UTK Examples in Healthcare

Implementing Process Improvement In Healthcare

By Gagan Rajpal

With Craig A. Stevens

PMI Nashville Symposium 2013

1 gaganrajpal1@gmail.com

craigastevens@westbrookstevens.com

Creating a Team Focused Improvement

Program

Agenda

Goals/Objectives

General PI Processes

4 Process Analysis

Value Chain Analysis

Layout Analysis and Spaghetti Diagrams

8 Summary of PI Program Approach

This is an example text. Go ahead and replace it 3 PI Assessment and Performance Measures

• 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 three-

phase 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.

Implementing Process Improvement In

Healthcare

1/7/2013 3

• Reinforce the Simple Three Phases

• To Show Some Examples of Process Improvement

using Healthcare

Goals and Objectives This Presentation

Improvement Focused Teams

Program

Agenda

Goals/Objectives

4 Process Analysis

Three Easy to Understand and Use

Improvement Phases

Assessments

P = Problem Solving

I = Implementation

Using Project Management Tools/Support

Westbrook Stevens, Seven Attributes of

Excellent Management Model, 1990 ©

People

Building

7 From Book Geronimo Stone

http://www.llumina.com/store/geronimostone2.htm

Step 1 –Build the Assessment Candidate Portfolio

Hospital Service

Doctor’s Office/

Department

Patient

Admissions

Life cycle of a patient needing services at

East Tennessee Children Hospital

Incoming Patients

Resource Allocation

gaganrajpal1@gmail.com

Step 2 –Assessment Phase

Assessments

P = Problem Solving

I = Implementation

Program

Agenda

Goals/Objectives

4 Process Analysis

Hospital Service

Doctor’s Office/

Department

Patient

Admissions

Incoming Patients

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

Incoming patient flow and trend

Hospital Service

Doctor’s Office/

Department

Patient

Admissions

Incoming Patients

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

Incoming patient flow and trend

Number of patients in year 2007 & 2010 are extrapolated

Is there any “trend” in number incoming patients over

the years?

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

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

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

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

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

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

Program

Agenda

Goals/Objectives

4 Process Analysis

3 PI Assessment and Performance Measures

Hospital Service

Doctor’s Office/

Department

Patient

Admissions

Incoming Patients

Is staffing logistics appropriate?

Is patient registration a smooth process?

Current layout

PART II : Patient Admission Applicable Lean Principle : Efficient, effective and reliable admissions process

Hospital Service

Doctor’s Office/

Department

Patient

Admissions

Incoming Patients

Current layout

PART II : Patient Admission Applicable Lean Principle : Efficient, effective and reliable admissions process

Assessments

P = Problem Solving

I = Implementation

3-4 registrations/ hr

Temporary solution will be to move one of the evening personnel to the peak hours

Doctor’s Office

Patient Registration

Pre-Cert # Order

Patients Name

Date of birth

Diagnosis

Tests to be done

Doctor’s Sign

Legal guardianship

House Address

Rarely on Order

Bad Faxes

No signature

Legal guardianship paper

No diagnosis on order Not having insurance card

No Order

Grand parents or Neighbors

Step parents

Interpreter

Doctor’s Office/

Department

Is patient registration a smooth process? (Continued)

Step 3 – Build the Problem Solving

Portfolio

Assessments

P = Problem Solving

I = Implementation

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

Program

Agenda

Goals/Objectives

4 Process Analysis

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)

Step 6 – Select the Solutions and Build

a Project Portfolio

Assessments

P = Problem Solving

I = Implementation

GFR GFR

The “current” layout

Front Desk

Call Center

Fax Room

Marty’s

Office

1 2 3 4

The “new” layout

The Achievable Target

5-6 registrations/ hr

Program

Agenda

Goals/Objectives

4 Process Analysis

Hospital Service

Doctor’s Office/

Department

Patient

Admissions

Incoming Patients

Resource Allocation

PART III : After Admission

Patient flow

Alignment between admissions & services provided

Lean Principle Applicable : Customer satisfaction due to the reduction in wait

time via Just In Time system/ pull system

Hospital Service

Doctor’s Office/

Department

Patient

Admissions

Incoming Patients

Resource Allocation

PART III : After Admission

Patient flow

Alignment between admissions & services provided

Lean Principle Applicable : Customer satisfaction due to the reduction in wait

time via Just In Time system/ pull system

Assessments

P = Problem Solving

I = Implementation

Focus Areas

Value added Vs Non-value added time

• Patient registration

• Explaining the

procedure

• Taking history

• Actual procedure

• Redundancy

• Waiting

• Walking/ transportation

• Excessive processing

• Errors

3/11/2013 44

3/11/2013 45

3/11/2013 46

3/11/2013 47

3/11/2013 48

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

Types of waste

3/11/2013 50

Program

Agenda

Goals/Objectives

4 Process Analysis

Hospital Service

Doctor’s Office/

Department

Patient

Admissions

Incoming Patients

Resource Allocation

PART IV : Resource allocation model

Hospital Service

Doctor’s Office/

Department

Patient

Admissions

Incoming Patients

Resource Allocation

PART IV : Resource allocation model

Step 3 – Build the Problem Solving

Portfolio

Assessments

P = Problem Solving

I = Implementation

1. To increase service/ patient satisfaction

2. To minimize cost

Depends on-

- Number of people

- Time/ Schedule of different departments

Allocation of resources to patient admissions

- Department

- Doctor

Patient

- Schedule

Admissions to the entrance of the service

Service

- Quality

Patient

Supplier Input Process Output Customer

Logic :

Ability to provide resources to serve the customer

Resources are provided in the process, therefore, they should

dictate the schedule

Our approach

• 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

Admissions

Pulmonary

Neurology

Surgery

Type - 1

Type - 2

Type - 3

Type - 4

Type - n

Patient QA

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

Output

1. To increase service/ patient satisfaction

2. To minimize cost

Depends on-

- Number of people

- Time/ Schedule of different departments

Allocation of resources to patient admissions

- Department

- Doctor

Patient

- Schedule

Admissions to the entrance of the service

Service

- Quality

Patient

Supplier Input Process Output Customer

Logic :

Ability to provide resources to serve the customer

Resources are provided in the process, therefore, they should

dictate the schedule

Our approach

• 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

Admissions

Pulmonary

Neurology

Surgery

Type - 1

Type - 2

Type - 3

Type - 4

Type - n

Patient QA

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

Output

Program

Agenda

Goals/Objectives

4 Process Analysis

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