process improvement and patient flow
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Healthcare Operations Management 2008 Health Administration Press. All rights reserved.
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Chapter 11
Process Improvement
and
Patient Flow
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Healthcare Operations Management 2008 Health Administration Press. All rights reserved.
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Process Improvement (PI)
Measuring and improving systems
Systems
Processes
Subprocesses
Tasks
PI tools can be used at any level
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Healthcare Operations Management 2008 Health Administration Press. All rights reserved.
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PDCA
Plan: Define the entire process to be improved usingprocess mapping. Collect and analyze appropriatedata for each of element of the process.
Do: Use process improvement tool(s) to improve the
process. Check: Measure the results of the process
improvement.
Act to hold the gains: If the process improvementresults are satisfactory, hold the gains. If the resultsare not satisfactory, repeat the PDCA cycle.
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Healthcare Operations Management 2008 Health Administration Press. All rights reserved.
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Flow
Theory of swift, even flow
Process is more productive as:
Speed of flow increases
Variability of process decreases
Example: advanced access
Decreased time from request to appointment
(speed)
Decrease in no-shows (variability)
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Healthcare Operations Management 2008 Health Administration Press. All rights reserved.
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Patient Flow
Hospital flow is negatively affected byvariability in scheduled demand:
Surgical admissions (scheduled)
Medical admissions (emergency) When surgical admissions have high
variability, backlogs and waiting occur
NHS study showed that at 90 percentoccupancy, only 6070 percent ofpatients were receiving active care.
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Healthcare Operations Management 2008 Health Administration Press. All rights reserved.
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Process Mapping Basics
Assemble and train the team. Determine the boundaries of the process (where does
it start and end?) and the level of detail desired.
Brainstorm the major process tasks and list them inorder. (Sticky notes are often helpful here.)
Once an initial process map (also called a flowchart)has been generated, the chart can be formally drawnusing standard symbols for process mapping.
The formal flowchart should be checked for accuracyby all relevant personnel.
Depending on the purpose of the flowchart, data mayneed to be collected or more information may need tobe added.
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Healthcare Operations Management 2008 Health Administration Press. All rights reserved.
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Triage -
Financial
Complexity
End
Patient
Arrivesat the ED
Triage -
Clinical
Intensive
ED Care
Low
High
Private
Insurance
Admitting
Private
Insurance
Admitting
Medicaid
Waiting
Waiting
Yes
No
Nurse
History/
Complaint
Exam/
TreatmentDischargeWaiting Waiting
Vincent Valley
Hospital and
Health System
Emergency
Department(ED) Patient
Flow Process
Map
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Healthcare Operations Management 2008 Health Administration Press. All rights reserved.
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Process Metrics
Capacity of a process: the maximum possibleamount of output (goods or services) that a processor resource can produce or transform.
Capacity utilization: the proportion of capacityactually being used. It is measured as actualoutput/maximum possible output.
Throughput time: the average time a unit spends inthe process. It includes both processing time andwaiting time and is determined by the critical (longest)path through the process.
Throughput rate: the average number of units thatcan be processed per unit of time.
Service time or cycle time: the time to process oneunit. The cycle time of a process is equal to thelongest task cycle time in that process.
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Healthcare Operations Management 2008 Health Administration Press. All rights reserved.
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Process Metrics (cont.) Idle or wait time: the time a unit spends waiting to be
processed.
Arrival rate: the rate at which units arrive at theprocess.
Work-in-process (WIP), things-in-process (TIP),patients-in-process (PIP), or inventory: the totalnumber of units in the process.
Setup time: the amount of time spent getting ready toprocess the next unit.
Value-added time: the time a unit spends in theprocess where value is actually being added to theunit.
Non-value-added time: the time a unit spends in theprocess where no value is being added. Wait time isnon-value-added time.
Number of defects or errors.
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Littles Law
Average throughput time =
People (or things) in the system/Arrival rate
Example
Clinic serves 200 patients in an 8-hour day (or 25 patients per hour).
Average number of patients in waiting room, exam rooms, etc., is 15.
15 patients/25 patients per hour = 0.6 hoursin the clinic
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Basic Process Redesign Techniques
Eliminate non-value-added activities
Eliminate duplicate activities
Combine related activities Process in parallel
Use load balancing
Use decision-based, alternative processflow paths
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Advanced Process Redesign Techniques
Six Sigma (Chapter 8)
Lean (Chapter 9)
Discrete event simulation (Chapter 10)
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