CLIENT:
CASE STUDY
NewYork-Presbyterian Morgan Stanley Children’s Hospital New York, NY
Testing different room utilization strategies allows for the optimization of patient throughput. An urban, pediatric hospital, Children’s Hospital of New York serves thousands of patients daily. Recently, in its continuous effort to improve service quality, this pediatric care facility hired Array to analyze potential throughput options for a new clinical space. The new space was expected to house three existing clinics, currently operating in three separate parts of the building.
CHALLENGE
EXECUTIVE SUMMARY
A new clinical space needed to house
The NewYork-Presbyterian Morgan Stanley Children’s Hospital (CHoNY) faced a
three existing clinics currently operating
tough situation—combining three separate clinics into one space. The architect
in three separate parts of the building. The
performed an initial feasibility study to determine the maximum amount of space
goal was to reduce patient waiting times
available for the desired renovation. The proposed number of exam rooms that could
and determine how many exam rooms
fit in the space was smaller than the staff expected could support the three clinics
were necessary to support the growing
once combined.
patient population.
Array’s Healthcare Systems Engineer observed the clinic to understand how patients flow through the current system, and worked with staff to discover their ideal patient flow. We worked with hospital staff for two weeks to develop and use a simple time
SOLUTION
study form to capture each major step in the patient care process. Each piece of data played an important role in creating a simulation model.
Throughput Analysis
Array worked closely with CHoNY staff to ensure the simulation model ran just like the
Observing workflow across all three clinics
actual system. We presented the staff with two options for patient throughput. In the
revealed that, despite serving different
first, the three clinics operated separately, but in the same space. Each had dedicated
patient populations, operating processes
exam rooms that were not shared among the clinics. The second allowed the three
were very similar. Array developed a
clinics to share all exam rooms. In this model, the rooms closest to the front of the
simulation model to test various patient
clinic were always used first.
throughput scenarios. This model proved
After seeing how patient waiting time drastically decreased when physicians shared
that sharing resources improved patient
exam rooms, minimizing the need for waiting room space and optimizing the number
throughput and satisfaction, while also
of necessary exam rooms, the staff was able to make critical decisions about the
optimizing resource utilization.
exam rooms, waiting and support spaces. The simulation results allowed CHoNY more flexibility in its planning so renovations would not be necessary in the near future.
PROJECT HIGHLIGHTS
3
Clinics Combined
2
Patient Throughput Options
2 weeks
Observation Data Combined with EMR
CLIENT PROFILE NewYork-Presbyterian Morgan Stanley Children’s Hospital New York, NY NewYork-Presbyterian ranks among the top in the nation for children’s care
1N Surgery
7N Genetics
7C GI
in every specialty evaluated in the U.S. News survey, which includes cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology and gastrointestinal surgery, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology and urology. NewYork-Presbyterian provides pediatric care in every area of medicine at two major sites: NewYork-Presbyterian/ Morgan Stanley Children’s Hospital and NewYork-Presbyterian/Komansky Center for Children’s Health; and is affiliated with two prestigious medical schools: Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College. www.nyp.org
Figure 1: Floor plans and locations of three separate clinics.
Three Separate Clinics CHoNY had concerns about the amount of space available to house three clinics currently operating in three separate areas of the hospital. While these clinics did not have the same layout (Figure 1), or even exist in the same building, the overall patientflow process in all three was consistent. Figure 2 shows the high-level process that each clinic followed. In all three cases, the resources needed to perform all of these tasks were the same. This consistency in resource utilization among the three clinics made it very easy to imagine a space in which all three operated, using the same shared resources.
Data Collection & Analysis
TOOL
Examine Patient Register Patient
Throughput Analysis
Triage Patient
Check Out/ Schedule Patient
Patient Arrival Perform Procedure
The processing rates of each step combine to create total throughput time. Steps with longer durations that occur later in the
Figure 2: Process flow map for all three clinics.
process create bottlenecks, and nonvalue-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 configuration that maximizes the value quotient in your system.
After confirming each clinic’s operational flow through direct observation and process mapping, Array developed a data collection form and shared it with all three clinics (Figure 3). Using the collected data, along with data available in the client’s electronic medical records, we began analyzing operational scenarios using a simulation model.
Simulation model Array built an initial simulation model for each clinic to ensure that all of the assumptions were correct, and that the models accurately represented the actual system. After ensuring the models’ accuracy, we combined them into one model where they utilized the same shared resources. Array performed additional tests to ensure that the model still represented the system accurately (Figure 3).
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 organization. We seek to empower team Figure 3: Data collection form (left) and model validation technique (right). Staff were concerned about the initial model which demonstrated the impact of utilizing shared resources among all three clinics. They imagined it would be easier to always assign doctors to the same exam rooms, and for their teams to work in the same areas. We adjusted the model so the team could see the results of this change, and they were surprised to see that waiting times increased by 300%.
Results & Recommendations We recommended this team use universal resources to help increase patient
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.
satisfaction. The simulation model showed the staff how sharing universal resources can help alleviate waiting times and improve patient flow. Using this approach, they were able to reduce the amount of waiting space and increase staff support space with confidence. The bottom of Figure 4 shows the new space’s floor plan, which includes plenty of room for patient waiting and adequate space for all of the operational functions the staff hopes to achieve.
How can we ensure effective resource utilization? Every aspect of the healthcare industry relies on resources, including staff, equipment and space. It’s imperative that organizations utilize tvheir resources effectively. Our skilled and experienced consulting team can help your organization develop a strategy for utilization optimization, ensuring that every resource is providing the highest value while improving process flow.
Tools used: Capacity & Utilization Assessment, Current State Assessment, Observation, Simulation Modeling, Time Study
Figure 4: Chart showing average patient waiting time (top-left), floor plan including additional staff work space gained (bottom).
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 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.
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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: MARCH 2016