applying theory of constraint TOC on PATA Case at Massachusetts General Hospital

1. Massachusetts
General
Hospital (MGH)
Pre- Admission Testing Area (PATA)
Group 1
1-Ahmed Ibrahim
2-Ahmed El-Hamalawy
3-Ahmed El-Shazly
4- Amira Hamed
5-Amgad Galal

3. Intro
Massachusetts General Hospital (MGH):
• one of the oldest medical institutions founded
in 1811
• Well-Known with:
1. Cutting-edge research
2. Innovative medical practices
3. Exceptional patient care

4. Intro
• Scope of Services:
1. comprehensive range of medical specialties
2. advanced treatment modalities
3. patient-centered care
Pre-Admission Testing Area (PATA)
focusing on ensuring the readiness of surgical
patients for anesthesia and subsequent
procedures.

5. PATA
• Mission and Purpose:
Before anesthesia administration
1. Conduct comprehensive pre-admission
work-ups
2. Assessing patient health
3. Ensuring their suitability for anesthesia
administration
For minimizing risks associated with surgery.

6. PATA
• Activities For PATA:
Before anesthesia administration
1. Evaluating patients' vital signs
2. Conducting essential Blood tests
3. Completing nursing assessments
4. Obtaining anesthesia consents.
The core of PATA activities is patient safety

7. PATA
• Operation For PATA:
1. Patient Check-in
2. Vitals, EKG, and Blood Work
3. RN Assessment
4. Anesthesiologist Examination
5. Blood Work Processing
6. Patient Check-Out

8. PATA Challenges
• PATA’s team faces :
1. Long working hours with high workload
2. Bad life work balance
3. Limited resources
4. Wrong referrals
5. Work duplication
6. Old way of communication
7. Too much paperwork
8. All leads to Unsatisfied patient and
premature customer departure

9. PATA Challenges
Bottle necks

10. Process flowchart
Patient
Arrival
Patient
Leave
Check-in Wait
1
Waiting Room
Wait
4
Waiting Room
Wait
2
Wait
2
Waiting Room
+ Exam Room
Wait
3
Exam Room
Viatls +EKG
in Lab
RN Visit
MD Visit
Blood work
in Lab
Check-out

11. Capacity and Utilization Calculation
Capacity Non-Lunch Lunch
Process
Service
Time
(min/pt)
Service
Rate
(pts/hr)
# of Staff
Capacity
(pts/hr)
# of
Staff
Capacity
(pts/hr)
Check-in 2 30 1 30 1 30
Vitals + EKG in Lab 10 6 2 12 1 6
RN Visit 43 1.40 5 7.0 2 2.8
MD Visit 64 0.94 8 7.5 4 3.8
Blood Work in Lab 6 10 3 30 2 20
Check-out 1 60 1 60 1 60
Utilization Non-Lunch Lunch
Process
Flow Rate
(pts/hr)
# of Staff
Capacity
(pts/hr)
Utilization
Flow
Rate
(pts/hr)
# of Staff
Capacity
(pts/hr)
Utilization
Check-in 8 1 30 27% 4 1 30 13%
Vitals+EKG in Lab 8 2 12 67% 4 1 6 67%
RN Visit 7 5 7.0 100% 2.8 2 2.8 100%
MD Visit 7 8 7.5 93% 2.8 4 3.8 75%
Blood Work in Lab 7 3 30 23% 2.8 2 20 14%
Check-out 7 1 60 12% 2.8 1 60 5%
The RNs are the 1st bottleneck,
then MDs, so should first solve
the RN utilization issue
according TOC
RN Queue Duratio
n
# of
waiting
(pts/hr)
Total
waiting
Queue
start
Queue
End
Avg
Queue
7 AM -12 PM 5 1 5 0 5 2.5
12 PM - 2 PM 2 1.2 2.4 5 7.4 6.2
2 PM - 3 PM 1 1 1 7.4 8.4 7.9
3 PM - ++ 8.4 0 4.2
Grand average
waiting in RN
queue
5.2

12. Process flowchart , capacity and bottleneck
Patient
Arrival
Patient
Leave
RN work Path
•RN Chart review
= 5 min/pt
•RN Visit with patient
= 27 min/pt
•RN Chart write-up
= 11 min/pt
MD work Path
•MD Chart review
= 10 min/pt
•MD Visit with patient
= 37 min/pt
•MD Chart write-up
= 17 min/pt
Check-in
Cap = 30 pts/hr
Wait
1
Waiting Room
Wait
4
Waiting Room
Wait
2
Wait
2
Waiting Room
+ Exam Room
Wait
3
Exam Room
Viatls +EKG
in Lab
Cap = 12 pts/hr,
Lunch = 6 pts/hr
RN Visit
Cap = 7 pts/hr,
Lunch = 2.8 pts/hr
MD Visit
Cap = 7.5 pts/hr,
Lunch = 3.75 pts/hr
Blood work
in Lab
Cap = 30 pts/hr,
Lunch = 20 pts/hr
Check-out
Cap = 60 pts/hr
Bottleneck

13. Proposed solution
 Remove RNs chart review and chart write-up to save 16 min/pt (not used
by doctors ) – or can be on-line
 We can increase RNs to 3 during lunch time to enhance RNs utilization
even more
 2nd bottleneck will become MDs
 We must reduce MDs work at least by 5 min/pt (Phone calls, disorganized
charts, or the need to consult with a colleague)
 Also, we can increase MDs to 5 during lunch time to enhance MDs
utilization even more.
 Or we can add 1 new RN if possible (Heir or Lab tech can take courses )

14. Alternative solution 1
• Current operation status • Proposed operation (one
stop shop)
Front
desk
RN
Dispatch
nurse
Lab stage
1
Dispatch
nurse
anther
Lab blood
sample
Front
desk
Front
desk
room1
Room2
Room 3
Room 4
Room 5
Room 6
Room 7
room8
• All rooms to be equipped
• RNs & lab technicians to exchange
knowledge
• Apply queuing system
• Revisit priority criteria
• Automation environment

15. Change Rooms layout:
Applying lean concepts by decreasing the time of transportation between Exams
room for both RNs and MDs
Also, it will give charge nurse better control over processes by better
communication between healthcare providers
Alternative solution 2