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Patient Flows & The Productivity Paradox
©primeASCENT,2015
PaulSchilstra,primeASCENT
November20,2015
ThePhysicsofPatientFlows
Scheduling Admission/Registration
Assessment Treatment Education&Discharge
Laboratory&Imaging
UnscheduledEmergencyPatients
HarmedPatients
Pharmacy
©primeASCENT,2015
FrustratedPatients
FrustratedPatients
CausesofDelaysandWaiting
• Poorschedulingpractices
• Limitedbusinesshours
• Variationinvolumesandcasemix
• Variationincapacityavailability
• Variationinskillsetsandexperience
• Variationincare
• Equipmentbreakdowns
• Communicationdisconnects
• Errors
ImpactofFlows
• Revenues
• Qualityandsafetyofcare
• PatientExperience
• Investments
• Expenses
• Unevennessinflowsandworkload
• Overburdeningoffront-linestaff
• Staffmorale
TheProductivityParadox
WhatManagementWants:1-Beproductiveallthetime!2-Domorewithless!Little’sLawImposesAPhysicalLimit:“Aqueuebecomesinfinitelylongwhenutilizationapproaches100%”
Thishappenswhenpatientsorordersarrivefasterthancanbeprocessed➔Bottlenecks➔Harriedandfrustratedstaff➔Poorsafety+unhappypatients➔Increaseincostperpatient
IncreasingProductivityIsNotStraightforward…
©primeASCENT,2015
WhathappensifwecutCTcapacitytoreducecostsandincreaseproductivity,withoutunderstandingtheprocessesandinterdependenciesinvolved?
TheProductivityParadoxAtWork
©primeASCENT,2015
Productivitydoesgoupbutevensmallvariationsinarrivalandscanningtimeswillcausewaittimesandthenumberofpatientstogrowdramaticallyand
disproportionally.
ImprovingClinicalProductivity
WhyManyEffortsFail
• Topdown-mandatedprocess• Mainmotivationiscostreduction• Onetimeeffort(“Problemsarelikeweeds.Theycomebackifyoudon’tkeepimproving”)
• Notempoweringfrontlinestaff• Focusononeareaonly(“suboptimization”)
• EmphasisonLeantoolsinsteadofcreatingalearningandcontinuouslyimprovingorganization
TheRightWay-Understanding&Knowledge
• Focuscontinuouslyon:o Thepatientexperienceand
perceptionso Theentiresystemo Continuousimprovement:reduction
inunevennessinpatientflows,overburdeningofstaff,andwaste(includingsafetyproblems)
o Empowermentofandrespectforfrontlinestaff
o Work&communicationflows
Scheduling Admission/Registration
Assessment Treatment Education&Discharge
Laboratory&Imaging
UnscheduledEmergencyPatients
HarmedPatients
Pharmacy
©primeASCENT,2015
FrustratedPatients
FrustratedPatients
TheWeakestLinkDeterminesOverallPerformance
TheConstraintorBottleneckMarket-Quality-Capabilities-Capacity-Policies
ThankYou!
PaulSchilstra,President
Email:[email protected]
Phone:410-444-6024
www.primeascent.com
©primeASCENT,2015