Designing Lean Processes to Increase Patient Access · 2015-04-28 · The Anticipated Benefits...
Transcript of Designing Lean Processes to Increase Patient Access · 2015-04-28 · The Anticipated Benefits...
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Designing Lean Processes to
Increase Patient Access
Cleveland Clinic Foundation November 12, 2012
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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
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• 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?
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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
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Measure- Current State Value
Stream Map
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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
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More Analysis – Flow & Schedules
The difference between Provider Exam Time not Statistically Significant
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Waiting Room – 136 scheduled
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More Analysis – Causal Mapping
Project Targets
A3 Projects
Out of Scope
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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
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Improve – Late Policy Standardization
Complete Agreed to by all
Providers
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Improvement – Level the Schedule
Creates a balanced, even workflow
Goal March, 2012
ACTUAL Oct., 2012
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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
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The Current Floor Plan
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The Current State
Long Walking Distances Long Hallways
200 ft. from one end to another
Walls everywhere
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Improve – Work Cell Design
Option #1 – internal work space Option #2 – Embedded clerical staff
One Day Rapid 3P – September 28, 2011
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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
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Improve – Mock Up of Design
The Warehouse
Waiting Room
Physician Offices Physiatry Entrance Exam Rooms
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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
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Communication to all staff
Newsletters sent to all NDSC staff daily • Photos • Daily accomplishments and findings
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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
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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)
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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