PmgmmandOperationsAmlysis and AnalysisResults ...ioe481/ioe481_past_reports/w0003.pdf · The Packard Bell NEC Zi was another recommendation that would result in a smaller monitor

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UniveiitycfMidiganHealthSystem

PmgmmandOperationsAmlysis

FacilityAnalysis Results andRecommendations

Registration Desk Space Redesign

Jason Bailey, Marwan Rateb, Risa Sparks

April 18,2000

TABLE OF CoNmrs

EXECUTIVE SIJMMARY 2

INTRODUCTION AND METHODOLOGY 4

INTRODUCTION 4Purpose ofProject 4Project Objectives 4Background and Environment 4Affected Parties 4Key Issues 4

METhoDoLOGY 5

CURRENT SITUATION OVERVIEW 6

DEPA1TMENT DEsCRllrIoN 6PROCESS FLOW 6

ANALYSIS AN]) RECOMMENDATIONS 8

RECOMMENDATION 1: PURCHASE ARM SETS 8RECOMMENDATION 2: MOVE PRINTER 9RECOMMENDATION 3: RELOCATE CLIPBOARDS 11RECOMMENDATION 4: PuRCHASE ROTATING SHELvING UNIT 12RECOMMENDATION 5: PLACE VELCRO UNDER SHELvEs 13RECOMMENDATION 6: PURCHASE SMALLER PHONES 13RECOMMENDATION 7: CHANGE MONiTOR PLACEMENT 14RECOMMENDATION 8: PURCHASE SHELVING UNIT 15RECOMMENDATION 9: MOVE STAIvIPING MACHINE 15RECOMMENDATION 10: PuRCHASE AN LCD MONITOR 16REC0IYIJvIENDATION 11: NOTCH DESK SPACE (SEE RECOMMENDATION 7) 16RECOMMENDATION 12: PURCHASE KEYBOARD WRIST PADS 17RECOMMENDATION 13: PURCHASE APACKARD BELL NEC Zi 17RECOMMENDATION 14: PURCHASE COMBINATION WRIST PADS AND MOUSE PAD 18RECOMMENDATION 15: PLACE PRIvACY FILTER OVER MONITOR 18RECOMMENDATION 16: FEASIBILITY OF THIRD REGISTRATION DESK 19FuTCRE CONSIDERATIONS 21

PROPOSED ENVIRONMENT OVERVIEW 22

RECOMMENDATION SIJIVIMARY 22

ACTION PLAN

APPENDIX A

PROJECF SCOPE 25

APPENDIX B 26

PROCESS FLOW DIAGRP.M 26

APPENDIX C 27

SMVIPLE FORMS 27SIJIvIMARY/ SURvEY RESULTS 28

Frequency Data 28Queuing Data 28

APPENDIX D.

The definition given for this project was to redesign the workspace in the reception desk area for spaceconstraints, ergonomics and cost. The reception area is crowded; charts are inaccessible for clerks,there is a lot of traffic and the area is disorganized. Data collection focused on the most utilized areasin the registration desk.

As this was a three-month project, the focus was placed on the workspace and organization of theregistration desk space. For the workspace area, the counter space and improving its ergonomicdesign was analyzed. To improve the organization, recommendations were made for the location ofthe clipboards, printer, shelves, and registration forms. Other issues considered were smaller phonesand patient confidentiality. The tools used for data collection were workflow efficiency analysis,ergonomics, facility analysis, data collection, and statistics.

The workspace area in Pod D is poorly organized. There is limited space resulting in inappropriatelylocated items such as clipboards, printer, and registration forms. Another problem is ergonomicallyincorrect designs, such as keyboard and telephone locations, height of the counter, and placement ofshelves.

It was determined that many of the inefficiencies in the registration desk area result from theplacement of desktop machines. Items such as the printer, computer monitors, stamping machines,and phones were either inappropriately placed or very large. By analyzing the layout and frequencyusage of the area, solutions to the poor organization and lack of workspace were found.

One such solution was to purchase LCD monitors, which are thinner than the CRT monitor and takeup less space on the registration desk. The Packard Bell NEC Zi was another recommendation thatwould result in a smaller monitor. The Packard Bell is a LCD monitor with a central processing unitin the screen. This means that the entire computer is located inside of the monitor therefore openingup space used by the larger monitor and the hard drive under the desk.

By moving items in the registration desk additional space will become available. Moving the printerfrom its current location to the center of the registration area, placing the stamping machines under thedesk on a mouse tray, and mounting the phones on the wall are all recommendations that will makethe registration area less crowded. These recommendations will assist in improving the efficiency ofthe clerks’ workflow.

Another cause of inefficiencies in the registration desk area is incorrect ergonomic layout. Toimprove this several recommendations have been made. One is to purchase a keyboard platform thatincludes wrist pads for both the keyboard and mouse. The platform has an ergonomic design, whichis meant to reduce the risk of Carpal Tunnel Syndrome (CTS). CTS typically affects typists and usersof computer keyboards, whose jobs require rapid finger movements and bent wrists. An additionalergonomic solution was to place armrests on the clerks’ stools. The armrests will give the clerks aplace to rest their arms and will improve the clerks’ posture thus reducing fatigue.

These recommendations will help reduce the inefficiency and clutter in the registration desk area. Thesolutions will improve both the working conditions for clerks and the patient registration process.Industrial & Operations Engineering Registration Desk RedesignProgram: Word97

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Table 1. Action Plan

Recommendation Action Priority Implementation Ease Purchase LocationNumber

1 Purchase attachable chair armrests 3 Immediate U of M Catalog

2 Move printer to the center of the 1 Immediate Office Depot &registration area Staples

3 Organize clipboards & consolidate 4 Medium (3 to 6 months) Staples & Homelocation Depot

4 Purchase rotating shelving unit 2 Immediate U of M Catalog

5 Velcro shelving unit to desk 1 Immediate Office Max

6 Purchase new telephones 2 Immediate Office Depot

7 Move Area 1 monitor to upper desk 1 Medium (relies on Rec. 11)level

8 Purchase 15 tier shelving unit 1 Immediate Staples

9 Purchase mouse tray, relocate 2 Immediate www.kellyrest.comstamping machine under desk

10 Purchase LCD monitor 2 Long Term (8 months to ayear)

11 Notch desk space for monitor 1 Immediateplacement

12 Purchase keyboard platforms wI 2 Immediate U of M Catalogwrist pads

13 Purchase Packard Bell all in one 2 Long Term (8 months to acomputer year)

14 Purchase keyboard and mouse wrist 1 Immediate U of M Catalogpads

15 Purchase monitor privacy filter 1 Immediate U of Catalog

16 Do not create a registration 1 Immediatestation

Priority Rating Scale: 1 = High, 2 = High/Medium, 3 = Medium, 4= Medium/Low, 5 = Low

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INTRODUCTION AND METHODOLOGY

INTRODUCTION

Purpose ofProiect

The purpose of this project is to redesign the workspace for clerks in the Pod D reception area.Pod D’s registration desk is a small and cramped area with a lack of counter space, workspacefor clerks, and storage area. These constraints lead to errors, discomfort for workers,obstructions in the check in process and potential breaches in patient confidentiality. Thespace will be redesigned for space constraints, ergonomics, and cost.

Pioject Objectives

To create a model and organized workspace for the clerks in Pod D that has an efficientworkflow. The redesign will focus on the registration desk, with the intention of making thecheck in process easier for both the clerks and patients.

Backgiound and Enviionment

The workspace area in Pod D is poorly organized. There is limited space resulting ininappropriately located items such as clipboards, printer, and registration forms. Anotherproblem is ergonomically incorrect designs, such as keyboard and telephone locations, heightof the counter, and placement of shelves.

Affected Parties

Pod D is the largest Pod in the Internal Medicine department of the University Hospital with avariety of individuals involved in the daily operations. This project will affect many peopleduring its duration. The clerks working at the registration desk will feel the greatest impact ofthis redesign project. The numerous changes proposed will result in a more efficientregistration desk.

Although the clerks working behind the desk are the focus of this project, any improvementsto their working conditions will be beneficial to patients, as waiting times at the registrationdesk would be reduced. Also, the general layout of the various registration desks in the fourInternal Medicine Pods are very similar and therefore any changes to Pod D’s layout could beemulated by the other Pods. Thus, this seemingly small redesign will potentially have farreaching effects on the Internal Medicine Department at the University Hospital.

Key Issues

There are a variety of problems that hinder the efficiency of registration at Pod D that need tobe addressed. The major problems facing the area include:

• Poor Workflow

• Front Desk Design

• Technology Malfunctions

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• Employee Absenteeism

• Excessive Utilization and Reliance on Forms

• Crowded Waiting Room

• Long Patient Waiting Time

• Inefficient Organization

METHODOLOGY

To solve the issues that exist in Pod D, the problems and their causes must be understood so a solutioncan be found. Several methods were used to analyze the registration desk at Pod D. The methods arelisted below.

• Interviews

• Log Sheets

• Ergonomics Department

• Existing Data Research

• Clinic Visits

• Past Report Research

To find obstacles in the registration desk workflow, the registration clerks’ knowledge was utilized asthey have the most exposure to the work environment. Interviews were conducted with both clerksand medical assistants to develop a list of problems within the workspace. Talking to the clerks tofind problems with the area and watching the registration process obtained this information. The datacollected helped prioritize which problems to address in the project. Pod D was visited ten timesduring the semester to determine a workflow process both by observation and interaction with theregistration clerks

Log sheets were used to ascertain the frequency of equipment usage. Twice per week a member ofthe team observed the registration desk for one hour. Each time a certain object (for example, theprinter or phone) on the registration desk was used the observer would mark the log sheet.

Although the log sheet gives equipment usage data, an understanding of the space layout and overallworkflow is needed. Space layout was determined by observation, and with assistance from theUniversity Of Michigan’s Ergonomics Department. The Ergonomics Department was used to obtainsuggestions on how to create a more comfortable and ergonomically correct work environment giventhe current space constraints.

Additional suggestions were found using the Internet, supply stores, past student reports, andmagazines. Also, other clinics in the University Hospital were visited. From these visits to differentclinics, with new or improved registration desks, additional solutions to problems were found. Thesesolutions were useful as they are already proven to be efficient and helpful.

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CuRRENT SrruATIoN OvERvww

DEPARmWN’r DEsciurnoN

Pod D is part of the Department of Internal Medicine at the University of Michigan hospital. Theclinic treats the following subspecialties:

• Gastroenterology

• Endocrinology & Metabolism

• Molecular Medicine & Genetics

• Allergy

• Rheumatology

• Infectious Diseases

In addition to the subspecialties, Pod D has special clinics that are held on Monday, Wednesday, andThursday. Monday morning there is an allergy clinic and an endocrinology, infectious disease, andrheumatology clinic throughout the day. On Wednesday there is a liver clinic and Thursday morninga medicine science genetics clinic.

Figure 1 shows the layout of the registration desk area for Pod D. Patients enter from the right handside of the figure and approach one of the two clerks seated at the desk. A clerk supposedly is selectedbased on the patient’s aliment. The clerk at Area 1 is responsible for gastroenterology, endocrinology& metabolism, and molecular medicine & genetics. Area 2’s clerk handles patients for allergy,rheumatology, and infectious diseases. A sign above each area indicates where the patient shouldcheck-in.

PROCESS FLOW

The steps for a patient to check-in are as follows. See Appendix B for the process flow diagram.

1. Patient hands clerk the registration card and parking ticket if appropriate

2. Clerk accesses patient information on computer which causes patient form to print out on theprinter

3. Clerk checks off patient on schedule

4. If the patient has a parking ticket, it is validated (stamped by the stamping machine)

5. Patient asked to sit down in waiting area

6. Based on patient’s aliment, the clerk gets the appropriate formsIndustrial & Operations Engineering Registration Desk RedesignProgram: Word97

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7. These forms are stamped twice

8. Patient information is written on the forms by the clerk

9. Clerk obtains print out from printer

10. Information is written on the print out

11. Registration card and forms are attached by a paperclip

12. Clerk places them in the patient bin

13. Patient name is checked off of schedule board by clerk

14. Process is complete

Figure 1. Current Registration Desk Diagram

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Registration Desk Redesign

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WallArea 2 Area 1

CBasket

Entrance

1[“Printer [3jcppjonwTj

Figure 2. Future Registration Desk Diagram

ANALYSIS ANI) RECOMMENDATIONS

RECOMTVIENDA’rION 1: PURCHASE Aicvi SETS

Problem Statement and Root Cause Analysis

The registration desk area in Pod D is awkward and poorly designed for employees to work inefficiently. Space is limited with few places for employees to rest their arms and hands whileeither waiting for or talking to a patient. As a result, clerks spend a large amount of time withtheir hands in their laps. This is an uncomfortable posture that can result in a tense bodyposition. A simple solution to this problem is to add annrests to the task stools (See Figure 3).

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Wall

I IIIIIIIIIINIIII[J Computer

Wall

5tamping machine

111111

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____

I Stamping machine

computer

Phone

KeYbo

basket

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Figure 3. Registration Desk View of Clerk 1 Area

Benefits

. Improve comfort of clerks while working at the registration desk

Help reduce fatigue

Costs

This is a low cost recommendation. Each optional arm set costs $78.00 and requires a simpleone-time installation. It is assumed that there are people available in the hospital to assemblethe arm sets. The arm sets can be purchased through the University of Michigan OfficeSupplies Catalog (page 22). This recommendation will incur a one-time cost of $78.00 withno future costs required as the arm sets come with a lifetime warranty.

RECOMMENDATION 2: MovE PRINTER


The printer is located on a low counter to the right of the clerk closest to Pod D’s entrance



Recommendation

Purchase arm sets to add to clerks’ chairs.

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(Clerk 1). Out of the equipment used in the registration process, the printer has an 11% usagefrequency (see Figure 4). Therefore, the printer is used frequently in the registration process.Clerk 2 can retrieve papers from the printer by two methods. One method is for Clerk 2 toleave his or her desk and walk to the printer. This increases traffic behind the registrationdesk. The second method is for Clerk 1 to pass Clerk 2 the printouts. To do this, Clerk 1 hasto reach over to the printer and hand Clerk 2 the papers.

Figure 4. Frequency Data

Recommendation

Move the printer to the center ofthe registration desk area. This area was previously usedto store the patientfiles, which have been moved. The printer should be placed on top ofaprinter stand.

This recommendation requires that both a cord cover and printer stand be purchased.

Benefits

By moving the printer, space will become available on the counter by the third computer. Theshelves currently located on the floor can be placed on the counter. Moving the printer willalso reduce traffic behind the clerks in the registration desk area. Clerk 1 will no longer haveto reach over to hand Clerk 2 printouts thus reducing reach and eliminating a step in theregistration process for both clerks.



Registration Desk Usage Frequency

El Computer

• Phone

O Printer

0 Stamping Machine

• Reg. Forms

El Patient Files

• Clipboard

O Basket

• Appt. Sheet

32%

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Costs

1. A six-foot by one-inch cord cover costs $9.99 and is available in black and putty and canbe purchased at Office Depot. The cord cover is necessary to prevent accidents that couldbe caused by tripping over the cord. It should be trimmed to 46.5 inches to reach theexposed cord located on the floor.

2. The printer stand costs $76.99 and can be purchased at Staples. The dimensions are28.375”H x 23.5”W x 21.125” D and can be purchased in both white and oak finish. Thestand has two shelves, which can be used to store printer accessories or patient files if thenew system does not work.

3. Total Cost of the recommendation = $9.99 + $76.99 = $86.98

RECOME’vIENDATION 3: RELOCATE CLIPBOARDS


The registration desk area does not have a place to store clipboards. Currently, clipboards areplaced on a rolling cart under the fax machine and in bin next to the first clerk. The locationof the clipboards results in clutter and increased traffic in the desk area.

Recommendation

Place the clipboards in one central location below the scheduling board.

There are two methods that can be used to store clipboards. A ranked list of therecommendations is located below.

1. Step Organizer

2. Peg Board

Benefits

This recommendation will result in reduced traffic and clutter in the registration desk area. Itwill make it easier for Medical Assistants to access the clipboards thus saving time. Byconsolidating the location of the clipboards space will be made available on the counter andunder the fax machine. This space can be used for many other purposes.

Costs

The one time cost incurred for each possible recommendation is listed below.

1. Step Organizer

Description

An organizer, which contains eight slots for clipboards to be placed on the low filing


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cabinet, located under the white erase board. The dimensions of this space and organizerare 12” W x 15.75” D and 8.5” W x 10.5 “D respectively. This can be purchased atStaples.

Cost

This recommendation costs $6.98.

2. Peg Board

Description

Place a pegboard on the unused wall space under the bulletin board on the wall.Clipboards can be placed on hooks attached to the pegboard. The dimensions of the spaceavailable is 40” Height x 36” Wide.

Cost

Pegboards with a dimension of 48” Height x 96” Wide cost $14.25 and can be cut to theappropriate size for no extra charge at Home Depot. Six-inch double prong hooks; used tohang clipboards, cost $0.59 each. The registration desk area has between ten to twenty-five clipboards at one time and approximately three to four clipboards can be hung on onehook. Therefore, ten hooks should be purchased to hold thirty clipboards, the maximumnumber of clipboards.

The total cost for the pegboard is: $14.25 + ($0.59 per hook)*(10 hooks) = $20.15

RECOMMENDATION 4: PURCHASE RoTATiNG SHELvINGUNIT


Shelving units used to house various registration forms are cluttering up valuable space, whichcould be used more efficiently in Area 2 (see Figure 1).

Recommendation

Using afour-sided magazine shelving unit that can rotate with shelving on each side.

The shelving unit can be found on page 607 (reference letter H) of the University of MichiganOffice Supplies Catalog. The dimensions of the unit are 13.75” W x 13.75” Dx 25.625” H,and it has a total of 20 slots for registration forms.

Benefits

The new shelving unit will result in free space becoming available. This space can be used torearrange the desktop machines (computer, phone, stamping machine), which in turn willcreate a more efficient work area for the clerk.

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Costs

There will be a one-time cost incurred of $246.95 per unit.

RECOMMENDATION 5: PLACE VELcRo UNDER SHELvEs


The small registration form shelf by Clerk 2 is teetering on the edge of the registration counter,and could easily be knocked down by patients registering.

Recommendation

For a temporary solution, use Velcro to attach the shelving unit to the top ofthe desktop.

Velcro strips can be purchased at Office Max in 4” x 2” strips.

Benefits

This short-term solution will reduce the chance of the shelf being pushed off of the counterand prevent clinic visitors from being injured by the falling shelf.

Costs

A one-time cost of 3.99 per Velcro strip will be incurred.

REc0rvIIVWNDATION 6: PURcHASE SMALLER Pfl0NES


The phones that are currently in use by the registration clerks are extremely large. Their bulkysize takes up needed desk space.

Recommendation

Replace oldphones with newerj, smallerphones, and using remote headsets.

A GE two-line phone is available at Office Depot. It also has wall hanging accessories for thepossibility of mounting the phone to the wall in Area 2. A Plantronics Encore Monauralheadset can be purchased at Office Depot (See Figure 6).

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Figure 6. Headset

Through the use of the new phones, valuable desk space will become available for theregistration clerks. The use of a remote headset will also give the clerks more freedom tomove around while talking on the phone.

Costs

There will be a one-time cost incurred of $29.99 per telephone and $89.99 per headset.

RECOMIVwNDATION 7: CHANGE MoNrroR PLACEMENT


The current placement of the computer monitor, stamping machine, and telephone in Area 1 isinefficient. The keyboard is located in front of Clerk 1, while the monitor is on the right handside, causing the clerk to contort into ergonomically incorrect positions when accessingregistration data.

Recommendation

Move the computer monitor onto the top ofthe desk and move the stamping machine andphone into the space where the monitor was.

Benefits

By swapping the location of these desk machines, the monitor will be in a more ergonomicallycorrect placement, making it easier for the clerk to access computer registration data.

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Benefits

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Costs

There is no cost incurred for this recommendation.

RECOMMENDATION 8: PURCHASE SnELvING UNiT


Registration forms are located on the floor under the registration desk by Clerk 1, forcing theclerk to bend down to reach them.

Recommendation

Move all registration forms into afifteen slot shelving unit, located directly on the clerk’sright hand side in Area 1. Also, move the telephone and stamping machine on top oftheshelving uniL

The fifteen-tiered shelving unit is available at Staples. The dimensions of the unit are 17” H x36” W x 15.75” D.

Benefits

By moving all of the registration forms to an accessible height, the clerk will be saved theoperation of bending down, which in turns save time and ergonomically incorrect positions.

Costs

There will be a one-time cost incurred of $45.14.

RECoMMENDATION 9: MovE STAMPNG MACHINE


The stamping machine that is used for imprinting patient information onto registration formsis large and bulky, taking up valuable desk space that could be used for other purposes.

Recommendation

Move stamping machine onto a mouse fray that would be located under the registrationdesk.

The mouse tray can be found on www.kellyrest.com under keyboard rests. The mouse tray issquare with the dimension 10” L x 10” W, which will easily accommodate the stampingmachine, which is 7” L x 8.5” W.

Benefits

By moving the stamping machine to a location off of the desk, free space is created that wouldgive the registration clerk more room to work.


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Costs

There will be a one-time cost incurred of $149.95

RECOMMENDATION 10: PURCHASE AN LCD MONIToR


In the clerk’s desk space a variety of tasks are performed in a limited area. The presence ofspace-consuming monitors hinder the clerk’s ability to perform these tasks efficiently andcomfortably, and allows potential breaches in patient confidentiality.

Recommendation

Replace the current monitors with LCD screens. This would increase the desk spaceavailablefor use by the clerks in the registration process, and assist in improving patientconfidentiality.

Benefits

CRTs are large and heavier monitors. LCD’s are only inches thick and light (the averageLCD weighs about 12 pounds, compared to approximately 50 pounds for a typical 17-inchCRT). Replacing CRT monitors with LCD’ s would assist in freeing up space on theregistration desk, and patients will be unable to view the contents of the monitors. See Figure7 in Appendix D for LCD specifications.

Costs

LCD monitors cost approximately $1,000 to $3,700 (all have 14- to 14.5-inch panels).

RECOrvIEvWNDATI0N 11: NoTcH DESK SPACE (sEE RECOMMENDATION 7)


Currently, the monitor cannot be moved to the upper desk space by Clerk 1, as there is notenough room. To implement recommendation 7, a notch needs to be created in theregistration desk. See Recommendation 7 for a more detailed explanation.

Recommendation

By creating a notch in the registration desk space the monitor can be placed on the uppercounter freeing up desk spacefor the clerk.

Benefits

There are several benefits resulting from moving the monitor. The new location of themonitor will produce a more ergonomically correct position for the clerk while using thecomputer. Furthermore, the movement of the monitor would result in more available deskspace. In addition, the placement of the monitor would prevent breaches in patientconfidentiality.

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Costs

There is no cost incurred by this recommendation.

RECOMMENDATON 12: PURCHASE KEYBOARD WRIST PADs


While using the keyboards at the registration desk, the clerks do not have a surface to rest theirwrists on while typing. This could lead to Carpal Tunnel Syndrome (CTS). Carpal tunnelsyndrome is a common Cumulative Trauma Disorder affecting the wrist and hand. Typistsand users of conventional computer keyboards, whose jobs require rapid finger movementsand bent wrists, have reported CTS.

Recommendation

Provide the clerks with keyboardpk4forms that have wrist-pads to prevent carpal tunnelsyndrome and other cumulative frauma disorders.

Benefits

The addition of wrist pads to the keyboard would prevent CTS from occurring and provide acomfortable and healthy environment for the clerks at the registration desk. Also, the mousecan be placed on the tray next to the keyboard making space available on the registration desk.

Costs

The cost of the ergonomic keyboard/mouse arm is $244.00 and can be found in the Universityof Michigan Office Supplies Catalog page 448 (Reference B).

RECOMrVIENDATION 13: PURCHASEAPACKARD BELL NEC Z1


The computers currently used at Pod D’s registration desk take up a lot of space. The 17 inchmonitors are 13.5” H x 13.5” W x 16” D. The place where the hard drives are currentlysituated could be used for a footrest.

Recommendation

Replace the existing computers with the Packard Bell NEC Zi.

Benefits

The Packard Bell NEC Zi will reduce space used, as the entire computer is the size of a LCDmonitor. Add foot rests under the desks.

Currently, the seating position for the clerks is awkward. By placing a bar on the wall by theemployees’ feet, they will be able to comfortably sit at the registration desk. This


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recommendation requires that the hard drive for the computers be moved. Therefore, if newcomputers are purchased without hard drives this recommendation could be implemented.Length of footrest required for each clerk is 13”.

Costs

The cost of the Packard Bell NEC Zi is $2,499.

RECOMMENDATION 14: PuRCHAsE CoMiINATIoN WRIsT PADs MousE PAD


While using the mouse at the registration desk, the clerks do not have a surface to rest theirwrists. This could lead to Carpal Tunnel Syndrome (CTS).

Recommendation

Provide the clerks with a combination mousepad and wristpad that wouldprovide supportfor the clerks’ wrist while using the mouse.

Benefits

By providing the clerks with a combination wrist rest and mouse pad, this would serve toreduce CTS. Also, by concentrating the mouse in one location unnecessary motion by theclerks is minimized.

Costs

The cost of a wrist rest with mouse platforms is $21.95 (found of page 462 of the Universityof Ivlichigan Office Supplies Catalog, reference D). This recommendation could beimplemented immediately.

RECOrvITVWNDATION 15: PLACE PRIVACY FILTER OvER MoNrroR


The current location of the monitor by Clerk 1 allows patients to see information located onthe screen. This leads to potential breeches in patient confidentiality.

Recommendation

Equ,), the registration computers with privacyfilters to prevent unauthorizedpersonnelfrom viewing confidential medical records.

Benefits

The privacy glare filter would prevent persons from seeing the contents of the monitor unlessthey are looking directly at the monitor.

Costs

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The cost of a privacy glare filter is $169.95 and can be found in the University of MichiganOffice Supplies Catalog page 546 (Reference A).

RECOMrvIENDATION 16: FEASIBILiTY OF THIRD REGISTRATION DESK


The purpose of this recommendation is to determine if there is a need for a third registrationdesk. Currently there is unused space on the low counter by the third computer. This spacecould be turned into a third registration desk to reduce patient wait time.

Recommendation

Do not create a third registration station.

Reasons

The entrance to the third registration desk area is 38.25” at the narrowest point. A person in awheel chair with the largest sideways grip(95th percentile male) requires 37.024” of space toenter a space. Although the space has enough room, the person in the wheel chair would havevery little space to maneuver. The space would also be considered a fire hazard, as it wouldbe difficult to evacuate the area if there was a queue or a person in a wheel chair in the area.

Given the queuing data collected (see Figure 4), the wait time for patients to register is notlarge enough to justify an additional registration desk.

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Figure 4. Queuing Data

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..

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Pod D Queuing Data

Furum CoNsmE1TIoNs

The recommendations located below should be implemented sometime in the future. Therecommendations are presented in no particular order.

• Extend the registration counter space to the wall.

• Use a light board to inform employees when a patient is occupying a room.

• Place a large clearly labeled map of the hospital outside of the Pod D entrance.

This map will reduce the number of lost patients asking for directions thus giving clerksmore time to register patients.

• Place the patient schedule on the computer. This will reduce the time it takes clerks to registerpatients and will also open up space on the counter currently used by the schedule.

• Remove the stamping machines.

• Automate the parking ticket validation process. One suggestion is to place machines in theparking area that would validate the ticket based on patient information. This would remove atime consuming step in the registration process, as currently the frequency usage of thestamping machine is 32% of which approximately one third is attributed to parking validation.

• Automate the registration process to reduce patient wait time.

• Place toys and magazines in the waiting area to entertain children and patients.

• Place pictures in the unused wall space by the third computer. This would make theregistration desk area more cheerful and improve morale amongst employees.

• Reorganize the entire registration area.


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PRoPosED ENvIRoNMENT OvERvww

RECOMMENDATION Su’vIIVIARY

The table below contains a summary of the recommendations.

Table 2. Recommendations Summary

Problem Statement Recommendation OneTimeCosts

Space is limited in the registration desk area with few places Purchase arm sets to add to the clerk’s chairs 78.00for employees to rest their arms and hands while waiting ortalking to a patient.

The current location of the printer results in increased traffic Move the printer to the center of the registration 86.98in the desk area and adds extra work for Clerk 1. desk area.

The registration desk area does not have one location to Place the clipboards in one central location by 6.98store clipboards resulting in clipboards piled under the fax putting the clipboards in a shelf or on a pegboard.machine and in a bin next to Clerk 1.

Multiple shelving units used to house various registration Use a four-sided rotating magazine shelving unit to 246.95forms are wasting valuable space by Clerk 2. consolidate space by Clerk 2.

The small shelf used for registration forms by Clerk 2 is For a temporary solution, use Velcro to attach the 3.99unstable and could easily be knocked down by patients. shelving unit to the top of the desk.

The phones currently used by the clerks are large and bulky. Replace old phones with newer, smaller phones, 119.89Their size takes up needed desk space. and remote headsets.

The current location of the monitor makes it awkward to use Move the computer monitor to the top of the desk No Costfor Clerk 1. and move the stamping machine and phone into the

space where the monitor was.

Currently, the registration forms by Clerk 1 are located on Move all of the registration forms into a 15 slot 45.14the floor under the registration desk, forcing the clerk to shelving unit located on the counter to the right ofbend down to reach them. Clerk 1. Also, move the telephone and stamping

machine on top of the unit.

The stamping machine is large and bulky, taking up Move the stamping machine onto a mouse tray that 149.95valuable desk space. would be located under the registration desk.

Space consuming monitors hinder the clerk’s ability to Replace the current monitors with LCD screens. Maxperform tasks efficiently and comfortably, and cause This would increase the desk space available for Cost ofpotential breaches in patient confidentiality, use by the clerks in the registration process, and 3,700

assist in improving patient confidentiality.

Move the monitor to the upper desk and create a notch in By making a notch in the registration desk space the No Costthe desk to open up space. monitor can be placed on the upper counter, freeing

up desk space for the clerk.

The lack of wrist support for clerks while using the Provide the clerks with keyboard platforms that 244.00keyboard and mouse can lead to Carpal Tunnel Syndrome have wrist-pads to prevent CTS and other(CTS). cumulative trauma disorders.

The computers currently use a lot of space. Replace the existing computers with the Packard 2,499Bell NEC Zi.

The mouse pads used at the registration desk do not have a Provide the clerks with a combination mouse pad 21.95surface for the clerks’ to rest their wrists, and wrist pad that would provide support for the


Page 22Updated: April 18, 2000

clerks’ wrists.

The current location of the monitor by Clerk 1 allows Equip the computer with privacy filters to prevent 169.95patients to see information located on the screen. This leads unauthorized personnel from viewing confidentialto potential breeches in patient confidentiality, medical records.

Determine if there is a need for a third registration desk. Do not create a third registration desk. No Cost

7,372.78

These recommendations will help reduce the inefficiency and clutter in the registration desk area. Thesolutions will improve both the working conditions for clerks and the patient registration process. Therecommendations focus on improving the inadequacies in the registration desk area that result bothfrom poor placement of desktop machines and incorrect ergonomic layout. These suggestions willassist in improving the efficiency of the clerks’ workflow.

Industrial & Operations Engineering Registration Desk RedesignProgram.’ Word97Updated: April 18, 2000

Page 23

ACTION PLAN

Table 3. Action Plan Summary

Recommendation Action Priority Implementation Ease Purchase LocationNumber

1 Purchase attachable chair armrests 3 Immediate U of M Catalog

2 Move printer to the center of the 1 Immediate Office Depot &registration area Staples

3 Organize clipboards & consolidate 4 Medium (3 to 6 months) Staples & Homelocation Depot

4 Purchase rotating shelving unit 2 Immediate U of M Catalog

5 Velcro shelving unit to desk 1 Immediate Office Max

6 Purchase new telephones 2 Immediate Office Depot

7 Move Area 1 monitor to upper desk 1 Medium (relies on Rec. 11)level

8 Purchase 15 tier shelving unit 1 Immediate Staples

9 Purchase mouse tray, relocate 2 Immediate www.kellyrest.comstamping machine under desk

10 Purchase LCD monitor 2 Long Term (8 months to ayear)

11 Notch desk space for monitor I Immediateplacement

12 Purchase keyboard platforms w/ 2 Immediate U of M Catalogwrist pads

13 Purchase Packard Bell all in one 2 Long Term (8 months to acomputer year)

14 Purchase keyboard and mouse wrist I Immediate U of M Catalogpads

15 Purchase monitor privacy filter 1 Immediate U of Catalog

16 Do not create a 3td registration 1 Immediatestation

Priority Rating Scale: 1 = High, 2= High/Medium, 3 = Medium, 4= Medium/Low, 5= Low



Page 24

APPENDIx A

PROJECr SCOPE

Due to time constraints, this project will only analyze the workspace and organization of theregistration desk space. In the workspace area, the feasibility of expanding and redesigning thecounter space, and improving its ergonomic design will be determined. To improve the organization,recommendations will be made for the following issues:

• Clipboard location

• Printer location

• Registration forms location

• Location of shelves

• Smaller phone

• Patient Confidentiality

The Industrial Engineering tools used for analysis include workflow efficiency analysis, ergonomics,facility analysis, data collection, time studies, and statistics.



age

APPENIix B

PRocEss FLOW DIAGRAM

Print and CollectStamp Blue CardPink Encounterand Parking, and

ingareand Registrationdirect patient to

Forms

Stamp Encounter Place Blue CardForm and and Forms in

Registration Basket forForms Scheduling



Patient Arrival

Page 26

APPENIIx C

SAipLE FoRMs

Log Sheet

Date:

Start time of survey:

End time of survey:

Patient arrivals: Busy I Moderate! Slow (circle one)

Clerk 1 (closest to entrance):

No. Of Stamp Patient Leave ApptPatients Phone Computer Reg. Form Machine Files Printer Clipboard Basket Desk Sheet

Clerk 2 (closest to entrance):

No. of Stamp Patient Leave ApptPatients Phone Computer Reg. Form Machine Files Printer Clipboard Basket Desk Sheet


V Page27Updated: April 18, 2000

Comments:

SurviIvLRYI SuRVEY RESULTS

Fiequency Data

SampleSize

Total 45Patients

Patients 28Clerk 1

Patients 17Clerk 2

Computer Phone Printer Stamping Reg. Patient Clipboard Basket Appt.Machine Forms Files Sheet

Clerk 1 38 12 23 62 23 1 2 19 22

Clerk 2 21 6 15 42 20 0 0 15 17

Total 59 18 38 104 43 1 2 34 39

Oueuing Data

START 1:40 PM

END 2:40PM

DATE 3/22/00

No. People in Queue No. People in QueueTIME for CLERK 1 for CLERK 2

1:40 1 1

1:45 1 0

1:50 1 0

Industrial & Operations Engineering Registration Desk RedesignProgram: Worc/97Updated: April 18, 2000

Page 28

1:55 1 1

2:00 1 0

2:05 0 3

2:10 0 0

2:15 1 0

2:20 0 0

2:25 1 0

2:30 1 0

2:35 1 1

2:40 1 0


Page29Updated. April 18, 2000

APPENDIx D

Table 4. LCD Specifications

LCD Monitors

ViewSonicCTX PanoView 745 HP 1024 NEC MultiSync LCD400 Sceptre FT15 VP14O View

Panel

Street price $2,600 $2,420 $2,700 $2,500 $2,500

Panel size (diagonal14.5 14 14.1 14.5 14inches)

Dimensions (HWD, in15/15.2/6.5 14.5/14.1/5.8 13.8/6.6/14.2 15.7/8.1/15.5 14.3/13.7/5.9inches)

Weight(pounds) 12.3 10.1 11.9 12.2 12.1

Pixel resolution 1 ,024-by-768 1 ,024-by-768 1 ,024-by-768 1 ,024-by-768 1 ,024-by-768

Maximum signal 1 ,024-by-768 1 ,024-by-768 1 ,024-by-768 1 ,024-by-768 1 ,024-by-768resolution

Maximum refresh at75Hz 75Hz 75Hz 75Hz 75Hz

1 ,024-by-768

Lower res imagesscaled/not scaled Yes/Yes Yes/Yes Yes/No Yes/Yes Yes/No(Yes/No)

Maximum colors 16.7 million 16.7 million 16.7 million* 262,144 16.7 million

Drivers needed No No No No Yes

VESA DPMS

Other software None HP Optimizer None Noneutility for DOSand Windows3.x

Tilt/swivel stand Yes/Yes Yes/Yes Yes/No Yes/No Yes/No

Brightness/contrastYes/No Yes/Yes Yes/Yes Yes/Yes Yes/Yescontrols

On-screen menus Yes Yes Yes Yes Yes

Maximum number otdefective pixels for 10 9 7; 2 it adjacentservice or replacement

Backlight, one

Warranty 1 year 1 yearBacklight, one year; other

1 yearyear; other

parts and labor, 3 years parts andlabor, 3 years

* This is an analog LCD, so theoretically there is an unlimited color palette (as with a CRT).**1 complete pixel; 15 sub pixels on, or 18 subpixels off.***Depends on the number and location of defects.


Page 30Updated: April 18, 2000

Figure 6. Registration Desk Area



Page 31

Documents

PmgmmandOperationsAmlysis and AnalysisResults ...ioe481/ioe481_past_reports/w0003.pdf · The Packard Bell NEC Zi was another recommendation that would result in a smaller monitor