CLIENT:
Columbia Orthopedics CASE STUDY
New York, NY
Rapid process analysis helps organizations determine where to focus improvement efforts. Through observation and shadowing, a team of lean process experts can quickly assess the current flow and patient experience. These activities lead to a summary of potential steps the organization can take to move toward their ideal future state - as a means to define scope, both of improvement work and physical design, if appropriate.
CHALLENGE
EXECUTIVE SUMMARY
The client recognized a patient flow
Columbia Orthopedics is a patient-focused, outpatient orthopedic physician practice.
problem, and needed assistance
They desired to improve the patient experience by reducing waiting time and
pinpointing the trouble areas and creating
improving flow throughout their process. The administrative team at Columbia knew
a path to future improvement.
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 at
SOLUTION
the clinic and offer suggestions for future improvements. In this case, the process analysis was a swift, targeted multidisciplinary series of one- to two-hour workshops
Process Analysis
in which we observed the process, collected preliminary data, briefly interviewed staff
A brief and rigorous assessment format
and developed suggestions for improvements as appropriate.
co-led by healthcare architects and
• Process Mapping: Staff gave a general overview of the process from patient arrival
systems engineers identified clear areas
to departure.
of scope, staffing model, communication
• Process Observation: Our team observed the clinic’s patient flow process from
and inter-departmental orders as
the perspective of the patient, physician and MA. We used spaghetti diagrams to
imperative to improved throughput.
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.
PROJECT HIGHLIGHTS
5
Focused Projects Identified
10
Staff Members Interviewed
2 hrs
Patient/Staff Observation Period
CLIENT PROFILE Columbia Orthopedics New York, NY
Observation After touring the facility to gain a high-level understanding of the typical patient flow, the team sat down to observe the process. Patient experiences were noted on observation records as they arrived at the facility. The amount of time spent in each
Columbia’s patient-centered focus
process step can be seen in the process map in Figure 1. A spaghetti diagram was
has always been the hallmark of their
also used to capture patient and staff movement through the clinic. Some common
department, and they are proud of the
themes became apparent after two hours of observation:
department members who continue that
• The team noted that, at times, patients were unsure of where to go next when
tradition today. Columbia’s orthopedic surgeons are leaders in their respective specialties and provide the most advanced treatments
unaccompanied by site staff. • Segregated staffing roles seemed to create disproportionate down time or burden for some team members. • Patients who were unable to move around on foot had difficulty navigating the
for musculoskeletal conditions in adults
waiting areas’ limited space. Additionally, the team noticed that patients were
and children. While they are on the cutting
aware of their arrival time relevant to other patients.
edge of the most significant advances in orthopedic surgery, they also deliver personalized care to every patient who seeks their expertise. www.columbiaortho.org
TOOL
• At times, the team observed staff members attempting to “fight fires” caused by breaking points in the system. These observations allowed the team to develop a deeper understanding of how patients flow through the system. Initial analysis of these themes, combined with the remainder of the assessment, led to our proposed improvement plan.
Executive Visioning Array’s senior healthcare personnel facilitated this portion of the process analysis. These individuals have specific experience translating healthcare observations into realistic improvement goals. Speaking with senior-level providers and management about daily issues that arise helped us create a detailed implementation strategy that was more client-specific than could ever be accomplished by providing a standard improvement strategy. In one hour, we determined current road blocks, highlighted
Process Analysis
strategic goals, and established scope boundaries for the improvement initiative.
You perform processes throughout your day. Our job is to assist with analyzing your work flows and determining where value is added. This helps us see where the waste is and eliminate those non-value-adding, unnecessary 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.
Figure 1: Current state process map including process time highlights for observed patients.
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 Figure 2: Waiting room volume over total observation time.
Front-Line Interviews We believe the front-line staff provides the greatest insight for process improvement. These individuals encounter potential areas for improvement in their daily work. Interviews with this staff group allow us to connect with the people who interact most with the patient. The discussions lasted about fifteen minutes and included the following questions: • What are the most pressing complaints from patients regarding their clinical experience? • What major issues do you encounter each day?
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 are explored. 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.
• If you could change the way you do one thing in the clinic, what would it be? We often find that the people who operate in the facility daily have a difficult
How can we improve flow?
time seeing the non-value added steps because they either are so familiar with
There are many tools available to see
the process or do not have time to stop and think about how to improve it. As
how work flows through a system. Value
individuals who are unfamiliar with the current operating procedures, it’s our job
stream mapping is a strategic exercise
to see potential areas of improvement with an unbiased eye. Once again, we were
that looks at the flow of work from
able to draw upon the staff experiences conveyed in this interview setting to
customer request to fulfillment. Process
create an implementation plan that was unique to the organization.
mapping focuses on detailed work flow
Summary Upon completion of the process analysis, we provided recommendations for further investigation. We offered these options to the client as separate services
elements and can be used to identify nonvalue-adding steps that reduce efficiency and add to lead time.
with the opportunity to best match services with current needs and resources.
Tools used:
The recommendations involved improvements to the patient experience,
Process Map, Observation, Staff
physical environment and staff interactions. Unlike organizations that focus
Interviews, Visioning, Spaghetti Diagram
on conventional improvement strategy elements, our one-day assessment allows us to create a customized list of improvement services that focus on our observations.
Final Remarks 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.
“Sometimes it takes unbiased eyes to see the potential for improvement.” Laura Silvoy Healthcare Systems Engineer
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 2015