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Black Belt Project
Bed Management Unit
Sonya Cotter
Background CUH only Level 1 Trauma Centre
Model 4 hospital
40 Specialties on site
65,000 ED presentations
48,000 Inpatient Discharges
86,000 Day Cases
Current Process 35% ED attendances
require hospital in- patient admission daily.
CUH needs 73 discharges / day.
White Boards on wards.
PDD recorded daily
Multiple ward rounds , multiple phone calls.
Aims and Objectives. To record and examine the Predicted Date of
discharges (PDD) provided daily from the wards to the Bed Management Unit.
To examine what the current work process is and using lean methodologies with a stakeholder group to produce a revised process that would increase the documentation and accuracy of PDD.
Aims and Objectives To implement changes that meet with the National targets
of 80% documentation of PDD thus improving patient flow, reducing waste and ensuring Patients are discharged from CUH in a safe and timely manner.
To enhance team performance and staff well-being and to
add value and improve efficiency. To develop new policies and procedures to support the
changes introduced and to implement a quality control programme to monitor compliance and to ensure the changes are maintained.
Define SIPOC
Pie Chart
Project Charter
Ganntt Chart
Stakeholder Analysis
Stakeholder Map
Define
Define Predicted Vs Actual Discharges
3113
1759
Actual
Potential
Problem Statement In May 2015 there was a recorded gap of 53 % between
PDDs and Actually discharges. This impacts on both patients’ experiences and outcomes and also impacts on the staff caring for the patients.
Goal is t0 reduce down the gap between Potential discharges and Actual discharges by 50% by December 2015.
Stakeholder Map
Measure Data Collection Plan
Histogram
Control Chart
Measure
0
5
10
15
20
25
30
-10.95 -5.05 0.85 6.75 12.65 18.55 24.45 30.35 36.25 42.15 48.05 53.95 59.85 65.75
Nu
mb
er
% Discrepency
Predicted vs Actual (Bed Management)
LSL 10.00 USL 10.00
Mean 20.95 Median 19.00 Mode 17, 15, 28 n 106 Cp 0.00
Cpk -0.30 CpU -0.30 CpL 0.30 Cpm 0.00 Cr #DIV/0! ZTarget/DZ 0.87 Pp 0.00 Ppk -0.29 PpU -0.29 PpL 0.29 Skewness 0.40 Stdev 12.56 Min -5.00 Max 54.00 Range 59.00 Z Bench 0.89 % Defects 97.2% PPM 971698.11 Expected 1000000.00 Sigma -0.41
Measure
UCL 13.1
CL 4.0 0
5
10
15
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Ran
ge
Period
mR Count
UCL 18.2
CL 7.6
LCL -3.1
-5.0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Co
un
t
Period
X Count
Analyse Current Process Maps
Fishbone
Brainstorming
Analyse
Improve
Brainstorming
Pilot Sites
Roll out to remaining wards.
Improve
Patient Flow ;CNM iPMs to be updated by CNM.
PDD to be updated by CNM.
Ward view of iPMS to be discussed at 8am hub each
morning.
CNM2 to confirm discharges at 8am.
Bed Management Confirm discharges at 8am hub.
Patient will be allocated to wards at this time.
Patients acuity, age and time on trolley will be prioritised.
Ward rounds to continue daily, at the white boards.
Staff Nurses All Ward rounds to have a nurse present .
Discussions with MDT re discharge plans.
White boards with PDD to be updated .
PDD documented over bed and communicated to families.
Control Control Plan
CUSUM control chart
Run Weekly
Available to view for all Stakeholders
Unscheduled Care Governance Group
Results
0
5
10
15
20
25
30
-10.95 -5.05 0.85 6.75 12.65 18.55 24.45 30.35 36.25 42.15 48.05 53.95 59.85 65.75
Nu
mb
er
% Discrepency
Predicted vs Actual (Bed Management)
LSL 10.00 USL 10.00
Mean 20.95 Median 19.00 Mode 17, 15, 28 n 106 Cp 0.00
Cpk -0.30 CpU -0.30 CpL 0.30 Cpm 0.00 Cr #DIV/0! ZTarget/DZ 0.87 Pp 0.00 Ppk -0.29 PpU -0.29 PpL 0.29 Skewness 0.40 Stdev 12.56 Min -5.00 Max 54.00 Range 59.00 Z Bench 0.89 % Defects 97.2% PPM 971698.11 Expected 1000000.00 Sigma -0.41
Results
Lessons Learnt Communication
DMAIC Tools
Data
Stakeholders
Quadrant of Productivity Productivity
Distraction Burn out
Fire fighting
Thank You