UTK Examples in Healthcare

Implementing Process Improvement In Healthcare

By Gagan Rajpal With Craig A. Stevens PMI Nashville Symposium 2013 gaganrajpal1@gmail.com craigastevens@westbrookstevens.com

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Agenda Creating a Team Focused Improvement Program

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Goals/Objectives

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General PI Processes

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PI Assessment andtext.

Performance This is an example Go aheadMeasures and replace it

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Process Analysis

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Layout Analysis and Spaghetti Diagrams

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Value Chain Analysis

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SPIOC

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Summary of PI Program Approach

craigastevens@westbrookstevens.com

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craigastevens@westbrookstevens.com

Implementing Process Improvement In Healthcare •

Process Improvement is all about implementing changes; many times these are small, requiring no project management. However, other improvements require major changes that become projects.

The biggest problem with many of the process improvement programs is that you have to have a degree in statistics or engineering to understand them. However, it does not have to be that way. During this presentation, we will apply a simple threephase Process Improvement process using PM, LEAN, Six Sigma, and TQM approaches to real Healthcare examples as applied by University of Tennessee’s Industrial and Systems Engineering Department.

1/7/2013

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craigastevens@westbrookstevens.com

Goals and Objectives This Presentation Improvement Focused Teams

• Reinforce the Simple Three Phases • To Show Some Examples of Process Improvement using Healthcare

craigastevens@westbrookstevens.com

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Agenda Creating a Team Focused Improvement Program

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1

Goals/Objectives

✓

2

General PI Processes

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PI Assessment andtext.

Performance This is an example Go aheadMeasures and replace it

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Process Analysis

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Layout Analysis and Spaghetti Diagrams

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Value Chain Analysis

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SPIOC

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Summary of PI Program Approach

craigastevens@westbrookstevens.com

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Three Easy to Understand and Use Improvement Phases A= Assessments

P = Problem Solving

I = Implementation Using Project Management Tools/Support

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Westbrook Stevens, Seven Attributes of Excellent Management Model, 1990 Š

People and Team Building

From Book Geronimo Stone http://www.llumina.com/store/geronimostone2.htm

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Step 1 –Build the Assessment Candidate Portfolio

craigastevens@westbrookstevens.com

Life cycle of a patient needing services at East Tennessee Children Hospital Resource Allocation

Hospital Service

Patient Admissions

Doctor’s Office/ Department

Incoming Patients

gaganrajpal1@gmail.com

Step 2 –Assessment Phase

A= Assessments

P = Problem Solving

I = Implementation Using Project Management Tools/Support

craigastevens@westbrookstevens.com

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Agenda Creating a Team Focused Improvement Program

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1

Goals/Objectives

✓

2

General PI Processes

✓

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PI Assessment and Performance Measures This is an example text.

Go ahead and replace it

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Process Analysis

5

Layout Analysis and Spaghetti Diagrams

6

Value Chain Analysis

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SPIOC

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Summary of PI Program Approach

craigastevens@westbrookstevens.com

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PART I : Incoming Patients Applicable Lean Principle : Consistent incoming patient flow

Incoming patient flow and trend

Hospital Service

Patient Admissions

Doctor’s Office/ Department

Incoming Patients

PART I : Incoming Patients Applicable Lean Principle : Consistent incoming patient flow

Incoming patient flow and trend

Hospital Service

Patient Admissions

Doctor’s Office/ Department

Incoming Patients

gaganrajpal1@gmail.com

Is there any “trend� in number incoming patients over the years?

Number of patients in year 2007 & 2010 are extrapolated

gaganrajpal1@gmail.com

Is there any “trend� in number incoming patients over the years?

gaganrajpal1@gmail.com

Is there any “trend” in “number” of incoming patients within an year?

gaganrajpal1@gmail.com

Is there any “trend” in “type” of incoming patients within an year?

gaganrajpal1@gmail.com

Is there any “trend” in “number” incoming patients within a week?

gaganrajpal1@gmail.com

Is there any “trend” in “type” of incoming patients within a week?

Is there any “trend” in “number & type” of incoming patients within a day?

Agenda Creating a Team Focused Improvement Program

✓

1

Goals/Objectives

✓

2

General PI Processes

✓

3

PI Assessment and Performance Measures

✓

4

Process Analysis

5

Layout Analysis and Spaghetti Diagrams

6

Value Chain Analysis

7

SPIOC

8

Summary of PI Program Approach

craigastevens@westbrookstevens.com

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PART II : Patient Admission Applicable Lean Principle : Efficient, effective and reliable admissions process Is staffing logistics appropriate?

Is patient registration a smooth process?

Current layout

Hospital Service

Patient Admissions

Doctor’s Office/ Department

Incoming Patients

PART II : Patient Admission Applicable Lean Principle : Efficient, effective and reliable admissions process Is staffing logistics appropriate?

Is patient registration a smooth process?

Current layout

Hospital Service

Patient Admissions

Doctor’s Office/ Department

Incoming Patients

Step 2 –Assessment Phase

A= Assessments

P = Problem Solving

I = Implementation Using Project Management Tools/Support

craigastevens@westbrookstevens.com

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Is staffing logistics appropriate?

gaganrajpal1@gmail.com

Is staffing logistics appropriate?

3-4 registrations/ hr

Temporary solution will be to move one of the evening personnel to the peak hours gaganrajpal1@gmail.com

Is patient registration a smooth process?

Doctor’s Office

Rarely on Order Pre-Cert #

Bad Faxes Order

Patient Registration Patients Name

No Order

Not having insurance card

Date of birth Diagnosis

No diagnosis on order

Tests to be done

Interpreter

Grand parents or Neighbors Step parents

Doctor’s Sign Legal guardianship

No signature Legal guardianship paper

House Address

gaganrajpal1@gmail.com

Is patient registration a smooth process? (Continued)

Doctor’s Office/ Department

gaganrajpal1@gmail.com

Step 3 – Build the Problem Solving Portfolio A= Assessments

P = Problem Solving

I = Implementation Using Project Management Tools/Support

craigastevens@westbrookstevens.com

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Recommendations  Pre-screening orders and have more proactive approach  Creating a Kanban system for orders that need attention  Having Pre-cert # already on the order  Having a “complete” & “readable” order  Better fax machines  “Standard format” for orders (Website access to input patient data) • No need for faxes • Direct upload onto the database • Can be easily read • Time & Money saved

 Pre-registration on phone  In case of surgery, doctor could send order directly to surgery  In case of standing order, direct admit

gaganrajpal1@gmail.com

Agenda Creating a Team Focused Improvement Program

✓

1

Goals/Objectives

✓

2

General PI Processes

✓

3

PI Assessment and Performance Measures

✓

4

Process Analysis

✓

5

Layout Analysis and Spaghetti Diagrams

6

Value Chain Analysis

7

SPIOC

8

Summary of PI Program Approach

craigastevens@westbrookstevens.com

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The current layout

1.4 Miles/ shift

gaganrajpal1@gmail.com

Recommendations  Change the current layout

 Apply principles 5 S in patient admissions office  Sort (Seiri),  Straighten (Seiton),  Shine (Seiso),  Standardize (Seiketsu) and  Sustain (Shitsuke) gaganrajpal1@gmail.com

Step 6 – Select the Solutions and Build a Project Portfolio A= Assessments

GFR GFR

GFR P = Problem Solving

I = Implementation Using Project Management Tools/Support

craigastevens@westbrookstevens.com

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The “new” layout

The “current” layout

Fax Room

Marty’s Office

4

3

2

1

Front Desk

Call Center

gaganrajpal1@gmail.com

The Achievable Target 5-6 registrations/ hr

Agenda Creating a Team Focused Improvement Program

✓

1

Goals/Objectives

✓

2

General PI Processes

✓

3

PI Assessment and Performance Measures

✓

4

Process Analysis

✓

5

Layout Analysis and Spaghetti Diagrams

✓

6

Value Chain Analysis

7

SPIOC

8

Summary of PI Program Approach

craigastevens@westbrookstevens.com

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PART III : After Admission Lean Principle Applicable : Customer satisfaction due to the reduction in wait time via Just In Time system/ pull system Patient flow Alignment between admissions & services provided

Resource Allocation

Hospital Service

Patient Admissions

Doctor’s Office/ Department

Incoming Patients

PART III : After Admission Lean Principle Applicable : Customer satisfaction due to the reduction in wait time via Just In Time system/ pull system Patient flow Alignment between admissions & services provided

Resource Allocation

Hospital Service

Patient Admissions

Doctor’s Office/ Department

Incoming Patients

Step 2 –Assessment Phase

A= Assessments

P = Problem Solving

I = Implementation Using Project Management Tools/Support

craigastevens@westbrookstevens.com

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Focus Areas

gaganrajpal1@gmail.com

Focus Areas

gaganrajpal1@gmail.com

Value added Vs Non-value added time • Patient registration • Explaining the procedure • Taking history • Actual procedure

• Redundancy • Waiting • Walking/ transportation • Excessive processing • Errors

gaganrajpal1@gmail.com

3/11/2013

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3/11/2013

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3/11/2013

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3/11/2013

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3/11/2013

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Types of waste  Redundancy in paper work  Waiting for technician  Waiting for room  Same questions asked by several personnel  Orders lost

 Delay in bringing patients from the floor lack of transporter technician being busy with other patients sometimes lack of technicians gaganrajpal1@gmail.com

3/11/2013

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Agenda Creating a Team Focused Improvement Program

✓

1

Goals/Objectives

✓

2

General PI Processes

✓

3

PI Assessment and Performance Measures

✓

4

Process Analysis

✓

5

Layout Analysis and Spaghetti Diagrams

✓

6

Value Chain Analysis

✓

7

SPIOC

8

Summary of PI Program Approach

craigastevens@westbrookstevens.com

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PART IV : Resource allocation model

Resource Allocation

Hospital Service

Patient Admissions

Doctor’s Office/ Department

Incoming Patients

gaganrajpal1@gmail.com

PART IV : Resource allocation model

Resource Allocation

Hospital Service

Patient Admissions

Doctor’s Office/ Department

Incoming Patients

gaganrajpal1@gmail.com

Step 3 – Build the Problem Solving Portfolio A= Assessments

P = Problem Solving

I = Implementation Using Project Management Tools/Support

craigastevens@westbrookstevens.com

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Allocation of resources to patient admissions

1. To increase service/ patient satisfaction 2. To minimize cost Depends on- Number of people - Time/ Schedule of different departments

gaganrajpal1@gmail.com

Our approach

SIPOC Supplier

Input

Department

Patient -Time

- Doctor

- Schedule

Process Admissions to the entrance of the service

Output Customer Service -Time

Patient

- Quality

Logic : Ability to provide resources to serve the customer Resources are provided in the process, therefore, they should dictate the schedule gaganrajpal1@gmail.com

Input • • • • • •

Insurance Order Relation to Patient Social Security # Address Doctor’s name

• Service Required • Availability of service • # of patients in queue for service • Avg. time required for service

Output Type - 1

X-ray

QS1

QS11 Type - 2

Pulmonary

QS12

QS2

Patient

Admissions

QA

Type - 3

Lab

QS3

QS13 Type - 4

Neurology

QS4

QS14 Surgery

QS5 Type - n

QS1n

Output = Min: ∑ QA + QS1 + QS11 --------------

Allocation of resources to patient admissions

1. To increase service/ patient satisfaction 2. To minimize cost Depends on- Number of people - Time/ Schedule of different departments

gaganrajpal1@gmail.com

Our approach

SIPOC Supplier - Department - Doctor

Input Patient -Time - Schedule

Process Admissions to the entrance of the service

Output Service -Time

Customer Patient

- Quality

Logic : Ability to provide resources to serve the customer Resources are provided in the process, therefore, they should dictate the schedule gaganrajpal1@gmail.com

Input • • • • • •

Insurance Order Relation to Patient Social Security # Address Doctor’s name

• Service Required • Availability of service • # of patients in queue for service • Avg. time required for service

gaganrajpal1@gmail.com

Output Type - 1

X-ray

QS1

QS11 Type - 2

Pulmonary

QS12

QS2

Patient

Admissions

QA

Type - 3

Lab

QS3

QS13 Type - 4

Neurology

QS4

QS14 Surgery

QS5 Type - n

QS1n

Output = Min: ∑ QA + QS1 + QS11 -------------gaganrajpal1@gmail.com

Agenda Creating a Team Focused Improvement Program

✓

1

Goals/Objectives

✓

2

General PI Processes

✓

3

PI Assessment and Performance Measures

✓

4

Process Analysis

✓

5

Layout Analysis and Spaghetti Diagrams

✓

6

Value Chain Analysis

✓

7

SPIOC

✓

8

Summary of PI Program Approach

craigastevens@westbrookstevens.com

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