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Changing Process and Practice to Meet Patient Demand

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This was presented in session F3 at the Quality Forum 2014 by:

Rita Janke
Quality, Safety & Accreditation Leader, Sunny Hill Health Centre for Children
Provincial Health Services Authority

Tracy Conley
Program Manager, BC Autism Assessment Network Sunny Hill Health Centre
Provincial Health Services Authority

Published in: Health & Medicine
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Changing Process and Practice to Meet Patient Demand

  1. 1. Changing Process and Practice to Meet Patient Demand Tracy Conley, MHA and Rita Janke, RN, MSN Sunny Hill Health Centre for Children Child Development and Rehabilitation Program of BC Children’s Hospital
  2. 2. Background Provincial Autism Resource Centre (PARC) Tier 3 and 4 Assessments Targeted 502 onsite multidisciplinary assessments/per year.
  3. 3. Background continued Increased Demand Increased Waiting Delayed Access to Funding and Community Services
  4. 4. Method Value Stream Map Current State Analysis LEAN Rapid Process Improvement Opportunity for improvement
  5. 5. Goal  To decrease assessment lead time from 8 weeks to 4 weeks.
  6. 6. Problem Statement Children are currently waiting longer than 4 weeks to complete their assessments First Appt to Family Conference Median Weeks Jan 2012 - March 18, 2013 - Under 6 years Weeks from 1st Appt to Family Conference 14 12 11.64 11 10 9.14 9.71 9 8.86 8.21 8 7.71 7 6 5.5 4.14 4 2 Weeks, 10 4.29 4 Target, 4 wks 2.14 0 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13
  7. 7. Address Scheduling Workflow Improve the workflow for scheduling to facilitate the reduction of time from 1st appointment to diagnosis:
  8. 8. Booking Clerk Process Family receives Multiple phone calls and letters Unpredictable Availability Family attends CDA appointment Next appointment only booked after previous visit Family attends Additional appointments Median 8 weeks Family attends Family conference (range 2-11 weeks)
  9. 9. Address Clinician Availability Set expectations to ensure timely, up-to-date clinician availability.
  10. 10. The Aims 80% of children will have all appointments booked within a 4 week block booking. 100% of the time, clinician availability will be up to date 3 months in advance to facilitate booking of appointments
  11. 11. Future Booking Process One letter to family GOAL: 4 weeks One phone call to family
  12. 12. Go to the Gemba Trial of new process
  13. 13. Shift Gears: Scheduling  Demand and Capacity How much availability should we have? What is our projected demand? What is our current capacity? What is the gap?
  14. 14. Demand/ Capacity
  15. 15. Analysis: Why can’t we reach our 4 week target? • Availability of clinicians is variable • Availability is not provided in a consistent way or time frame • The current pace of working is unpredictable • Current capacity does not meet demand
  16. 16. Meeting Demand – Predictable Pace Work with each discipline to identify/develop:  Strategies to meet demand.  Develop predictable assessment pace.
  17. 17. Master Rotation  Predictable pace.  Pace = projected demand.  Changes to schedule submitted minimum 3 months in advance.  Predictable room booking.  “One Piece Flow” scheduling process.
  18. 18. Clinician Improvement Plans Identify patient streams vs ‘one size fits all’ Master rotation. Report writing. Reduction in demand :  Duplication of assessment.  ?need for specific disciplines  Assessments based upon child’s needs.  Room Set up    
  19. 19. 2/10/14 2/3/14 1/27/14 1/20/14 1/13/14 1/6/14 12/30/13 12/23/13 12/16/13 12/9/13 12/2/13 11/25/13 11/18/13 11/11/13 11/4/13 10/28/13 10/21/13 10/15/13 10/7/13 9/30/13 9/23/13 9/16/13 9/9/13 9/2/13 8/26/13 8/19/13 8/12/13 8/5/13 7/29/13 7/22/13 0% 7/15/13 100% 7/8/13 Percent 7/1/13 6/24/13 Results Percentage of children who achieved a 4 week lead time from 1st appointment to diagnosis. P Chart 120% UCL 80% 60% 40% 20% LCL
  20. 20. 0 6/24/13 6/24/13 7/1/13 7/8/13 7/8/13 7/8/13 7/8/13 7/8/13 7/15/13 7/15/13 7/15/13 7/15/13 7/22/13 7/22/13 7/29/13 7/29/13 8/5/13 8/12/13 8/12/13 8/12/13 8/12/13 8/19/13 8/19/13 8/26/13 8/26/13 9/2/13 9/2/13 9/9/13 9/9/13 9/9/13 9/9/13 9/16/13 9/16/13 9/23/13 9/23/13 9/23/13 9/30/13 9/30/13 9/30/13 10/7/13 10/7/13 10/15/13 10/15/13 10/21/13 10/28/13 10/28/13 11/4/13 11/4/13 11/4/13 11/18/13 11/18/13 11/18/13 11/25/13 11/25/13 11/25/13 12/2/13 12/2/13 12/9/13 12/9/13 12/9/13 12/9/13 12/9/13 12/16/13 12/16/13 12/16/13 12/16/13 1/6/14 1/6/14 1/6/14 1/13/14 1/13/14 1/13/14 1/13/14 1/20/14 1/20/14 1/20/14 1/27/14 1/27/14 1/27/14 1/27/14 2/3/14 2/3/14 2/10/14 2/10/14 2/10/14 Results Measure 25 Median 7.8 20 UCL Median 4.8 15 10 5 LCL
  21. 21. Lessons Learned Understand current state and the actual problem. Engage staff. Commitment to daily management.
  22. 22. Sustainability  Performance wall meeting.  Ongoing evaluation.  Daily management.  Ongoing continuous improvement.

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