Capital HealthMedical Outpatient Unit

April 12th 2007Final Presentation

Kyle Brown

Hillary Higgins

Justin Lang

OutlineOutline

1. OverviewMOUThe Problem

2. Methodology3. Analysis and

ApplicationAcademic ResearchSurvey ResultsSimulationDesign Layout

4. ST RecommendationsImplementations

5. LT RecommendationsImplementations

6. Implementation Steps

OverviewOverview

Overview Methodology Analysis and Application Short-Term Long-Term Steps

PROBLEM: Increased demand Poor facility Inadequate layout design Nature of treatments procedures

Scheduling“The MOU needs a more effective layout,

and better utilization of resources”

OverviewOverview

Overview Methodology Analysis and Application Short-Term Long-Term Steps

MethodologyMethodology

Overview Methodology Analysis and Application Short-Term Long-Term Steps

From Understanding to Insight Extensive time in the MOU Surveys Academic research Layout measurements (AutoCAD)

Hospital investigation Staff presentation & feedback

Analysis and Application

Analysis and Application

Overview Methodology Analysis and Application Short-Term Long-Term Steps

ACADEMIC RESEARCH Focus on patient experience Reducing perceived procedure times

- Low cost, high benefit solutions

Layout Design- Focus on decreasing clutter and improving work-flow

Analysis and Application

Analysis and Application

Overview Methodology Analysis and Application Short-Term Long-Term Steps

ACADEMIC RESEARCH Specific Techniques- Told wait times, procedure/treatment durations- Distractions: posters, TV’s, soft music, portable DVD’s, library collection

Analysis and Application

Analysis and Application

Overview Methodology Analysis and Application Short-Term Long-Term Steps

SURVEY RESULTS (Staff) Increased safety for staff and patients

- Reduce clutter- Better organization

Improve the working environment - Need more suitable area for charting and medication mixing

- Need increased privacy for patients

Analysis and Application

Analysis and Application

Overview Methodology Analysis and Application Short-Term Long-Term Steps

SURVEY RESULTS (Patients) Need better scheduling system for advance booking and appointment changes

Need better privacy Need more information on wait time and duration of appointment

Would like more entertainment while waiting

Analysis and Application

Analysis and Application

Overview Methodology Analysis and Application Short-Term Long-Term Steps

SURVEY RESULTS (Doctors) Long wait time to get patients in for treatment (1 month)

- Checking Out-patients in as In-patients

Desire a private medical assessment area

Analysis and Application

Analysis and Application

Overview Methodology Analysis and Application Short-Term Long-Term Steps

SURVEY RESULTS (Overall) Top Priorities

- Improve safety in the MOU- Improve organization of the layout and organization of work space

- Need more capacity for procedures

- More space allocated to the MOU- Enhanced privacy for assessments and for procedures

Analysis and Application

Analysis and Application

Overview Methodology Analysis and Application Short-Term Long-Term Steps

DESIGN LAYOUT Measured entire MOU

- As well as surrounding units

- Also measured all furniture and equipment

AutoCAD Model- To scale replica of the MOU- Permits experimentation with various layouts and designs

Analysis and Application

Analysis and Application

Overview Methodology Analysis and Application Short-Term Long-Term Steps

CAPACITY Issues

- Wide range on procedure times- No recorded patient out-times- Daily procedure hours difficult to calculate

- Undocumented patients

Electronic Scheduling System

- Would resolve many of these problems

Analysis and Application

Analysis and Application

Overview Methodology Analysis and Application Short-Term Long-Term Steps

CAPACITY Utilization Rates

- Minimum utilization rate: 26%Minimum daily procedure hours

16 hours of unrestricted capacity

- Maximum utilization rate: 74%Maximum daily procedure hours

10 hours of unrestricted capacityAdditional 30 hours of daily procedures(To account for undocumented patients)

Analysis and Application

Analysis and Application

Overview Methodology Analysis and Application Short-Term Long-Term Steps

CAPACITY Daily procedures

- Average week day procedures: 58- Minimum week day procedures: 41- Maximum week day procedures: 76- Does not account for undocumented visits

Analysis and Application

Analysis and Application

Overview Methodology Analysis and Application Short-Term Long-Term Steps

CAPACITY Seasonality

- Typical procedure hours on Monday: 120- Typical procedure hours on Wednesday: 150

Main have implications toward more efficient scheduling

- Both staff and patients

Analysis and Application

Analysis and Application

Overview Methodology Analysis and Application Short-Term Long-Term Steps

CAPACITY Seasonality Electronic Scheduling System

- Would resolve many of these problems

MOU Procedure Hours/ Day

0

20

40

60

80

100

120

140

160

180

Mon Tues Wed Thur Fri Sat Sun

DAY

HO

UR

S Min

Max

Avg

Short TermShort Term

Overview Methodology Analysis and Application Short-Term Long-Term Steps

RECOMMENDATIONS Assuming current facility layout…

Short term:- Safety- Clutter & Reorganization- Patient Wait Time- Patient Privacy

Short TermShort Term

Overview Methodology Analysis and Application Short-Term Long-Term Steps

IMPLEMENTATION Safety

- Centralized utility outlets - Hillrom

- Stools- Hand Sanitizers

Reorganization- Chemical mixing station

- Exchange large desks for shelves and charting tables

Short TermShort Term

Overview Methodology Analysis and Application Short-Term Long-Term Steps

IMPLEMENTATION Reduce Perceived Wait

- Patient told wait and appointment duration

- Wall posters- DVD personal players and library

- Book library- TV suspensions- Soft music and personal lighting

Patient Privacy- Isolation room for assessments

RECOMMENDATIONS Layout Design

- 2 possibilities

Scheduling- Increase capacity- Better patient care (pre MOU)

- Increased morale

Long TermLong Term

Overview Methodology Analysis and Application Short-Term Long-Term Steps

Long TermLong Term

Overview Methodology Analysis and Application Short-Term Long-Term Steps

ROOM NEGOTIATION:Advantages Disadvantages

Book multiple appointments in the future Staff training

Schedule updating Adapting to the new system

Rolling cancellation lists Price

Appointment history

Links to Capital Health patient information

Identify medication requirements

Assign staff to patients

Assign treatments; given doctor availability

Report generation and statistics

Technical training and helpdesk support

X-Ray Room ETU RoomAdditional Capacity

- 3 Chairs - 4 Chairs- 2 Beds

Confidentiality - Private assessment room- No Bed/Chair segregation

- Bed/Chair segregation- No private assessment room

Waiting Area - Designated waiting area

- Designated waiting area

Office Space - Designated office space

- Designated office space

Patient/Staff Storage

- Locker space - Locker space

Safety - Improved staff flow and proper storage of supplies

- Improved staff flow and proper storage of supplies

Long TermLong Term

VARiSAdvantages Disadvantages

Book multiple appointments in the future Staff training

Schedule updating Adapting to the new system

Rolling cancellation lists Price

Appointment history

Links to Capital Health patient information

Identify medication requirements

Assign staff to patients

Assign treatments; given doctor availability

Report generation and statistics

Technical training and helpdesk supportOverview Methodology Analysis and Application Short-Term Long-Term Steps

Implementation Steps

Implementation Steps

Overview Methodology Analysis and Application Short-Term Long-Term Steps

STEP:I STEP:II STEP:III STEP:VSTEP:IV

• Regulations• Room Negotiations• Inquiries

• Short Term• Layout

• Short Term• Distractions

• Long Term• Layout

• Long Term• Scheduling

Implementation Steps

Implementation Steps

STEP ONE: Regulations

- budgetary approval- work orders- hospital order

catalogue

Room Negotiations(Benefit of chairs & beds)- X-ray Room (3 chairs)- ETU Room (4 chairs, 2 beds)

Overview Methodology Analysis and Application Short-Term Long-Term Steps

Implementation Steps

Implementation Steps

STEP ONE: (continued) Inquiries

- ‘Artists on the Ward’- Safety disposal- Sanitization stations- VARiS software(focus long term)

Overview Methodology Analysis and Application Short-Term Long-Term Steps

Implementation Steps

Implementation Steps

STEP TWO: Short Term (layout)

- Chair movement- Remove old equipment(Desks)- Purchase shelving &

install- Install new mixing

station- Purchase new stools- Reorganize supplies

Overview Methodology Analysis and Application Short-Term Long-Term Steps

Implementation Steps

Implementation Steps

STEP THREE: Short Term (distractions)

- Nurse assignmentsPostersBook/magazine

libraryPersonal DVD playersDVD library

- Overhead music (no vocals)

- TV installation

Overview Methodology Analysis and Application Short-Term Long-Term Steps

Implementation Steps

Implementation Steps

STEP FOUR: Long Term (layout)

- New room assigned to MOU- Create weekend plan to

change layout- Renovations to

waiting/office space- Installation of lockers- Other ... (depends on

room)

Overview Methodology Analysis and Application Short-Term Long-Term Steps

Implementation Steps

Implementation Steps

STEP FIVE: Long Term (scheduling)

- Obtain funding - Obtain software- Schedule training

Out of houseIn house

- Run software with paper scheduling concurrently

Overview Methodology Analysis and Application Short-Term Long-Term Steps

QuestionsQuestionsQuestionsQuestions