Vicky Hines used strategic relationships to improve the quality and efficiency of this home care agency.

Vicky Hines, president and CEO of New York-based Visiting Nurse Service of Rochester, believes collaboration is key. And, in the past three years, she has proved her point.

Vicky Hines, President and CEO

Commitment to quality
The VNS umbrella includes standard home care services, such as a Medicare and Medicaid certified agency, and Visiting Nurse Signature Care, the private pay and licensed arm of the organization. VNS also offers a Meals on Wheels program that delivers roughly 300,000 meals a year and a long-term home healthcare program Hines refers to as a nursing home without walls.

With that diversity comes great responsibility, which is why in 2005 VNS voluntarily joined New York’s ReACH program. “We were one of 15 agencies in the state to participate to reduce avoidable hospitalization, which is a primary indicator of quality in a home care agency,” Hines said. “You want your patients to stay healthy at home and not return to the hospital.”

Three years later, VNS is number one in New York for relative improvement. In July 2004, the organization’s baseline hospitalization rate was 23.4%. As of March 2007, it was 18.7%—much lower than the state’s 40.1% average, a 28.6% national average, and the 31.2% average of other New York home health agencies participating in the project.

Hines attributes much of her organization’s success to her staff’s preexisting commitment to quality. “If your organization doesn’t have a culture focused on continuous improvement, it takes much longer to achieve results,” she said.

Care providers, front-line staff, and the quality management team at VNS developed a high-risk EMR screening tool to identify patients who may need more attention during their first weeks in home care. The team then developed a high-risk protocol to follow patients after the initial admission, including more visits during the first week, more frequent nurse phone calls, and emergency plans developed with and fully explained to the patients and their families. Our emergency plans are on the ReACH Web site, and we’ve been featured twice as a Web presenter,” Hines said. “Getting families to understand we’re only a phone call away and available 24/7 greatly increases the number of times we’re called before 911.”

Lean processes
At the same time, VNS began a company-wide performance improvement initiative. As the reimbursement structure for home care changes, primarily from Medicare and Medicaid moving patients to private managed care plans, Hines realized she needed to figure out how to make home care cost less. “About 60% of our admissions are managed care rather than traditional Medicare and Medicaid,” she explained. “The national percentage is closer to 16%, which means we have a higher percentage of discounted fee-for-service reimbursements.”

Hines found her solution in three local partners, the first of which was the United Way. United Way funds industry leaders to train not-for-profits on how to use Six Sigma and lean performance techniques, and in 2005 VNS was one of the first to sign up. Hines then partnered with Kodak.

For no charge, two of Kodak’s Six Sigma facilitators ran a performance improvement project that ended up saving VNS $250,000. “For our first project, we focused on our referral-to-admission process because it was so complex. We changed our skill mix, right-sized our RN staff, and hired certified coders. It reduced the amount of time our RNs spend on the process, which made them more satisfied with their jobs, and it saved our organization quite a bit of money,” she explained.

Hines then partnered with Xerox to continue Six Sigma and lean training. In the past three years, VNS has completed at least seven performance improvement initiatives, engaging its staff in improving the quality of care delivered. “We have a portfolio of performance improvement projects we adopt at the beginning of each year and complete at the end,” Hines said. “You can’t improve performance only at the top. It must be done throughout the organization.”

Care from all ends
The Six Sigma expertise developed at VNS has done more than improve the quality of care provided to patients. It has also enabled Hines to strengthen the relationship her organization has with its owner, the University of Rochester.

As the performance improvement projects began showing results, Hines realized it was a perfect opportunity to add value to the organization’s partnership with the university. “We’re in the midst of a cross-system performance project to improve patient flow, which includes getting them in and out of UR’s nursing homes and getting them out of nursing homes and into home care,” she said. “The affiliation also gives us access to expertise we might otherwise not be able to afford.”

As she looks to the future of VNS, Hines sees the challenges incumbent with an aging population, including a higher percentage of chronic illnesses and a stronger desire to stay home. However, she knows her organization’s front-end focus ensures its success in handling whatever may come. “We’re constantly working on the front end to keep people healthy rather than on the back end to address problems when they happen. We’re prepared to handle the back end, but our focus will continue to be on the front.”