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Wsmc outpatient flow lean project

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outpatient flow for lab and imaging

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Wsmc outpatient flow lean project

  1. 1. Outpatient Flow: Lab and ImagingOutpatient Flow: Lab and Imaging Northwestern Michigan CollegeNorthwestern Michigan College Lean Office Champion ProjectLean Office Champion Project October 2014 – March 2015October 2014 – March 2015 Darrell Lavender, MBA Performance ImprovementDarrell Lavender, MBA Performance Improvement West Shore Medical CenterWest Shore Medical Center
  2. 2. Project CharterProject Charter  Project: Outpatient Flow: Lab & ImagingProject: Outpatient Flow: Lab & Imaging  Value Stream Manger:Value Stream Manger: Sonja Ganger, Director, Patient AccessSonja Ganger, Director, Patient Access  Team Members:Team Members: – K. Acker, Provider Based ClinicsK. Acker, Provider Based Clinics – C. Young, RegistrationC. Young, Registration – T. Pepera, LabT. Pepera, Lab – K. Erickson, ImagingK. Erickson, Imaging – S. Ganger, Patient AccessS. Ganger, Patient Access – K. Balzuweit, LabK. Balzuweit, Lab – J. Brand, ImagingJ. Brand, Imaging – D. Lavender, Performance ImprovementD. Lavender, Performance Improvement  Purpose: Improve WSMC’s outpatient experience byPurpose: Improve WSMC’s outpatient experience by improving the patient flow for lab and imaging.improving the patient flow for lab and imaging.
  3. 3. Project Charter ContinuedProject Charter Continued  Metrics for Registration/Lab/Imaging include:Metrics for Registration/Lab/Imaging include: – Patient Experience Percentile Rank (outcome)Patient Experience Percentile Rank (outcome) – Patient Experience top box percentages (outcome)Patient Experience top box percentages (outcome) – Patient Experience negative comments about this process (outcome)Patient Experience negative comments about this process (outcome) – Waiting times (process)Waiting times (process) – Documentation missing/incomplete rates (process)Documentation missing/incomplete rates (process) – Rework rates/times (process)Rework rates/times (process)  Scope:Scope: PBC order process patient completes test at HospitalPBC order process patient completes test at Hospital  Parameters:Parameters: – RegulationRegulation – PayersPayers – TJCTJC – FacilityFacility – StaffingStaffing
  4. 4. Project Charter ContinuedProject Charter Continued  Deliverables:Deliverables: – Current state value stream mapCurrent state value stream map – List of opportunitiesList of opportunities – Prioritization of opportunitiesPrioritization of opportunities – Analysis of key opportunitiesAnalysis of key opportunities – Future state value stream mapFuture state value stream map – Implementation plan for key opportunitiesImplementation plan for key opportunities – Improve efficiencyImprove efficiency – Improve satisfactionImprove satisfaction  Timeline:Timeline: – Complete entire planning by February, 2015.Complete entire planning by February, 2015. March!March! – Implementation begins April/MayImplementation begins April/May – Project completes by June.Project completes by June. Start another round?!?!Start another round?!?!
  5. 5. BackgroundBackground Market share and access are strategically vital. ThereMarket share and access are strategically vital. There are multiple processes which are highly variable andare multiple processes which are highly variable and fraught with waste, delays, and rework. These result infraught with waste, delays, and rework. These result in poor experiences for outpatients. Quality, safety,poor experiences for outpatients. Quality, safety, customer experience, and finances are directly impactedcustomer experience, and finances are directly impacted by this value stream.by this value stream.
  6. 6. BackgroundBackground Laboratory Imaging
  7. 7. Going to the GembaGoing to the Gemba
  8. 8. Going to the GembaGoing to the Gemba
  9. 9. Going to the GembaGoing to the Gemba
  10. 10. xxGoing to the GembaGoing to the Gemba
  11. 11. Going to the GembaGoing to the Gemba
  12. 12. Going to the GembaGoing to the Gemba
  13. 13. Going to the GembaGoing to the Gemba
  14. 14. Going to the GembaGoing to the Gemba
  15. 15. Value Stream Map: Current StateValue Stream Map: Current State Once the Provider and/or Clinical Coordinator at the PBC launch the order(s), our patients were subject to 1 or more of 3 primary tracts: Pre Op, Pre Reg, Unscheduled
  16. 16. Value Stream Map: Current StateValue Stream Map: Current State Drilldown: Unscheduled LabDrilldown: Unscheduled Lab Some steps not value added but necessary; some steps not value added 1-10 Mean: 23.5 minutes Range: 9-131 minutes Sample n= Reg:792 Lab:546 0.5 4 7 3-190-49 5 2-421-2 2 0 1-7 0 1-2 4 1 Cycle Time: 7-122 Wait Time: 2-9 Lead Time: 9-131
  17. 17. Value Stream Map: Current StateValue Stream Map: Current State creating flow & problem solvingcreating flow & problem solving
  18. 18. Value Stream Map: Current StateValue Stream Map: Current State Drilldown: PBCDrilldown: PBC Current Condition:
  19. 19. Value Stream Map: Current StateValue Stream Map: Current State Drilldown: PBCDrilldown: PBC Root Cause Analysis for not having more lab draws at the primary care office location Only 2 certified phlebotomists Competencies needed Others capable; trained/untrained Location/space logistic issues for office and patient Phlebotomist notificationProvider awareness Lab equipment limitations Need more lab equipment EQUIPMENT PROCESSMANAGEMENT PEOPLE MATERIAL MEASUREMENT BARRIERS TO LAB DRAWS
  20. 20. Value Stream Map: Current StateValue Stream Map: Current State Drilldown: PBCDrilldown: PBC CounterCounter measuremeasure EffectivenessEffectiveness (1-5)(1-5) FeasibilityFeasibility (1-5)(1-5) ScoreScore competency checkcompetency check offoff 55 55 2525 train more peopletrain more people 55 55 2525 address spaceaddress space (centralized vs.(centralized vs. decentralize)decentralize) 44 22 88 educate providerseducate providers 55 55 2525 get more labget more lab equipmentequipment 44 44 1616 Counter measures: Standardized work and leveling
  21. 21. Value Stream Map: Current StateValue Stream Map: Current State Drilldown: RegistrationDrilldown: Registration Wait Time –Wait Time – Record name inRecord name in lobby to completelobby to complete reg processreg process MinutesMinutes Complete andComplete and accurateaccurate When issues areWhen issues are identified withidentified with orders – percentorders – percent resolvedresolved Time spent in regTime spent in reg dealing withdealing with documentationdocumentation issuesissues MinutesMinutes n=792n=792 Mean = 9Mean = 9 Range = 1-52Range = 1-52 85%85% 80%80% n=37/66n=37/66 Mean = 24/16Mean = 24/16 Range = 5-60/2-50Range = 5-60/2-50 Current Condition:
  22. 22. Value Stream Map: Current StateValue Stream Map: Current State Drilldown: RegistrationDrilldown: Registration Problem Tree: Incomplete/missing orders/doc for lab/imaging Technology investigation Variation in office practice Not tested ahead STAT testing / scheduled missed authorizations Missing fax Patient walk in from Doctor’s office Imaging needed pre-auth Dx code incorrect (ABN) All 7 criteria not met Greater wait time Staff re work Patient has to come back Standardized work and visual management
  23. 23. Value Stream Map: Current StateValue Stream Map: Current State Drilldown: ImagingDrilldown: Imaging Current Condition:
  24. 24. Value Stream Map: Current StateValue Stream Map: Current State Drilldown: ImagingDrilldown: Imaging Current Condition: Imaging Volume Analysis 3/16/2015 Katie, Kathy, Jim, Darrell Imaging Volume: March 9-13, 2015 Total tests Scheduled Add ons Cancel / no show Lab draws for PT, PTT, Bun/cre missing papers CT 72 37 37 2 16 1 US 88 71 20 3 4 MRI 35 35 3 3 8 Nuc 8 6 3 1 Mammo 49 51 1 3 Xray 205 10 195 1 Dexa 10 11 1 OR calls 5 5 0 total: 472 221 264 13 24 6 percent: 100% 47% 56% 3% 5% 1% note: numbers may not be exact but margin of error is small Leveling and pull process
  25. 25. Value Stream Map: Current StateValue Stream Map: Current State Drilldown: LabDrilldown: Lab Current Condition:
  26. 26. Value Stream Map: Current StateValue Stream Map: Current State Drilldown: LabDrilldown: Lab Leveling and pull process Current Condition:
  27. 27. Existing Visual ManagementExisting Visual Management
  28. 28. 5S Opportunities5S Opportunities Especially for pre-visit order management
  29. 29. First Up A3sFirst Up A3s PBC – Increase lab draws at Primary CarePBC – Increase lab draws at Primary Care Registration – Improve pre visit order managementRegistration – Improve pre visit order management Lab – Improve process for lab draws in imagingLab – Improve process for lab draws in imaging & Improve lab coverage and patient& Improve lab coverage and patient intake processesintake processes Imaging – Improve pre visit order managementImaging – Improve pre visit order management & Improve scheduling process& Improve scheduling process
  30. 30. Final ThoughtsFinal Thoughts WSMC has used the PDCA model for over 4 yearsWSMC has used the PDCA model for over 4 years Historically a performance improvement focus; now adding LeanHistorically a performance improvement focus; now adding Lean Healthcare rich for improvement opportunitiesHealthcare rich for improvement opportunities Complicated processes to consider; can be over whelmingComplicated processes to consider; can be over whelming Lean offers a methodical approach, valuable tools, and efficient use ofLean offers a methodical approach, valuable tools, and efficient use of resources to improve process and outcomesresources to improve process and outcomes Beneficial to analyze flow and list problems from neutral participantsBeneficial to analyze flow and list problems from neutral participants Team consists of line staff and leadership with appropriate mixTeam consists of line staff and leadership with appropriate mix Team is making progress and leadership is anxious for resultsTeam is making progress and leadership is anxious for results WSMC leadership brain stormed broken processes and prioritized listWSMC leadership brain stormed broken processes and prioritized list
  31. 31. QuestionsQuestions

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