Kaizen is a Japanese philosophy that comes from two words that, together, mean "good change."
This philosophy includes a river analogy. When we look at a stream or river, we may first notice its beauty and flow. When the river level lowers, however, we can see that what looks like whitewater is actually rocks, logs, and debris that obstruct the river's flow. When we identify and remove obstructions, the river's flow and capacity improves — benefiting communities both upstream and downstream.
This aligns with Intermountain Health's ongoing efforts to simplify for our caregivers, patients and health plan members. Caregiver and team efforts to simplify include two types of activities.
The first is local ideas shared and implemented through daily huddles and the continuous improvement process, which identify and remove obstacles unique to a specific location or service, like a tributary that enters the main stream. Since we began this focus in 2023, Intermountain caregivers and teams have shared and implemented more than 6,800 simplification ideas.
The second type is broader simplification initiatives that can be aligned and shared across the system, like identifying rocks or debris slowing the main river's flow and finding a solution to remove the obstacle so the river can continue flowing freely across the system. In this case, leadership and caregiver teams have launched more than 60 system-wide initiatives.
As leaders, we can help our teams best understand our simplification efforts and successes when we share the following information:
- What is the problem we are solving for?
- What is different or changing?
- How does this specifically benefit caregivers or patients?
- How can this inform our own efforts to support simplification of our work?
Here are two recent examples of simplification at Intermountain Health.
Increasing patient access at Intermountain Medical Center, a level one trauma hospital in the Salt Lake City area
A collaborative effort by nursing operations and project management included an in-depth review of the inpatient discharge process. They identified obstacles that delayed discharging patients by the goal of 11 a.m. Working across departments and functions, teams removed many of these barriers, increasing inpatient discharges by 11 a.m. from about 35% in the first quarter of 2023 to more than 70% in the first two quarters of 2024. The benefits for patients include:
- Five more patient beds were available per day, with a goal for 18 more beds available per day by the end of 2024.
- The hospital's ability to meet the requests for accepting transfer patients increased 10% year over year.
- There was a 67% decrease in emergency department patients having to board in the ER for more than 70 minutes while waiting for an inpatient bed to become available. This also increased access for ER patients.
Adopting EHR tools to save time responding to patient messages to providers
The inboxes of physicians and APPs are often overflowing with patient email messages, on top of their full patient daily schedules. Providers want to maximize time with their patients while balancing their personal time.
In June of this year, we opened an EHR "In Basket" tool to our physicians and APPs in Colorado and Montana. This artificial intelligence tool creates first draft responses to patients' email messages. The provider then personally reviews and modifies the messages to meet the needs of each patient. On average, providers using the tool are able to keep 71% of the content drafted by the "In Basket." This saves nearly three minutes of time per message, which can add up to saving hours each week for clinicians to spend more time with patients, without sacrificing quality in their email responses or adding extra time to the end of their workday.
Intermountain is testing and scaling other AI tools to support providers, nurses, and other caregivers across the system.
Are there workflows or processes in your department or hospital that you could find ways to simplify? Could those efforts be shared and implemented at similar facilities or services in other areas across your organization? If so, identify and make those changes.
Do you need more reasons to simplify? A national survey in June 2024 found that only 40% of Americans have a favorable view of the nation's healthcare system. Our industry must do better, and simplifying healthcare is a critical component of doing better.
As leaders we must encourage caregivers to simplify and improve the overall healthcare experience. Together, we can identify and remove obstacles to benefit our caregivers and improve the flow of our healthcare river, which is a vital resource for our patients and communities.
Rob Allen is president and CEO of Intermountain Health, a system of hospitals, clinics and health plans in six Western states.