Business Process Redesign in Health Care IT Types of BPR Project Management Implications Examples from the Field 10/10/20141Group 4: Farabaugh, John, Katzovitz,

Business Process Redesign in Health Care IT

Types of BPRProject Management Implications

Examples from the Field

04/11/23 1Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow

Lee Farabaugh, Susan John, Larry Katzovitz, Eric Lott, Ashwini Patki, Jessica Pearce, Josh Snow

Group 4: Project Agenda • Overview of Business Process Redesign models

used in healthcare. • Applicability of principles of Business Process

redesign related to overall Project Management methodologies.

• Effectiveness of such models as part of a Healthcare IT initiative.

• Examples where organizations have used such a model as part of a Healthcare IT initiative.

• Class exercise and questions.

Project Management Methodologies (Traditional)

• Waterfall• Spiral• Build and Fix

Traditional Methodology Model• Identify Deficiencies• Define Specific Proposals for Improvement• Proposed System is Designed• New System is Developed• System is Implemented• System is Continuously Evaluated and

Maintained

Traditional Methodologies Characteristics

• Looked to improve existing systems or implement new systems

• Task oriented• Processed based• Step-by-step approach

Business Process Redesign Characteristics

• “Clean Slate” • Outcomes oriented• Priority based• Cyclical approach

Business Process Redesign Model

• Envision New Processes• Initiate Change• Diagnosis Process• Process Redesign• Reconstruction• Process Monitoring

Agile Principles• Projects built around self-organized teams• Rapid adaptation to changing circumstances• Continuous attention to technical design• Working product is the measure of progress

Health Care Challenges that encourage use of BPR

• Medical errors and high costs of healthcare• Underinsured or uninsured population • Increasing number of heterogeneous and older

population,• Globalization/ medical outsourcing, • Maintaining quality for given cost and cost

minimization for given quality• Shortage of clinical and nursing staff

Expectations from BPR models• Increase in efficiency• Reduce medical and medication errors• Health care cost reduction• Better access and quality in healthcare• Procedure optimization• Time effectiveness• Customer and health care provider

satisfaction

Highlighted solutions• Automating and monitoring processes in

healthcare• Redesigning or improving clinical processes

where necessary and possible• Identifying patient expectations and improving

patient care processes for better customer services.

BPR – What & Why?• Business Process Redesign is a set of activities

undertaken to make sustained improvements in the …

• SPEED (lead time)• QUALITY• COST OF PROCESS

HELPS AN ORGANIZATION STAY

COMPETITIVE IN THE

MARKETPLACE

HELPS AN ORGANIZATION STAY

COMPETITIVE IN THE

MARKETPLACE

BPR – How?HIGH LEVEL ASSESSMENTHIGH LEVEL ASSESSMENT

• BUSINESSS MISSION• GOALS• CUSTOMER NEEDS

• BUSINESSS MISSION• GOALS• CUSTOMER NEEDS

RESULTS IN

NEW PRODUCT REDESIGN

(FOR EFFICIENCY & ALIGNMENT OF

MUTUAL GOALS)

RESULTS IN

NEW PRODUCT REDESIGN

(FOR EFFICIENCY & ALIGNMENT OF

MUTUAL GOALS)

STRUCTURED ORDERING OF WORKSTEPS

•MEASURED•IMPROVED•(OR) ELIMINATED

STRUCTURED ORDERING OF WORKSTEPS

•MEASURED•IMPROVED•(OR) ELIMINATED

BPR - Methods• LEAN• SIX SIGMA• TOTAL QUALITY MANAGEMENT (TQM)• KAIZEN• PLAN, DO, STUDY ACT (PDSA)• CLINICAL MICROSYSTEM MODEL• TALENT PROFILING

LEAN – What?RETHINKING & REDESIGN OF BUSINESS

PROCESSRETHINKING & REDESIGN OF BUSINESS

PROCESS

SHORTENED LEAD TIMESSHORTENED LEAD TIMES

REDUCED PROCESS WASTES

REDUCED PROCESS WASTES

IMPROVED CUSTOMER SATISFACTION

IMPROVED CUSTOMER SATISFACTION

EFFICIENCY IMPROVEMENTS

PROCESS COST REDUCTION

REVENUE INCREASE

EFFICIENCY IMPROVEMENTS

PROCESS COST REDUCTION

REVENUE INCREASE

LEAN – How?

HIGH LEVEL ASSESSMENTHIGH LEVEL ASSESSMENT

WHO ?WHO ? PRODUCT DELIVERED ? PRODUCT DELIVERED ?

LEAN – How?

STEPS THAT HAVE NO

VALUE

STEPS THAT HAVE NO

VALUE

WAITING TIMEWAITING TIME

PROCESS WASTE

PROCESS WASTE

Improving Processesby eliminating…

LEAN – How? (Six Concepts)1. Value2. Value Stream3. Flow4. Pull5. Perfection6. Replication

LEAN – What helps?

LEAN IMPLEMENTATIONS

LEAN IMPLEMENTATIONS

STRONG MANAGEMENT SUPPORT & SPONSORSHIPSTRONG MANAGEMENT

SUPPORT & SPONSORSHIP

COMMUNICATION OF SHARED GOALS

COMMUNICATION OF SHARED GOALS

LEAN - Conclusion• Can be applied to any business process or service

industry.• Can be used to dramatically reduce lead times

– HR recruitment– New product development– Customer development

TO GAIN COMPETITIVE ADVANTAGE OVER OTHER COMPANIES

Six Sigma (Six sigma was invented by Motorola in the 1980s)

• Analytical approach to indentify the inefficiencies and inadequacies in the process and provide a step by step solution based on analysis of real time data.

• Process must have < 3.4 defects per million occurrences (Carrigan, 2006)

• Statistical calculation that suggests customer needs /satisfaction to meet 99.99997% or 6-Sigma level. (Caldwell 2006)

• Focuses on customer satisfaction, process improvement and cost reduction. (Breyfogle, 2003)

• Uses structured methodology and powerful statistical tools that provide a scientific approach to process improvement and patient safety. (http://www.medscape.com)

Six Sigma Sub methodologies• DMAIC: Define, Measure, Analyze, Improve, and

Control; (improve existing processes ) • DMADV: Define, Measure, Analyze, Design,

Verify; (develop new processes or products at Six Sigma quality levels) (http://www.isixsigma.com/sixsigma/six_sigma.asp)

• Implementing 6sigma: “Black Belt” = organize of Six Sigma project “Green belt” = implement and monitor the

project.

Applications of BPR

BPR Obstacles

04/11/23 Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow 23

What is TQM?• Total Quality Management (TQM) is a philosophy that says

uniform commitment to quality in all areas of an organization promotes an organizational culture that meets consumers' perceptions of quality.

• TQM philosophy focuses on teamwork, increasing customer satisfaction, and lowering costs.


The concept of TQM rests largely on five principles:1. Produce quality work the first time. 2. Focus on the customer. 3. Have a strategic approach to improvement. 4. Improve continuously. 5. Encourage mutual respect and teamwork.

The concept of TQM rests largely on five principles:1. Produce quality work the first time. 2. Focus on the customer. 3. Have a strategic approach to improvement. 4. Improve continuously. 5. Encourage mutual respect and teamwork.

TQM Process/Benefits• Process begins by listening to customers' wants and needs

and then delivering goods and services that fulfill these desires.


Http://www.cliffsnotes.com/WileyCDA/CliffsReviewTopic/Total-Quality-Management-TQM-.topicArticleId-8944,articleId-8931.html#ixzz0WJep9lSX

An effective TQM program has numerous benefits:• Financial benefits (lower costs, higher returns on sales and

investment, and the ability to charge higher rather than competitive prices)

• Improved access to global markets• Higher customer retention levels• Less time required to develop new innovations• Reputation as a quality firm

An effective TQM program has numerous benefits:• Financial benefits (lower costs, higher returns on sales and

investment, and the ability to charge higher rather than competitive prices)

• Improved access to global markets• Higher customer retention levels• Less time required to develop new innovations• Reputation as a quality firm

What is Kaizen?• Philosophy/practices focusing on continuous improvement in

manufacturing activities, business activities, & life in general. • Refers to activities that continually improve all functions of a

business, – Manufacturing to management – CEO to assembly line workers

• Kaizen aims to eliminate waste.


Kaizen Cycle• The cycle of kaizen activity can be defined as:

• Standardize an operation • Measure the standardized operation• Gauge measurements against requirements • Innovate to meet requirements and increase

productivity • Standardize the new, improved operations • Continue cycle ad infinitum


Kaizen


http://www.valuebasedmanagement.net/methods_kaizen.html

Other BPR Methods

•PDSA – Plan, Do, Study, Act•Clinical Microsystem Model•Talent Profiling

04/11/23 29Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow

PDSA – Plan, Do, Study, ActThree Questions

• What are we trying to accomplish?

• How will we know that a change is an improvement?

• What changes can we make that will result in improvement?


The PDSA Cycle


PDSA – UW Rheumatology Office Visit Data Collection

• Cycle 1 – Standardized Database & Dictation Template

• Cycle 2 – Disease Activity Scoring• Cycle 3 – CPT Visit Coding Level• Cycle 4 – Full Implementation


PDSA – UW Rheumatology Office Visit Data Collection

Improvements• More Complete Data• 40% Time Savings• More Effective Patient/Physician Visit• Improved Therapeutic Decision Making• Research Study Revenue


Clinical Microsystem Method• Smallest Replicable Unit• Building Blocks to Larger System• 5 P’s - Purpose, Patients, Processes, Professionals,

and Patterns • Improvements – Transformation of Workforce

and Culture• Hospital Quality = Quality of Microsystem 1 +

Quality of Microsystem 2 + Quality of Microsystem 3 and Microsystem (n)


Talent Profiling

• Worker rather than Process• Right Person – Right Job• Important Characteristics to be Successful


Business Process Reengineering and Health Care IT

• IT often plays a support role in BPR in health care

• “What has to happen when you design the new process, you find how information technology is going to be used to support that new process, and if you don’t have that technological capability, you’re going to have to go and get it.” (George W. Whetsell)


Denver Health (Lean)• Pure IT project: patient scheduling application

development• Project timeline reduced 50%, outside

consulting cost reduced 36%.• IS had previously sat “on the sidelines” in lean

initiatives, but sought to use lean to make the department more efficient

• Challenge was to fit lean concepts to a longer term IT project.


Denver Health (Lean)• Rapid Improvement Event (RIE) model was

tweaked to fit this specific project– Embedded into project cycle, redefining how

project was managed– Custom templates created– Special attention given to lean tools, activity flow,

and frequency of RIE events• Involvement of end users• “Red phone” mentality


BayCare Health & Blue Cross• Optimize Electronics Claims Processing

– Understand Sub-processes in claims processing– Blackbelts held team meetings– Six page swim lane process map

• Results• Reduced processing time• Fewer denied claims• $500,000 annual savings


VA’s VistA QUERI system (TQM)• Quality Improvement initiative within the VA,

where data from the organization’s nationwide interoperable VistA EMR system is integral to the total process of improving patient outcomes.



Hynes, D. M., Perrin, R. A., Rappaport, S., Stevens, J. M., & Demakis, J. G. Informatics Resources to Support Health Care: Quality Improvement in the Veterans Health Administration. Journal of the American Medical Informatics Association. 2(5), 344-350.

Virginia Mason (Lean)• IT served as a support role to improve areas

identified as cost-centers– Provided feedback to individual clinicians on cost

performance– Implementation of CPOE to reduce unnecessary

prescriptions and reduce ER visits due to low refill allowances

– Implementation of decision support to alert clinicians when tests fall into the “not useful” category


BPR Recap• Methods

– How different from traditional– Variety of methods

• Application


Q&A• Questions?


Class Exercise


Business Process Redesign: Jeopardy


Lean Six-SigmaTotal Quality Management

(TQM)Kaizen

Plan, Do, Study, Act

(PDSA)

25 Points 25 Points 25 Points 25 Points 25 Points



Jeopardy Questions (Modified Version)



(TQM)Kaizen


(PDSA)

Name 1 of the 3 improvements that can be expected with ‘Lean’

The acronym “DMAIC” stands for what?

What area of an organization does TQM focus its efforts?

What is the aim of Kaizen?

Name 1 of the 3 questions that should be asked before implementing PDSA

Lean improves processes by eliminating what? (name 2 of the 3)

What are the two types of “belts” that can be received if an org. implements six-sigma?

The TQM process first begins by what?

“Muda” stands for what?

The “Do” stage of PDSA involves a number of duties, name 2.

Lean can be applied to what business or industry?

What organization invented the six-sigma methodology?

Name 2 of the 5 benefits that can be expected with TQM?

Name 2 of the 5 elements of Kaizen

Name 2 elements involved with the “Act” cycle of PDSA?

Jeopardy Answers



(TQM)Kaizen


(PDSA)

1. Shortened lead times

2. Reduction in process waste

3. Improved customer satisfaction

DMAIC = Define, Measure, Analyze, Improve, and Control

All areas of an organization

Eliminate waste

1. What are we trying to accomplish?

2. How will we know that change is an improvement?

3. What changes can we make that will be an improvement?

1. Steps that have no value

2. Process waste3. Waiting time

Black Belt and Green Belt

Listening to customers’ wants and needs

Elimination of waste and incorporation of efficiency

1. Carry out the plan2. Document

observations3. Record Data

Any process or industry!

Motorola

1. Financial Benefits2. Improved access3. High customer

retention4. Less time for R&D5. Improved

Reputation

1. Teamwork2. Personal

discipline3. Improved morale4. Quality circles5. Suggestions for

improvement

1. Asking “what changes are to be made?”

2. Asking “what is the next cycle?”

Bibliography• Alexandrou, Marios (2009). Methodologies. Retrieved from http://www.mariosalaxandrou.com• Beck, K., Beedle M., Bennekum, A., et al. (2001), The Agile Manifesto. Retrieved from

http://agilemanifesto.org• Caldwell, C., Lean-Six Sigma tools for rapid cycle cost reduction, Healthcare Financial Management. Oct

2006, 60 (10)• CliffsNotes.com. Total Quality Management (TQM). 24 Nov 2009. Retrieved from

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New York, NY.• Carrigan M. D., Kujawa D. Six Sigma in health care management and strategy. Health Care Management.

2006;25(2):133-141• Caldwell, C., Lean-Six Sigma tools for rapid cycle cost reduction, Healthcare Financial Management. Oct

2006, 60 (10)• Davenport, D. and Short, J. The New Industrial Engineering: Information Technology and Business Process

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Methodology”, Information Systems Management, Summer 1993, Vol 10 (3), 13-22

• Harrington, T. J., Newman, E. D. (2007). Redesigning the care of rheumatic diseases at the practice and system levels. Clinical and Experimental Rheumatology, 25, S55-S63.

• Improvement Methods. Institute of Healthcare Management. Retrieved from http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/

• Lanham, B., Maxson-Cooper, P. Is Six Sigma the Answer for Nursing to Reduce Medical Errors...: Implementing Six Sigma in Health Care. MedScape Today. Retrieved from http://www.medscape.com/viewarticle/449692_6

• Mahalik, P. Learning to Think Lean: Six Steps with Review Points. Retrieved from http://www.isixsigma.com/library/content/c060821a.asp

• McQueen, H. E. (1993). The healthcare CIO’s role in business process redesign. Computers in Healthcare. February, 1993, 24-28.

• Mohr, J, Batalden, P., Barach, P. (2004). Intergrating patient safety into the clinical microsystem. Qual Saf Health Care, 13,34-38.

• Plan-Do-Study-Act (PDSA) Cycle (2008). AHRQ Healthcare Innovations Exchange. Retrieved from http://www.innovations.ahrq.gov/content.aspx?id=2398

• Schweikhart S. A., Dembe A. E. J Investigative Medicine. 2009 Sep 2• Shaffer, Vi. (2008). Case Study: Denver Health Leverages ‘Lean’ for a Breakthrough in Enterprise Patient

Scheduling Implementation. Gartner Industry Research. 17 December, 2008.• Six Sigma. Retrieved from http://www.pqa.net/ProdServices/sixsigma/sixsigma.html• Six Sigma - What is Six Sigma? Retrieved from http://www.isixsigma.com/sixsigma/six_sigma.asp• ValueBasedManagement.com. Kaizen Philosophy and Kaizen Method. Retrieved from:

http://www.valuebasedmanagement.net/methods_kaizen.html

Documents

Business Process Redesign in Health Care IT Types of BPR Project Management Implications Examples from the Field 10/10/20141Group 4: Farabaugh, John, Katzovitz,