Case Study: Complex Problem Solving in Neurological Health Care

Problem: 500 bed hospital encountered high levels of inpatient bed utilization with their neurological and neurobehavioral patients.

Overview: NNH, LLC worked with senior managers to use LSS DMAIC approach to approach the problem.



Hospital and NNH consultants defined two goals:

1. Improve patient discharge process without adding to patient dissatisfaction or risk.

2. Reduce costs and improve overall financial performance of the service line.

Step 2:

Neural Network Health managers reviewed flows and discharge statistics in several areas, using flow chart analysis to evaluate discharged patient profiles. Patient data was collected, which included qualitative research regarding customer satisfaction with in-place processes.

Step 3:

The team analyzed the percentage of discharges and times at which those discharges occurred. Teams were divided to address four (4) different issues or problems, which were: triage, fast track, time to diagnosis and time to discharge.

The team utilized several change management initiatives including: engagement of hospitalists to expedite the discharge process, improvement of time to diagnostic test result acquisition, ED control of bed overflow and improvement in discharge processes, to include a distinct neurological care plan enactment.

Step 4

Quality metric changes were tracked over a 6-month time period.  Quality metrics were tracked across pertinent business units based on teams, which included business unit administrators, physicians, physician trainees, nurses, clinical pharmacy technicians and hospital case managers.



  1. ED length of stay decreased by 40%,
  2. Direct admission to floor decreased by 100%,
  3. ED department load reduced by 15%,
  4. Provider hours of work per patient decreased by 20%
  5. Patient “left -with-out-treatment-plan” went from 7% to less than 1%.
  6. The ratio of cost unit of care per resources dedicated to  neurological and neurobehavioral patients was slashed by 1/3.
  7. Cost savings over a 6-month period extrapolated to an equivalent two $1 million cost savings over two years.


  • Analysis and intervention systems were successfully implemented to identify key factors that hindered neurological patient flow-through.
  • Actionable processes were successfully deployed to reduce time delays and hospital care costs.