Changing Process and Practice to Meet Patient Demand

Sunny Hill Health Centre for Children Child Development and Rehabilitation Program of BC Children’s Hospital

Tracy Conley, MHA and Rita Janke, RN, MSN

Background

Provincial Autism Resource Centre (PARC)

Tier 3 and 4 Assessments

Targeted 502 onsite

multidisciplinary assessments/per year.

Background continued

Increased Demand

Increased Waiting

Delayed Access to Funding and Community Services

Method

LEAN

Value Stream

Map

Opportunity for

improvement

Rapid Process Improvement

Current State Analysis

Goal To decrease assessment lead time from

8 weeks to 4 weeks.

Problem Statement

Children are currently waiting longer than 4 weeks to complete their assessments

2.14

11

5.5

9.14

4.14

8.21 9

4.29

7

11.64

4

7.71

9.71 8.86

Weeks, 10

Target, 4 wks

0

2

4

6

8

10

12

14

Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13

Wee

ks fr

om 1

st A

ppt t

o Fa

mily

Con

fere

nce

First Appt to Family Conference Median Weeks Jan 2012 - March 18, 2013 - Under 6 years

Address Scheduling Workflow

Improve the workflow for scheduling to facilitate the reduction of time from 1st appointment to diagnosis:

Booking Clerk Process

Unpredictable

Availability

Median 8 weeks (range 2-11 weeks)

Family attends CDA appointment

Family attends Additional

appointments

Family attends Family conference

Next appointment only booked after

previous visit Family receives Multiple phone

calls and letters

Address Clinician Availability

Set expectations to ensure timely, up-to-date clinician availability.

The Aims

80% of children will have all appointments booked within a 4 week block booking.

100% of the time, clinician availability will be up to date 3 months in advance to

facilitate booking of appointments

Future Booking Process

One letter to family

GOAL: 4 weeks

One phone call to family

Go to the Gemba

Trial of new process

Shift Gears: Scheduling Demand and Capacity

How much availability should we have?

What is our projected demand?

What is our current capacity?

What is the gap?

Demand/ Capacity

Analysis: Why can’t we reach our 4 week target?

• Availability of clinicians is variable

• Availability is not provided in a consistent way or time frame

• The current pace of working is unpredictable

• Current capacity does not meet demand

Meeting Demand – Predictable Pace Work with each discipline to identify/develop:

Strategies to meet demand.

Develop predictable assessment pace.

Master Rotation Predictable pace. Pace = projected

demand. Changes to schedule

submitted minimum 3 months in advance.

Predictable room booking.

“One Piece Flow” scheduling process.

Clinician Improvement Plans

Identify patient streams vs ‘one size fits all’ Master rotation. Report writing. Reduction in demand : Duplication of assessment. ?need for specific disciplines

Assessments based upon child’s needs. Room Set up

Results

UCL

LCL 0%

20%

40%

60%

80%

100%

120%

6/24

/13

7/1/

13

7/8/

13

7/15

/13

7/22

/13

7/29

/13

8/5/

13

8/12

/13

8/19

/13

8/26

/13

9/2/

13

9/9/

13

9/16

/13

9/23

/13

9/30

/13

10/7

/13

10/1

5/13

10/2

1/13

10/2

8/13

11/4

/13

11/1

1/13

11/1

8/13

11/2

5/13

12/2

/13

12/9

/13

12/1

6/13

12/2

3/13

12/3

0/13

1/6/

14

1/13

/14

1/20

/14

1/27

/14

2/3/

14

2/10

/14

Percentage of children who achieved a 4 week lead time from 1st appointment to diagnosis. P Chart

Percent

Results

UCL

LCL 0

5

10

15

20

25

6/24

/13

6/24

/13

7/1/

137/

8/13

7/8/

137/

8/13

7/8/

137/

8/13

7/15

/13

7/15

/13

7/15

/13

7/15

/13

7/22

/13

7/22

/13

7/29

/13

7/29

/13

8/5/

138/

12/1

38/

12/1

38/

12/1

38/

12/1

38/

19/1

38/

19/1

38/

26/1

38/

26/1

39/

2/13

9/2/

139/

9/13

9/9/

139/

9/13

9/9/

139/

16/1

39/

16/1

39/

23/1

39/

23/1

39/

23/1

39/

30/1

39/

30/1

39/

30/1

310

/7/1

310

/7/1

310

/15/

1310

/15/

1310

/21/

1310

/28/

1310

/28/

1311

/4/1

311

/4/1

311

/4/1

311

/18/

1311

/18/

1311

/18/

1311

/25/

1311

/25/

1311

/25/

1312

/2/1

312

/2/1

312

/9/1

312

/9/1

312

/9/1

312

/9/1

312

/9/1

312

/16/

1312

/16/

1312

/16/

1312

/16/

131/

6/14

1/6/

141/

6/14

1/13

/14

1/13

/14

1/13

/14

1/13

/14

1/20

/14

1/20

/14

1/20

/14

1/27

/14

1/27

/14

1/27

/14

1/27

/14

2/3/

142/

3/14

2/10

/14

2/10

/14

2/10

/14

Measure

Median 7.8

Median 4.8

Lessons Learned

Understand current state and the actual problem.

Engage staff.

Commitment to daily management.

Sustainability

Performance wall meeting.

Ongoing evaluation.

Daily management.

Ongoing continuous improvement.