Case Studies

Lean Healthcare: Utilization Review



Problem

Less than 100% of daily Utilization Reviews (UR's) are being submitted before 5pm each day.

Solution

The Lean team conducted a problem solving using the A3 as a guide to take a deep dive to understand the problem from all perspectives that affect the Utilization Review process. Using the PDCA methodology, there was a lot of analysis of data, front-line observation and information gathering. Many areas were identified for improvement based on the information gathered and performing a waste analysis on their process. Lean tools and philosophies, such as Standard Work, were used to eliminate those wastes and improve the ability to complete the daily requirement for UR's.

Results

  • Reduced morning set-up time by 50%, saving up to 1 hour per Care Manager
  • Developed and implemented a Standard UR process for all Care Managers, which reduced the time to complete an average UR by at least 30% based on a typical work load for a Care Manager equates to 1.8 hours per Care Manager per day
  • Standardized clinical content for each UR
  • Developed a consistent and defined training process for new Care Managers
  • Started daily huddle with each Care Manager Service line.