Implementing Process Improvement In Healthcare By Gagan Rajpal With Craig A. Stevens PMI Nashville...

Implementing Process Improvement In Healthcare

By Gagan Rajpal With Craig A. Stevens

PMI Nashville Symposium 2013

1gaganrajpal1@gmail.com

craigastevens@westbrookstevens.com

Creating a Team Focused Improvement Program

Agenda

Goals/Objectives

General PI Processes

4 Process Analysis

Value Chain Analysis

Layout Analysis and Spaghetti Diagrams

8 Summary of PI Program Approach

This is an example text. Go ahead and replace it3 PI Assessment and Performance Measures

• Process Improvement is all about implementing changes; many times these are small, requiring no project management. However, other improvements require major changes that become projects. The biggest problem with many of the process improvement programs is that you have to have a degree in statistics or engineering to understand them. However, it does not have to be that way. During this presentation, we will apply a simple three-phase Process Improvement process using PM, LEAN, Six Sigma, and TQM approaches to real Healthcare examples as applied by University of Tennessee’s Industrial and Systems Engineering Department.

Implementing Process Improvement In Healthcare

1/7/2013 3

• Reinforce the Simple Three Phases• To Show Some Examples of Process Improvement

using Healthcare

Goals and Objectives This Presentation Improvement Focused Teams

Agenda

Goals/Objectives

4 Process Analysis

Three Easy to Understand and Use Improvement Phases

A = Assessments

P = Problem Solving

I = ImplementationUsing Project Management Tools/Support

Westbrook Stevens, Seven Attributes of Excellent Management Model, 1990 ©

People and

Team Building

7From Book Geronimo Stone http://www.llumina.com/store/geronimostone2.htm

Step 1 –Build the Assessment Candidate Portfolio

Example

Hospital Service

Doctor’s Office/

Department

PatientAdmissions

Life cycle of a patient needing services at East Tennessee Children Hospital

Incoming Patients

Resource Allocation

gaganrajpal1@gmail.com

Step 2 –Assessment Phase

A = Assessments

P = Problem Solving

Agenda

Goals/Objectives

4 Process Analysis

Hospital Service

Doctor’s Office/

Department

PatientAdmissions

Incoming Patients

PART I : Incoming PatientsApplicable Lean Principle : Consistent incoming patient flow

Incoming patient flow and trend

Hospital Service

Doctor’s Office/

Department

PatientAdmissions

Incoming Patients

PART I : Incoming PatientsApplicable Lean Principle : Consistent incoming patient flow

Incoming patient flow and trend

Number of patients in year 2007 & 2010 are extrapolated

Is there any “trend” in number incoming patients over the years?

Is there any “trend” in “number” of incoming patients within an year?

Is there any “trend” in “type” of incoming patients within an year?

Is there any “trend” in “number” incoming patients within a week?

Is there any “trend” in “type” of incoming patients within a week?

Is there any “trend” in “number & type” of incoming patients within a day?

Agenda

Goals/Objectives

4 Process Analysis

3 PI Assessment and Performance Measures

Hospital Service

Doctor’s Office/

Department

PatientAdmissions

Incoming Patients

Is staffing logistics appropriate?

Is patient registration a smooth process?

Current layout

PART II : Patient AdmissionApplicable Lean Principle : Efficient, effective and reliable admissions process

Hospital Service

Doctor’s Office/

Department

PatientAdmissions

Incoming Patients

Current layout

PART II : Patient AdmissionApplicable Lean Principle : Efficient, effective and reliable admissions process

A = Assessments

P = Problem Solving

3-4 registrations/ hr

Temporary solution will be to move one of the evening personnel to the peak hours

Doctor’s Office

PatientRegistration

Pre-Cert # Order

Patients Name

Date of birth

Diagnosis

Tests to be done

Doctor’s Sign

Legal guardianship

House Address

Rarely on Order Bad Faxes

No signature

Legal guardianship paper

No diagnosis on orderNot having insurance card

No Order

Grand parents or Neighbors

Step parents

Interpreter

Admissions

Doctor’s Office/Department

Parents

Is patient registration a smooth process? (Continued)

Step 3 – Build the Problem Solving Portfolio

A = Assessments

P = Problem Solving

Recommendations Pre-screening orders and have more proactive approach

Creating a Kanban system for orders that need attention

Having Pre-cert # already on the order

Having a “complete” & “readable” order Better fax machines “Standard format” for orders

(Website access to input patient data)• No need for faxes• Direct upload onto the database• Can be easily read • Time & Money saved

Pre-registration on phone

In case of surgery, doctor could send order directly to surgery

In case of standing order, direct admitgaganrajpal1@gmail.com

Agenda

Goals/Objectives

4 Process Analysis

The current layout

1.4 Miles/ shift gaganrajpal1@gmail.com

Recommendations

Change the current layout

Apply principles 5 S in patient admissions office

Sort (Seiri), Straighten (Seiton), Shine (Seiso), Standardize (Seiketsu) and Sustain (Shitsuke)

Step 6 – Select the Solutions and Build a Project Portfolio

A = Assessments

P = Problem Solving

GFRGFR

The “current” layout

Front Desk

Call Center

Fax Room

Marty’s Office

The “new” layout

The Achievable Target

5-6 registrations/ hr

Agenda

Goals/Objectives

4 Process Analysis

Hospital Service

Doctor’s Office/

Department

PatientAdmissions

Incoming Patients

Resource Allocation

PART III : After Admission

Patient flow

Alignment between admissions & services provided

Lean Principle Applicable : Customer satisfaction due to the reduction in wait time via Just In Time system/ pull system

Hospital Service

Doctor’s Office/

Department

PatientAdmissions

Incoming Patients

Resource Allocation

PART III : After Admission

Patient flow

Alignment between admissions & services provided

Lean Principle Applicable : Customer satisfaction due to the reduction in wait time via Just In Time system/ pull system

A = Assessments

P = Problem Solving

Focus Areas

Value added Vs Non-value added time

• Patient registration• Explaining the

procedure• Taking history• Actual procedure

• Redundancy • Waiting• Walking/

transportation• Excessive processing• Errors

Lab.igx

(7 minutes)

0.5 minutes

8.5 minutes 3 minutes (10 minutes) (2 minutes)

Lead Time = 31 minutes

VA / T = 19 minutes

WIP = 31 minutes

Admissions Of f ice

Value Add: 7 minutesTransport Time: 0.5 minutes

Lab Waiting Room

NVA = 8.5 minutes

Lab Room # 3

NVA = 3 minutes

Rest Room

Value Add: 10 minutes

Lab Room # 3

LABValue Stream MapDate: 05/21/10Author: Gagan Rajpal

Doctor's Of f ce

Current state

38.7 % Non-value added time

Current stateWrist X-Ray .igx

180 seconds

300 seconds

60 seconds 120 seconds 30 seconds

60 seconds

150 seconds 300 seconds Lead Time = 1200 seconds

VA / T = 360 seconds

WIP = 570 seconds

3 minutes

Admissions Of f ice

Value Add: 5 minutesDef ect = 25%

Distance Trav eled: 600 f t.Transport Time: 1 minutes

X-Ray Waiting Room

NVA = 2 minutes

Transport Time: 30 seconds

X-Ray Room # 3

Value Add: 1 minutes NVA = 2.5 minutes

X-Ray Waiting Room

NVA = 5 minutes

SchedulingRadiology

Wrist X-Ray Value Stream MapDate: 05/21/10Author: Gagan Rajpal

70 % Non-value added time

Current state – OPS Ear Tube

Lead time: 233 minVA/ T: 85.3 minWIP: 168 min

Neuro-EEG.igx

Neuro Room # 2

NVA = 5 minutes

5.5 minutes

0.5 minutes 29 minutes 0.667 minutes 10.5 minutes

31 minutes

5 minutes Lead Time = 82.2 minutes

VA / T = 36.5 minutes

WIP = 77.2 minutes

Admissions Office

Value Add: 5.5 minutes Transport Time: 0.5 minutes

Neuro Waiting Room

NVA = 29 minutes Transport Time: 40 seconds

Neuro Room # 2

NVA = 10.5 minutes

Neuro Room # 2

Neuro Scheduling

Neuro - EEGValue Stream MapDate: 05/21/10Author: Gagan Rajpal

Current state

Neuc Med.igx

Check in

Value Add: 5 minutesDefect = 25%2 Shifts

SchedulingRadiology

(5 minutes)

1.5 minutes

2.5 minutes

1 minutes 75 minutes (65 minutes)

47 minutes (1 minutes)

Lead Time = 133 minutes

VA / T = 71 minutes

In-plant Time = 131 minutes

Transport Time = 150 seconds

Control

Information

Radiology

NVA = 2.5 minutes

Distance Traveled: 1200 ft.Transport Time: 1.5 minutes

Consolidate Check in process

Distance Traveled: 600 ft.Transport Time: 1 minutes

Value Add: 65 minutesNVA = 10 minutes

47 minutes

Final Scan

Control

Information

Milk Scan Process Value Stream MapDate: 05/19/10Author: Gagan Rajpal

Information

Current state

Redundancy in paper work

Waiting for technician

Waiting for room

Same questions asked by several personnel

Orders lost

Delay in bringing patients from the floorlack of transportertechnician being busy with other patientssometimes lack of technicians

Types of waste

Current state – OPS Ear Tube

4th Floor 6th Floor

Agenda

Goals/Objectives

4 Process Analysis

Hospital Service

Doctor’s Office/

Department

PatientAdmissions

Incoming Patients

Resource Allocation

PART IV : Resource allocation model

Hospital Service

Doctor’s Office/

Department

PatientAdmissions

Incoming Patients

Resource Allocation

PART IV : Resource allocation model

Step 3 – Build the Problem Solving Portfolio

A = Assessments

P = Problem Solving

1. To increase service/ patient satisfaction2. To minimize cost

Depends on-- Number of people- Time/ Schedule of different departments

Allocation of resources to patient admissions

- Department

- Doctor

Patient- Time- Schedule

Admissions to the entrance of the service

Service- Time- Quality

Patient

Supplier Input Process Output Customer

Logic : Ability to provide resources to serve the customerResources are provided in the process, therefore, they should dictate the schedule

Our approach

• Insurance• Order• Relation to Patient• Social Security #• Address• Doctor’s name

• Service Required• Availability of service• # of patients in queue

for service• Avg. time required for

service

Admissions

Pulmonary

Neurology

Surgery

Type - 1

Type - 2

Type - 3

Type - 4

Type - n

PatientQA

Output = Min: ∑ QA + QS1 + QS11 --------------

Output

1. To increase service/ patient satisfaction2. To minimize cost

Depends on-- Number of people- Time/ Schedule of different departments

Allocation of resources to patient admissions

- Department

- Doctor

Patient- Time- Schedule

Admissions to the entrance of the service

Service- Time- Quality

Patient

Supplier Input Process Output Customer

Logic : Ability to provide resources to serve the customerResources are provided in the process, therefore, they should dictate the schedule

Our approach

• Insurance• Order• Relation to Patient• Social Security #• Address• Doctor’s name

• Service Required• Availability of

service• # of patients in

queue for service• Avg. time required

for service

Admissions

Pulmonary

Neurology

Surgery

Type - 1

Type - 2

Type - 3

Type - 4

Type - n

PatientQA

Output = Min: ∑ QA + QS1 + QS11 --------------

Output

Agenda

Goals/Objectives

4 Process Analysis

Implementing Process Improvement In Healthcare By Gagan Rajpal With Craig A. Stevens PMI Nashville...

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