Healthcare organizations face tremendous challenges in addressing efficiency, cost, quality, staffing shortages and mounting pressure to raise salaries. To bolster lagging morale and improve retention rates, management must empower staff and effectively leverage existing resources. Tools and techniques that support these imperatives are critical to the success of modern healthcare organizations.

Many problems in healthcare involve processes that require analysis and improvement, but do not require detailed statistical study. Instead of appointing a task force that may meet for short periods of time over weeks or months, Work-out offers a one-day to two-day concentrated problem-solving effort.

What Is Work-out?

Work-out is a problem-solving approach that involves employees in process improvement and addresses communication gaps between management and employees. A Work-out takes place in three phases: planning, the session itself, and implementation of the action plan. It starts by identifying an issue complex enough to require more than a simple decision, but not so complex as to require detailed statistical analysis.

Background information is gathered and participants are identified. Next, the Work-out itself takes place. Typically 6 to 12 individuals who do the work meet for one or two full days. The Work-out usually follows two or three cycles of idea generation and prioritization: identifying the details of the process under consideration, examining barriers and finally producing strategies for improving the process. The result is a structured action plan with target dates and individuals assigned to clear actions or deliverables. The plan is designed to quickly implement recommendations – usually within 30 days. The final step is follow-up to ensure improvement strategies are being executed.

Work-out roles are clearly defined:

• The sponsor has the ultimate responsibility for the process in question.
• The Work-out coach is an impartial facilitator who guides the team.
• The process owner has front-line responsibility for the process and is responsible for tracking the action plan.

Participants are carefully selected. Some have detailed process knowledge while others are influential among their peers. Others may be included to make on-the-spot decisions that will affect the execution of the recommendations.

Advantages of Work-out

Work-out is similar to other improvement techniques, and many tools are familiar to experienced facilitators. It is fair, then, to ask, “What makes Work-out different?”

Work-out is designed to deliver a specific set of results. It fosters teamwork and encourages solutions from the bottom up. Work-out also offers immediate results by assembling employees who quickly and efficiently solve problems. As Jack Welch said, “Work-out is common sense, just not commonly applied.”

Perhaps the most important benefits are stronger commitment and better results from the accurate process understanding that Work-out participants bring to the session. Managers may think they know the answers, but involving employees can lead to stronger and more readily adopted solutions.

Work-out at Virtua Health

One example of a successful Work-out at Virtua Health targeted the control of supply costs at one of Virtual Health’s four hospitals. Six clinical areas, including surgical and medical areas, sent teams of four to eight members to a two-day Work-out. The hospital chief operating officer presented the problem and gave a firm target of $820,000 reduction in supply expenditures for the current year.

The two-day Work-out challenged teams to reduce the current budget by $347,000 and avoid projected overspending by $473,000. Teams were given specific goals based on their proportion of the overall supply budget. By year-end, some had met their goals, some had slowed their rate of overspending and others had exceeded their challenges. Overall, the teams exceeded the total $820,000 challenge for a total project benefit to the organization of $893,000. Hard savings alone accounted for $468,000 while avoidance of projected overspending was $425,000.

Work-outs are rarely either completely successful or unsuccessful, with results limited by failure to attend to any of the important characteristics. Some have an excessively broad focus. One Work-out proposal involved improving interactions between Housekeeping and Information Systems (IS) staff in cleaning around sensitive IS equipment in the emergency department. During initial discussions, this broadened to include the cleaning of all movable hospital equipment. The former was a well selected, appropriate topic, while the latter is a life’s work and could not have been successfully tackled with Work-out.

Success can also be limited when follow-up is lacking. In one emergency room, a Work-out resulted in a number of recommendations for changing the physical placement and movement of medical records. This took place at a time when the emergency room was undergoing construction and competing priorities took precedence over recommendations for chart flow. Front-line staff became discouraged and felt their participation had been a waste of time. Lesson learned: Work-out recommendations should be implemented promptly with follow-up from both the process owner and sponsor.

Augmenting Other Initiatives

Work-out also complements other improvement methodologies. Statistically driven methods such as Six Sigma frequently identify more narrowly scoped issues that benefit from the rapid-cycle, qualitative advantages of Work-out. In this setting, Work-out provides a structured format that helps to promote project success.

The Work-out approach can support other healthcare activities. Root cause analysis follows a serious process failure that affects patients. The output of a root cause analysis often depends on the preferences and practices of the team leader. Work-out provides a framework for analysis, seeking primary causes for the breakdown and producing a structured action plan.

The Joint Commission for the Accreditation of Healthcare Organizations has recently mandated at least one failure mode and effects analysis (FMEA) be done by each healthcare organization annually. FMEA methodology encompasses process mapping followed by brainstorming and consensus building around failure modes.

At Virtua, a Work-out was used to perform a FMEA prior to the expanded use of low molecular weight heparin. The team constructed a process map and identified likely failure modes. Following the FMEA approach, a risk priority number was assigned to each effect from the many failure modes and safeguarding steps were built in. Several important failure mechanisms were identified and safeguards created.

Making Work-out Work

It is important to change systems and structures to support the routine use of Work-out. Managers should be expected to use this approach to solve departmental problems and meet operational goals. Staff members need to be made available for sessions. Most importantly, mid-level managers must be held accountable by senior management for supporting the approach and following through on recommendations.

Work-out is a powerful tool for solving a wide range of problems. At a time when healthcare organizations are challenged to find new ways to improve processes and engage employees, Work-out is an important tool set that should be added to their problem-solving methodologies.