- Topic:Increase quality, decrease stress in a hospital
- Speaker:Pieter E. Buwalda, The Netherlands
- Occupation:Manager Hospital Operations Programs, Nij Smellinghe Hospital in Drachten
- About speaker:Pieter is working in Nij Smellinghe Hospital in Drachten (The Netherlands) since 1999 . He started his career as coordinator of the patient planning unit. In this position he started gaining experience in Hospital Operations Management on an operational level and became certified by the American Association of Operations Management as CPIM. During his career, Pieter extended his knowledge and skills to scientific and tactical/strategic perspectives on healthcare delivery systems. He attended the Young Management Program (Nyenrode Business University, 2005) and got graduated as Master of Science in Business Administration (University of Groningen, 2012).
Today Pieter is responsible for improving the healthcare delivery system of his hospital. Pieter advises the Board of Directors and the Medical Board on matters like capacity management and (re)designing healthcare delivery systems. He is also responsible for implementing his advised improvements within the budget and timeframe.
He strongly beliefs that (a) creating patient flow within and beyond the hospital walls (in- and outbound) and (b) reducing variability, are key in gaining strategic advantages as a hospital. Therefore he creatively combines different approaches and theories like Lean, Swift Even Flow, Litvak’s Variability Studies and Theory of Constraints in order to reach that strategic advantage. Together with the University of Groningen, Pieter is also researching the causes and effects of these approaches in his hospital by conducting different (sometimes scientific) studies. While conducting these studies, Pieter was surprised by the effects of some implemented elements of the Theory of Constraints (inpatient length of stay reduction >20%).
Pieter shares his expertise in Hospital Operations Management and was consulted by already more than 80 other hospitals in the Netherlands and Belgium. He also is asked frequently as speaker on workshops, congresses and training programs. Today he is mainly occupied with developing a new healthcare delivery system for De Sionsberg Hospital in Dokkum, as part of a preliminary program of an intended merge with Nij Smellinghe Hospital.
Topic of the presentation
Increase quality, decrease stress in hospital
This presentation will demonstrate what management principles were applied in a general hospital that improved the quality of care AND decreased the workload on nurses and doctors, while the same amount of patients was treated. This implementation took place in a Dutch hospital and is still in the process of completion. The implementation strategy is used in several hospitals in The Netherlands and abroad and delivers similar results over and over again.
What was the problem?
Clinical wards in most hospitals, at least in The Netherlands, are usually occupied for more than 90% on average on a yearly basis. This average occupation means that from time to time wards are fully occupied, resulting in some major negative effects: patients cannot be admitted, operations are cancelled, patients are admitted on the wrong ward, nurses and doctors experience a lot of stress.
Before our implementation started, the average occupation in this particular hospital was well over 90% and the amount of patients admitted on wrong wards was almost 1000 per year on a total of 8000 admissions for the concerning wards (5 in total in this case). On top of that, 10 to 15 times a year the hospital was completely full, resulting in patients being sent through to other hospitals in the region. The average length of stay was at the time of the beginning of the project (2010) 7,3 days per patient.
What had to be changed?
The goal of the implementation was to eliminate guest-admissions and to prevent a full-house situation during normal market demand (i.e. not taking into account winter crises or disasters). The way to achieve this was to reduce the length of stay for each patient by eliminating non-medical waiting times.
These non-medical waiting times are often caused by mis-synchronization of resources inside and outside the hospital: diagnostic departments, such as Radiology, Physiotherapy and the like, also suffer from fully planned schedules, resulting in not being available at the right time for clinically admitted patients. But also nursing homes and rehab clinics tend to be occupied for almost 100%, also resulting in blocking patients to be discharged from the hospital.
Occupation of beds decreased by 20%.
Length of stay decreased by 15%.
Ongoing improvement on daily basis.
Decisions based on performance.
Management focus on improvement.
Speakers’ role in the project
Pieter Buwalda is the manager of patient logistics and thus responsible for the appropriate infrastructure of resources and procedures in order to establish an optimal flow of patients throughout the hospital. As such he was the internal project-leader of the implementation of Buffer Management in Hospital Nij Smellinghe in Drachten, The Netherlands. During the project Pieter managed the scope, time and budget of the project by working closely together with nurses, management, doctors and the external project-leader, Gijs Andrea.