Discovering Your Healthcare Solutions Together
ARRAY-ADVISORS.COM
Our Purpose What differentiates Array? We understand that asking the right questions positively affects your Health System’s goals. Our purpose is to ask the questions that turn your goals into tangible realities, as we continually seek improvement: For ourselves, for our clients, for our communities.
The challenges you face are not unique, but your solutions should be. Through a partnership of Strategy and Transformation we help you achieve and sustain. DISCOVERING YOUR HEALTHCARE SOLUTIONS TOGETHER Array Advisors has the expertise to help position your organization for success in tomorrow’s uncertain market. As your trusted partners in Strategy Development and Organizational Transformation, we can help you solve strategic business problems, and develop methods to improve efficiency and utilization. We approach each problem from a unique angle, providing a plan tailored to help you overcome your toughest challenges. Having dedicated our careers to healthcare innovation, our objective viewpoint and industry-wide knowledge provide you the decision support you need.
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THOUGHT LEADERS
TRUSTED PARTNERS
We specialize in making your ideas a reality. From optimizing asset utilization to mapping your ideal future state, Array Advisors’ expertise can help position your organization for future success.
We are here for you. Having dedicated our careers to healthcare innovation, we honed our skills to reach beyond our clients’ milestones.
DATA DRIVEN
COLLABORATORS
The optimal path in an uncertain environment is best guided by your information. We leverage your organization’s data and our national experience to empower you to make confident decisions.
As you form your future direction, we work beside you with tools tailored to your strategic challenges. Our objective viewpoint and industry-wide expertise provide you the decision support you need.
CUSTOMER FOCUSED
CULTURE OF IMPROVEMENT
We are dedicated to improvement. Problem-solving and forward-thinking individuals lead our efforts, which focus on your unique place in the healthcare delivery spectrum.
We are continually seeking improvement: For ourselves, for our clients, for our communities.
Transformation Our core mission is the same as that of our clients, improve the quality of our work, increase our efficiency, and motivate our staff to reach for success. At Array, we are establishing a culture of continuous improvement at all levels of our organization. We seek to empower team members to be agents for good change. We begin all endeavors by considering process before exploring solutions. Our team can guide your organization through pre-design, ensuring clear goal-setting; target outcomes; process analysis and design; and decision support. Our Lean-led approach to project definition provides a clear path to the right project before you begin to design. Below are just some of our frequently asked questions with tools that could benefit your organization. HOW CAN WE IMPROVE FLOW? There are many tools available to see how work flows through a system. Value stream mapping is a strategic exercise that can look at the flow of work from customer request to fulfillment. Process mapping focuses on detailed work flow elements and can identify non-value-adding steps that reduce efficiency and add to lead time. HOW CAN WE MAKE A RAPID IMPROVEMENT? One of the most successful strategies for making lasting change is involving those affected by that change. We have found that kaizen events provide the appropriate platform for consensus-based decision making across a multi-disciplinary team of stakeholders. These events target specific problems; can include other improvement tools, such as process design and throughput analysis; and typically last three to five days. HOW CAN WE PLAN FOR FUTURE IMPROVEMENT? Developing a strategy for implementing future improvements can lead to substantial future successes. Our knowledgeable consultants can provide your organization with the experience necessary to create a well-informed plan for organizational transformation. Bringing all of the stakeholders to the table for a conversation about improvement strategy aligns all areas of the organization with its goals.
Our Methods Our Toolkit of methods is infused with Lean principles. Our process begins by understanding your current operations and clearly defining your project goals. We employ a variety of integrated tools, such as process mapping, operational planning, virtual mock-ups, and simulation modeling as we work to develop a comprehensive project that supports your mission of caring for your community.
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Inside Look: Case Study DESIGN VALIDATION CLIENT: Laser Spine Institute
Our design validation tool can help ensure that your new space will operate as intended
METHOD: Design Validation
before you even start construction. We introduce the variation you experience daily
CHALLENGE
simple averages.
into our system validation analysis, which leads to results that are more accurate than
Sometimes a process looks good on paper,
RESOURCE UTILIZATION
but might not function as expected. When there are a number of variables in play, each with a distinct variation distribution, it can be difficult to predict how a system will react.
A resource is anything that aids the movement of work through a system. Organizations hope to optimize their resources’ utilization because they typically have an associated cost, which decreases with higher utilization. After determining ways to
SOLUTION
maximize throughput and implement flow, we can ensure full utilization of resources
Array used a simulation study to determine
without creating non-value-adding process steps.
whether the newly designed process was optimal and whether the number of rooms was adequate for the patient volume the outpatient spinal surgery center hopes to serve. Basing the process design on efficient
Children’s National Medical Center sees more than 85,000 visits each year in their emergency department. This client sought out Array to determine an appropriate number of resources for a new registration process in their ambulatory center family practice.
practices leads to an easier implementation
The care of emergent pediatric patients is complex. Rapid decompression and non-
of productive work flows, staff movement and
specific symptoms make any unsupervised wait dangerous. In an effort to gain as
patient routing.
much information as possible, a two-step triage and assessment process was in place.
DEEPER DIVE The study began with patient flow observation, allowing the Healthcare Systems Engineer to gain an understanding of the ambulatory surgery center’s operations. Array captured input data using the system’s electronic medical record and validation; we used verification techniques to ensure the simulation accurately represented the system. The valid model was used to test different operating scenarios.
Protocols could be started early and providers knew that patients were evaluated in detail, even if they had a long wait. The unintended consequence was a bottleneck at assessment. To combat the problem, the providers felt a redesign of the arrival area, in conjunction with combining some existing care steps to reduce patient moves, was necessary. While this seemed like sound logic, we were concerned the root cause of the problem might be deeper. Together, we conducted an
eight-week,
process-led
design study to understand the
CNMC Current ED
ACUITY
Acute Treatment
current condition and develop a sustainable future state model. Arrival & Initial ESI Check In / Triage
Figure 2: Current state process map including average process time and time between steps, as provided by internal improvement group.
Security: Check ID, issue security badge
Assessment
Registrar: Name, DOB, SSN RN: quick assessment, complaint
1.5% 9.6% 30.4% 45.9% 12.6% 100%
Diagnostic
ED Physician: assessment, orders, treatment, discharge/admit decision, bedside registration
Security
PERCENTAGE
1- Resuscitation 2- Emergent 3- Two + Resources 4- One Resource 5- No Resources TOTAL
85,000 visits Washington, DC 35% Fast Track
Admission
Registration Bay
RN: full assessment
Discharge
ED Physician: assessment, orders, treatment, discharge/admit decision 3 Minutes
73 Minutes
7 Minutes
175 Minutes 8 Minutes
15 Minutes
6 Minutes
20 Minutes
Acute Care
Assessment
Wait
Check in Triage Fast Track
Security
When appropriate, we employ simulation modeling and predictive analytics to help Figure 1: The simulation study results lead the engineer to believe that eight flexible PRE-OP/PACU rooms could support the expected number of surgeries without increasing patient wait times. Additionally, adding a surgeon negligibly increases time spent waiting for a PACU room, but decreases the average total waiting time when the same quantity of patients is seen.
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clients make important early-design decisions with clarity and certainty. Rapid testing and data-driven decisions guide our work. We were able to leverage existing throughput data to rapidly build a simulation model. The model incorporated existing patient census data, which was quickly enhanced by the expertise of the nurses and doctors in the room. As we built the simulation model, we continued a dialogue with the emergency department staff to ensure that the output was matching reality.
Meet Our People
LAURA SILVOY Healthcare Systems Engineer
Using simulation and process improvement tools, Array’s healthcare Figure 3: Simulation model (right) showing simplified adjacency configuration (left) with three security/ check-in staff and five triage bays.
Using the simulation model, our cross-functional team of engineers, nurses, doctors and other support staff was able to test a number of patient flow options. As we experimented with different solutions, everyone in the room could see the impact of adding an additional security desk staff or removing a triage room. This hands-on approach helped the group quickly arrive at the optimal solution, which balanced patient waiting times and staff utilization, and ensured each provider was working at the top of their licensure.
STRATEGIC DECISION SUPPORT Every day, we make choices. They can be trivial, only affecting a small group; they can also be critical, affecting many aspects of an organization. Array’s trusted advisors can assist with your next strategic decision so you can see the impacts of your options before choosing. Utilizing proven techniques, we provide a range of custom analysis options that focus on your specific need. To dive deeper into how your health system could benefit from this method, consider this case study in which a regional healthcare provider that operates multiple ambulatory and acute care facilities hired Array. We assisted in a departmental space allocation study, where the emergency department and observation unit were key departments, for their new greenfield hospital. Array used discrete event simulation to build a model with readily available data, including average LOS, patient mix and arrival rates, that enabled the swift turn-around of a tool that answered the strategic question, “Should we use a universal
systems engineering staff strives to create a better patient experience by combining efficient work flows with effective spatial planning. Continuously advancing our own productivity and design culture is also a top priority, and the team works toward improvement in each aspect of our delivery process. Laura is part of Array’s healthcare systems engineering team. Her background in both architecture and healthcare systems engineering provides a unique blend of proficiency around the built environment, improvement methodologies and analytical approaches. Armed with technical expertise and the philosophies of lean, Laura transforms high-level process mapping data into digestible information clients can utilize as they work toward an ideal future state.
resource for observation and the emergency department?” Applying the information gleaned from the model results, the executive team was able to quickly make a strategic decision that resulted in an estimated $1.8M in savings.
Observation
Click here to watch an example Simulation Model
Emergency Department
Figure 4: Relationship diagram showing the proposed space interaction between the ED and observation unit (left). Results graphic depicting wait times for each scenario (right).
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Meet Our People THROUGHPUT ANALYSIS JONATHAN BYKOWSKI
The processing rates of each step combine to create total throughput time. Steps
Practice Leader,
with longer durations that occur later in the process create bottlenecks, and non-
Continuous Improvement, Transformation Advisory Services
value-added waiting time will increase the time it takes to get through the system. Array’s experienced team works with you to determine the optimal process-steps
Jonathan has dedicated his career to not only transforming healthcare systems for clients, but also their facilities’ design. As a Principal and Lean facilitator, Jonathan infuses process improvement into each step of the process.
We may be performing well, but we want to be better and really understand what it means to be outstanding.
configuration that maximizes the value quotient in your system. A dialysis center in Canada was looking for ways to reduce inefficiencies as the cost of health services increase. Winnipeg Regional Health Authority was interested to see whether smaller arrival groups could improve dialysis patient hook-up efficiency. Early in the project, they needed to decide how they might adjust their process and desired evidence to support their decision. Array presented a two-scenario simulation model to our client, which demonstrates the difference between staggering 20 patient arrivals by groups of five over 20 minutes and batching 20 patients in one arrival group. For each patient in the different scenarios, we measured the length of time from arrival to the start of set up. The model demonstrated a significant reduction in patient waiting time between arrival and port access when staggering arrivals by groups of five. Additionally, we presented an option to stagger nursing shift arrivals to help minimize the cost of staffing and align staffing with patient volumes. By visualizing the possible scenarios, we were able
His passion for problem solving drives
to provide concrete evidence of potential efficiency gains.
him to challenge traditional solutions and approaches. He tailors the project their organization and develop
Stagger
Batch
approach for each client to understand
them. Jonathan is most excited about developing new tools to help engage stakeholders, drive consensus and
Stagger
improvements that support and enhance
increase value for capital projects. Figure 5: Batch simulation model demonstrating 20 patients arriving at 8:00 am and Stagger simulation model demonstrating 5 patients arriving at 8:00 am (left). Experiment results showing effects of increasing initial nursing capacity on patient waiting time and number of patients waiting in stagger model (right).
PROCESS ANALYSIS You perform processes throughout your day. Our job is to assist with analyzing your workflows and determining where value is added. This helps us see where the waste is and eliminate those non-value-adding activities, allowing your work to flow more effectively. We combine reliable tools, such as spaghetti diagrams, failure modes and effects analysis (FMEA), and process mapping, with expertise to develop a solution tailored to your organization.
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Columbia Orthopedics is a patient-focused, outpatient orthopedic physician practice. They desired to improve the patient experience by reducing waiting time and improving flow throughout their process. The administrative team at Columbia knew about process improvement, but were unsure of where they should start and which improvements would provide the most value. Array saw this as the perfect opportunity to analyze the patient flow process
Figure 6: Waiting room volume over total observation time.
at the clinic and offer suggestions for future improvements. In this case, the process analysis was a swift, targeted multidisciplinary series of one- to twohour workshops in which we observed the process, collected preliminary data, briefly interviewed staff and developed suggestions for improvements as appropriate. •
Process Mapping: Staff gave a general overview of the process from patient arrival to departure.
•
Process Observation: Our team observed the clinic’s patient flow process from the perspective of the patient, physician and MA. We used spaghetti diagrams to track the flow of each population and time-study sheets to capture data regarding length of stay and physician interaction time.
•
Staff Interviews: To gain a better understanding of the daily operations, we spoke with staff from all levels of the organization using a custom interview questionnaire.
Utilizing process analysis and associated tools, we were able to develop a targeted improvement plan that identified a number of specific items that could improve patient flow and reduce waiting times. We provided this plan in a clear format, which included additional detailed information about our study. The observed clinic was a well-run, high-functioning patient services center. The custom improvement suggestions, provided as a result of process analysis, could be used to enhance the patient experience and move the clinic from good to outstanding. This assessment provided our client with an illustration of the improvement work we could deliver and allowed them to get to know our team on a deeper level. After process analysis, the client chooses which services fit with the current strategic goals. We work with them to develop an implementation plan for these improvement projects. The plan will include a more detailed process analysis session, future-state process design, and a comprehensive transformation plan.
PROCESS DESIGN Process design follows process analysis. After analyzing the work flow, we use process design to determine how to transform the results into a new way of working. In cases where a process does not already exist, its design comes first. When planning how a new process will work, it’s important to keep in mind the current system’s successes and failures discovered in process analysis. Array’s skilled facilitators can lead you through the process transformation, from analysis to design. When given the opportunity to design a greenfield hospital, our client knew they wanted to do it correctly. Their desire to improve applied Patient Arrival Distribution
Model 2-2 |
9%
to the physical space and the processes performed
Peds Beds Available as Resource for Horizontal Patients Peds Directly to Peds Beds (Peds Under 13)
within. Using process analysis and design, we
8%
Behavioral
Area=F
Area=F
7%
ESI 1,2 Peds ESI 1
Intake
Age<13
Vertical
5%
3%
2%
Resource
Count
Intake
10
Behavioral Bed
6
Main ED Bed
14
Peds
6
Vertical Trmt
12
Horizontal
Main ED
Lobby (wait) Peds
*Overflow
solutions.
Horizontal
Census Patient Type
1%
12:00:00 1:00:00 2:00:00 3:00:00 4:00:00 5:00:00 6:00:00 7:00:00 8:00:00 9:00:00 10:00:00 11:00:00 12:00:00 1:00:00 2:00:00 3:00:00 4:00:00 5:00:00 6:00:00 7:00:00 8:00:00 9:00:00 10:00:00 11:00:00 AM AM AM AM AM AM AM AM AM AM AM AM PM PM PM PM PM PM PM PM PM PM PM PM BIN Pediatrics
5
Waiting for Resource
Overflow Use
Incorrect Resource Use 0%
department as they explored the impact of multiple
Vertical
Intake
Resources Available 4%
facilitated a cross-functional team from the emergency
Vertical
Age<13 ESI 1,2 Peds ESI 1
Peds FREQUENCY
Lounge
Main ED
Quick Reg/Look 6%
Resource
Patient Type
Count
Patient Type
Main ED
Behavioral
167
Behavioral
Intake
ESI 3, 4 Vert
1,007
Main ED
Count
Resource
Patient Type
Count
Time (min)
25
ED
Horizontal ESI 3
185
Ave: 10; Max: 54
371
Intake
ESI 3, 4, 5
1,463
Ave: 12; Max: 105
Count
Behavioral
3,067
ESI 1, ESI 2
13,276
ESI 3, ESI 4, ESI 5
42,017
Horizontal ESI 3 Vertical ESI 3, ESI 4 Lounge ESI 4, ESI 5
10,501 26,221 5,295
Main ED
Peds
460
Peds
282
Vertical
Lounge ESI 4, 5
1,033
Ave: 10; Max: 108
Peds
8,385
Peds
Main ED
852
Total
677
Peds
Horizontal ESI 3
96
Ave: 10; Max: 49
Total
66,745
Adults
Expected Peds Observation Bed Utilization
0
Figure 7: Patient arrival distribution (top left), results from one simulation model scenario (top right), expected pediatric observation bed utilization (bottom).
Using process analysis, we worked with the team to map the current process. This mapping exercise allowed the team to see where reality deviated from expectations, and how their traditional triage model impacted patient waiting times. As the clinical team developed their desired future state, they began to PAGE 7
Inside Look: Case Study realize how different variables could affect waiting times for varied patient types. Many CLIENT: Indian River Medical Center METHOD: Value Stream Mapping CHALLENGE A fractured check-in and triage process that
questions surfaced, including the effects of providing dedicated pediatric care. Our Healthcare Systems Engineer developed a simulation model to test the impact of each potential patient flow and demonstrate the effect of varying resource allocation strategies. Ultimately, the team chose a hybrid model that combined a specialized pediatric experience with universal beds that could flex. The new process includes quick triage to help minimize patient waiting and improve the delivery of care.
evolved over time left patients waiting in long queues and sharing private information in the open lobby. Array suggested a complete throughput analysis before developing front door renovation solutions. SOLUTION After careful data collection and process analysis, an improved future state process was developed and implemented with
PEDIATRIC VOLUME= 10,000/yr
IRMC ED Arrival
No consistent person/role to call
CURRENT STATE MAP 5.22.2014
Outpatient Pavilion entry causes confusion; safety issue
ED LOBBY-SECOND FLOOR
ED DOOR/ FRONT DOOR/ OPP DOOR
LEVELS ACUITY * Collect # of patients that are repeat = _____________
Unassigned = 2.9%
* # of Patients discharged from Triage = ___________
0=0.1% 1=0.4% 3=58.4% 4=16.6% 5=1.6%
RAPID RESPONSE
MID LEVEL & TRIAGE RN PROXIMITY IS GOOD
57,000 VISITS/YEAR
AMBULANCE LOW ACTIVITY
LESS SEASONALITY THAN PAST YEARS
Triage 2 Station Room has no privacy for patients
157 PATIENTS/DAY RECENT TREND
Emergent Distress
CURRENT CCTV CAMERA VIEWS DRIVE
• Immediate Triage Assessment • Registration comes to Triage Room or get info from family
Arrival • Patient presents at ED entry • If needed, staff brings a wheelchair to car
Medic at front desk steps away to do transport or EKG leaving desk w/o clinical team member
No security monitor in Triage
Medic not always at front desk
• Medic places chart in plastic bin or gives to RN
POPULATE TRACKING BOARD
• Patient gives clipboard to registrar • Registrar creates an account and checks existing acct. +/- 2 min • Ask have you been a patient before • Ask for SSN if can’t find record (not often) • Print labels • Arm band patient • Paperclip check in form and labels and give to Medic
(ALL ON CLIPBOARD)
No way to track patients who arrive but don’t return clipboard
Not everyone knows to fill out clipboard
Mass of patients crowd desk with clipboards
Vitals if Medic
Privacy Issue
Length of quick registration can delay Triage documentation
New requirement to list admitting Dr. at time of registrastion causes longer accounts creation and its corrected later
• Sometime during quick registration • BP, Pulse, Respiration, Weight/Height (ask only) • Ask chief complaint • Visual Assessment
Wait
EKG • Chest pain patients • Medic does EKG • EKG walked to MD for review
No PC in rooms
Room
Chart to Triage
Return Clipboard
• Name • DOB • Scan Photo ID • Chief Complaint • Do they have an MD?
Verbalizing chief complaint has privacy issues
Wait
• Call to assign patients to rooms for bed side triage if rooms are open
Quick Registration
Wheelchair storage not as close to door as possible
Might delay flow
Triage RN Calls Charge RN
Triage (+- 2-3 min) • Vitals if not complete • Review chief complaint • Review Symptoms • History • Med rec if volume low • Suicide screen • TB screen • Begin protocol if no room available • Call charge RN to assign room • Labs only if protocol started • Sometimes to Xray/ orders if in protocol
NO MEDS IN RN PROTOCOLS
No minor care waiting
* Registrar until 11pm * Medic until 7pm
Bedside Reg does not always occur before visit ends
BEDSIDE REG.
Lab/ Xray/ Mid-Level Holding • Triage 3 as a holding room • Used as sub wait
Some visitors wait at check in desk, but only needed to see a volunteer
Registration Booth
Mid-Level • Eval patient • Treatment • Order Meds/Tests
Staff notes that not having a constant security presence is a danger
• Dedicated midlevel staff & RNs MInor care also now sees patient that are level 2 and going to main ED
Concern over to discontinuation of badging
Security • Not stationed in ED • Monitor back at position • No longer badge visitors • Transports • 12Hr coverage (Sheriff covers other 12 Hrs) • +- 25% seated in waiting room (might be less)
ED DOOR/ FRONT DOOR/ OPP DOOR
BACKER ACT/ PRISONER/ INJURY
RAPID RESPONSE
Minor Care & Mid level RNs
AMBULANCE LOW ACTIVITY
Security at ED is a roaming position. Not always at desk
Need to identify space for regist. start
Acute
Arrival
Volunteers disconnected from other staff
ED ENTRY Need to add Non-ED Registration After Hours
Bedside Reg. & payment for all patients except urgent care
* Security
ED ENTRY
Volunteers • Provide Information to family • Transport (on tracker or via phone) • Clinical Setup • Goal 2/day • To assist staff (if not available, the RN or Medic transports)
Discharge
Wait
ED LOBBY-SECOND FLOOR
Outpatient Pavilion entry causes confusion; safety issue
X Ray Labs
* = Not 24 Hour Coverage
• Bedside Triage if room open
Minor Care Charge RN has no visual oversight of Minor Care Room Status, but responsible for Room Assignments
No consistent person/role to call
* Volunteers 9am-9pm 7 days/wk Triage RN * Triage RN * Mid level * Phlabotomy * Medic
* Need Data on throughput in part of bedside triage
Security at ED is a roaming position. Not always at desk
IRMC ED Arrival
FUTURE STATE MAP 6.11.2014
2=20.0% BACKER ACT/ PRISONER/ INJURY
• Patient presents at ED entry • Access to wheelchair
Rapid Medical Evaluation
Quick Registration • Pivot RN • Name • DOB • Chief Complaint • Phone # • Find Existing Patient Record • Visual Assessment
Roaring? Registrar
• RN Assessment • Vitals • Need List • Review Symptoms • History • Suicide Screen • TB Screen • Begin Protocols
Wait
Sub Wait
Registration
Discharge
Provider More Primary MD to RN Assessment or Reg. at bedside
Pargon access to Primary MD ? not open to RNs
No badge for visitors makes access to acute area tough to monitor
Registration Urgent Care
• Full Registration • Payment
• Registration • Mid level Provides Assess • Vitals in Room
Discharge
Sub-wait Use Exist Triage as Urgent Care
Lewe
Urgent Care Treatment
Wait in Main Waiting Room
• Mid-Level
Develop Registration/ Check out area in Waiting
Figure 8: After observing the process in action, Array worked with a multi-disciplinary team to map the current state (left) process and identify opportunities for improvement seen in the future state map (right).
only minor space reconfigurations. The facility was able to test the process in their current department to be sure it would drive improvement before expending capital
VALUE STREAM MAPPING
dollars.
Mapping the value stream from customer request to completion is one of the best
DEEPER DIVE
number of steps in their process that the customer actually values often surprises
We began this project with current-state
organizations that perform this activity. Value stream mapping clearly depicts the
process mapping and observation.
interactions between departments and technology platforms, and the process times
Seeing how the system operates, we can
associated with each step.
ways to determine whether your system is providing value to the customer. The small
understand where bottlenecks and system failures might be occurring. The mapping session highlights discrepancies between
KAIZEN EVENTS
how the system should operate and how it is
A Kaizen Event is a three-to five-day improvement event that brings together an
actually working.
interdisciplinary team to solve a problem and create a lasting change. We facilitate
Data collection helped pinpoint the areas where the team believed a problem might
these events using consensus-based decision-making to ensure all voices are heard and each stakeholder supports the final decision.
be occurring, and helped them determine
Laser Spine Institute (LSI), a multi-site ambulatory surgery center, desired to improve
the root cause of the issue. After collecting
their overall patient experience. Experiencing challenges related to their clinic flow
data, we used future state mapping to
process, LSI hoped to identify areas of improvement that could help further enhance
design an improved patient flow, which
their Planetree designation. Patient concerns expressed in satisfaction surveys
involved developing a split flow model, rather
included clarity around payment and waiting times. Keeping in mind the voice of the
than traditional triage. Array developed a
customer, Array used a kaizen event to help this cross-disciplinary team quickly identify
transformation plan so the team knew which
problems around their clinic flow and develop a plan for implementing an improved
changes were necessary to turn the newly
future state.
designed future state into reality. With help from process improvement experts, the emergency department team was able to improve their waiting times in a small space, with very little construction.
PAGE 8
During the current-state mapping session, where members from each constituent group explained their part of the process, they discovered many opportunities for improvement. They also developed a better understanding of how each piece of the clinic day fits together and how individual departments interact. After identifying three key areas for improvement, the team designed a future state that incorporated these changes. The clinic mapping workshops also resulted in a detailed study around MRI utilization and the potential value of roomers in the new, larger space. Array used a simulation model to test different scenarios of LSIâ&#x20AC;&#x2122;s proposed future state and determine the best staffing option for the imaging department. LSI could see possible increases in patient satisfaction and value-added process time resulting from the implementation of three key improvements identified in the kaizen event. The added potential for reducing the duration of the first clinic day results in a larger number of patients scheduled for surgery and an improvement in the overall patient experience.
TRANSFORMATION PLANS Itâ&#x20AC;&#x2122;s much easier to reach your destination if you know which route to take when you begin. Transformation plans can help your organization set realistic milestones that lead to the realization of overall improvement that aligns with your goals. About to embark on a large capital project, and feeling the pressure of a growing service line, a south Florida medical campus desired a plan for future improvement they hoped would lead to a more efficient care delivery model. They needed to understand these implications before beginning design. Array worked with the client to understand what their organizational goals were and how they might achieve them. After clarifying the desired outcomes and developing high-level process maps to support them, Arrayâ&#x20AC;&#x2122;s team helped develop a transformation plan that became the roadmap to reach the future state.
PAGE 9
Strategy
Our Purpose
Healthcare is a complex and diverse business enterprise that is constantly in flux. New legislations, shifting reimbursement structures, evolving technologies and changing consumer preferences are just some of the forces reshaping the industry. In this dynamic context, healthcare organizations must endeavor to anticipate investments that will have long term value for the organization and its clients. As your trusted partners in Strategy Development, we can help you solve strategic business problems, and develop methods to improve efficiency and utilization. Below are just some of our frequently asked questions with tools that could benefit your organization. HOW CAN WE IDENTIFY THE BEST SERVICE LOCATIONS? A healthcare organizationâ&#x20AC;&#x2122;s long-term success will be defined by their ability to select prime locations to deliver clinical services that not only facilitate access and utilization by key customer segments, but also balance health systemâ&#x20AC;&#x2122;s service line portfolio to ensure an efficient allocation of resources and the establishment of a comprehensive continuum of care. Our team provides in-depth location and real estate analysis that combines real time market potentiality with the physical and fiscal realities of specific lease and / or development opportunities. WHAT IS THE BEST APPROACH TO PROJECTING DEMAND IN A DYNAMIC MARKET? The process of projecting volumes and utilization needs to change to adjust for the effect of legislation and the advent of a consumer-driven market for healthcare services. Our team provides a unique, comprehensive look at the evolving market by applying retail analysis methodologies coupled with historical, episodic care projections. HOW CAN WE GET THE MOST OUT OF OUR PHYSICAL ASSETS? An effective real estate and asset management strategy is essential to the longterm success of any healthcare organization. Whether seeking to align capacity and utilization with projected service and operational needs, or balancing the relative operating and valuation metrics of individual facilities, our team provides the tools and the knowledge necessary to help you maximize the performance of your portfolio of assets. HOW CAN YOU MAXIMIZE ROI ON FACILITIES BASED INVESTMENTS? In order to ensure optimal utilization of limited financial resources, maximize the potential returns for every dollar invested and to facilitate the realization of short and long term organizational goals, health systems must engage in a robust strategic planning process. With our specialized tools and expertise, we will help you develop an allocation strategy based upon objective analytics and from strategy, operations and finance. HOW CAN WE USE DATA IN SUPPORT OF STRATEGIC DECISIONS? Our team aggregates multiple data pools in order to provide a comprehensive and dynamic view of the community you serve. We use data mining, predictive and prescriptive modeling techniques to project how the market may change, and what effect it may have upon your organization. Due to the vast amount of data available, two equally important aspects of utilizing data modeling in support of strategic decisions are prioritization and visualization. Data prioritization is the identification of the critical and most influential variables and relationships that define the potential outcomes. The effort will not only improve the value of the model, but will also allow you to focus on strategies and actions that will have the most impact. Because strategic decisions are generally made by a group of people with different perspectives and expectations, clear and effective communication strategies are needed in order to maximize engagement. Our team will work with you to create data visualizations, usually done through dynamic BI platforms, that can convey complex relationships in a clear and appealing manner to help improve message efficacy and to drive consensus. See next page for a more in-depth look on predictive and prescriptive analytics.
PAGE 10
The Role of Predictive & Prescriptive Analytics in Strategic Decision Support
Meet Our People FADY BARMADA Practice Leader, Strategy Advisory Services
The environment of care can have a profound impact upon the perceived quality of care and potential outcomes.
As our healthcare system transitions from episodic care towards a population health
Understanding the myriad of needs and
model of care, hospitals and health systems find themselves in a challenging operating
expectations of the various constituent
environment. With near-term revenue growth impacted by declining inpatient volumes
client groups and then balancing those
and operating margins under pressure from the shift from hospital-based care towards
with the spatial and technical demands
care provided in outpatient settings, health systems must now focus on re-examining
of clinical processes is what we, at Array,
the services they provide, developing new capabilities and reducing the cost of doing
do. With the inclusion of Strategy Advisory
business in order to maintain competitiveness. The need to add capabilities to manage
Services, we help our clients take a broad,
a population’s health, in addition to historical cost pressures, is straining most health
systemic look at their total portfolio of
systems’ ability to fund organizational and care model transformation. In order to ensure
care and support environments to better
optimal utilization of limited financial resources, maximize the potential returns for every
understand the value those assets
dollar invested and to facilitate the realization of short and long term organizational
have to the patients and their families,
goals, health systems must engage in a strategic planning process based on rigorous
clinicians and staff, and to the community
scenario testing and data-based decision modeling.
which the organization serves. Given the
Most healthcare organizations have long had the capacity to use descriptive models to define their business and clinical operations. Over the years, these models have become increasingly detailed as new sources of information, such as EMR or EDW (Enterprise Data Warehouses) allow for broader, richer data sets to be created and utilized. As these sources matured and gained a critical mass, allowing for trending and data mining, some systems developed predictive models that utilize past performance metrics to help envision the future. While predictive modeling may be very helpful in analyzing the future performance of some systems, it is fairly limited due to the fact that it relies on known, relatively constant variables. Predictive analytics can be used for projecting bed utilization rates and near term readmission rates, or to inform staff scheduling decisions, yet if there is a change in the relationship of critical variables, or a new unplanned event
dynamic nature of healthcare, and the constant evolution of population and community needs, we recognize that optimizing a portfolio of physical assets is not an “episodic” effort, but rather is a continuous process. The key value of Strategy Advisory Services lies in the formation of long-term relationships with our clients and the creation of a dynamic tool set that provides information critical to strategic decision-making.
occurs that changes the system’s context, then a predicative model’s utility suffers. In
Fady brings 20 years of healthcare
order to inform strategic operations, or to guide individual and organizational action,
consulting and design to his role as
prescriptive models are the most useful.
Practice Leader, Strategy Advisory
Prescriptive analytics focuses on the creation of dynamically linked, multi-variate models that describe the relationships and constraints of particular systems. Manipulating the critical variables and constraints allows for the exploration of the effect of change on the potential outcomes, this is the basis of scenario-testing and optimization. Prescriptive analytics have been used outside of the healthcare industry for years, and most of us are familiar with some practical examples. In finance, most investment managers or financial planners use prescriptive analytics to optimize your investment portfolio, or to help you plan for retirement. Retail and service industries use prescriptive
Services. He works with a wide range of healthcare organizations; community and children’s hospitals; and academic medical centers. Fady’s expertise focuses on strategic and capital planning; market assessment and clinical alignment; and real estate and physical asset portfolio optimization.
modeling to understand their market and to help align products with consumer needs and expectations. Interestingly, this approach is slowly percolating into the healthcare industry, as healthcare organizations find that they are increasingly
Click here to watch Fady’s Healthcare Real Estate video. PAGE 11
in a consumer-driven market-place. With the migration to a population health care model, organizations are looking to the psychometric data commonly used in retail to understand behaviors and preferences in order to help them understand how to impact outcomes, and how they are perceived against their competitors. Another example of how prescriptive analytics are being used in the healthcare industry is in facility throughput optimization and capacity analysis. Throughput and capacity analysis can be done in many ways, including comparative benchmarking and utilization planning, yet these methods rely on aggregated (on peer group, regional or national levels) data that may not be specific enough to provide valuable, actionable results. New tools are enabling healthcare organizations to optimize their operations, maximize cost efficiencies and improve consumer and patient experiences through the collection of localized and specific data as a basis for prescriptive modeling. One of those tools is Simulation Modeling. This powerful tool allows us to optimize systems through manipulating key variables and constraints and to visualize the impacts to both the individual operators and to the projected outcomes. Healthcare organizations are using this tool not only to optimize their systems, but also to communicate specific strategies and their potential outcomes to key stakeholders, as they can visualize the model, the manipulations that are the basis for strategic decisions, their fiscal ramifications and operational outcomes.
Our Methods Our team aggregates multiple data pools in order to provide a comprehensive and dynamic view of the community you serve. Our toolkit of methods includes data mining and predictive modeling techniques to project how the market may change, and what effect it may have upon your organization.
DEMAND IMPACT ANALYZER
PHYSICAL ASSET PORTFOLIO ANALYSIS
Historical means of demand analysis no longer provide
A health systemâ&#x20AC;&#x2122;s portfolio is critical for successfully
health systems with an accurate or actionable pro-
delivering its core mission: to provide care for its con-
jection of the market for services due to the utilization
stituents and community. Understanding the condi-
shifts driven by the population health care model and
tion, utility and value of each asset is an essential part
a consumer-focused market. Our demand impact
of a comprehensive management strategy.
analyzer incorporates retail strategies to provide a comprehensive look into an increasingly complex, competitive marketplace.
CONSUMER SEGMENTATION
CLINICAL PRACTICE MODELER
For health systems developing population-health-
With mounting cost pressures and uncertain long-
management-strategies, psychographic (lifestyle
term revenue profiles, operating efficiencies have
and consumer profiling) information is critical to
never been more important. Physician practices are
understanding constituent and community behaviors.
complex business with a broad range of operating
Working with you to identify key trends, issues and
needs and staffing structures.
insights, we utilize our consumer segmentation reports to deliver relevant, actionable information.
PAGE 12
Inside Look: Case Study SPACE PROTOTYPING Whether developing new care environments or analyzing your existing practice spaces,
CLIENT: Academic Medical Center Physicians
service line and volumes-based space benchmarks are critical to understand the
METHOD: Space Prototyping
investment needed for projected growth. Our specialized facility prototypes can help you identify utilization and capacity targets, contribute to clinical standardization and optimize your service management strategy.
CHALLENGE The physician group and their real estate
Figure 1: Utilizing Tableau, a data analysis and visualization software, to generate an interactive site selection tool from data collected during facility assessments, you can achieve a level of clarity of easily digestible data to inform and influence our client’s healthcare real estate decisions.
agent did not have a clear way of searching for and evaluating potential sites for ambulatory expansion. With a real estate agent unfamiliar with the architectural and engineering needs of a medical practice, they could not narrow down a list of available sites that worked operationally for a physician practice.
CLINICAL SERVICE ALIGNMENT
SOLUTION A team of healthcare design experts led by
The development of a population health care model will force healthcare organizations to
Array, created a visual Lean-led process
re-evaluate the composition and distribution of the clinical services they provide. We will
to guide the client through their search for
work with you to identify the current and projected gaps within the care continuum, and
appropriate expansion sites in downtown
devise strategies that align your portfolio of services with community need.
Manhattan. Stakeholders developed a
A healthcare system could not meet the demand for certain inpatient services due to space limitations within their flagship hospital. The System knew it had to decant some outpatient services and modalities to create efficient expansion space within the existing facility, yet it did not have the capability to evaluate space requirements and potential service line
detailed selection criteria and Array created a weighted matrix for the leadership team and real estate agent’s use during initial site visit.
impacts.
DEEPER DIVE
Array’s experts ran a strategic planning process to optimize the existing facility’s
As the design/construction and healthcare
utilization, and map the service lines and modalities that were most suited to an outpatient environment. Array developed scenario-testing and prototyping tools that enabled the System’s senior leadership team to evaluate each decision’s potential ROI.
PHYSICAL ASSET VALUATION MATRIX Since individual assets perform at varying levels throughout their life cycle, we work with you to dynamically measure, value and compare their performance to form a prioritized asset strategy. Our unique management frameworks use standardized metrics to scenariotest investments on a portfolio level, as well as compare and measure each initiative’s potential operational impacts and fiscal returns.
industries increasingly rely on data, the opportunities to use data visualization to improve healthcare design planning increase as well. From early strategic planning to functional and space program development, utilizing data visualizations can offer deeper insights into a health system’s needs. Moreover, in Array Advisors’ case, the ability to live-connect to data or receive automated updates within a visualization platform reinforces our continuous improvement culture. By tracking real-time
A healthcare system wanted to replace its current facilities to improve clinical capacities
internal process and work flow data, we
and better serve the needs of its community. As senior leaders began to evaluate sites,
can continually improve our processes and
they realized that comprehensive comparative evaluation of each location and market was
strategies to better serve our employees and
essential to supporting a strategic decision of this magnitude.
our clients.
The analytical platform Array created is providing the healthcare system’s senior leaders the ability to visualize the decision ramifications of not only the site selection process, but also the potential for service line optimization, market improvement and revenue enhancement.
PAGE 13
Discovering Your Healthcare Solutions Together We are innovators who specialize in the areas your system seeks out to leverage its valuable operational and facility resources. Array Advisors has the expertise and skills to reach beyond your milestones and provide you the decision support you need.
Our Purpose Our Solutions We are dedicated to improvement. Problemsolving and forward-thinking individuals lead our efforts, which focus on your unique place in the healthcare delivery spectrum. Our knowledgeable staff can help you solve strategic business problems and develop a method to improve efficiency and utilization.
We are Array Advisors, your trusted partners in Strategy Development and Organizational Transformation. The challenges you face are not unique, but your solutions should be. Through a partnership of Strategy and Transformation we help you achieve and sustain. Our process begins by understanding your current operations and clearly defining your systemâ&#x20AC;&#x2122;s goals before generating options. We employ a variety of integrated methods tailored to your strategic challenges, such as process mapping; operational planning; and healthcare real estate portfolio optimization, to help position your organization for future success.
STRATEGY The need for healthcare real estate portfolio optimization has never been greater. With the acceleration in mergers and acquisitions, as well as the evolution of clinical models, healthcare organizations must continuously evaluate their physical assets and maximize the value they derive from them.
Click here to learn more about our Strategy services.
TRANSFORMATION Transformation and lean methods are very useful when focusing on operational process improvement. By bringing all constituents together and giving them the tools to experiment and test new ideas, current state barriers can be identified and transcended.
PAGE 14
Click here to learn more about our Transformation services.
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