CLIENT:
Martin Health System CASE STUDY
Stuart, FL
High volumes of admitted patients waiting for inpatient beds lead to decreased capacity in ED. Knowing that the inpatient capacity will not be increased significantly in the near future and that improvement work is being done to help increase bed availability, the emergency department must assume that they will continue to hold admitted patients until a bed is available.
CHALLENGE
EXECUTIVE SUMMARY
Due to a need for inpatient capacity,
Array partnered with Martin Health System (MHS) and HKS to facilitate process
Martin Health System uses the emergency
analysis and process design of an emergency department (ED) renovation. During
department to hold admitted patients
this engagement, a multi-functional team of stakeholders from MHS participated in
waiting for a room. This decreases their
current state and future state mapping exercises to define how they would like to
available capacity to treat new patients.
work, and developed a plan for reaching their goals. As Array led the team through the mapping exercises, members developed a better understanding of how each patient moves through the ED. Due to the number of
SOLUTION Kaizen Event
admitted patients held in the ED because of limited inpatient capacity, the team wanted to ensure that the new process would focus on providing high-quality, effective care to all patients.
The Martin team focused on delivering
Uncertainty around resource utilization resulted in a detailed study of patient flow
efficient and effective emergency care,
through the ED, and the effect that holding admitted patients has on resource
while providing a safe place to hold
utilization. Array used a simulation model to test different scenarios and determine
admitted patients. Array developed
the best resource allocation plan for the ED. The simulation model’s results
a simulation model to determine the
demonstrate the trade-off between resource capacity and throughput time.
appropriate number of holding and treatment beds for the Martin ED. This led to a new patient flow in the ED.
PROJECT HIGHLIGHTS
Upon completion of the mapping events, key improvement opportinities became apparent to the team. Utilizing the transformation plan to guide these activities, MHS could see potential increases in patient satisfaction and improved emergency care.
<5min Expected Average Wait for Provider
18
Treatment Beds Needed
15
Simulation Model Scenarios Tested
CLIENT PROFILE Martin Health System Stuart, FL
Current Conditions The engagement kicked off with a leadership listening session, where the group shared key issues related to their current process and layout. Highlights include a need for a more effective and efficient space to support the emergency department
Martin Health System, a non-profit,
(ED) process and improve communication; the desire to provide more private care in
community-based system comprises
the correct location; and better accommodate different patient populations, including
three hospitals, one MediCenter, a free-
geriatric and behavioral health.
standing emergency center, and numerous
The team started the day discussing how non-urgent patients moves through the
outpatient centers and clinics.
ED, from the time they arrive until they are discharged. Next, the team focused on
The system offers preventive, primary and
the process steps for acute patients. They used a single map to record both patient
acute hospital care, as well as cancer care,
types, allowing them to see where the process steps overlapped. Throughout the
a heart center, wellness and rehabilitation
mapping activity, the team uncovered numerous opportunities for improvement for all
services, and more.
patients moving through the ED.
martinhealth.org
TOOL
Kaizen Events A kaizen event is a three- to five-day improvement event that brings together an interdisciplinary team to solve a problem and create a lasting change. We facilitate these events using consensus-based
Figure 1: Future state process map including average process times.
decision-making to ensure all voices are heard and each stakeholder supports the final decision.
Future State The multi-functional team gathered for a second time to determine how they should operate in the future. Array provided education to the team about different ways to design a new process flow for their ED. Due to the patient mix in their emergency department, the team decided to develop their own hybrid version of a split flow ED, which took into account their specific patient population. The future state process (Figure 1) also takes into account a large number of patients held in the ED until an inpatient bed is available. Using only a process map, it was difficult to determine how many ED beds were necessary and how many should be allocated for holding patients. Array recommended using a simulation model to determine the appropriate amount of space necessary to meet demand.
Simulation Modeling The simulation study revealed that the new process, which shifts the traditional triage activities to an intake step and incorporates a pivot nurse, could significantly improve door to doctor time seen in the current state, if they allocated the appropriate resources (Figure 2).
Page 2 | Case Study
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 Figure 2: Simulation results showing trade-offs between patient waiting time and necessary department footprint. The goal of this expansion and renovation project was to provide patients with quality care in the appropriate space while accounting for the boarding inpatients that will remain in the ED. To meet this goal, the team determined that no more than 2% of patients should wait longer than 10 minutes before seeing a provider. While the first scenario pushes the boundaries of the currently-allocated space, the team believed that it was the only way for the Martin Emergency Department to provide high-quality, safe care for their patients using the right resources. The second scenario shows the effects of staying within the currently-allocated
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.
space. In this situation, the average door to doctor time is more than five minutes and more than 8% of patients wait more than 10 minutes to see a provider. While this scenario fits within the current space available, the number of resources will not support improved patient care delivered in the appropriate space, resulting in a patient experience that sometimes mirrors the current situation.
How can we ensure effective resource utilization? Every aspect of the healthcare industry relies on resources, including staff, equipment and space. Itâ&#x20AC;&#x2122;s imperative
Recommendations
that organizations utilize their resources
MHS faced a trade-off between available space and acceptable waiting time for
effectively. Our qualified consulting
their patient population. The two scenarios presented are both very good options
team can help your organization develop
and allow the ED to provide a high-level care. Array recommended that MHS
a strategy for utilization optimization,
renovate their ED to support their newly-developed process.
ensuring that every resource is providing the most value while improving process flow.
â&#x20AC;&#x153;The simulation modeling was an excellent suggestion and I am so glad we did it.â&#x20AC;? - Laurie Daccarett, Manager of Planning, Construction & Real Estate, Martin Health System
Tools used: Process Mapping, Observation, Simulation Modeling, Capacity and Utilization Assessment, Consensus
Figure 3: Simulation model (right) showing simplified adjacency configuration. Future state mapping session (left) in progress.
Cast Study | Page 3
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 SOLUTIONS
OUR SERVICES
We are dedicated to improvement.
How can we assist you?
Problem-solving and forward-thinking
We are Array Advisors, your trusted partners in Strategy Development, Organizational
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.
Transformation, and Facility Informatics. 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.
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Informatics Building Information Model management (BIM) is an enabler of most other technology trends in the Architecture, Engineering, Construction, Operations (AECO) industry, including but not limited to: sustainable design, offsite fabrication, LEAN construction, and energy efficient operations. Carefully considering how best to leverage virtual/digital representations of physical buildings can provide significant returns on innovation throughout the entire lifecycle of your facilities.
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.
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.
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Published: AUGUST 2016