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This is a presentation for the April Symposium for the Nashville Tennessee PMI. {PhD Students Gagan Rajpal and Craig Stevens present their work using Gagan's examples.
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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 it 3 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 it 3 PI Assessment and Performance Measures
✓
Three Easy to Understand and Use
Improvement Phases
6
A =
Assessments
P = Problem Solving
I = Implementation
Using Project Management Tools/Support
Westbrook Stevens, Seven Attributes of
Excellent Management Model, 1990 ©
People
and
Team
Building
7 From Book Geronimo Stone
http://www.llumina.com/store/geronimostone2.htm
Hospital Service
Doctor’s Office/
Department
Patient
Admissions
Life cycle of a patient needing services at
East Tennessee Children Hospital
Incoming Patients
Resource Allocation
Step 2 –Assessment Phase
10
A =
Assessments
P = Problem Solving
I = Implementation
Using 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 it 3 PI Assessment and Performance Measures
✓
✓
Hospital Service
Doctor’s Office/
Department
Patient
Admissions
Incoming Patients
PART I : Incoming Patients Applicable Lean Principle : Consistent incoming patient flow
Incoming patient flow and trend
Hospital Service
Doctor’s Office/
Department
Patient
Admissions
Incoming Patients
PART I : Incoming Patients Applicable 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
Patient
Admissions
Incoming Patients
Is staffing logistics appropriate?
Is patient registration a smooth process?
Current layout
PART II : Patient Admission Applicable Lean Principle : Efficient, effective and reliable admissions process
Hospital Service
Doctor’s Office/
Department
Patient
Admissions
Incoming Patients
Is staffing logistics appropriate?
Is patient registration a smooth process?
Current layout
PART II : Patient Admission Applicable Lean Principle : Efficient, effective and reliable admissions process
Step 2 –Assessment Phase
24
A =
Assessments
P = Problem Solving
I = Implementation
Using 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
Patient Registration
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 order Not having insurance card
No Order
Grand parents or Neighbors
Step parents
Interpreter
Step 3 – Build the Problem Solving
Portfolio
29
A =
Assessments
P = Problem Solving
I = Implementation
Using 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 admit [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 = Implementation
Using Project Management Tools/Support
GFR
GFR GFR
The “current” layout
Front Desk
Call Center
Fax Room
Marty’s
Office
1 2 3 4
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
Patient
Admissions
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
Patient
Admissions
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
Step 2 –Assessment Phase
40
A =
Assessments
P = Problem Solving
I = Implementation
Using 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
3/11/2013 44
3/11/2013 45
3/11/2013 46
3/11/2013 47
3/11/2013 48
Redundancy in paper work
Waiting for technician
Waiting for room
Same questions asked by several personnel
Orders lost
Delay in bringing patients from the floor
lack of transporter
technician being busy with other patients
sometimes lack of technicians
Types of waste
3/11/2013 50
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
Patient
Admissions
Incoming Patients
Resource Allocation
PART IV : Resource allocation model
Hospital Service
Doctor’s Office/
Department
Patient
Admissions
Incoming Patients
Resource Allocation
PART IV : Resource allocation model
Step 3 – Build the Problem Solving
Portfolio
54
A =
Assessments
P = Problem Solving
I = Implementation
Using Project Management Tools/Support
1. To increase service/ patient satisfaction
2. 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 customer
Resources 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
Patient QA
QS1
QS2
QS3
QS4
QS5
QS11
QS12
QS13
QS14
QS1n
Output = Min: ∑ QA + QS1 + QS11 --------------
Output
1. To increase service/ patient satisfaction
2. 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 customer
Resources 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
Patient QA
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
✓
✓
✓
✓
✓
✓
✓
