CLIENT:
Jackson-Madison Co. General Hospital CASE STUDY
Jackson, TN
Best practices are benchmarks at best, and do not address the specific issues facing a particular client. Designing for, and accommodating the peaks and valleys of, census coupled with the need to always provide appropriate, timely emergency care makes the ED a complex challenge as more individuals rely on it for primary care. Best practices are benchmarks at best, and do not address the specific issues facing a particular client.
CHALLENGE
EXECUTIVE SUMMARY
A fractured check-in/triage process,
Our kaizen events are geared to help clients quickly assess their current condition,
the result of an incomplete master plan
map out patient flows impacted by the process, identify areas for improvement or
renovation, funneled walk-in patients
streamlining, and then establish an ideal future workflow. This future workflow is the
through one semi-private triage station
critical first step in creating a viable and sustainable capital project.
inside the ED’s front door. Long wait times,
The event is a swift, targeted multi-disciplinary workshop often consisting of two or
safety concerns, and patient confusion
three sessions. When appropriate, data is collected between sessions to better focus
and dissatisfaction led administration
improvement activities.
to engage Array to review the current
Implementation Methods :
operations and configuration.
• Observation & Current State Mapping
SOLUTION
• Data Collection • Future State Mapping
Kaizen Events
• Develop the Road Map to Implementation
Through value stream mapping, direct observation, and data collection, a multidisciplinary improvement team identified the root causes of current operational break-downs and developed a simplified future state employing a pivot nurse to pre-sort patients, reducing the number that require a full traditional triage.
PROJECT HIGHLIGHTS
2
Team Sessions
50% Wait Time Reduction
4
Methods Implemented
CLIENT PROFILE Jackson-Madison Co. General Hospital Jackson, TN
Current Conditions The Jackson-Madison County General Hospital (JMCGH) emergency department (ED), which averages 95,000 visits per year, underwent an expansion to increase capacity and provide new facilities. They planned this addition assuming a second phase of expansion would complete the arrival, waiting and check-in experience.
The flagship of West Tennessee
They did not complete the second phase, leaving the ED with a sub-optimal entry
Healthcare, Jackson-Madison Co.
configuration.
General Hospital (General Hospital)
The ambulatory entry, located at the end of a long, narrow waiting space, yields a
offers the only open heart surgery
long distance between entry and triage. When JMCGH sought Chest Pain Center
program in rural West Tennessee.
designation, it had to shorten the time from arrival to EKG for chest pain patients.
General Hospital’s cardiothoracic
The existing triage arrangement, seen as a barrier to this benchmark, prompted the
surgeons have performed tens of
creation of an auxiliary triage zone directly adjacent to the walk-in entry.
thousands of procedures, including
The satellite space included a registration clerk position and a semi-private triage
Robotic microsurgery. Their surgical
alcove with a stretcher and EKG. The physical distance between the existing triage
services host two daVinci robotic
and the satellite triage led to the abandonment of the original location. The satellite
units, used to perform hysterectomies
zone now handled all triage. This led to long delays and sub-optimal patient care.
and prostatectomies, as well as
The openness and lack of physical barriers in the triage zone further degraded the
hernia repair, colon, urology, and
experience.
cardiovascular procedures. www.wth.org/locations/jacksonmadison-co-general
Our kaizen event, focusing on the registration and triage process, explored improvement opportunities to both the process and physical environment.
Current State After observing the process in action, we worked with a multi-disciplinary team including nurses, patient care techs, registration clerks, physicians and department leaders, to map the current-state process and identify opportunities for improvement.
TOOL
Data After mapping the current state, the team developed a simple data collection tool. Over the course of one week, hospital staff collected a random sampling of patient encounters throughout all shifts every two hours.
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 decision-making to ensure all voices are heard and each stakeholder supports the final decision.
Page 2 | Case Study
Future State Following the collection and review of current state data, the team met for a second workshop to define the ideal future state. By the workshop’s conclusion, the team had successfully mapped their ideal future state check-in and triage process for the ED.
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
The new process featured a cross-trained clinical greeter who could initiate an encounter by reducing the information needed for a quick registration. This combined interview would allow the clinician to make an initial treatment designation, immediately routing fast track and highly-acute patients directly to those service locations. Only patients not easily designated would then continue through the full triage process. By immediately directing patients who may not require full triage to the location best suited to serve them, staff could reconfigure the constrained entry area to accommodate the reduced number of patients in a safer and more consistent manner.
Lean-led approach to project definition provides a clear path to the right project before you begin to design.
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.
Tools used: A3 Dashboard, Observation, Adjacency
Road Map
Diagram, Systems Approach, Collaboration
ED Check-in/Triage Process Improvement
The team reviewed the future state plan and identified barriers to its implementation. These key items provided the next steps for the hospital and quickly summarized the area requiring a more focused investigation.
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.
MEET YOUR ADVISORS
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: OCTOBER 2015