Introduction to Patient Flow: Design and Systems Development

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Introduction to Patient FlowDesign and Systems
Development

• Maria Montanaro, President/CEO
• mmontanaro_at_thundermisthealth.org

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Who are we?

• Multi-site
• Multi community
• HRSA grantee for over 30 years
• 25,000 patients
• 80,000 encounters
• Medical, Dental, Behavioral Health, SBHCs, HCH,
  Pharmacy
• www.thundermisthealth.org

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Todays Agenda

• Patient Flow Systems and Resources
• Designing a Value Based System
• Facility Design and Patient Flow
• IT Development and Patient Flow
• Q A

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Patient Flow- working definitions

• Everything that occurs from the time a patient
  walks into the health center to the time s/he
  leaves- encounter based CYCLE
• Everything that occurs around the scheduling and
  encounter of a patient
• The systems interface around a patients
  encounter at the health center

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Patient Flow- where the rubber hits the road
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Systems affecting patient flow

• Information Technology
• Practice Management Software
• Health Records Management
• Telephone
• Facility
• Design and layout
• Location/site
• Equipment/Capacity

• Clinical
• Policies and Procedures
• Staffing
• Services
• Registration
• Policies and Procedures
• Staffing
• Billing
• Policies and Procedures

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Stop and Think

• Systems are perfectly aligned to deliver the
  results that they do

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Top Ten Hints You Have Bad Flow.

• You have trouble shooters who do nothing but
  navigate a patient through the system
• Providers are waiting for a patient to be put in
  a room
• Patients are waiting for a room to open up
• Staff draw straws to see who will go out there
  to settle patient disruptions
• Patients are overlooked in the waiting room
• Patients cannot get in for a sick appointment
• Patients leave without being seen
• Patients leave without checking out
• Low Productivity
• Unhappy staff and/or unhappy patients

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Do you hear what I hear?.....

• I will try to squeeze you in
• You may have to wait
• The doctor is running late
• Please fill out these forms (again)
• Someone will have to get back to you
• I will have to reschedule you
• I will be with you in a minute
• Please dont touch the glass
• Mr. Bueller? Bueller?....Bueller?????

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Clarify your values

• State your values for Flow and measure your
  current systems against those values
• Be specific- have values and objectives for
  various segments of the flow process
• Make sure any new or reformed system design
  measures up against those values

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Improving Patient Flow

• Study Your Current Flow
• Mapping and Time Measurement
• Cycle time and mapping
• Wait times
• Interval times
• Footstep Analysis
• Patient Satisfaction
• Perception of wait time
• Communication
• Friendliness
• Ease of system
• Employee Evaluation of Systems
• Outcome Measures
• Financial
• Data
• Clinical
• Set Benchmarks Based on Values?
• What are you trying to achieve and WHY?
• Study Improvement Techniques and Begin
  Implementation

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Evaluate Current Systems Effects on Patient Flow

• Clinical Policies
• Fiscal Policies
• Regulations
• Systems are typically designed to accommodate
  policies based in organizational need, not
  patient convenience.

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Stop and Think

• Life is what happens while your making other
  plans
• __________ happens

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Patient Flow- where the rubber hits the road
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Case Study

• Thundermist Facility Design

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How we went from this
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To This
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Starting with the end in mind

• Redesign our delivery system to our values
• Room for now and the future
• Integration of services under one roof
• Operational efficient
• Financially sound

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First Steps- (beyond our discussion today)

• Sizing the space for the program needs
• Getting a large footprint
• Finding the right property

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More Steps Beyond Our Scope of Conversation Today

• Architect Selection
• Financial Planning and Execution
• Construction Project Management
• Move and Implementation

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• Facility Design to Enhance Patient Flow
• Design Processes
• Technology Enhancements for Patient Flow
• Lessons Learned

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Values for Design Work

• Founded in the principle that if healthcare is
  truly a right (not a privilege) then the facility
  must be second to none and reflect
• State of the art innovation
• Patient Centric
• Functionally Efficient

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Goals for design

• Intimate interactions between staff and patients
• Privacy and Congeniality
• Beauty in form and function (not institutional)
• Reduction of paper, speed in flow
• Flexibility in use
• Integration of services
• Self Intuitive- navigation, orientation, function

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Process

• Team began with Values Clarification and a charge
  to innovate
• Interdisciplinary (with patient) Design Team met
  biweekly with architect
• Feedback loop back to staff
• Patient focus group on values and concepts
• Six month process included looking for prototypes
• Team took risks and used technology to form new
  methods where design limitations impeded values
• Systems and operation groups formed to create the
  systems that would support the design
  (transformation)

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Values for the Public Interface

• Intimate interaction between patient and staff
• Patient Privacy
• Sense of Community/Conviviality
• Freedom of Movement
• Atrium/Artsy feel
• Paperless
• Efficiency of Office Staff
• Flexibility of Workflow deployment
• State of the Art

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Features Free floating check in
kiosks Stationary check out desks Pagers for
patient call Directive Phone System Martini Bar
Furnishings and Art
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• Stationary check out
• Light filled space
• Ambient Noise
• 20 foot high ceilings
• Community Room off the lobby

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• Open Stairway
• Minimal Signage
• Unified feel with departmental signature

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Values for the Treatment Floor

• Privacy
• Tranquility
• Integration of Services
• Flexible Deployment of Rooms
• Departmentalized
• Orientation to outside, light

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Knocking a large interior core box down to size
Light filled transoms Cross halls connecting
depts Integrated medical, behavioral health, and
social service rooms Departmental
Hallways Constant Orientation to the
outside Floor Visualization from the Clinical
Support Space in back Quiet sound control Double
insulated walls Never 3 steps from natural light
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Good visualization of main departmental
corridor Off the patient footpath Co-location of
clinical support rooms Paper to paperless Flow
managed from the back Co-location of all clinical
provider staff Forced Communication Noisy, but
private and still open
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Keeping Community in the Community Health Center
People space up front Flexible 10-70 design with
moving furniture Teleconferencing Capacity Multi
purpose floor Internal and External Use Keep it
clean and usable
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Lessons to Remember

• Form eats function for lunch
• Function should be equally a patient definition
• Dont start with what you know, start with what
  you want
• Technology is your friend
• Build with the future in mind

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Lessons to Remember

• Stick to your knitting what business are you
  in?
• Size Matters
• You never have enough closets
• _________ happens (vigilance after the build)
• Systems need to be worked before the move
• Study what you do after you do it
• Get professional help!
• Bricks are expensive, paper is cheap!

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Resources

• Other health centers
• Professional Project Managers
• Architects
• Capital Link
• IHI office redesign materials

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Maria MontanaroPresident/CEOThundermist Health
Center450 Clinton StreetWoonsocket, RI
02895401-767-4100 x 3010mmontanaro_at_thundermisthe
alth.org