let my patients flow-streamlining the or suite

Let My Patients Flow!

Patient Flow Summit

2015

1

Agenda

• Background

• Approach

• Process Improvement Teams

• Simulation Model

• Results

• Q&A

2

Robert Wood Johnson University Hospital

965-bed Academic Medical Center located in New Brunswick, NJ

Principal Teaching Hospital of Rutgers Robert Wood Johnson Medical School

Flagship Hospital of multi-hospital system

Centers of Excellence: Cardiovascular; Cancer; Women’s & Children’s; Neuroscience Center of Excellence; Level 1 Trauma Center

Located mid-way between New York and Philadelphia, serving six county population of approximately 1.4 M

Owner of Physician-Led Accountable Care Organization

3

Situation at RWJUH

Anticipated a significant increase in patient volume for the OR suite. As a

major source of revenue for the hospital, the leadership team needed to

make sure the OR suite was as efficient as possible while also minimizing

costs.

Due to the highly variable nature of work flow in the OR and the expenses

involved in managing the projected increase of volume, as well as the

introduction of case carts into the OR system, leadership requested that an

objective data driven analysis be conducted in order to assure optimal

performance of the OR suite.

5

Key Considerations/Potential Pitfalls when writing the

Problem Statement

Is the problem based on observation (fact) or assumption (guess)?

Does the problem statement prejudge a root cause?

Can data be collected by the team to verify and analyze the problem?

Is the problem statement too narrowly or broadly defined?

Is a solution included in the statement?

Would customers be happy if they knew we were working on this?

Problem Statement

6

RWJUH Problem

• Environmental factors driving a significant volume increase

• Introducing case carts to improve material flow and control

• OR utilization not acceptable

• Significant OR “churn” resulting in staff and patient stress

• Significant OR hold time due to PACU utilization issues

7

Problem Statement

A well formed problem statement should answer specific

questions and include specific information:

What is the problem?

When or under what conditions does this problem occur?

Where does this problem occur?

What is the extent of the problem?

What is the impact of the problem?

8

Simulation

9

Identify Your Business Goal From Your Project Sponsor

Identify Which of Those Goals Your Project Supports

Goal Statement

10

The Purpose of the Problem Statement

Is to Describe What Is Wrong

The Goal Statement Defines

The Team’s Improvement Objective

Problem vs. Goal Statement

11

Defines the improvement the team is seeking to accomplish

Starts with a verb (e.g., reduce, eliminate, control, increase)

Tends to start broadly—eventually should include measurable target and

completion date

Must not assign blame, presume cause, or prescribe solution!

Example:

Reduce the number of ER turnaround times for level 2 type patients

beyond 1.5 hours by 50% from 500 to 250 by January 1

Goal = Project Improvement Objective

The Goal Statement

12

RWJUH Problem / Goal

“Problem” - Old system processes and infrastructure made efficiency a daily

challenge with a growing perioperative service line. Competing stakeholders

with competing cultures and goals. Highly variable work flow in the OR, high

cost inefficient set-up with the introduction of new systems and targeted

expansion putting pressure on phasing and new work flow processes.

“Goal” – Improve overall efficiency of the OR Suite for both adult and

pediatric services while also minimizing costs. Leadership requested that

lean teams were deployed to ensure maximum return on investment of our

new COE dedicated to pediatric surgery, new dedicated robotic suites,

expanded PACU capacity and a new highly functioning case cart system.

13

Stakeholder Analysis

A Stakeholder is any person or group of people who are:

• Responsible for the final decision

• Likely to be affected, positively or negatively, by the outcomes

you want

• In a position to assist or block achievement of the outcomes

• Experts or special resources that could substantially affect the

quality of your end product/service

• Can have influence over other stakeholders

Identify those individuals with an interest in the process and what

their positions on a particular Six Sigma Change might be.

14

Stakeholder Analysis

SA MA N MS SS

Stakeholder A X

Stakeholder B X

Stakeholder C X X

Stakeholder D X X

Stakeholder E X X

Stakeholder F X X

Stakeholder G X

Stakeholder H X

Stakeholder I X

Stakeholder J X

Stakeholder K X X

15

Sources of Resistance

Source of

Resistance

Definition/Causes

of Resistance

Some Strategies for Overcoming

Resistance

Technical

Political

Cultural

Habit and inertia

Difficulty in learning new skills

Lack of skills

Threat to status quo

See Initiative as a “loss”

Power and authority

imbalance or self-

preservation

Control Issues

Locked into old "mindset“

Afraid of letting go

Provide education and training

Provide coaches, green belts, tools / job aids

Get people involved

Do a cultural audit: what beliefs drive us?

Articulate desired mindset and gaps

Give resistor control over the initiative

Give the resistor credit for the change

Empathize with the loss and show WIIFM

Do a political map to understand influence patterns

Provide “safe exits” and/or alternate job designs

New measures and rewards -- customer driven

Clarify roles and responsibilities -- accountabilities

16

Approach

• Form clinical based process improvement teams

• Teams define the processes

• Teams gather data on the processes

• Teams to recommend process changes

• Teams to guide change implementation

• Need arose to verify process changes prior to implementation and define which changes worked well together in combination

17

Charter Development

18

How do we remove the causes of the defects?

How can we maintain the improvements? Control

Define

Measure

Analyze

Improve

Who are the customers and what are their

priorities?

How is the process performing and how is it

measured?

What are the most important causes of the

defects?

ANALYZE

19

An approved charter establishes the purpose and plan for the project. The key

elements of the charter are:

Problem Statement

Project Timeline

Goal

Project Scope

Milestones

Team Members, Stakeholders and Roles

Develop Team Charter - Objectives

A charter: Clarifies what is expected of the team

Keeps the team focused

Keeps the team aligned with organizational priorities

Transfers the project from the Project Sponsor to the project team

20

Process Improvement Teams

• Formed steering team of clinical personnel who manage the work in the area affected

• Formed process oriented clinical teams for each major process

• Team supported by training and central quality improvement resources

• Started team and asked team if others were required to ensure all stakeholders involved

• Teams set goals for process improvement

21

How do you want the Project Sponsor to work with the team? Is the team’s

role to implement or recommend?

When must the team go to the Project Sponsor for approval?

What authority does the team have to act independently?

What and how do you want to inform the Project Sponsor about the team’s

progress?

What is the role of the team leader (Black Belt) and the team coach (Master

Black Belt)?

Are the right members on the team? Functionally? Hierarchically?

Team Member Roles

22

Process Improvement Teams • Teams created a flowchart of the

process under study

• Teams measured current performance

• Teams brainstormed changes and selected those rated most effective in reaching the goal

• Team reported to central steering committee

• Team and steering committee agreed on implementation – What

– How

– Time Frame

23

ROLE RESPONSIBILITIES BEHAVIORS

Executive Sponsor

Strategic guidance

Active participation (Regular mtgs, event kick offs & report outs)

Eliminate barriers

Communication to admin staff & organization

Committed to success of project

Trusts process

Fosters feeling of unity

Respect for team

Empowers team

Project Owner

Oversight & results of project

Team selection

Hold team accountable

Communication: Report status (up and down)

Monitor progress & attend regular progress mtgs

Sustain improvements after project completion

Recognize achievements

Mentors team members

Inspires team members

Utilizes listening skills

Maintains team focus

Team Leader

Content expert & team member,

Provide data as needed, coordinate observations

Recommend team members

Manage team focus / progress / follow-up, help lead meetings

Communication (Work with facilitator & project owner)

With project owner, own process & sustain changes

Positive (Trust)

Motivated and motivates others (Commitment)

Listens (Learning)

Open to suggestions (Respect)

Improvement Team

(Typically 3-8 consistent members)

Includes subject matter experts

Participate in observations and data collection as appropriate

Attend project meetings & improvement events (contribute ideas & execute action items)

Communication with coworkers

Respectful of each other

Holds self and others accountable

Actively engaged

Promotes positive environment

Influential among coworkers

Confident

Facilitator

Guide the team (scope project, assist with team selection, provide structure for project)

Lead pre-work w/ project owner / team leader incl. analysis

Lead improvement events (e.g. Kaizen, Work-Out)

Communication with entire project team

Hand off of project including metrics to project owner

Highlight achievements

Committed to success of project

Understanding of team’s needs

Inspires team

Respect for team

Supportive of improvement efforts throughout the project

Objective

Team Member Roles

24

Approach

• Some processes were highly interdependent making process change effectiveness difficult to predict

• Some changes needed their effectiveness demonstrated to engage all stakeholders

• Needed to test alternatives quickly and quantify their relative effectiveness

• Collaborated with ProModel Corp. to construct a simulation model of the entire OR suite

• This model used to analyze and verify changes prior to implementation

25

Lean in the OR

• PI teams tasked with applying lean

principles to the OR

• Eliminate waste!

– Excessive movement

– Excessive waiting

• Pull instead of push

– Paradigm shift for OR

26

What process will the team focus on?

What are the boundaries of the process we are to improve? Start point? Stop

point?

What resources are available to the team?

What is out of bounds for the team?

What constraints must the team work under?

What is the time commitment expected of team members? What will happen

to our “regular jobs” while we are doing the project?

Project Scope

27

In/Out of the Frame

n Visual tool based on the analogy of a picture frame

n It challenges the team to identify those aspects of the project (the type and

extent of end results or deliverables, the people impacted, timing, product

lines impacted, sites involved, etc.) which are :

– “in the frame” (meaning clearly within the scope of work)

– “out of the frame”

– “half-in-half-out” (meaning this is either up for debate, or some aspects

are in the scope of work but only in a partial way)

Tools to Define Project Scope

28

A high-level project plan with dates

Tied to phases of the project management process (define, measure,

analyze, improve, and control/sustain)

Aggressive (don’t miss “window of opportunity”)

Realistic (don’t force yourselves into “band-aid” solution)

Documented, shared with all project team members and Champion, and

updated regularly

Milestones

29

Pediatric Suite Elevator Changes

Scenario

Patient

Type

Total

Exits

Average

Total

Cycle

Time Difference

Class P

Patients

Above 120

Min Wait

(/Year)

Case Cart

Utilization

Time In

Pre-Op

As Is with Class P peds patient 58 293.70 22.00 57.00% 57.58

Seventh Floor Peds

Proposed Opening Day

Configuration peds patient 243 382.51 30.24% 3.00 72.00% 89.69

Seventh Floor Peds

Proposed Opening Day

Configuration With

Elevator Policy peds patient 243 352.51 20.02% 3.00 61.00% 58.02

30

Summarizes large data sets into frequency intervals

Represents data to evaluate: • Central Tendency • Spread • Patterns in data • ID sources of variation

Histogram

31

Pediatric Room Use Effect

Increased Time Spent in Pre-Op

versus Current State

Increase of 32 minutes

32

Helps to ID possible causes

related to a problem or a

condition

The team focuses on the content

of the problem “not the history”

Creates a snapshot of collective

knowledge

Builds support for resulting

solutions

Cause and Effect Diagram

33

Fishbone Diagram Example

* NOT RWJUH DATA

34

Nursing Staffing Requirements of Various

Changes

35

Investigation into Three Possible

Pediatric Configurations • The majority of this extra time occurs due to patients spending extra time in pre-op

and 1st stage recovery due to contention for beds when these two stages are

occurring in the same space. This is shown by the chart of patient time in stage

shown below.

36

Displays data in time order sequence

Run Charts

* NOT RWJUH DATA

37

Throughput Affect of Various Changes

As Is As Is with Class P Class P Bump Own

Service Only

Class P with Peds

Recovery

Total

Exits

Average Time In

System (Min)

Total

Exits

Average Time In

System (Min)

Total

Exits

Average Time In

System (Min)

Total

Exits

Average Time

In System

(Min)

MOR

patient

1502 457.759915 1502 475.017964 1502 475.017964 1502 466.596929

peds

patient

117 279.553803 116 293.697336 116 293.6973362 116 297.772465

SDS

patient

1348 386.533171 1348 372.123897 1348 372.1238976 1348 374.340928

38

20% of the sources cause 80% of any problem

Helps team focus on

causes

Based on the Pareto

Principle – 80/20 Rule

Displays the relative

importance of

“problems”

Shown by frequency or

size in a descending

bar graph

Pareto Analysis

39

Need for Simulation

• Many processes interdependent

• Patient care processes too critical to experiment requiring proof of change effectiveness

• Case cart processes totally new to the OR suite

• All of these factors make it necessary to have a safe trial environment to test changes, investigate processes, and prove effectiveness BEFORE their introduction into the patient care process

40

Simulation

• Collaborated with a trusted consultant

• Model constructed on floorplan (Autocad) of OR suite and scaled to drawing

• One year+ of data used to construct time and arrival distributions

• Model driven by Excel frontend for quick update and scenario creation

• Multiple scenarios created to test the introduction of case carts by itself and multiple process change combinations

41

Simulation

42

IMPROVE

• How can we fix the process?

• Generate alternatives

• Assess the risks

• Test the alternatives

• Select the best alternative

• Can we confirm the problem by turning it “off” and “on”?

... determine and confirm the

optimal solution ...

Outputs

Process X’s

or Factors

PROCESS

X1

X2

X3

X4

Y1

Y2

Y3

Before Improvements

After Improvements

The after curve shows a

more standardized

practice with reduced

variation – a more

predictable model

44

Model Benefits

• Explain what the model provided

• Explain how it let us know the unknowable

• Explain how it let us experiment with the

processes to define those changes that

are effective

45

Helps us determine whether observed differences are:

statistically significant

or

due to chance

(random variation)

Hypothesis Testing

46

Utilize different methods to identify solutions:

• Brainstorming

• Creative Thinking

• Best Practice

• “Should Be” Process Map

• Run A Pilot Study

• Full Implementation

•Design of Experiments

Identify Improvement Strategy

47

How do we remove the causes of the defects?

How can we maintain the improvements? Control

Define

Measure

Analyze

Improve

Who are the customers and what are their

priorities?

How is the process performing and how is it

measured?

What are the most important causes of the

defects?

IMPROVE

48

Objective and Solution Objective

To increase throughput while optimizing staff and plan for the necessary actions required to further accommodate a rise in patient volume.

Solution

The leadership team for the OR needed to understand; The overall constraints on throughput in the OR Suite

The cycle time for patients flowing through the system

Where patient flow problems existed, managers needed to determine if they were being caused by a lack of space or insufficient staff. The team was tasked with determining whether the OR suite could accommodate a 30% increase in patient volume without changing the OR’s physical environment or adding additional space. Additionally, case carts were being introduced into the system and the team needed to make sure that the carts were properly resourced to keep up with patient flow through the OR.

To deal with the effects of high variability in the OR it was decided that a simulation solution was the only way to reliably predict the impact of changes to the work and/or workflow.

49

Objective and Solution

Objective

To increase throughput while optimizing staff and plan for the necessary actions

required to further accommodate a rise in patient volume.

Solution

Particular attention was paid to the two patient recovery (PACU) areas in the OR

System, the Main PACU and Cardiac PACU. Expansion areas were also added

to the model to help understand if they could potentially add capacity and

improve patient flow through the OR, or if they were sources of further constraint

to the system.

The model was also designed to be fully costed, incorporating financial elements

and reporting on how much profit is generated with each patient flow scenario.

The output data of the model allowed the leadership team at RWJUH to design

an optimal workflow process that consisted of adjusting their staffing levels to

ensure maximum throughput with minimum patient delay and at minimum cost.

50


Pediatric Configurations

Objective

• This study was to investigate the three different

configurations under consideration for the

Pediatrics department operating suite on the

seventh floor of Robert Wood Johnson

University Hospital.

51


Pediatric Configurations The analysis was performed using the RWJUH OR Suite flexible simulation

model previously defined and validated. Data covering OR cases from

November 1, 2012 to January 30, 2013 was used for all runs during this study.

Any patient below eighteen years of age was considered pediatric for use in this

study.

This study also used the updated case cart washer configuration where the

washer capacity is:

Two large carts

Four small carts

One large and two small carts

52

Some solutions are easier to implement than others

Some solutions are more expensive than others

Some solutions have a bigger impact than others

It is impossible to implement everything at once

Tools:

Pay-off Matrix (Benefit VS Effort)

N/3 Voting (30 items/each person votes for 10 items)

Must/Want Matrix (assign weights/quantify)

Prioritize Solutions

53

A Pay-Off Matrix looks at the relationship of benefit and effort to

reduce the number of solutions to address

Benefit

Effort

High

Low

Low High

Pursue

Eliminate Eliminate

Rescope / Reconsider

Prioritize Solutions

54

Example: Improving Admission Cycle Time

Benefit

Effort

High

Low

Low High

• Redo admission into simpler form

• Streamline packet completion step

• Call patients before completing

admission

• Develop new software system

for registration/admission desk

• Develop new training course

for all employees

Pay-off Matrix Example

55

Pilots are important when: The scope of change is large

Change could cause far-reaching unintended consequences

Implementing the change will be a costly process

Change would be difficult to reverse

Test part or all of a proposed solution on a small scale It helps to better understand the effects of a change

We learn how to make full scale implementation more effective

Pilot

56


Pediatric Configurations Results - The key metrics of patient cycle time and PACU closing times are

shown in the table below.

Scenario Name

Monthly

Through

put

Patient

Cycle

Time

Normal

PACU

Close

Time

Normal

Late

Close

Time

Current State MOR patient 732 479 11:30 PM Midnight

Current State SDS patient 436 376 6:30

Current State peds patient 62 349 11:30 AM 1:00 PM

All Recovery Seventh Floor MOR patient 736 481 10:30 PM 11:30 PM

All Recovery Seventh Floor SDS patient 437 378 6:30 PM

All Recovery Seventh Floor peds patient 249 341 3:00 PM 4:00 PM

1st Stage Recovery Seventh Floor MOR patient 734 519 11:45 PM 1:00 AM

1st Stage Recovery Seventh Floor SDS patient 435 385 6:30 PM

1st Stage Recovery Seventh Floor peds patient 248 368 4:30 PM 5:30 PM

1st Stage Recovery Seventh Floor

With Revised Elevator Assignments MOR patient 734 515 11:30 PM 12:30 AM


With Revised Elevator Assignments SDS patient 435 385 6:30 PM


With Revised Elevator Assignments peds patient 248 359 3:45 PM 4:40 PM

57


Pediatric Configurations The most effective performing scenario is that with all Pediatric

recovery occurring on the seventh floor. This scenario avoids contention for pediatric PACU beds between pre-operative and post-operative patients.

Splitting the pediatric recovery between the first and seventh floor so that stage two occurs in the main OR floor increases the patient cycle time and the PACU closing times due to the transport for pediatric inpatients and the effect of reducing the ability to flex PACU to beds in this space.

Reassigning the elevator transports to alleviate the elevator congestion reduces some amount of the impact but does not eliminate this reduction in efficiency versus having all pediatric recovery in one space.

58


Pediatric Configurations • These configurations also affect the number and utilization of the case carts.

This result is shown below.

Scenario

Large

Carts

Small

Carts

Cart

Utilization

Current State 36 22 69%

All Recovery Seventh Floor 36 24 89%

1st Stage Recovery Seventh Floor 42 28 88%

1st Stage Recovery Seventh Floor With

Revised Elevator Assignments 40 26 84%

59

• Implementation of

standardized order sets

• Selection of correct

CareMap

• Consultations

• Initiation of D/C planning

• Turnaround time of

echo

• Documentation of echo

• Discharge disposition

• Documentation of

ACE/ARB

• Compliance of MD to utilize

standardized order set

• Comorbidities

• Compliance of use of CareMap

• Necessity of needing

echo during

hospitalization

• Patient compliance to

follow-up care

• Patient resistance to

D/C

• Support system

High Medium Low

In

Control

Out of

Control

Control / Impact Matrix

60


Pediatric Configurations • The split recovery configurations also take a higher level of labor due to the

extra inefficiency of the transport. This is shown in the table below.

Scenario Name

Work Time

(HR/Month)

Difference

(Hr/Month)

Difference

(%)

All Recovery Seventh Floor ORRN 1769.711683

All Recovery Seventh Floor PACURN 1750.139175

All Recovery Seventh Floor PreOpHoldingRN 24.75219583

All Recovery Seventh Floor Stage1RN 210.2421708

All Recovery Seventh Floor Stage2RN 284.1366333

All Recovery Seventh Floor PreOpRn 168.4124917

All Recovery Seventh Floor pedsor rn 503.7172042

All Recovery Seventh Floor pedspacu rn 447.3996583

Total Direct Work Hours 5158.511213

1st Stage Recovery Seventh Floor ORRN 1933.453766 163.7420825 9.25%

1st Stage Recovery Seventh Floor PACURN 1955.386574 205.2473992 11.73%

1st Stage Recovery Seventh Floor PreOpHoldingRN 34.21132917 9.459133333 38.22%

1st Stage Recovery Seventh Floor Stage1RN 227.6355263 17.39335542 8.27%

1st Stage Recovery Seventh Floor Stage2RN 308.7912758 24.6546425 8.68%

1st Stage Recovery Seventh Floor PreOpRn 184.9787271 16.56623542 9.84%

1st Stage Recovery Seventh Floor pedsor rn 546.7629521 43.04574792 8.55%

1st Stage Recovery Seventh Floor pedspacu rn 477.2634808 29.8638225 6.67%

Total Direct Work Hours 5668.483631 509.9724188 9.89%


Revised Elevator Assignments ORRN 1865.26964 95.55795661 5.40%


Revised Elevator Assignments PACURN 1886.428978 136.2898028 7.79%


Revised Elevator Assignments PreOpHoldingRN 33.00485109 8.25265526 33.34%


Revised Elevator Assignments Stage1RN 219.6078559 9.365685113 4.45%


Revised Elevator Assignments Stage2RN 297.9016111 13.7649778 4.84%


Revised Elevator Assignments PreOpRn 178.4553682 10.04287652 5.96%


Revised Elevator Assignments pedsor rn 527.481108 23.76390388 4.72%


Revised Elevator Assignments pedspacu rn 460.4325672 13.03290891 2.91%

Total Direct Work Hours 5468.581979 310.0707669 6.01%

61


Pediatric Configurations Conclusions

The configuration with pediatric pre-op in the main OR area and all pediatric recovery occurring on the seventh floor is the most efficient since it minimizes the elevator use and avoids contention for bed space in the seventh floor complex between incoming pre-operative patients and outgoing post-operative patients. This option demonstrates superior metrics in the following areas versus the other two options:

Lower overall patient cycle time for all patients including Pediatric patients

Lower number of Class P patients that exceed the 120 minute threshold

Lower patient hold times due to higher efficiency of Phase I and II recovery in the same physical space

Lower number of case carts required to support the ORs in total

The revision to the case cart process showed a marked decrease in the number of case carts required to support the ORs using the most recent volumes. This analysis shows that approximately 40 large carts and 26 small carts are required to ensure no delays due to unavailability of case carts. The case carts and case cart washer remain an area of concern. All possible measures need to be taken to ensure the reliability and uptime of the cart washer.

62

Simulation

63

Simulation

• Model found that the cart washer was an important point of failure

• Model found the best set of PACU changes to reduce OR hold time

• Model verified multiple staffing changes

• Model found the optimum set of changes to OR assignments

• Model verified “smoothed” OR schedule to improve patient flow

through the OR suite and into inpatient units

• Model verified that current and next year projected volumes could be

handled by the new configuration

• Model determined the volume increase that could be tolerated

without further changes

• Model found the elevators to Seventh Floor to be problematic

without usage policies in place

65

Simulation Inputs

66

Pediatric Suite OR Close Time

Five Rooms

Close at 1:30

PM

Four Rooms

Close at

3:00 PM

Three Rooms

Close at 5:00

PM

67


Pediatric Configurations 1. Pediatric patients would check into Pre-op on the first floor complex, then are

transported Main OR area on the seventh floor using the back elevators, receive their procedure in seventh floor OR suite, recover in the seventh floor PACU for Phase I & Phase II and either depart home or move to an inpatient room from the seventh floor PACU.

2. Pediatric patients would check into the Pre-Op Area on the seventh floor complex using the back elevators, receive their procedure in seventh floor OR suite, then from the OR Suite patients will move to the Phase I PACU on the seventh floor, then be transported downstairs via the back elevators to Phase II recovery on the first floor. Finally, patients will either depart from Phase II PACU to inpatient unit or home.

3. Pediatric patients would check into the Pre-Op area on the seventh floor complex using the main elevators, receive their procedure in seventh floor OR suite, then from the OR Suite patients will move to the Phase I PACU on the seventh floor, then be transported downstairs via the back elevators to Phase II recovery on the first floor. Finally, patients will either depart from Phase II PACU to inpatient unit or home.

68

Results of project

Learned which patient types and surgery types caused the most

disruption in flow and the length of OR hold times by patient type. In

particular, the model indicated that the PACU areas were the major

limiting factor and constraint to OR flow.

The OR suite simulation output significantly affected the decision

making process and was used to determine which actions were needed

to take regarding the PACU areas.

69


Pediatric Configurations Results

The most effective performing scenario is that with all Pediatric recovery occurring on the seventh floor. This scenario avoids contention for pediatric PACU beds between pre-operative and post-operative patients.

Splitting the pediatric recovery between the first and seventh floor so that stage two occurs in the main OR floor increases the patient cycle time and the PACU closing times due to the transport for pediatric inpatients and the effect of reducing the ability to flex PACU to beds in this space.

Reassigning the elevator transports to alleviate the elevator congestion reduces some amount of the impact but does not eliminate this reduction in efficiency versus having all pediatric recovery in one space.

70

Appendix

71

Poor Example:

Under skilled staff takes too long to prepare and distribute Radiology reports.

Updated training is needed.

Improved Example:

60% of all Radiology reports over the past year have been delivered beyond 24

hours after exam at Speedy Medical Center. The result has been delayed

diagnosis by our Radiologists and delayed treatment for our patients.

Poor Example:

ER is understaffed, causing patients to wait too long for treatment. This is

making ER turnaround too long.

Improved Example:

ER patients are spending about 3 hours in ER before either being released or

admitted. Time in ER is especially long during the hours between 10 AM and 1

PM. The long time issue is causing many patients & physicians to complain.

Problem Statement Examples

72

let my patients flow-streamlining the or suite

Data & Analytics