Lean Incontinence Care

The June issue of Provider has an interesting article entitled, “How to do it…Incontinence Management.”  In the upper right hand corner there was a highlighted quote that summarized the essence of this article:  “As far as costs are concerned, there are undoubtedly many exotic and expensive therapies available for incontinence, but the best treatment is simply to pay attention.”  This statement can be viewed as a foundation for Lean Thinking, an approach to management that is essential given the realities of reimbursement, regulations and the growing consumer awareness.

                Over the last few months, this blog has focused on Lean Thinking.  Lean Thinking is based on concept of maximizing consumer value while minimizing waste.  This approach requires organizations to create products/services that maximize customer value with fewer resources.  Lean Thinking was developed and is used in manufacturing and there are still many who believe it only works in manufacturing.  Lean Thinking works in any organization that has process and system including long term care.  It can be effective because Lean Thinking is a mindset and a culture that can lead to quality outcomes and efficiencies that reduce the cost of operation.  This relatively simple description is not so easy to implement since it is based upon the organization’s mindset and culture. However, the impact of this approach can be enormous.  We can see the power of Lean Thinking when we look at Incontinence Care.

                A Lean Thinking approach to Incontinence Care would begin with a culture that promotes incontinence, as stated in the Provider article.  What better way to maximize customer value! Residents hate incontinence briefs and families/visitors loathe the smell of urine (there is no better way to change the public’s negative view of nursing homes then to minimize diapers and eliminate the smell of urine)!  Consider the waste and cost implications of an environment that is committed to continence.  The best incontinence briefs, when used properly, are still a significant cost.  Some of the best facilities are able to minimize this cost (less than $1.00 per patient per day).  These are facilities that make sure that their residents who are incontinent are in the proper sized brief and are being changed as specified by the manufacturer (no longer six (6) times a day, now under four (4) times a day).  However, these facilities could reduce this expense further if they had a mindset/culture of continence.  A $.25 per patient per day reduction in incontinence brief expenses for a 200 bed nursing home is $18,250 reduction in this supply expense on an annual basis.      There are many facilities that are spending more than $1.50 per patient per day on incontinence briefs.  There are several reasons, which can be summarized by the article’s main point – paying attention. 

Waste occurs because facilities are not paying attention to the proper sized brief for their residents.  Too many staff members think that a bigger diaper is better for their residents.  The new incontinence brief technology does not work that way; proper fit is crucial.  If the brief is too big, the resident is not kept dry.  As a result, staff members use too many improperly sized briefs in their attempt to keep their resident dry.  Not only are the costs of the briefs higher than they should be, but other related supply costs are higher too as wounds become a clinical problem.  As a result a facility may end up with several problems:  supply expenses for incontinence and wounds are higher than they should be, the facility has negative clinical outcomes that are evident in the Nursing Home Compare Portal and the Annual State Survey, and the facility has a distinct urine aroma.  These are avoidable problems and Caretech can assist a facility eliminate them and/or prevent them.

Caretech can help a facility monitor and control the use of supplies.  In this case, Caretech can pay attention for the facility, assuring that the right incontinence brief is being used.  Since Caretech is well aware that a facility’s resident population is dynamic, it can assure that the proper sizing changes along with the population.  This action will help control and reduce the cost of incontinence supplies, thereby eliminating waste.  With Caretech monitoring this facet of the operations, the nursing home staff can focus on changing the mindset/culture of the organization to one that is committed to continence and more globally, creating a mindset/culture that is committed to creating value for our residents and eliminating waste.

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