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Designing Lean Processes to
Increase Patient Access
Cleveland Clinic Foundation November 12, 2012
The Burning Platform
• NDSC statistics :
Over 100 employees
30 Providers
27,000 patients visits a year
450 children waiting for appointments
• Our patients have significant challenges with:
- physical limitations
- emotional fragility
- large mobility equipment
- behavioral issues
• The facility challenges:
- linear design with long hallways
- walls obstruct flow and visibility
- 60% of the facility is made up of offices
- just 40% is clinic space for the patients
- long walks for patients from the front door
- staff spent time looking for each other
What were the Facility Issues?
Define - What is the issue?
• Problem Statement: The length of the NDSC
appointment is too long
• The Goal: Reduce the length of the NDSC
appointment from an average of 66 minutes to
an average of 56 minutes by November, 2012
Measure- Current State Value
Stream Map
The Analysis
• Spaghetti Diagram: Showing motion for each staff member, patient, and family
• Cause and Effect Matrix:
The team weighted and scored those things that they felt added time and delay to the average appointment. Items included:
1) incomplete supplies in exam rooms
2) late policy application inconsistencies
3) scheduling inconsistencies
4) triage process delays
More Analysis – Flow & Schedules
The difference between Provider Exam Time not Statistically Significant
0
2
4
6
8
10
12
14
9
5 4
9
7
12
9
7
2
4
7 7
14 12
8
11 10
5
3
Waiting Room – 136 scheduled
More Analysis – Causal Mapping
Project Targets
A3 Projects
Out of Scope
Improvement - Standardization
• Standardization of Patient Prep
- Pocket cards made for medical
assistants
• Standardization of Room Content
• - Restocking completed at
• 7 and noon daily
- Draws standard in rooms
• - Photo Kanbans in place
- Par level Kanbans in place
Improve – Late Policy Standardization
Complete Agreed to by all
Providers
Improvement – Level the Schedule
Creates a balanced, even workflow
Goal March, 2012
ACTUAL Oct., 2012
Improve – A3 Inventory Project
• Inventory 5S
- Right Content
- Right Sized
- Visual Management
- Kanban Placement
- Standard Work for
- Ordering Supplies
- Restocking the Exam Rooms
Sarah Shaffer, MA A3 Project Lead
The Current Floor Plan
The Current State
Long Walking Distances Long Hallways
200 ft. from one end to another
Walls everywhere
Improve – Work Cell Design
Option #1 – internal work space Option #2 – Embedded clerical staff
One Day Rapid 3P – September 28, 2011
Mapping It Out – Getting It Right
Orange = Exam Rooms
Green = Provider Offices
Yellow = Nurses & Social Work
Pink = Work Space
We Are Ready To BUILD !!
From Concept to Drawings
Improve – Mock Up of Design
The Warehouse
Waiting Room
Physician Offices Physiatry Entrance Exam Rooms
Parent Involvement
-Visioning Sessions with parents - Scenario Testing with parents - Members of the full team - Gave Tours to fellow parents
Our Parent Team Members of Parent Advisory Council Volunteers from NDSC parents Members of NDSC FAC Group
Communication to all staff
Newsletters sent to all NDSC staff daily • Photos • Daily accomplishments and findings
Staff Tours and Feedback
What needs changed: • We need sinks ! ! • Can we have blinds? • Let’s lock the med room • Waiting Room is small • Where is Check In ? • Where is the Trash Bin?
What Looks Good ? • We can see everything and everybody !! • “ I love the interior team space !” • I can find the provider immediately ! • Everyone is on the “playing field” • The team neighborhood idea will really help with communication and teamwork • This will be easier for our families
The Anticipated Benefits
• Increase the satisfaction of patients and families
by reducing wait time and motion and providing a pleasant, less stressful environment for the visit
• Increase the satisfaction of the providers and staff by reducing their transportation and motion throughout the day allowing time to see patients rather than trying to finding patients
• Increase the number of visits available by 2,500 annually for an increase in gross revenue of $727,000 (pending Decision Support approval)
Where are we Now?
• Portions are moving into swing space
• Actual renovation will be in stages with each of
the 5 subspecialties going one at a time
• Anticipated completion Summer, 2013
• Already seeing increased patients with
standardization and level loading
• Are creating staffing “neighborhood teams”
• Moving clerical and clinical in one space
• Creating lots of excitement and team spirit
