Case Study: West Chester GI Group Resource Utilization

CLIENT:

West Chester GI 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.

CHALLENGE

EXECUTIVE SUMMARY

Current scheduling paradigms and bed

A gastrointestinal clinic in West Chester, PA is growing rapidly and wants to

assignment practices lead the client to

operationalize a fourth procedure room. They performed some surveys to see

believe they need to expand their clinic

whether they could benefit from an additional procedure room within their existing

space to accommodate the volume with a

space. The results led them to believe that expansion might be necessary, and they

fourth procedure room.

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,

SOLUTION

which might prevent the need for disruptive construction. The cross-functional team

Resource Utilization

Our Healthcare System Engineer developed a simulation model to test different

Developing a simulation model helped

scheduling paradigms. We also used the model to determine the best practice for bed

us test different scheduling and

assignment practices. Modeling these two variables allowed us to show the impact of

resource assignment options without

choosing from different combinations of scheduling and bed assignment.

disrupting the clinic. Analyzing the

With the help of simulation modeling, the physicians could visualize how different

results of the model helped physicians see the potential impact of changing the current scheduling practices.

PROJECT HIGHLIGHTS

identified scheduling and room assignment as two areas for study.

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.

26

Potential Mins Wait Time Reduction

10%

Increase Patient Volume

4

Available Procedure Rooms

CLIENT PROFILE West Chester Gastrointestinal Group West Chester, Pa

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

West Chester Gastrointestinal Group

tested different work flows that might improve efficiency and allow for utilization of

(WCGG) is one of the largest groups of

the fourth procedure room. The administration is worried that some of the current

board-certified gastroenterologists in

scheduling paradigms and flow practices might be preventing them from optimally

southeastern Pennsylvania.

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. www.westchestergi.com Figure 1: Current state mapping showing patient flow through the clinic.

Current State The clinic currently experiences procedures starting later than the scheduled 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

TOOL

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

Resource Utilization 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.

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.

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.

Page 2 | Case Study

TRANSFORMATION

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 double-booked. 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.

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

Waiting Room Volumes

Not Double Booked

Double Booked

15

13 Beds

14 Beds

10 5

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 Lean-led approach to project definition

Figure 2: Simulation model results showing wait times (minutes) and waiting room volumes based on varying resource capacities.

0

15

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

10 5 0

our clients: improve the quality of our

and design; and decision support. Our

Universal – Double Booked

12 Beds

Our core mission is the same as that of

July ‘15-April ‘16

July ‘15-April ‘16

July ‘15-April ‘16

customer request to fulfillment. Process

Figure 2 (above) is waiting room volume for each four-procedure room scenario.

mapping focuses on detailed work flow

This is the number of patients in the waiting room over time and does not include

elements and can identify non-value-

the patient’s caregiver. Each scenario has benefits. Array provided the results

adding steps that reduce efficiency and

with the understanding that having access to each possible outcome will allow the

add to lead time.

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.

Tools used:

“

Simulation Modeling, Observation, Current

It is always encouraging to see a client make a decision based on well-presented data that is validated using simulation modeling. It is not always easy to trust the output of a model, but in this case, the simulation truly helped this group of

State Assessment, Systems Approach, Data Visualization, Collaboration

physicians see the outcome of potential options and ultimately led to a better patient experience and continued growth without the need for a capital project.”

- Laura Silvoy, Lean Bronze Certified, Healthcare Systems Engineer

Outcomes We presented this information to the practice physician-owners. After absorbing the simulation model results, the group voted unanimously to stop double-booking the first appointment of each session, something previously proposed but never agreed upon. This initially reduced the weekly procedures by 10. The physicians also felt confident they could operate four procedure rooms without building any additional prep/recovery spaces. After opening this fourth room, they were able to add nine procedures to the daily schedule, for a net gain of 35 procedures/week. In addition to seeing more patients each week, the clinic noticed better patient satisfaction scores since they stopped double-booking at the start of each session. Overall, patient satisfaction related to perceived waiting increased from 84% to 96%.

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.

ARRAY-ADVISORS.COM

Published: DECEMBER 2016