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Patient Flows & The Productivity Paradox © primeASCENT, 2015 Paul Schilstra, primeASCENT November 20, 2015

Patient Flows & The Productivity Paradox

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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.

ASimpleIllustration

ClickHereForVideo

©primeASCENT,2015

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