Increasing Profitability for a 104 Rehab Hospital Group


The client’s 104 rehabilitation hospitals were acquired over several years from many different organizations. The hospitals were well regarded professionally and had excellent physical plants and medical facilities. Accreditation scores were high, and the medical staffs were proud to work in a high performing environment.

Within hospitals, significant variations in non-clinical work practices were noted among departments and among shifts. No effective supervisory coaching was done, and the few training sessions were classroom-based. Individual departments and supervisors within departments varied in their documentation of processes and their productivity.

Coordination of training among hospitals was done informally and based on personal relationships.


Patients came to client facilities based on recommendations from orthopedists and their nursing staff.  Relationships with the staff were not refreshed with regularity.  Prescribing physicians and nurses forgot to recommend patients to client facilities.

Accounting and related clerical personnel positions were poorly defined and supervised. Some competent processes were not uniformly followed.

In observing and documenting accounting procedures, the improvement teams noted that certifications and recertifications with patient insurers were not performed on a timely basis. As a direct result, payments from insurers were delayed or denied.

Cafeteria discounts to customers were poorly rationalized and controlled.


A phased approach was used with the project starting in a single region. Best practices were developed and then implemented. The process was then repeated in a second region with some revisions to previously determined best practices. The process was then repeated across the remaining regions.

All work was done using teams led by and consisting mostly of client employees. Consultants added project management skills and expertise in developing analytics as needed.

All teams reported progress weekly in developing process improvements and associated tools. Operational teams consisted of management, individual performers, and consultants from the areas within scope. They mapped current processes and weaknesses. Process improvements were identified and implemented with no change to IT systems. Team members led training and on the floor, coaching of supervisors and key personnel.

Operational teams were supported by Staff Teams for topics including organizational communication, change management, training materials, and metrics.


Weekly metrics maintained by client finance group used to identify progress and savings objectively. Operational and financial metrics were reviewed weekly by operational management and biweekly by the executive team.

The multi-million dollar annual savings goal was achieved. The project achieved its payback rate of three to one.