CLIENT: West Chester Gastrointestinal Group
CASE STUDY
West Chester, PA
Exploring the impact of changing the resource assignment model helped avoid construction. Sometimes, it seems like the only option is to expand a current facility to accommodate a growing patient population. We employ lean thinking while working with our clients to improve process and flow, helping us determine if construction is actually necessary. An objective party can provide candid advice about how to better utilize available resources without the cost and disruption of construction. SERVICE: Transformation SOLUTION: Resource Utilization
EXECUTIVE SUMMARY A gastrointestinal clinic in West Chester, PA is growing rapidly and wants to operationalize a fourth procedure room. They performed some surveys to see whether
Challenge
they could benefit from an additional procedure room within their existing space. The
Current scheduling paradigms and bed assignment practices lead the client to believe they need to expand their clinic space to accommodate the volume with a fourth procedure room.
results led them to believe that expansion might be necessary, and they desired a second opinion. Array worked closely with the clinic’s staff to map their patient flow current state. This helped the team identify bottlenecks and other opportunities for improving flow, which might prevent the need for disruptive construction. The cross-functional team identified scheduling and room assignment as two areas for study. Our Healthcare System Engineer developed a simulation model to test different
Solution
scheduling paradigms. We also used the model to determine the best practice for bed
Developing a simulation model helped us test different scheduling and resource assignment options without disrupting the clinic. Analyzing the results of the model helped physicians see the potential impact of changing the current scheduling practices.
choosing from different combinations of scheduling and bed assignment.
PROJECT HIGHLIGHTS
assignment practices. Modeling these two variables allowed us to show the impact of
26
With the help of simulation modeling, the physicians could visualize how different schedule types affected patient waiting time, which they were trying to reduce. It also allowed us to quantify the impact of adding more beds and determine whether there was enough return on the investment of construction time and cost.
POTENTIAL WAIT TIME REDUCTION
10
%
INCREASE PATIENT VOLUME
4
AVAILABLE PROCEDURE ROOMS
Client Profile WEST CHESTER GASTROINTESTINAL GROUP WEST CHESTER, PA West Chester Gastrointestinal Group (WCGG) is one of the largest groups of boardcertified gastroenterologists in southeastern Pennsylvania.
CURRENT CONDITIONS The West Chester GI clinic is a rapidly growing physician-owned practice. The physicians want to provide efficient and effective care to all of their patients. The clinic has a fourth procedure room available, but does not currently use it because they are unsure if there are enough prep/recovery beds available. They recently tested different work flows that might improve efficiency and allow for utilization of the fourth procedure room. The administration is worried that some of the current scheduling paradigms and flow practices might be preventing them from optimally utilizing a fourth procedure room.
Specializing in the diagnosis, treatment and prevention of all gastrointestinal and liver disorders, WCGG physicians and staff are dedicated to providing the highest possible standard of medical care to all patients in a kind and professional manner. http://www.westchestergi.com/
Figure 1: Current state mapping showing patient flow through the clinic.
Solution
CURRENT STATE
RESOURCE UTILIZATION
The clinic currently experiences procedures starting later than the scheduled
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 maximize throughput and implement flow, we can ensure full utilization of resources without creating non-value-adding process steps.
time, which is causing patient and physician dissatisfaction. Some believe that the current scheduling paradigm, which allows scheduling the first two patients of each session (morning and afternoon) within 15 minutes of each other might be causing these delays. This practice is common in settings where there is a high probability of patients failing to arrive on time for their appointment, and is thought to reduce the amount of physician idle time. There are a number of problems with this paradigm. The most significant of which is the delay caused when both patients show up at their scheduled time. The clinic is also currently assigning four prep/recovery beds to each procedure room. They believe this model allows for better staffing, but fear it may not work as well if there are four procedure rooms operating. We recommended using a simulation model to test different scheduling paradigms and prep/recovery bed allocation strategies. DATA After mapping the clinic’s current state, the team determined which data points they could use in the simulation model. Because there is no electronic medical record, it was necessary to group some process steps together so we could use manuallycollected data in the model. A nurse from the clinic extracted the data for each of the process steps directly from patient records. Since the process was manual, we only looked at two weeks of patient data. In this case, the small sample size was sufficient due to the specialization and high volume of the clinic. In this two-week sample, we received close to 400 data points for each process time.
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In addition to key milestones collected manually, such as wheels in and wheels out, we used available electronic scheduling data to simulate an accurate arrival stream of patients. The scheduling data, combined with the manually collected process times, provided enough information to build a simulation model to determine an appropriate number of procedure rooms and prep/recovery beds. SIMULATION RESULTS Array developed the simulation model to test the interaction between scheduling and room utilization. The current state splits prep/recovery beds into three pods of four beds, one for each active procedure room. The beds are used some of the time for patients who are waiting for a ride or final consult. Currently, the first appointment of each session is double-booked. The results seen above the dotted line show the impact on total non-value-added patient waiting time. In these tested scenarios with three procedure rooms, it is assumed that the beds are always used when a patient completes Phase II recovery. These results highlight the impact of treating all prep/recovery beds universally, rather than as independent pods of beds, and not allowing the first appointment to be
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.
double-booked. Universal – Double Booked
Universal – Not Double Booked
Pods – Double Booked
Pods – Not Double Booked
3 Procedure – 12 Beds
50
34
61
43
4 Procedure – 12 Beds
67
46
4 Procedure – 13 Beds
59
41
4 Procedure – 14 Beds
52
37
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-valueadding steps that reduce efficiency and add to lead time.
Waiting Room Volumes
Not Double Booked
Double Booked
15
12 Beds
13 Beds
14 Beds
TOOLS USED:
10 5 0
15 10 5 0
July ‘15-April ‘16
July ‘15-April ‘16
July ‘15-April ‘16
Simulation Modeling, Observation, Current State Assessment, Systems Approach, Data Visualization, Collaboration
Figure 2: Simulation model results showing wait times (minutes) and waiting room volumes based on varying resource capacities. After adding a fourth procedure room, we tested three different prep/recovery bed capacities: 12 beds, 13 beds and 14 beds. These capacities were all assumed universal resources, and the impact of double booking and not double booking can be seen. Listed below the table in Figure 2 is the waiting room volume for each four-procedure room scenario. This is the number of patients in the waiting room over time and does not include the patient’s caregiver. Each scenario has benefits. Array provided the results with the understanding that having access to each possible outcome will allow the team at West Chester GI to make informed decisions about how they will operate based on seeing the impact of different scheduling and bed assignment systems.
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case study: West Chester GI Clinic | 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 Services 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.
HOW CAN WE ASSIST YOU? 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 system’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.
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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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.
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Published: DECEMBER 2016