Patient Flow Process Efficiency Projects

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Patient Flow Process Efficiency Projects

• Presented by
• Christian Baldwin

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The Goal

• To Leverage Experience in Engineering Healthcare
  Systems in order to Provide a Unique Benefit to
  Customers Focusing on Enhanced Patient Care,
  Higher Revenues, Lower Costs, and Provider
  Satisfaction

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The Vision
Simulation Model
Tracks patients with RFID and IR Integrates with
EMR Eliminates most manual paper
processes Schedules dynamically based on the
state of all resources Increases staff efficiency
Algorithms In System Program
Data In Patient Location Current Process and
Timing
EIs SYS.
Anticipation of Patient Arrivals
EMR
Dynamic Scheduling and Artificial Intelligence
Engine
Allows for on the fly dynamic scheduling and
reduces the overall cost of patient care
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Current Trends / Challenges

• LOS issues
• Transport
• Bed TAT
• Discharge
• Etc. . .
• ED patient volume increasing
• ED TAT and patient wait times way up
• Increased bottlenecks waiting for hospital beds
  from ED

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More Challenges . . .

• Difficulty increasing/maintaining nursing and
  staff headcount
• Insufficient of beds
• Acute care
• ED
• Inefficient Processes throughout Hospital
• Culture resistant to change

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Resulting In . . .

• Excessive TAT
• Excessive patient wait times
• Increasing loss per patient
• Bottlenecks waiting for treatment and beds
• Low patient satisfaction
• Difficulty to implement change and affect overall
  performance

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Its Not Just About Beds . . .

• TAT is affected by processes as much as beds
• Beds are not the only limiting factor
• If beds are the limiting factor, then more beds
  are the answer
• If other issues are the limiting factor (i.e.
  staff is busy elsewhere, short-staffed, etc.)
  then
• More beds are not necessarily the solution and/or
• May not have the overall desired ROI

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Simulation Modeling Will . . .

• Provide the DATA YOU NEED to make the correct
  decisions
• Determine if expansion is needed. And by how
  many?
• Determine optimal layout
• Optimize processes
• Reduce TAT and patient wait times
• Reduce costs per patient / Improve cash flow
• Provide data to support Six Sigma efforts
• Provide detailed cost analysis SPECIFIC ROI
• Performance measurements
• Financial analysis

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Case Study
Current ASC Client with 17 Doctors
Assumptions Labor 40 of Gross Before and
After Labor is constant based on study
results Material Supplies 10 of Gross Before
and After Other 20 of Gross Before and After
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Process Improvement

• From Manufacturing to Healthcare How does it
  relate?... What are we talking about? Are we
  crazy?

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The Goal

• The goal of any organization is to be
  profitable.
• Eli Goldratt, The Goal
• Manufacturing First Started Using Process
  Improvement Techniques in order to SURVIVE
  Pennies Per 1000 Units Add Up Over Time

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Time Studies

• Key Terms
• Cycle Time
• Process Time
• Queue Time (Wait Time)
• Failures (Machines and Humans)
• Variability
• Probability
• Data Collection and Analysis

Cycle Time (Tc) Process Time (Tp) Queue Time
(Tq)
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Resources

• We Are All Constrained by Resources
• People
• Money
• Time
• Machinery
• What Else?...

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Industrial Engineering 101

• You Cannot Improve What You Do Not Measure
• Maximize the Probability of Achieving Your Goal
  by Establishing a System that Includes Resources,
  Time, Money, and All Constraints (Variables)

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Thought Evolution

• Manufacturing
• US Military
• NASA
• US Government
• Retail
• Service Industry
• Healthcare

• Check-Out Lines
• Drive-Thru and Payment Lines
• More Efficient Customer Throughput

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Manufacturing Game

• The object of the game is to produce as many
  quality products as possible in the given amount
  of time.
• Finished units will be inspected to determine
  quality.
• The team with the most number of units to pass
  inspection wins.

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Game Instructions

• Divide Into Teams
• Determine How to Accomplish The Objective per
  Team
• The Finished Product
• One Piece of Red Construction Paper Folded in
  Half, Stapled 3 Times to One Blue Piece of Paper,
  with 1 Sticker in the Top Right-hand Corner
• 5 Minutes to Produce As Many As Possible
• Quality
• Quantity

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Game Review

• How did we do?
• Where were our bottlenecks?
• What are the key components to manufacturing
  processes and their efficiency?
• How are manufacturing processes similar to or
  different from healthcare processes?

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Additional Resources

• Mango and Shapiro, Hospitals get serious about
  operations, McKinseyQuarterly 2001 The
  innovative organization, (New York McKinsey
  Company, 2001)
• The Goal, Eliyahu Goldratt
• Cheaper by the Dozen, Frank Gilbreth, Elizabeth
  Gilbreth Carey
• Simulation with Arena, (Textbook) W. David Kelton

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Delivering Successful Simulation Projects

• What can you take home today and use tomorrow?
  Lets get started

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Project Steps

• Objective Statement
• Team Assignments
• Process Diagram
• Data Gathering
• Statistical Analysis
• Model Construction

• Model Validation
• Model Analysis
• Recommendations
• Implementation
• Ongoing Monitoring

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Objective Statement

• What are we trying to accomplish and why?
• Current Situation
• Wait Times
• Process Times
• Variability
• Financial Concerns

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Team Assignments

• Administration Representative (VP Champion)
• Team Leader
• Physician(s)
• Clinical Lead (Head Nurse)
• Architect(s)
• Engineer(s)
• Data Support Personnel
• IS/IT
• Accounting or Finance
• HR

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Process Diagram

• Diagram Existing Processes
• Resources
• Staff
• Machines
• Process Steps
• What happens next?
• Software Suggestion -MS Visio

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Data Gathering

• Time Study Data What is needed to turn our
  diagram into a live system?
• Length of Time for a Process
• Frequency of an Event
• Resource Information
• Staff Cost
• Staff Schedules

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Statistical Analysis
Distribution Summary Distribution Normal
Expression NORM(17, 2.99) Square Error 0.000250

• Organize Data
• Enter Into Software Program
• MS Excel
• Input Analyzer
• Look for Best Fit, Quality Results

Chi Square Test Number of intervals 31
Degrees of freedom 28 Test Statistic
32.3 Corresponding p-value 0.267
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Model Construction

• Build Process Blocks from Diagram
• Decisions
• Logic
• Floor Diagrams
• Add Resources
• Schedules
• Cost
• Software Suggestions
• Arena
• ProModel

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Model Validation

• Is the model accurate?
• Who should help verify?
• Doctors
• Nurses
• Administration
• Patients
• Once Verified, Approve Baseline Simulation

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Model Analysis

• What-if
• Play with the Model
• Change Resource Assignments,
• Schedules,
• Teams, etc until an Optimal System is Obtained
• Record Output for Each Trial
• Financial Data
• Process Times
• Wait Times
• Productivity and Utilization

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Recommendations

• What is the most realistic and best way to move
  forward?
• Do Not Automatically Recommend the Best Model
  Trial
• Simulation is a Tool Used for Quality Improvement
• Other Factors to Consider
• Feasibility (Implementation Timeline)
• Politics

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Implementation

• Agree on Recommendations
• Form Implementation Team
• Define Objectives
• Who, What, When, Where, Why
• Outcomes Measurement
• People are People Creatures of Habit
• Select Champions for Change and Encourage
  Coaching if Needed

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Monitor Progress

• Even if you are on the right track, you'll get
  run over if you just sit there.
• Will Rogers
• The Successful Modeling Project is Really Never
  Complete

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Additional Items for Follow Up

• What have we learned?
• What questions are left to be addressed?
• How should we begin to use our knowledge for
  process improvement?