Implementing Process Improvement In Healthcare By Gagan Rajpal

Implementing Process Improvement In Healthcare By Gagan Rajpal With Craig A. Stevens PMI Nashville Symposium 2013 gaganrajpal 1@gmail. com craigastevens@westbrookstevens. com 1

Agenda Creating a Team Focused Improvement Program ✓ 1 Goals/Objectives 2 General PI Processes 3 PI Assessment andtext. Performance This is an example Go ahead. Measures and replace it 4 Process Analysis 5 Layout Analysis and Spaghetti Diagrams 6 Value Chain Analysis 7 SPIOC 8 Summary of PI Program Approach craigastevens@westbrookstevens. com

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 3

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 4

Agenda Creating a Team Focused Improvement Program ✓ 1 Goals/Objectives ✓ 2 General PI Processes 3 PI Assessment andtext. Performance This is an example Go ahead. Measures and replace it 4 Process Analysis 5 Layout Analysis and Spaghetti Diagrams 6 Value Chain Analysis 7 SPIOC 8 Summary of PI Program Approach craigastevens@westbrookstevens. com

Three Easy to Understand Use Improvement Phases A= Assessments P = Problem Solving I = Implementation Using Project Management Tools/Support 6

Westbrook Stevens, Seven Attributes of Excellent Management Model, 1990 © People and Team Building From Book Geronimo Stone http: //www. llumina. com/store/geronimostone 2. htm 7

Step 1 –Build the Assessment Candidate Portfolio e l p m a x E craigastevens@westbrookstevens. com

Life cycle of a patient needing services at East Tennessee Children Hospital Resource Allocation Afte r. A dm issi ons Hospital Service Patient Admissions Doctor’s Office/ Department Incoming Patients gaganrajpal 1@gmail. com

Step 2 –Assessment Phase A= Assessments P = Problem Solving I = Implementation Using Project Management Tools/Support craigastevens@westbrookstevens. com 10

Agenda Creating a Team Focused Improvement Program ✓ 1 Goals/Objectives ✓ 2 General PI Processes ✓ 3 PI Assessment and Performance Measures This is an example text. Go ahead and replace it 4 Process Analysis 5 Layout Analysis and Spaghetti Diagrams 6 Value Chain Analysis 7 SPIOC 8 Summary of PI Program Approach craigastevens@westbrookstevens. com

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 gaganrajpal 1@gmail. com

Is there any “trend” in number incoming patients over the years? Number of patients in year 2007 & 2010 are extrapolated gaganrajpal 1@gmail. com

Is there any “trend” in number incoming patients over the years? gaganrajpal 1@gmail. com

Is there any “trend” in “number” of incoming patients within an year? gaganrajpal 1@gmail. com

Is there any “trend” in “type” of incoming patients within an year? gaganrajpal 1@gmail. com

Is there any “trend” in “number” incoming patients within a week? gaganrajpal 1@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

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 24

Is staffing logistics appropriate? gaganrajpal 1@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 gaganrajpal 1@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 gaganrajpal 1@gmail. com

Is patient registration a smooth process? (Continued) Doctor’s Office/ Department Insu ran ce C omp any Pa ren ts tor a r Ope s n o i ss i m Ad gaganrajpal 1@gmail. com

Step 3 – Build the Problem Solving Portfolio A= Assessments P = Problem Solving I = Implementation Using Project Management Tools/Support craigastevens@westbrookstevens. com 29

Recommendations v Pre-screening orders and have more proactive approach ü Creating a Kanban system for orders that need attention v Having Pre-cert # already on the order v Having a “complete” & “readable” order ü Better fax machines ü “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 v Pre-registration on phone v In case of surgery, doctor could send order directly to surgery v In case of standing order, direct admit gaganrajpal 1@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

The current layout 1. 4 Miles/ shift gaganrajpal 1@gmail. com

Recommendations v Change the current layout v Apply principles 5 S in patient admissions office ü Sort (Seiri), ü Straighten (Seiton), ü Shine (Seiso), ü Standardize (Seiketsu) and ü Sustain (Shitsuke) gaganrajpal 1@gmail. com

Step 6 – Select the Solutions and Build a Project Portfolio A= Assessments GFR GFR P = Problem Solving I = Implementation Using Project Management Tools/Support craigastevens@westbrookstevens. com 34

The “new” layout The “current” layout Fax Room Marty’s Office 4 3 2 1 Front Desk Call Center gaganrajpal 1@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

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 Afte r. A dm issi ons 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 40

Focus Areas gaganrajpal 1@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 gaganrajpal 1@gmail. com

Current state 38. 7 % Non-value added time gaganrajpal 1@gmail. com

Current state 70 % Non-value added time gaganrajpal 1@gmail. com

Current state – OPS Ear Tube Lead time: 233 min VA/ T: 85. 3 min WIP: 168 min 63. 4 % Non-value added time gaganrajpal 1@gmail. com

Current state 55. 6 % Non-value added time gaganrajpal 1@gmail. com

Current state 46. 6 % Non-value added time gaganrajpal 1@gmail. com

Types of waste v Redundancy in paper work v Waiting for technician v Waiting for room v Same questions asked by several personnel v Orders lost v Delay in bringing patients from the floor ülack of transporter ütechnician being busy with other patients üsometimes lack of technicians gaganrajpal 1@gmail. com

Current state – OPS Ear Tube 4 th Floor 6 th Floor gaganrajpal 1@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

PART IV : Resource allocation model Resource Allocation Afte r. A dm issi ons Hospital Service Patient Admissions Doctor’s Office/ Department Incoming Patients gaganrajpal 1@gmail. com

Step 3 – Build the Problem Solving Portfolio A= Assessments P = Problem Solving I = Implementation Using Project Management Tools/Support craigastevens@westbrookstevens. com 54

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 gaganrajpal 1@gmail. com

Our approach SIPOC Supplier - Departmen t - Doctor Input Patient -Time - Schedule Process Admissions to the entrance of the service Output Customer Service Patient -Time - Quality Logic : Ability to provide resources to serve the customer Resources are provided in the process, therefore, they should dictate the schedule gaganrajpal 1@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 QS 1 Patient QS 2 QA Admissions QS 3 QS 4 QS 5 X-ray Pulmonary Lab Neurology QS 11 QS 12 QS 13 QS 14 Type - 1 Type - 2 Type - 3 Type - 4 Surgery QS 1 n Type - n Output = Min: ∑ QA + QS 11 -------

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 gaganrajpal 1@gmail. com

Our approach SIPOC Supplier - Department - Doctor Input Patient -Time - Schedule Process Admissions to the entrance of the service Output Service Customer Patient -Time - Quality Logic : Ability to provide resources to serve the customer Resources are provided in the process, therefore, they should dictate the schedule gaganrajpal 1@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 gaganrajpal 1@gmail. com

Output QS 1 Patient QS 2 QA Admissions QS 3 QS 4 QS 5 X-ray Pulmonary Lab Neurology QS 11 QS 12 QS 13 QS 14 Type - 1 Type - 2 Type - 3 Type - 4 Surgery QS 1 n Type - n Output = Min: ∑ QA + QS 11 -------gaganrajpal 1@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