the doors open while maintaining patient care values by using a simplified application of Lean methods and tools uniquely tailored to healthcare organizations.

Greene Memorial Hospital, located in Central Ohio, has proudly served patients in surrounding communities for over 67 years. But in the wake of a slow-recovering economy and an increase in poverty-level population, the hospital faced an alarming decline in its collections. In fact, direct payments collected from patients had shrunk to less than 20% of all billings " a prescription for going out of business.

Poor hospital-patient communication, low employee confidence, and a lack of easy-to-access payment methods were some of the factors contributing to twin problems of poor collections and rising bad debt.

Tim Ols, Greene Memorial's COO at the time, recognized quick action was required, but also knew a turnaround would only be possible if he engaged frontline employees directly involved in the billing and collections processes. Ols reached out to Leap Technologies for support based on his prior experience at Carle Foundation Hospital. According to Ols, "I found real benefits in my prior role using a healthcare-friendly approach to introducing Lean thinking and tools. That's why I immediately thought of Rapid Action as an answer to our billing and collections problem."

I found real benefits in my prior role using a healthcare-friendly approach to introducing Lean thinking and tools. That's why I immediately thought of Rapid Action as an answer to our billing and collections problem.

Rapid Action is a just-in-time, learn-as-you-improve, small improvement team method that makes Lean accessible and fun for frontline employees.

Applying Lean to Non-Clinical Healthcare Processes

Lean methods have been highly touted as the prescription for helping hospitals address chronic patient satisfaction issues such as waiting times and appointment availability. However, less attention has been given to processes impacting costs and revenue " everything from supply chain management to billing and collections. While at Carle Foundation Hospital, Ols sponsored a number of Rapid Action projects directed at supply chain and collections issues that generated thousands of dollars in savings. His formula for success: Engage employees close to these "behind the scenes" processes in the application of basic Lean principles, while taking advantage of in-house ingenuity.

Ols was confident similar success could be accomplished at Greene Memorial. Shortly after briefing the hospital's senior leadership team on the direct patient payment problem and the proposal to deploy Rapid Action, Ols launched the hospital's first Rapid Action team, consisting of six employees including representatives from accounting services, patient registration, and community relations. The team's assignment: Improve the process for direct patient payment at the point of service in order to speed collections and reduce non-payment problems after service delivery.

The team went to work immediately using Rapid Action's unique "all in one" toolkit for guiding frontline improvement including meeting guides, posters, templates, and supplies. The first meeting focused the team on understanding the problem and team mission, brainstorming potential solutions, and then prioritizing ideas for testing and implementation. Key to the speed and appeal of the Rapid Action approach to Lean is the concept of pulling vs. pushing Lean thinking to hospital employees.

In contrast to sitting through a long tutorial on Lean, Rapid Action team members learn about Lean methods as they explore and refine their ideas for solving the problem at hand. Through the use of job aides (such as a quick-read guide to Lean methods and tools) the Rapid Action team pulls relevant Lean ideas to enhance their experience-based solutions. The result: Faster action and higher employee energy and enthusiasm as employee ideas take center stage.

According to Rapid Action team leader Bonnie Monnin, "After just the first meeting, I could sense the energy in the room. The staff felt that management would not only listen to their ideas, but more importantly, they were empowered to put those ideas into action."

After just the first meeting, I could sense the energy in the room. The staff felt that managementwould not only listen to their ideas, but more importantly, they were empowered to put those ideas into action.

Rapid Action is ideally suited for fast-paced hospital environments because it operates through short weekly meetings conducted over a 60-day timeframe. This low burden method worked very effectively at Greene Memorial given heavy workloads and stretched staffing.

Using Lean Thinking in Creative Ways

The Patient Payments Rapid Action Team emerged from its initial meeting with eight priority ideas for testing. Top among the solutions were actions to provide more convenient ways for patients to pay their portion of billings, as well as more direct support for patients trying to unravel complex insurance plans. The first solution to be implemented by the team reduced the logjam at the hospital's patient payments office. Serving a large uninsured population, the hospital experienced long queues of patients and families looking to pay for services at the point of delivery. Unfortunately, staffing and operating hours for the payment office did not match with patient demand during evenings and weekends, creating a bottleneck and long delays.

The team investigated the cost/benefit of adding credit card payment devices at high-demand patient service departments to provide enhanced opportunities for patients to pay at the point of service.

Based on the direct experience of a few team members, the Rapid Action team also identified limited patient knowledge about insurance and government aid, as well as the lack of comfort completing forms, as major sources of delinquent or non-payments. Taking inspiration from the Lean 5S concept of "making work easier to do through better organization," the team redesigned forms and simplified procedures for guiding patients through the process of applying for government aid, and trained payments office staff to better explain insurance plan coverage and patient obligations.

Within 60 days, the team successfully tested and deployed all eight solutions. Within 90 days from implementation of the team's "Lean inspired" solutions, the collections picture at Greene Memorial Hospital looked vastly different. Point-of-service payments more than doubled from less than 20% to over 42%.