The Fiscal Efficiency Community is a dedicated space to collaborate on practices that generate revenue through elimination of waste and inefficiency in various organizations. This Community is a space to share resources & connect with others interested in improvements within this realm. (Note that since this is a public space, posting confidential information is not recommended). Browse our resources to see case studies, tools, and articles that might help generate some ideas for implementation within your organization. Share your thoughts and expertise, and ask questions to join the conversation – you can also upload additional resources here.

General information about communities of practice can be found below:

 
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Colleaga White Paper: Purposefully Cultivating Mission-Based Innovation Programs

 ContentsIntroductionComputational Supernova and Moore's LawInnovation EcosystemsMission-Based Innovation ProgramsBuilding Mission-Based Innovation ProgramsjkhaIntroductionAs global populations c...

What are Communities of Practice?

Cultivating Communities of Practice: A Guide to Managing Knowledge - Seven Principles for Cultivating Communities of PracticeQuiz: You Might be a CoP If...Communities of Practice: The Art of Learning ...

Moore's Law

 Amazingly, Moore's Law applies not only to the computational speed of microchips that have been in steady nonlinear acceleration....

Crowdsourcing Ideas to Accelerate Innovation at Markham Stouffville Hospital

Innovation is a priority for Markham Stouffville Hospital (MSH) to help improve patient experience and the care provided by staff and physicians....

North York General: Improving Patient Flow with Access to Care

North York General Hospital embarked on a number of initiatives to improve patient flow in the emergency department and beyond beginning in 2011 as part of the "Access to Care" project. 

Bridging the Divides at Christiana Care Health System

Bridges began in July 2012 and is part of a three-year grant funded for $10 million by the Center for Medicare and Medicaid Innovation....

HSC Adult Emergency “No Wait Emergency Department": Reducing Time To Treatment

The Health Sciences Centre (HSC) Emergency Department in the Winnipeg Regional Health Authority noted that patients were waiting too long to be seen by a physician and spent unnecessary time in waitin...

Fallon Medical Center in Montana Saves Time and Distance with Lean Supply Organization Model

Many hospitals are facing the challenge of trying to satisfy the growing healthcare needs of an aging population while utilizing limited available resources....

Best practices for engagement

what are you thoughts?

Running a More Efficient Emergency Department

 How to Improve Emergency Department OperationsThe key to fixing overcrowding in the ED is to clearly delineate the effects of the different queues and devise appropriate strategies to counteract...

Keeping Patients Vertical in the Emergency Department

What is Vertical Treatment?The premise behind vertical treatment is in facilitating patient throughput and satisfaction. These spaces are designed for short-term occupancy....

How to Reduce Diagnostic Imaging in Emergency Departments

Underlying CausesThere are many potential reasons that diagnostic imaging tests are overused. ED physicians work in a high-stress environment where clinical information is often unclear or missing....

Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals

Key Questions: How do I improve patient flow in my ED? Why is my ED overcrowding?...

Current situation... I am in the engineering field, looking to gain further insight into the healthcare field through the use of lean tools
Where I want to go... What kind of lean tools are there that lend themselves to analysis in the healthcare field?
Help I'm looking for... n/a

Perioperative Supply Costs Whitepaper

Key Questions: How can healthcare organizations reduce OR supply costs while improving patient safety, operational efficiency, and staff productivity?...

How Florida Hospital Orlando Used Lean Process to Save Millions of Dollars and Decreased ED Door-to-Door Time

Long waiting times in an Emergency Department can result in life-threatening risks as well as dissatisfaction for patients....

PICK Chart

Key Questions: What is a PICK Chart?...

Integrated Comprehensive Care at St. Joseph's Health System Improves Coordination and Reduces Costs

Population aging combined with increasing levels of chronic disease and comorbidity puts pressure on health systems to deliver care more efficiently....

Emerging Idea: Reducing Waste in the Critical Care Setting at London Health Sciences Centre

Reducing the amount of discarded unused medical supplies in the ICU is believed to reduce organizational costs, help protect the environment and reduce infectious transmissions of antibiotic-resistant...

Root Cause Analysis

A Root Cause Analysis (RCA) is a popular technique--before one seeks solutions--that helps answer the question of why the problem originally occurred....

The Use of Arena Simulation Software in Staffing Decisions at Blank Children's Psychiatry Clinic

As the Blank Children's Psychiatry Clinic increased its patient load, the staff struggled to complete necessary administrative tasks....

Productive General Practice in the NHS

The Productive General Practice Programme was designed in 2010 to help general practice continue to deliver high quality care whilst meeting increasing levels of demand and diverse expectations....

Economic Arguments for Shifting Health Dollars Upstream

In this discussion paper, evidence is presented supporting the position that greater investment in upstream action from within the health sector is both socially just and economically sound....

Partners HealthCare Improves Quality of Care While Slowing Cost Growth

Partners HealthCare is an Accountable Care Organization (ACO) which are groups of doctors and other health care providers who work together to provide high quality care for their patients....

Don’t Waste Green! Launching a Budget Awareness Campaign

Budget cuts have become a way of life in many healthcare organizations. Healthcare funding is always a target in a seemingly constant state of budget crises....

Emerging Idea: Saving Costs through the Decontamination of the Packaging of Unused Medical Supplies Using Hydrogen Peroxide Vapor

Contamination of environmental surfaces and medical equipment is an increasingly common source of in hospital transmission of multidrug-resistant organisms (MDROs)....

Adding a Measure of Patient Self-Management Capability to Risk Assessment Can Improve Prediction of High Costs

Patients with the knowledge, skills, and confidence needed to manage their health conditions are sometimes referred to as “activated.” Health care systems can use patient activation scores...

NICHE Initiatives Improve Geratric Care in a Community-Teaching Hospital

Improving clinical and fiscal outcomes for the elder population is essential....

EnergySmart Hospitals: Retrofitting Existing Facilities

EnergySmart Hospitals has developed the following tips—on lighting, HVAC, building envelope, and plug loads/water efficiency—to assist hospital facility managers and operators in getting s...

MSH-CARES: Markham Stouffville Hospital Caesarean Section Reduction Strategy

An increase in caesarean sections (CS) and induction rates were observed at Markham Stouffville Hospital (MSH) in Ontario, Canada....

Efficiency: Comparisons of Teaching Hospitals in Ontario with Teaching Hospitals in Other Provinces

This report presents a comparison of the clinical and operational efficiency of teaching hospitals in Ontario with the clinical and operational efficiency of teaching hospitals in other parts of the c...

A Comparison of Preliminary and Adjusted Cost per Weighted Case Determinations for Manitoba Hospitals: Impact for Evaluation and Report Cards

The purpose of this report is to evaluate whether information currently submitted by acute care hospitals to Manitoba Health can be used to make accurate and timely financial comparisons between facil...

A New Patient-acuity Tool Promotes Equitable Nurse-Patient Assignments

At Indiana University Health Ball Memorial Hospital in Muncie, we moved our progressive care unit (PCU) to a newly constructed areaof our regional medical center....

Environmental Cleaning Top 10 Best Practices

I.V. pumps, bedrails & linens have been implicated in MRSA outbreaks as have stethoscopes, commodes, B/P cuffs, telephones, call bells, and medication carts with respect to VRE outbreaks....

The Champlain Geriatric Emergency Management Plus (GEM+) Program Improves Outcomes & Reduces Hospital Utilization

Many people enter and access the healthcare system through the emergency department (ED). This can lead to overcrowding combined with a high stress environment....

Alberta Standardizes Hip & Knee Arthroplasty Care to Optimize Patient Experience

Hip and Knee Arthroplasty care protocols and practices in Alberta were highly variable, resulting in wasted time, money, resources, and expertise due to the inability to keep track of where the patien...

How Sourcing Excellence Can Lower Hospital Costs

Around the world, existing models of health care are becoming economically unsustainable....

Health Care Governance in Volatile Economic Times: Don’t Waste a Crisis

As part of its mandate to promote and foster excellence in health care governance, the Ontario Hospital Association (OHA), in partnership with Deloitte, is pleased to offer Health Care Governance in V...

Reducing Costs in the Health Care System: Learning from What has Been Done

Many strategies to contain costs have been tried in recent years....

"Cost of Current Quality" at St. John's Family Medical Associates

St....

Impact of Tele-ICU Coverage on Patient Outcomes: A Systematic Review and Meta-Analysis

A systematic literature review and meta-analysis of 13 studies encompassing more than 41,000 patients indicated that tele-ICU coverage was associated with a significant reduction in both ICU mortality...

Efficient Financial Management for Local Governments: The Nigerian Experience

This article attempts to present the local governments’ executives with a number of options to consider as they deal with the complex and ever changing questions of financial management for the ...

Health care systems: Getting more value for money

The OECD has assembled new comparative data on health policies and health care system efficiency for its member countries....

Kanban

Kanban is a visual method for controlling production as part of Just in Time (JIT) and Lean Manufacturing. As part of a pull system it controls what is produced, in what quantity, and when....

Just in Time (JIT) Production

Just in Time (JIT), as the name suggests, is a management philosophy that calls for the production of what the customer wants, when they want it, in the quantities requested, where they want it, witho...

Poka Yoke - Mistake Proofing

Poka Yoke or Mistake proofing is a simple technique that developed out of the Toyota Production system through Jidoka and Autonomation....

Using Lean Principles to Develop the Virginia Mason Production System (VMPS)

After visiting Japan in 2001, Virgina Mason Medical Centre applied the Toyota Production System (TPS) to the healthcare context....

Disruptive Innovation in Integrated Care Delivery Systems

Disruptive innovations in health care have the potential to decrease costs while improving both the quality and accessibility of care....

Heijunka: The Art of Levelling Production

Heijunka (pronounced hi-JUNE-kuh) is a Japanese word that means “levelling.” When implemented correctly, heijunka elegantly – and without haste – helps organizations meet deman...

Predictive ehCOS SmartICU Technology Pilot in Spain Shows Promising Results

Caring for cricially ill patients in hospital intensive care units is demanding....

Does improving quality save money? A review of evidence of which improvements to quality reduce costs to health service providers

The most successful hospitals or primary care organisations are not the ones which just deliver the best evidence-based clinical services, or are most focused on safety, or whose services are highly c...

An Overview of Public Private Partnerships in Health

In today’s world of complexity and rapid pace it is almost impossible to do anything alone....

U.S. Department of Veterans Affairs (VA) Builds a New EHR Ecosystem to Facilitate Innovation with External Agencies

The U.S....

Efficiency in Health Care: Does Anyone Know What It Is?

These slides are part of a Cyber Seminar on efficiency in health care addressing the overarching problem of quality and equitable allocation of services. 

Health Care For Our Neighbourhoods: Transforming Health and Hospitals in New York

The entire healthcare industry is in transition. Increasingly, healthcare systems are no longer being paid more to do more....

Reducing Unnecessary Red Blood Cell Transfusions in Hospitals

This toolkit was created to support the implementation of interventions designed to reduce unnecessary red blood cell (RBC) transfusions in your institution or hospital....

Appropriate Use of Urinary Catheters in Hospitals

This toolkit was created to support the implementation of interventions designed to reduce the use of unnecessary urinary catheters in your hospital....

How Can An Innovation Ecosystem be Developed and Sustained in Healthcare?

 Finding, Engaging & Collaborating with Potential Ecosystem PartnersA critical ingredient to the development of a succesful ecosystem is finding the right stakeholders....

What is Value Stream Mapping?

 What is Value-Stream Mapping?Value stream mapping is "a lean-management method for analyzing the current state and designing a future state for the series of events that take a product or servic...

How Do I Participate?

...

What is Colleaga?

Colleaga is a voluntary non-profit organization whose members share the common belief that when we join together, we are stronger and wiser and can achieve significantly greater impact.Reaching a...

Adherence to Clinical Practice Guidelines Improves Care for Patients at Ontario Shores

Ontario Shores Centre for Mental Health Sciences (Ontario Shores) is a public teaching hospital specializing in comprehensive mental health and addiction services for those with complex, serious and p...

What role does performance information play in securing improvement in healthcare? A conceptual framework for levers of change

Key Questions: What are the benefits to healthcare using performance information?Across healthcare systems, there is consensus on the need for independent and impartial assessment of performance....

Sharing Best Practices Through Online Communities of Practice: Global Alliance for Pre-Service Education (GAPS)

...

Boston Children's Hospital Reduces Stress with Mobile Navigation App 'MyWay'

Hospitals, by nature, can be a stressful environment for patients and their visitors....

CONNECT's Life Redesign Model™ - Client and Family Centred Care in Acquired Brain Injuries

Traumatic Brain Injury is the biggest disabler of Canadians under 45 years of age and an estimated 50,000 strokes occur in Canada each year with incidence rates on the rise in nearly every age group.&...

Understanding Emergency Department Wait Times

 Background on Emergency Department OvercrowdingOvercrowding occurs when service providers and processes function at a slower rate than the frequency of new patients arriving to the ED....

How Can a Population Health Approach be Used to Improve Outcomes & Lower Costs?

 IntroductionA population health approach is a useful strategy to aid health organizations in improving patient outcomes for specific groups (e.g., those with chronic conditions such as chronic o...

How Can Unnecessary Health Care Utilization be Eliminated?

 Identify and Utilize Evidence-based Best Practice Protocols and Guidelines for Diagnosis, Treatment and CareThere are a number of good sources for evidence-based recommendations that can be acce...

Chronic Disease is Healthcare’s Rising-Risk

Key Questions: What is value-based care?...

How Can You Improve Fiscal Efficiency in Healthcare?

 Common efforts to improve the financial health of hospitals may include reducing staff numbers and renegotiating contracts with suppliers, which may compromise the quality of care...

Lean Project Charter Template

The Project Charter is an official, basic document that outlines a process improvement project....

How Energy Efficiency Ensures Financial Health for Hospitals

Key Questions: How can hospitals gain energy efficiency to ensure financial health?This tool provides guidance on taking a proactive and integrated approach to energy management to achieve energy...

Effective Operating Room Inventory Management

Key Questions: What are the key factors in effective operating room inventory management? This tool is intended to provide perioperative nurses and other healthcare professionals with ways t...

5-Whys Guide & Template

The 5-Whys is a simple brainstorming tool that can help QI teams identify the root cause(s) of a problem....

Quality Improvement for Sustainability through Excellence Teams: Bellin Health System

When Bellin acquired 20 sites across Wisconsin in the late 90s, they struggled with physicians who were frustrated by the disjointed nature of the system....

Reduction in Gross Accounts Receivable at St. Mary's Duluth Clinic, MN

The St. Mary's/Duluth Clinic (SMDC) Health System serves a regional midwest of approximately 460,000 patients....

Emerging Idea: Automated Staffing & Scheduling Streamlines Workflow For Children's Hospital of Wisconsin

Children’s Hospital and Health System sought a more effective way to manage its staffing and scheduling processes....

The Case for Investing in Public Health

The economic crisis has led to increased demand and reduced resources for health sectors. The trend for increasing healthcare costs to individuals, the health sector and wider society is significant....

Introducing a Patient Flow Bundle to Improve Discharge at Ipswich Hospital

Across the UK there are wide variations in length of stay, even for patients with similar conditions....

Brigham and Women's Hospital Nursing Innovation Units Reduce LOS for Orthopedic Surgical Patients via Discharge Bundle

The Brigham and Women's Hospital Innovation Units were identified in September 2011. One of the innovation units’ areas of focus was improved discharge of the patient.

Lessons in Efficiency from Four Top Performing Hospitals

Problems that contribute to high costs and reduced quality are complex and intertwined with the organization and financing of health services....

High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care?

Finding ways to improve outcomes and reduce spending for patients with complex and costly care needs requires an understanding of their unique needs and characteristics. This brief examines healt...

Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences

Achieving a high-performing health system will require improving outcomes and reducing costs for high-need, high-cost patients—those who use the most health care services and account for a dispr...

Operating Room Utilization and Efficiency: A Study to Find Out Methods for Improvement

The operating room (OR) is a key department in any institution and it runs with heavy resources. Improper running carries not only loss of revenue but it also affects patient care....

Designing an Efficient Hospital Porter System

This paper describes 10 steps necessary to develop a centralized managed porter system. These steps are the outcome of a comparative study of porter operations at two Vancouver area hospitals....

Ontario Hospital Performance: Comparing Ontario Community Hospitals with Community Hospitals in Other Provinces

This report presents a comparison of the clinical and operational efficiency of major community hospitals in Ontario with those in other Canadian provinces....

Discharge Information Use Case

There is significant inconsistency in the timing and content of the discharge information that is sent to primary care providers (PCPs) from hospitals....

Making Open Innovation Ecosystems Work: Case Studies in Healthcare

In the midst of tightening budgets, many government agencies are being asked to deliver innovative solutions to operational and strategic problems....

Visual Assessment of Cleanliness

Visual assessment is only one of a number of methods available to assess the efficacy of cleaning. Visual assessment is most applicable to the monitoring of ‘Hotel Clean’ procedures....

Emerging Idea: Expanding Paramedicine in the Community (EPIC) Pilot Designed to Reduce ED Visits

Pressures on emergency departments globaly are increasing due to factors such as population aging and chronic disease and comorbidity....

North York General Hospital Awarded Prestigious IT Award for EHR Success with eCare

North York General Hospital (NYGH) paired with the healthcare technology company Cerner in 2007 to integrate an effective EHR system into their healthcare delivery model....

Defining Standardization in Healthcare

Standardization is a hot topic in today’s healthcare industry....

The Model for Improvement

The Model for Improvement is a simple yet powerful tool for accelerating improvement....

Effectiveness and Efficiency: Lessons for Building and Managing a Culture of Performance

Performance management is a critical tool for agencies striving to improve performance, get the most out of every dollar, increase efficiency, reduce unnecessary costs, and size programs to meet ...

Telehomecare in Ontario Improves Chronic Disease Management

Chronic diseases are a major cause of death and disability worldwide....

Improving Access to Medicines through Centralised Dispensing in the Western Cape Province, South Africa

Access to necessary medications is considered a crucial part of universal health coverage and an important part of the delivery of health services and care in South Africa....

Quality Improvement for General Practice

As GPs, we strive to deliver the highest quality of care to our patients. There is a pressing need to harness this aim with ‘evidence-informed’ quality improvement (QI)....

Health Care Systems: Efficiency & Institutions

This paper presents a set of indicators to assess health care system performance. It also presents new comparative data on health care policies and institutions for OECD countries. 

Policy Framework for Effective and Efficient Financial Regulation

The Policy Framework is a tool that can support ongoing efforts by policymakers, regulators, and supervisors to achieve stronger, more resilient financial systems.

Jidoka

Jidoka is the often forgotten pillar of the Toyota Production system and lean manufacturing yet it is one of the most important principles of lean that can help you achieve true excellence....

Planning and Running Kaizen Events

Kaizen events are short duration improvement projects with a specific aim for improvement; typically they are week long events led by a facilitator with the implementation team being predominantly mem...

Expenditure Rules: Effective Tools for Sound Fiscal Policy?

This paper provides new evidence on the effectiveness of expenditure rules....

Additional Revenue Generated through Home Care Plan Oversight

MercyCare Community Physicians' in Arizona re-evaluated their billing process to achieve a better understanding of the requirements for submitting against the codes for care plan oversight as well...

Becoming a Preferred Partner to Facilitate Better Health Outcomes

Mount Sinai Hospital is a world-class academic health centre with an outstanding reputation for excellent clinical services and advanced research....

Critical Care, Critical Choices: The Case for Tele-ICUs in Intensive Care

If tele-ICU systems were broadly and effectively implemented in Massachusetts, it is conservatively calculated that more than 350 additional lives could be saved each year, the hospitals would benefit...

Looking to the Future: Canada's Innovation Ecosystem

Canada’s innovation ecosystem is at an important point in its evolution....

The Business Case for the Efficiency and Effectiveness of Tele-Intensive Care Units

A tele-Intensive Care Unit (tele-ICU) is the use of telemedicine in an Intensive Care Unit (ICU) setting, using technology to provide care to critically ill patients by off-site clinical resources....

Guidelines for TeleICU Operations

The following teleICU guidelines were developed to assist practitioners in providing assessment, medical intervention, continuous monitoring and/or consultation to the critical care population using t...

TeleICU saves California hospital thousands, improves patient satisfaction

Dignity Health Woodland Memorial Hospital, a 108-bed community medical center in California, originally had one intensivist to cover eight beds in the ICU....

Failure Mode Effects Analysis (FMEA)

Originally from the US military in the 1940s FMEA is a step-by-step approach for identifying all possible failures in a design, a manufacturing or assembly process, or a product or service.

High Users of Health Care Bibliography

This resource, a comprehensive bibliography, has been produced for practitioners, researchers and others interested in the issue of frequent users of health care....

Reducing Unnecessary Visits and Investigations in Pre-operative Clinics

...

Starter Kit for the Choosing Wisely Campaign

This guide is intended to provide basic information and tools to help you start your Choosing Wisely campaign....