SANTA ROSA, Calif., April 6, 2005 (PRIMEZONE) -- REACH Air Medical Services has shaved critical time off its air emergency air ambulance operations due to its application of "lean thinking" throughout the company. Headquartered in Northern California, REACH serves over 3,000 patients a year with 60 percent of its transports being hospital-to-hospital (interfacility), and 40 percent being 911 scene responses. Working closely with several large receiving hospitals and approximately 200 sending hospitals, the company operates five bases of helicopter operations and one base of airplane operation -- all manned 24X7.
REACH's lean endeavors began after its Director of Program Development, Jennifer Hardcastle, attended a week-long course at the Lean Learning Center (Novi, Mich.). Unlike many lean education providers who focus on manufacturing, the Center's approach applies to any industry by focusing on lean guiding principles and rules. With a dedicated lean learning facility tailored to develop lean thinkers, concepts are taught through discovery, simulation, case study, peer coaching, personal action planning, role playing, and journaling.
"After attending the Lean Experience class, I realized how lean thinking could significantly improve our response time and critical patient bedside time while conducting an interfacility transport. By implementing tools like value stream mapping, we saw how many broken links there were along the chain between REACH and our hospital customers."
Prior to working with the Lean Learning Center, REACH had no structured methodology in place for the sending-hospitals to convey how urgently a patient needed to be transported. Using lean rules, the first step was to study the process flow between hospitals and REACH. "We worked with the hospitals to define a Level One Acuity patient -- someone requiring the most urgent need for care and transport," reports Hardcastle. "We established four patient categories -- acute aortic emergencies, unstable trauma, unstable pediatric, and anyone requiring critical lifesaving intervention. We then identified what sending hospital staff members can expect when they encounter each patient category and the processes involved in emergency treatment and transport. For this level of patient minutes can mean the difference of life and death -- so process efficiency through lean thinking took on the highest level of importance."
The teams worked on structuring a process flow for each Level One category to eliminate wasted time. Now a facility calls REACH's dispatch center and notifies it that it has a Level One request, activating a plan that launches an aircraft to that facility (Point A) even if a patient's ultimate destination (Point B) is not yet known. Historically, an aircraft wouldn't be launched until Point B was determined. But, by launching prior to confirmation of the final destination, the company has eliminated up to forty minutes of wasted wait time.
Lean also helped REACH reduce time spent collecting bedside information at a given facility prior to transporting a patient to another facility. Before, the verbal report between the bedside nurse and REACH's transport nurse had no structure to it. Hardcastle says, "The bedside nurse-to-nurse report was a series of questions and answers which varied greatly depending on the people involved." A one-page flow sheet was created that contained essential information for each Level One Acuity category, making the transfer of information standardized and quicker -- ultimately saving from three to five minutes.
Another action taken by REACH that has probably reduced the most waste involves the medication infusion procedure. The equipment a patient is hooked up to must stay at the sending facility, meaning REACH must transfer all the infusions from the hospital equipment to its own equipment. Replacing established infusion lines and transferring them to new transport tubing is very time-consuming. To combat this, REACH now stocks its own transport infusion pump at the hospital and has trained the hospital staff on how to utilize it. Now when there is a Level One Acuity patient, the hospital transfers the patient to the REACH equipment and the patient is ready for transport when REACH arrives. This shaved off ten critical minutes.
A healthy solution for the healthcare industry
Says Hardcastle, "My own mindset before attending The Lean Learning Center was one of frustration, thinking that little could be done to solve the inefficiencies inherent in our systems . . . I now know differently."
"Lean transformation starts with a change in the way everyone thinks about what they do, how they do it and why it matters," says Jamie Flinchbaugh of the Lean Learning Center. "REACH grasped this concept early on and has been able to eliminate waste in the form of valuable time. And, using this systematic approach will help them sustain these results."
"By viewing problems as individual process flows that can be restructured, dramatic change is possible," says Hardcastle. "If we can do it, so can others in healthcare."