Case Study: Mid-Atlantic Academic Medical Center

CLIENT:

CASE STUDY

Mid-Atlantic Academic Medical Center

Constructing a simulation model and mapping unique departmental processes are ideal for pinpointing the best staffing scenarios.

In hospitals with large, piecemeal campuses, inpatient transportation can be challenging. Coordinating staff size, scheduling, and departmental location are critical to developing the best solution. We employ a data-driven study process to help each client optimize their resources to reach a solution that works best for them.

CHALLENGE

EXECUTIVE SUMMARY

The client’s PES was unable to respond

The hospital staff lost confidence in the Patient Escort Services department

to every transportation request in a

because of delays. As a result, hospital units began creating their own

timely manner, resulting in inpatient

transportation teams, complicating staffing scenarios for the Patient Escort

hospital units losing confidence in

Services (PES) team. After investing in a manager for PES, furnishing the

the system and developing their own

department with a dedicated suite, and employing pilot programs to test

method of transport. Patient care

solutions for the problem, the hospital turned to Array Advisors.

staff also began performing transport

Array undertook a comprehensive study to explore the current transportation

themselves in certain instances.

operations, using data collection, current state mapping and simulation modeling to identify an optimal transportation staff size and structure. Current

SOLUTION Simulation Modeling

state gemba mapping allowed the Array team to create a snapshot of how the transportation process occurs prior to any changes. Data collection is integral to the accuracy of a simulation model, and in this instance, the team undertook a manual data collection process and used Electronic Medical Record (EMR)

A comprehensive study that employed

data. Using the data, Array Advisors created a simulation model with scaled floor

current state gemba mapping and

plans, and then generated a simulated transportation request from different

simulation modeling allowed Array to

groups at varying rates.

identify four scenarios that maximize staff utilization, minimize transport wait time, and greatly reduce the number of unit staff performing transport.

The study revealed that by putting all transportation into one resource pool, the department would be more efficient and better equipped to operate at optimal staff utilization. Based on the results of the simulation model, Array arrived upon four recommended scenarios that would ensure a staff size and schedule that enables transport in 10 minutes or less in 86% or more instances, with a staff utilization up to 97%, and allowing for unit staff transports in only 2.2% or fewer instances.

PROJECT HIGHLIGHTS

4 Staffing Options

At Least

Up to

86%

97%

of Transports Completed within 10 Minutes

Staff Utilization

CLIENT PROFILE Mid-Atlantic Academic Medical Center One of the oldest continuous care institutions on the East Coast, this midAtlantic academic hospital hosts one of the most entensive neonatal intensive care units in the country, features a sleep disorders center, a neurosurgery center,

Current Conditions The Array team gemba mapped (figure 1) the current state for the Hospital’s PES and six different service line groups that had been added for transport purposes.

The transport groups employed by specific units of the hospital were known as Unit Service Associates. While a Unit Service Associate did perform other responsibilities, such as getting the patient water or a blanket, 80-90% of the time they performed transport. Array found that nurses were transporting patients as well, which prevents them from working to the top of their license.

and an area-wide trauma center - to name a few departments.

Situated just south of a major city with a myriad of health concerns, the sprawling campus and mutli-disciplinary system pose unique challenges for operational efficiency and process improvement.

Figure 1: Gemba Mapping reveals the current patient transport processes and associated problems.

TOOL

Data Collection & Analysis Array performed onsite data collection to determine how patients were being transported and by whom. Combining that data with Epic EMR records, we were able to develop a simulation model using scale drawings to identify the exact distances people were traveling and project what would happen in various scenarios. We observed several surprising trends:

Simulation Modeling

1.

In the current state, only about 10% of patient transports are completed by PES.

Simulation is used for improving workflows

2.

If units called PES every time they needed transport, the service could in fact

and processes that involve ordered

complete 35% of the requests, which is much more than the 10% they were

steps, such as production lines. Hospitals

completing. This represents a dramatic increase in staff utilization.

generally follow the same types of processes, but the entities flowing through the system are people instead of parts and it is often much more difficult to reduce variation. To accommodate for this, Array uses a tested data collection method that accounts for the effect of human error.

More importantly, Array Advisors clearly show how the simulated system is working in relation to the actual one.

Page 2 | Case Study

3.

By combining the Unit Service Associates and PES into one pool, the 20-person staff could complete 99.9% of patient transports within 10 minutes of the request being made.

Recognizing that having 20 people on every shift wouldn’t account for peaks and valleys in service demand, we looked at minimizing that number to arrive upon a realistic amount of staff to cover specific parts of the day. Having 20 staff members available at 4 am when there is not a high need would be a waste of resources, for example. By distributing the pool of staff according to demand during specific times of the day, Array was able to identify four scenarios that minimized transports by clinical staff and maximized PES staff utilization.

TRANSFORMATION

0000 - 0700 4-6 Staff 0700 - 1900 12-14 Staff 1900 - 0000 6-8 Staff

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;

Figure 2: Escort allocation based on time of day to maximize staff utilization.

target outcomes; process analysis and design; and decision support. Our Lean-led approach to project definition

Scenarios for Future State

provides a clear path to the right project

As you can see in the chart below, tradeoffs exist in a shift-based staffing model.

before you begin to design.

While a high staff utilization is important, it must be balanced with how many unit top of their credentials. While a higher number of staff may decrease utilization in

How can we ensure effective resource utilization?

general, it will also decrease the percentage of unit staff transports.

Every aspect of the healthcare industry

By preparing multiple options for the client, Array Advisors was able to provide

relies on resources, including staff,

staff transports are being performed to ensure licensed clinicians are working to the

a pathway to greater PES efficiency and operational excellence within the constraints of their business.

equipment and space. It’s imperative that organizations utilize their 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 3: Chart showing staff size, corresponding utilization, and unit staff transport percentage based upon each scenario.

“Sometimes it takes unbiased eyes to see the potential for improvement.”

Laura Silvoy, Lean Bronze Certifed Healthcare Systems Engineer

Case 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: January 2019