Eliminating, consolidating forms save $750,000
Key was establishing benchmark following merger
What do you get when you merge 12 hospitals, six nursing homes, and multiple independent living sites and ambulatory care centers?
About 20,000 forms, says a performance improvement team at BJC Health System, an integrated health care delivery system in St. Louis.
"Each facility had its own set of forms as well as different suppliers, delivery, and warehouses to produce them," Larry Messmer, printing/copy coordinator. With the 1993 merger, some departments (and their need for forms) were being diverted to other locations, while others were expanding and needed new forms.
"We wanted to bring some sanity and savings to the situation by eliminating duplication and promoting standardization," Messmer says.
Here’s how the health care system not only saved $749,378 by establishing a benchmark of 1,936 essential documents but curtailed future proliferation by establishing a gatekeeper team.
"We didn’t want to be in the forms business anymore, so we knew that outsourcing to a common vendor would save us money immediately," says Jim Francis, BJC’s vice president for materiel services. "Yet we also wanted a long-term strategy that would enable us to redesign our operation for future efficiency and effectiveness. We wanted to establish aggressive goals, set annual maximum costs as well as a achieve a guaranteed savings."
This type of risk sharing agreement, however, would require a vendor "committed to a long-term process as well as one that could actively participate in the redesign," says Messmer. "It wasn’t business as usual." However, partnering with a vendor would supply expert knowledge on best practices gleaned from clients nationwide.
Of the 10 vendors that were sent a request for a proposal, four made presentations to the BJC performance improvement team, which consisted of materials and print shop managers.
Partner with dedicated supplier
"We knew that this would take time and that the vendor would be an active member of our team so we wanted to select a company that shared our direction and initiative," Messmer says. The team selected Standard Register of St. Louis because it "understood the health care industry and was large enough to meet our needs and grow with us."
"It wasn’t a matter of just filling their orders at a better price," explains Mark R. Augustine, project manager, health care group systems at Standard Register. Because health care is changing so fast, documents also change quickly, he explains. "So the old bid-and-buy system doesn’t work anymore. You have to focus on the bottom line, and in order to do that you must establish quantifiable benchmarks. And for that you need information."
So Standard Register representatives, now a part of BJC’s performance improvement team, issued their own tall order: Identify every form in use at the health care system.
"We sent out a survey to materiel managers at all the facilities in the form of a spread sheet," Augustine says. "We also asked them to attach three sample copies of each form."
The categories on the spreadsheet included the following:
• form name;
• form number;
• where printed (O for outside, P for print shop);
• unit of measure (pad, pack, or carton);
• quantity per unit;
• cost per unit;
• monthly usage.
If a manager didn’t have time to respond, Standard Register team members went to the site to collect the samples and the information. "This wasn’t perceived as being invasive because we were team members," Augustine says. "From the beginning, there was an open and accurate exchange of information prices, invoices, reports that we needed in order to make this happen."
After the team developed a "catalog" of all existing forms used in the system, they began the process of elimination with the obvious criteria: obsolete forms. They looked for forms with old logos, forms for which the application didn’t exist anymore, pre-printed stationery that belonged to a person who didn’t work there anymore.
The second phase of the elimination process was to audit the standing inventory. This stage was not about questioning the form itself, but about how it got in the system. The team looked at who authorized the forms, and at what price and quantity by examining purchase orders, requisitions, and invoices. It then challenged every item that did not have the proper authorization.
The next round involved getting rid of stockpiled forms that were out of date. The old way of doing business was for vendors to give a customer a price break on quantity, but the team found that the bulk of forms purchased were never used, just warehoused.
Develop strategy for cuts
With the fourth and final cut came the really tough decisions that called for cooperation across many different departments. Once the team had identified a viable group of forms, it was finally at the point it could begin standardizing forms and, in many cases, their application.
To make this process easier, the team developed a targeting strategy based on the four ways in which a form could be used:
1. Nonclinical, nonsystem-specific.
This was the easiest group to tackle first. For example, each human resource department had its own requests for vacation, its own employment application, etc. So the team just went down the line and standardized every human resource form across the entire system.
The team also standardized forms in all other administrative departments, such as return goods notice in purchasing, request for check in finance, and request for clarification in accounts payable. They also developed stationery, letterhead, envelopes, and business cards. Only seven executives at vice president status and above got their own personalized stationery, which wiped out huge numbers of forms.
2. Clinical, nonsystem-specific.
Next, the team standardized forms that weren’t dependent on a computer program or specific clinical requirements, yet were used by clinicians to document services for payer purposes.
3. Nonclinical, system-specific.
The third step was to work with re-engineering teams key employees from nursing, laboratory, pharmacy, and human resources to standardized forms that were specific to certain systems but used different software. "BJC had many incompatible systems," Augustine explains. "By serving on each re-engineering team, we could help them understand ramifications of their choice of software packages, and therefore forms."
About 1,900 of these most-used forms survived these rounds of cuts. "We used this number to determine our baseline for the number of forms and dollars to be spent for 1996," says Augustine. "However this benchmark is not static and must be reexamined each year."
It took the improvement team more than two years to get to this point but the effort has more than paid for itself in the nearly three-quarters of a million dollars saved in eliminating duplicate forms. Plus, the new five-year contract with Standard Register calls for even more savings: a 50% reduction in the total number of most-used forms in the first year, plus a 20% reduction of costs in the first year, an additional 5% in the second and third year, and to hold costs steady in the last two years.
Automation is important to continue the savings. For example, clinics now use less paper when registering patients by typing patient information into computer templates that are reproduced on a laser printer as needed. BJC has converted 295 of the 1,900 forms to print-on-demand forms, which has saved $107,779.
But once the paper chase is tamed, it isn’t over. "You have to fight proliferation, or you won’t meet your goals," Messmer warns.
So, at BJC a "gatekeeper" team, consisting of Messmer and Standard Register sales representatives, stand watch over who orders or reorders what type of form. An order notice requires the person requesting a form to examine not only its specifications, but the amount on hand, as well as any upcoming changes that may affect it. (See copy of reorder notice, inserted in this issue.)
"Nothing is ordered automatically anymore," Messmer says. "We have to challenge every piece of paper." So while the 1,900-form benchmark was good for this year, it will be re-examined annually with the aim to lower that number even further.
[Editor’s note: For more information, contact Larry Messmer, BJC Health System, St. Louis. Telephone: (314) 454-5125. Or contact Mark Augustine, Standard Register, 12101 Woodcrest Executive Dr., Suite 310, St. Louis, MO 63141. Telephone: (314) 434-9440.]
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