Embed Size (px)
Citation preview
Implementing Process Improvement In Healthcare
By Gagan Rajpal With Craig A. Stevens
PMI Nashville Symposium 2013
Creating a Team Focused Improvement Program
Agenda
Goals/Objectives
General PI Processes
✓
2
1
2
7
6
5
4 Process Analysis
Value Chain Analysis
Layout Analysis and Spaghetti Diagrams
SPIOC
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
4
Creating a Team Focused Improvement Program
Agenda
Goals/Objectives
General PI Processes
✓
2
1
5
7
6
5
4 Process Analysis
Value Chain Analysis
Layout Analysis and Spaghetti Diagrams
SPIOC
8 Summary of PI Program Approach
This is an example text. Go ahead and replace it3 PI Assessment and Performance Measures
✓
Three Easy to Understand and Use Improvement Phases
6
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
Hospital Service
Doctor’s Office/
Department
PatientAdmissions
Life cycle of a patient needing services at East Tennessee Children Hospital
Incoming Patients
Afte
r Adm
issi
ons
Resource Allocation
Step 2 –Assessment Phase
10
A = Assessments
P = Problem Solving
I = ImplementationUsing Project Management Tools/Support
Creating a Team Focused Improvement Program
Agenda
Goals/Objectives
General PI Processes
✓
2
1
11
7
6
5
4 Process Analysis
Value Chain Analysis
Layout Analysis and Spaghetti Diagrams
SPIOC
8 Summary of PI Program Approach
This is an example text. Go ahead and replace it3 PI Assessment and Performance Measures
✓
✓
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 “type” of incoming patients within a week?
Is there any “trend” in “number & type” of incoming patients within a day?
Creating a Team Focused Improvement Program
Agenda
Goals/Objectives
General PI Processes
✓
2
1
21
7
6
5
4 Process Analysis
Value Chain Analysis
Layout Analysis and Spaghetti Diagrams
SPIOC
8 Summary of PI Program Approach
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
Is staffing logistics appropriate?
Is patient registration a smooth process?
Current layout
PART II : Patient AdmissionApplicable Lean Principle : Efficient, effective and reliable admissions process
Step 2 –Assessment Phase
24
A = Assessments
P = Problem Solving
I = ImplementationUsing Project Management Tools/Support
3-4 registrations/ hr
Is staffing logistics appropriate?
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
Is patient registration a smooth process?
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
Insu
ranc
e C
ompa
ny
Parents
Ope
rato
r
Is patient registration a smooth process? (Continued)
Step 3 – Build the Problem Solving Portfolio
29
A = Assessments
P = Problem Solving
I = ImplementationUsing Project Management Tools/Support
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 [email protected]
Creating a Team Focused Improvement Program
Agenda
Goals/Objectives
General PI Processes
✓
2
1
31
7
6
5
4 Process Analysis
Value Chain Analysis
Layout Analysis and Spaghetti Diagrams
SPIOC
8 Summary of PI Program Approach
3 PI Assessment and Performance Measures
✓
✓
✓
✓
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
34
A = Assessments
P = Problem Solving
I = ImplementationUsing Project Management Tools/Support
GFR
GFRGFR
The “current” layout
Front Desk
Call Center
Fax Room
Marty’s Office
1234
The “new” layout
The Achievable Target
5-6 registrations/ hr
Creating a Team Focused Improvement Program
Agenda
Goals/Objectives
General PI Processes
✓
2
1
37
7
6
5
4 Process Analysis
Value Chain Analysis
Layout Analysis and Spaghetti Diagrams
SPIOC
8 Summary of PI Program Approach
3 PI Assessment and Performance Measures
✓
✓
✓
✓
✓
Hospital Service
Doctor’s Office/
Department
PatientAdmissions
Incoming Patients
Afte
r Adm
issi
ons
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
Afte
r Adm
issi
ons
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
Step 2 –Assessment Phase
40
A = Assessments
P = Problem Solving
I = ImplementationUsing Project Management Tools/Support
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
HOME
(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
Value Add: 2 minutes
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
HOME
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
1
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
63.4 % Non-value added time
Neuro-EEG.igx
Neuro Room # 2
NVA = 5 minutes
HOME
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
Value Add: 31 minutes
Neuro Scheduling
Neuro - EEGValue Stream MapDate: 05/21/10Author: Gagan Rajpal
Current state
55.6 % Non-value added time
Neuc Med.igx
Check in
Value Add: 5 minutesDefect = 25%2 Shifts
2
SchedulingRadiology
HOME
(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
2
Distance Traveled: 1200 ft.Transport Time: 1.5 minutes
Consolidate Check in process
Distance Traveled: 600 ft.Transport Time: 1 minutes
NM
Value Add: 65 minutesNVA = 10 minutes
1
47 minutes
Final Scan
Value Add: 1 minutes
Control
Information
Milk Scan Process Value Stream MapDate: 05/19/10Author: Gagan Rajpal
Information
Current state
46.6 % Non-value added time
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
Creating a Team Focused Improvement Program
Agenda
Goals/Objectives
General PI Processes
✓
2
1
51
7
6
5
4 Process Analysis
Value Chain Analysis
Layout Analysis and Spaghetti Diagrams
SPIOC
8 Summary of PI Program Approach
3 PI Assessment and Performance Measures
✓
✓
✓
✓
✓
✓
Hospital Service
Doctor’s Office/
Department
PatientAdmissions
Incoming Patients
Afte
r Adm
issi
ons
Resource Allocation
PART IV : Resource allocation model
Hospital Service
Doctor’s Office/
Department
PatientAdmissions
Incoming Patients
Afte
r Adm
issi
ons
Resource Allocation
PART IV : Resource allocation model
Step 3 – Build the Problem Solving Portfolio
54
A = Assessments
P = Problem Solving
I = ImplementationUsing Project Management Tools/Support
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
SIPOC
- 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
Input
Admissions
X-ray
Pulmonary
Lab
Neurology
Surgery
Type - 1
Type - 2
Type - 3
Type - 4
Type - n
PatientQA
QS1
QS2
QS3
QS4
QS5
QS11
QS12
QS13
QS14
QS1n
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
SIPOC
- 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
Input
Admissions
X-ray
Pulmonary
Lab
Neurology
Surgery
Type - 1
Type - 2
Type - 3
Type - 4
Type - n
PatientQA
QS1
QS2
QS3
QS4
QS5
QS11
QS12
QS13
QS14
QS1n
Output = Min: ∑ QA + QS1 + QS11 --------------
Output
Creating a Team Focused Improvement Program
Agenda
Goals/Objectives
General PI Processes
✓
2
1
63
7
6
5
4 Process Analysis
Value Chain Analysis
Layout Analysis and Spaghetti Diagrams
SPIOC
8 Summary of PI Program Approach
3 PI Assessment and Performance Measures
✓
✓
✓
✓
✓
✓
✓
