Removing Waste and Rework Improving Flow in Presurgery Testing

April 19th, 2011

Vanessa Calderon,

Shelby Neel

Agenda

What is Presurgery Testing at IMMC?What is Lean Six Sigma (LSS)?Project Timeline, Structure, and RolesUnderstanding the Current StateStep-By-Step DMAIC ProcessResultsQuestions?

Outpatient Surgery IMMC

Presurgery Testing Area (PST) Focus

6 Month Process Improvement Project

Strong Leadership Support

PST (Pre surgery Testing)

Information Needed for Day of SurgeryHistory and Physical created within 30 days

(Surgeon) Internist History and Physical (if requested)Orders for SurgeryEKGLabsDiagnostic TestsCardiac Records

When Information Not Available

Show Stopper Frustrating for All

Options Call for Information

day of Surgery Impossible to get info

for 0700 start Delay Surgery Cancel Surgery

What is Lean Six Sigma?

Lean Six Sigma: Integrates the most powerful tools from Lean and Six Sigma Philosophies to remove waste from the

customers perspective as well as reduce variation in quality and processes (Customer Centric and Data Driven

Improvement)

Lean

Waste (Muda)

Muda: Anything that adds time or

cost to the process without

adding value

Seven Wastes: Transport,

Inventory, Motion, Waiting,

Overproduction, Over processing

(Rework), Defects

Value Stream

(Mapping)

Six

Sigma

DMAIC Framework

Define, Measure, Analyze, Improve, Control

Variation and Defects

Muda (Waste): 7 Wastes

 

Waste: Anything that adds cost without adding value; The 7 Wastes are:

1. Transport – moving products that is not actually required to perform the processing

2. Inventory – all components, work in process, and finished product not being processed

3. Motion – people or equipment moving or walking more than is required to perform the processing

4. Waiting – waiting for the next production or process step5. Overproduction – production ahead of demand6. Over Processing – the creation of unnecessary activity due to

poor tool or product design7. Defects – the effort involved in inspecting for and fixing defects

Value Stream Mapping

Fax , phone , or email req ues t for s urger y

Orders sent and i nfo entered into OR SOS

Review by OR Super visor Initial Scheduling

Delay for Revi ew , Scheduli ng / Rescheduling

Confirm Case with Physician Check resource availability Clerk creates chartbacks and

calls patients wi th surger y instructions and ti mes

Confirm Scheduling

Delay for repeat Physici an and Patient calling

Case Confir med ? Issues Found by OR Super vis or /

Nurses ? Pull charts Order tests , labs Check for C urrent H & P ,

Signed Orders Check that Anesthesia

Protocol tests or der ed Check Charts

Call Physici ans’ Offices for missing infor mation

Las t R esort : Call Pati ent for infor mati on on tes t locati ons

Chart is “CHEC KED” but not finished Call for Missing

Information Did the requir ed

fax arri ve ? Is H & P / Lab Wor k in Chart

Complete ?

Walk to Admitting office or C hart room to check for new faxes Check Fax Machine

NO YES

NO

YES : Call PO for R esch edu ling

NO

Physicians’ Offices ( 120 ) 13000 Surgeri es / Year Avg . 52 Surgeri es / Day Lead Time : 3 weeks Call PO to Confirm C ase NO : Call PO for R esch edu ling

YES

Delay for Repeat / Returned Calls Leaving Messag es and Fax Checking

Filled Incompl ete Chartbacks

Gi ves Final Schedul e to PST Clerk

Gi ves Final Schedul e to PST Nurses for Chart C ompleti on Assignments

Admitting

Patients ( 13000 ) Lead Time : 2 Hours

Completed Chart YES

Call pati ent for phone heal th assessment Call for Phone

Assessment

Delay for NVA Phone Time , Repeat / Returned Calls

Leaving Messag es

Final Schedul e

Final Schedul e

Patient arrives and sits in waiting r oom

Patient is visited by Pati ent Registrati on

Patient is Taken to Prep Room Pre Prep Arrival Nurse confir ms patient with

Chart and starts IV , verifies assessment , last dose meds , vitals , and patient signs consent

Anesthesiol ogist perfor ms assessment and Surgeon mar ks site

Initial Prep Does the pati ent

need a Lab / EKG ?

Surger y RN confirms pati ent with chart and ar mband

Checks for all necessar y infor mati on for surger y Final Prep

Lab – Blood T esti ng Capacity : Non - Cons trai nt Time Variation : N / A unless additi onal testi ng req uired Lead Time : 1 – 3 hours

All infor mation Avail abl e and

Correct ? RN Directs famil y to Waiting Room

Patient is taken to Oper ati ng Room Surgery NO

YES Blood Taken to Lab and / or

test performed Perform Lab / Test

YES NO : Cancel and R eschedule

Avg : 8 Hours / day Total : 2 days –

3 W eeks

Avg : 4 Hours / day Lo : 3 . 4 Hours Hi : 4 . 6 Hours Avg : 4 Hours

Lo : 2 . 4 Hours Hi : 3 . 6 Hours Avg : 3 Hours

Lo : 1 . 75 Hours Hi : 4 Hours

Avg : 2 . 9 Hours Lo : 1 . 25 Hours

Hi : 2 . 5 Hours Avg : 1 . 9 Hours

Lo : 45 Minutes Hi : 2 Hours

Avg : 1 . 4 Hours Lo : 45 Minutes Hi : 2 . 2 Hours

Avg : 1 . 5 Hours

Final Schedul e

Avg : 10 Minutes

Avg : 10 Minutes Avg : 10 Minutes

Lo : 15 Minutes Hi : 45 Minutes

Avg : 30 Minutes Lo : 10 Minutes Hi : 60 Minutes

Avg : 35 Minutes Lo : 5 Minutes Hi : 20 Minutes

Avg : 12 . 5 Minutes Delay for In H ouse Tes t R esults Delay for Missing Infor mation

( Short for m H & P , find doc ument ) Lo : 0 Minutes Hi : 15 Minutes

Avg : 7 . 5 Minutes Lo : 5 Minutes Hi : 20 Minutes

Avg : 12 . 5 Minutes NVA Percentage : 60 % VA Percentage : 40 %

Non Val ue Added Ti me Avg : 17 . 2 Hours Val ue Added Ti me Avg : 11 . 5 Hours

Current State Value Stream Map Presurgery Testing Process at Iowa Methodist Medical Center

Des Moines , IA November 2009 Iowa State Process Improvement Group : Vanessa Calderon , Scott Deger , Bobbi Wendorff

References : Outpati ent Surger y VSM ( Jul y 2009 ) facilitated by DMAC and a cros s functional team , specificall y from OR Amy Bethel , Wanda Mars hall , Sher yl Sulli van , Kar en Powell Seemiller , Glenda ( Patient Access ) ; Helgeson , Matthew ( Radi olog y ) ; Culbertson , Gayl e ( Lab ) ; McDanel , Joyce ( Integrated Ser vices ) ; Clemen , Linda ( Emergenc y ) ; Eas tin , Kathleen ( Phar macy ) ; Ruth , Lisa ( Cardiolog y ):

Wadding ham , Curtis ( Diagnostic Ser vices ) ; Patton , Sue ( PACU ) ; Myers , Debr a ( Health Info Manag ement ) In Additi on ( November 2009 ): Burt , Sue ( Lean R edesign Leader ) ; Dingel , Val erie ( PST RN ) ; Crandall , Mar yAnne ( scheduling technician )

Jimmerson , Cindy ( 2009 ) Val ue Stream Mapping for H eal thc are Made Easy ; Keyte , Beau ( 2004 ) The Complete Lean Enterprise : Val ue Stream Mapping for Administrati ve and Office Processes

1 Day Befor e Surger y 3 Days to 1 befor e Surger y Day of Surger y Arri val Surger y Begins 2 Days to 3 Weeks befor e Surger y

Call PO for M issing Chart Information

Charts not i mmediatel y created when surger y

scheduled

Process Cycle Efficiency , 40 %

Multipl e C alls to the same PO for multipl e char ts

Repeated Wal king to Differ ent F axes

outside r oom

Phone C all to Patient for Surger y ti me and

Assessment ar e separate calls Patient N ot Notified of

need for test until D ay of Surger y

Doctors not req uired to send Or ders / H & P

duri ng Scheduling

Chart Assignments happen onl y day before

surger y Online

Scheduli ng ?

Iconarchive . com

Current State (Before Improvements): Must determine how things actually are – not how people perceive the process to be!

This is achieved through observations and data gathering on activities, time studies, and interviews.

Value Stream Mapping

Issues (Areas of opportunity) Identified using “Kaizen Bursts”

Value Stream Mapping

Wastes and Rework Identified (Transportation, Walking, Rework, Non-Value Adding Activities such as phone calls)

Value Stream Mapping

Process Cycle Efficiency

Determined (VA vs. NVA Time) – 40%

DMAIC Project Framework

Define

Define the customer and their 'Critical To Quality' issues and expectations Define the business processes that are involved, the boundaries of the project Create a Value Stream and/or Process map Decide on the metrics 'Big Y', little y's and the x's Form a project team and develop a Project Charter

MeasureMeasure the existing process by gathering data from the process; Determine Baselines (starting points) so that you are able to see if improvements have a positive impact and the magnitude of the impact

Analyze

Analyze the data using critical statistical methods.Identify the gaps between existing and desired performance.Identify sources of variation Decide on the processes that will be improved Gather more data ('measure') if necessary

ImprovePropose solutions Carry out pilot studies, design of experiments etc. to test and evaluate the proposed solutions Develop an implementation plan

Control Implement systems and procedures to ensure the improvements are sustained Develop procedures, control plans, staff training etc.

Project Background – Timeline (Ramp-up)

 

Fall 2009: ISU Industrial Engineering Student Projects

Early Winter 2010: Implementation of some student recommendations

Winter 2010: Explored Outside Consultant Work

Spring 2010: Decide on internal process improvement project; preparation begins

Summer 2010: Project Team Forms and Kick’s Off to begin DMAIC Process; 40 hours of LSS training for Core Team

Project Background – Timeline (DMAIC Project)

 

November 2010 – Present: CONTROL (monitor improvements, garner feedback, update training and reference materials, execute Transition Plan)

September 2010 – February 2011: IMPROVE (Small tests of change, trials, training)

August – October 2010: ANALYZE (Confirm root causes, Deep dive into results of data analysis and consider alternative routes of action)

June – August 2010: MEASURE (Observations and Data collected)

June 2010: DEFINE (Charters Created, Operational Definitions and scope refined)

Project Structure and Roles

Core Team

Core team• Manages and structures the project, develops and executes overall project

plan• Communicates project deliverables and status to Steering Committee• Consists of key clinical process owners 1)MD’s 2) RN’s and 3) One

project lead/manager that stays the same over the course of the project for continuity (50% - 100% time spend)

Team Leaders• Dedicated Process leaders that organize, develop, and leads problem

definitions, metrics, root cause analyses, solution development and testing, and final implementations

• Delivers information and prepares recommendations

SME, Subject Matter Experts (e.g. ORSOS expert)• Supply input, based on experience and expertise on a specific part of the

project. • The required experts can change per phase. (5-10% time spend)

Team Leaders

Staff / SME’s

Steering Committee

Steering Committee• Steers the project and makes decisions about goals and milestones• Makes strategic/directional and financial related decisions• Active involvement with roadblocks and overall progress• Recommend same people over life of the project (1-5% time spend)

Project Structure and Roles

Margie H. Shelby NeelLeigh Ann W./ Chanel Hubby

Doug R.

Steering Committee

Core Team

Team Leaders

Staff and SME’s

Physicians Team Leaders (RN’s, Techs, MD’s)Dr. Stubbs (Surgeon) Margie Higdon – IMMC OR (Surgery)Dr. Sundet (Anesth.) Leigh Ann Wachter /Chanel Hubby-CSP Douglas (Doug) Reed – ILH OR (All)

Shelby Neel – IMMC PST Project Leaders / Process Improvement: Dennis McInerney/

(Industrial Engineers) Vanessa Calderon

Amy Bethel, Eric Lothe, Kathie Nessa, Dennis McInerney, Dr. Mark Purtle, Dr. Steve Stephenson, Dr David Stubbs, Dr. Mark Sundet

Understanding the Issues of the Current State in PST

What were we dealing with?

Our Process

Call the day before surgery requesting missing information for patients. H & P Orders Labs EKG Cardiac Information

Issues with Faxes Faxes deemed lost Sensitive Patient Info “Batching” or faxes means waiting

needlessly for information or calling for something we already have!

DCR Tracker Electronically converts fax to PDF-like

document for viewing on computer screen rather than printing paper copy immediately

Reduced but did not eliminate these issues (still batching and faxes claimed to be lost)

Issues Addressed

We Understand

Physician Offices are Busy

Our calls disrupt their work flow

Chart information may not be available the day surgery scheduled.

Surgeons

Many Surgeons (141)

Many Offices (>100)

Information comes to us randomly

Required call before send information

Problem with Current Work Process

Information Not Always Available Day of Surgery

Assessments Not Completed

Labor Intensive for BOTH of us.

Labor Intensive

3 Nurses Dedicated to PST Process

Each Nurse Spends about 4 hours a day calling for information

~ 60 hours/week 1.5 FTE dedicated to

calling for info.

Financially

Roughly $100,000 per year spent on nursing salary calling for information.

Proportional amounts of financial strain on physician’s offices as well

Ideally

At time schedule surgery Orders H & P Labs EKG (if applicable) All pertinent chart

information

Two Main Issues

Not getting required chart Information by day of surgery

Pre-Assessments not getting completed (Requiring them to be done on the Day of Surgery which takes extra time and is a patient dissatisfier)

Using the DMAIC Framework

DefineMeasureAnalyzeImproveControl

Define

Measure (Call Tracker)

Populates with special instructions specific to the Physician’s Case

Data (Measure)

Missing Chart In-formation on Day

of Surgery17%Chart Complete on

Day of Surgery83%

Missing Chart Information on Day of Surgery

Although 83% of information is received day before surgery,17 out of 100 charts are still missing crucial information.

Missing H & P by Specialty (Measure)

General Obstetrics & Gyno-cology

Orthope-dic

Neuro-surgery

Urology Ear, Nose, Throat

Vascular Gastroen-terology

Bariatrics Peds General

General Obstetrics & Gyno-cology

Orthope-dic

Neuro-surgery

Urology Ear, Nose, Throat

Vascular Gastroen-terology

Bariatrics Peds General

Missing H&P

215 207 178 136 111 92 81 53 52 43

To-tal Cases

640 432 401 272 274 254 204 135 144 86

% Missing

0.3359375 0.479166666666667

0.443890274314215

0.5 0.405109489051095

0.362204724409449

0.397058823529412

0.392592592592593

0.361111111111111

0.5

50

150

250

350

450

550

650

5.0%

15.0%

25.0%

35.0%

45.0%

55.0%

Missing H&P's by Specialty

Missing H&P Total Cases

Day prior to surgery missing 33% to 50% H & P by specialty. Problem with the process.

Completed Assessments (Measure)

Assessment Not Completed, 1967,

54%

Assessment Completed, 1649,

46%

Assessments CompletedBased on Call Tracker Data from Jan to

June 2010Sample Size 3,616 Charts

Nurses spending a lot of time calling for missing information. Unable to get assessments completed.

Calls to Physician’s Office (Measure)

Total; 1967; 63%

Total Number of calls to Office;

1140; 37%

Calls to Physicians OfficeBased on Call Tracker data from Jan to

June 2010Based on 3,107 Charts Reviewed

Based on 3,107 charts reviewed, there was 1,140 calls to offices.

Missing Orders Day Prior to Surgery(Measure)

Day prior to surgery missing 23% of orders for surgery.

Signed Orders Present, 1967,

77%Signed Orders Missing; 574; 23%

Missing OrdersBased on Call Tracker Data from Jan to

June 2010; Sample Size 2,541

Missing History and Physicals (Measure)

H&P Present, 1967, 65%

Current H&P Miss-ing; 1057; 35%

Missing History and PhysicalsBased on Call Tracker Data from Jan to

June 2010Based on 3,024 Charts Reviewed

Day prior to surgery missing 35% of H & P’s.

Time to Receive Faxes (Measure)

6:44

AM

8:51

AM

9:02

AM

9:16

AM

9:21

AM

9:24

AM

9:31

AM

9:33

AM

9:36

AM

9:40

AM

9:47

AM

9:53

AM

9:59

AM

10:0

8 AM

10:1

3 AM

10:2

2 AM

10:3

0 AM

10:3

5 AM

10:3

9 AM

10:4

3 AM

10:5

0 AM

11:0

1 AM

11:0

7 AM

11:1

7 AM

11:3

2 AM

11:5

0 AM

12:0

2 PM

12:5

2 PM

1:14

PM

2:25

PM

12:00 AM

2:24 AM

4:48 AM

7:12 AM

9:36 AM

12:00 PM

2:24 PM

4:48 PM

7:12 PM

PST: Time Needed to Complete Chart CheckingAverage Time to Check Chart 1 hour 42 minutes

Chart Start Time

Chart Finish Time

Chart Start Time

Ch

art

Fin

ish

Tim

e

From time nurse starts processing a chart in pre surgery areauntil they receive all information for surgery, is average

of 1 hour 42 minutes.

Assessment Length (Measure)

Used data from Carecast timestamps to compare Day of Surgery Assessment reviews with and without pre-assessments completed

Often found it didn’t save time overall, but did save a few minutes (5-10 min.) on the day of surgery.

If we can eliminate the time to pre-assess, the overall time between pre-assessment and day of surgery will be reduced…Online Assessments!

Surgery (Measure)

Average Surgery scheduled at IMMC is 21 days prior to actual surgery date.

This represents our lead time to collect the proper documentation and patient assessment.

Analyze

Value Stream Map / Process Map

Data Spaghetti Diagrams Mapped Work Flow Root Cause Analysis 5 Y’s Problem

Identification Issue Log’s

Analyze (Vision)

Getting Chart Information How ?????

Online Assessment How?????

Leadership Support

Tell Our Story

Analyze (Potential Solutions)

Meeting with Offices Lackluster Response

IT Solutions Roadblocks

Work Smarter not Harder

Online Assessment Company

Denied

Analyze

What direction to go??

Became Detectives

Started Testing Solutions

Improve – Test of Change

Process Flow Map Remove waste (rework) by

eliminating repeat calls to same location.

Scheduling asks for missing documents while confirming surgery

Get Organized: What is 5S?Based on five Japanese words that begin with ‘S’, the 5S Philosophy focuses on effective work place organization and standardized work procedures.

Sort – eliminate items not used in the process Set In Order - organize, identify and arrange everything

in a work area Shine - regular cleaning and maintenance Standardize - make it easy to maintain - simplify and

standardize Sustain -maintaining what has been accomplished

Before/After Pictures (Drawers)

BEFORE AFTER

Before/After Pictures (Binders)

BEFORE AFTER

Before/After Pictures (Standard Work)

BEFORE AFTER

NONE

Implementation

Communication SheetFront of Chart

See what has been done at a glance

Also helped Pre-Op and OR

Test of Selected EMR Access

Allscripts Selected Access (Only see certain

parts of patient record) Learned of opportunity through OB

Implementation

Leadership Support Meeting with The Iowa Clinic (TIC)

(Spearheaded by Dr. Stubbs) 40% Surgeries

Goal Have selected access to their

EMR Orders (60 days) H & P’s (60 days) Labs and Diagnostic Tests (1 year)

Implementation (Allscripts)

Great Collaboration – WIN-WIN! Just as Important to them as us

Schedule Surgery Electronically Tasking (Request List of Documents Needed) Access Insurance Information Made orders available in Allscripts

Implementation (Allscripts)

Old versus New Process

Add video

Implementation (Online Patient Assessments)

Online AssessmentPatients enter their

own health history information

Work with PRWeb DeveloperLearned of Possibilities

through OB (again!)Developed own form

Methodist West Iowa Lutheran Iowa Methodist

Implementation (Auto-Populate Consents)

Transcription = Rework = Waste!

Eliminate transcription whenever possible.

New Process: Future State Map

• Smoothed Processes• Eliminated Rework by Assigning Tasks to

one person whenever possible• One Piece Flow vs. Batching• Eliminate the need for excessive phone calls

Results: Complete Documentation

Measurable Objective Baseline Current

Improve percentage of charts that have complete

chart documentation from 83% to 90%.

83% 95.50%

Delta Time Savings Financial Impact / Year

Reduction of 12.50% 208.333333333333 hours per year About 10% of an FTE

Results: Pre-Assessments

Measurable Objective Baseline Current

Improve percentage of preadmission history

assessments completed from 53% to 90%.

46% 77%

Delta Time Savings Financial Impact / Year

Reduction of 31% 516.66 hours/year About 25% of an FTE

Results: Reduced Phone Calls

Measurable Objective Baseline Current

Reduce percentage of charts requiring phone

calls37%

18% (since implementing new process giving list to

scheduling and All Scripts)

Delta Time Savings Financial Impact / Year

Reduction of 19% 633.33hours/year About 30% of an FTE

Results: Missing Orders

Measurable Objective Baseline Current

Reduce percentage of charts missing orders 23% 10.3%

Delta Time Savings Financial Impact / Year

Reduction of 12.7% 84.66 hours / year About 4% of an FTE

Results: Missing H&Ps

Measurable Objective Baseline Current

Reduce percentage of charts missing H&Ps 35% 16.4%

Delta Time Savings Financial Impact / Year

Reduction of 18.6% 205 hours/year About 10% of an FTE

Results: Time to Check Charts

Measurable Objective Baseline Current

Reduce the amount of time it takes to

completely check a chartI hour 42 minutes 44 minutes

Delta Time Savings Financial Impact / Year

Reduction of 58 minutes 4000 hours / year About 2 FTEs

Results: Time to Pre-Assess Patients

Measurable Objective Baseline Current

Reduce the amount of time it takes to pre-assess

a patient25 minutes 25 minutes

Delta Time Savings Financial Impact / Year

FUTURE (at current level of about 75%) 10 minute review for a reduction of

15 minutes1875 hours / year About 90% of an FTE

Results: Time to Fill out Consents

Measurable Objective Baseline Current

Reduce the amount of time it takes to fill out anesthesia and surgery

consents5 minutes 5 minutes

Delta Time Savings Financial Impact / Year

FUTURE (eliminate hand-written consents) 833.33 hours / year About 40% of an FTE

Control: Transition Plan

Transition Plan: Lays out our plans to monitor improvements and finish up action items left from project

Transition Plan – PST (Shelby)Team Leader Name: Shelby Neel Project Area: PST/Pre-op

TaskWho's Responsible?

(1 Person) End Date Recurring Resources Needed

Useful Contact Info (Phone Numbers, Email Addresses) Update 3/10/2011 Update 3/25/2011

Oversee Online Assessment Build Shelby Neel Mar-11

Access to site where model being built from web developer

Drew Harden, Tonya Terrell, Kim Utterback, Jeff Croonquist, Marian Collison, Jennifer Perry

Have been in contact with builders; emailed again to see if we can view progress

Received link to work-in-progress site. Looks great. Will receive excel output file week of 3/28/2011.

Develop Work Flow with Online Assessment

Shelby Neel Vanessa Calderon Apr-11

Access to Online Assessment; PST Standard Work

Vanessa Calderon, Shelby Neel

Looking into workflow - who will input data into Carecast or if that is necessary. Suggestion of having clerk input has been brought up - Janet Freese has approved this as not a violation of policies.

Trial Online Assessment Shelby Neel April 30 2011

Access to Online Assessment, Access to individuals to trial form

Drew Harden, Tonya Terrell, Kim Utterback, Jeff Croonquist, Marian Collison, Jennifer Perry

A request has been made to an orthopedic group as well as to other large gatherings of patients so we can gather feedback in a focus group in real time.

5S PST Area (Update Notebooks, Clean drawers, check documents for relevance) Terri Springer Ongoing

First Wednesday of each month

5S training, 5s Scorecard

Report to Sheryl Sullivan TBD

Implement Auto Population of Consents Vanessa Calderon 15-Mar-11

Medical Records, Access 2007, Crystal Reports, Outpt Report

Vanessa Calderon, Al Hornocker, Shelby Neel

Next Thursday and Friday Installed. Need to train Kelly.

Printing Consents each day Kelly Drake Ongoing Daily

Access 2007, Crystal Reports, OUTPT Report

Vanessa Calderon, Al Hornocker, Shelby Neel Installed. Need to train Kelly.

Allscripts Monitoring Sheryl Sullivan Ongoing As Indicated Access to AllscriptsMarilyn Backus Deann Shepherd

*when people leave, she needs to call appropriate person to delete access

Implementing Daily Huddle Sheryl Sullivan Ongoing Daily

Metrics Board, Access to Metrics, One Staff Sammy Jayakhumar

* Still looking into staffing issues ON HOLD

Determining Effectiveness of One Staff Sheryl Sullivan Ongoing Daily One Staff Karen Lutter

Not correct product - looking into something else ON HOLD

Access Surgery Schedule on Home Drive Vanessa Calderon April 30 2011

Dedicated secure drive for Outpatient Surgery staff

Vanessa Calderon, Shelby Neel

Shelby has been approved for drive. Now just need to fill out some more paperwork.

Revise Call Tracker Vanessa Calderon 31-Mar-11 Excel 2007 on PST computers

Vanessa Calderon, Shelby Neel Completed 3/8/2011

Suspended call tracker use - may move away from full data collection to simple spreadsheet. Call tracking may have done its job by now in the data collection arena.

Input Doctor Preferences into CallTracker

Shelby Neel or Jenny Westberg April 30 2011 An Indicated

Access to Call Tracker Excel File Vanessa Calderon

Completed - will print out for use by staff as call tracker not being used.

Run Monthly Call Tracker Report Sheryl Sullivan Ongoing Monthly Call Tracker DataVanessa Calderon, Shelby Neel N/A

Trial Tasking with Allscripts in PST Shelby Neel April 30 2011 ONGOING AllscriptsDeann Shepherd Shelby Neel

Begun - Nurses are hesitant to use it but have gotten response in 20-30 minutes so they are very happy with it (the ones who have used it)

Many nurses very happy with All Scripts and are reporting things are "much easier"

Build Reports for Daily Huddle Vanessa Calderon April 30 2011 Excel 2007 on PST computers

Vanessa Calderon, Shelby Neel

Build own staffing model using Arena (Look at Variation) Shelby/Vanessa end of May Excel 2007

Control & Results

Current State Continue Seeking out

Opportunities to Improve

Amazing Results Instant Access to Surgery

Documents by End-Customer (Eliminating rework and over processing)

Assessments being Completed

Questions?

Thank you to all those involved in making this project such a great experience for everyone.