This document outlines a project to reduce door-to-door time for patients in the OBGYN clinic at Eskenazi Hospital from an average of 1 hour and 30 minutes to 1 hour or less. Current door-to-door times and a process map are analyzed to identify opportunities to standardize processes, improve communication, and better prepare exam rooms to minimize wait times. Recommendations include using visual cues like colored flags to signal patient status, standardizing exam room supplies, and providing training to staff on new standardized processes. Metrics like wait times and patient satisfaction will be monitored post-implementation to measure the impact of changes.

1. PROJECT TITLE: OCC5 / OBGYN Door-to-Door Cycle Time
Goal: Through the implementation of process improvement tools, our project goal is to reduce the overall door-to-door time in OCC-5 / OBGYN to 1:00 hour or less Outcomes - Final Capability
DEFINE: Background Information and Project Y
ANALYZE: Identify and screen potential X's, determine the f(x)
IMPROVE: Recommendations & Target State
Date: 09/23/2015 Hospital: Eskenazi Health
MEASURE: Current Situation & Process Capability
Implementation Plan
CONTROL: Follow-up & Sustainment Plan
The currently observed clinic time for a patient in Eskenazi Hospital / OCC5 / OBGYN
(door-to-door time) is averaging 1hr 30mins, while the desired visit duration is 1 hr.
Project Y = Door to door time for Eskenazi Health Center / OCC5 / OBGYN
OCC-5 / OBGYN Door-to-Door Time Trend
Door-to-Door Visit Time at OCC-5 / OBGYN
OCC-5 / OBGYN Door-to-Door Upper and Lower
Time Ranges
0
20
40
60
80
100
120
140
160
180
200
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Control Chart of Patient Tracer Times
TOTAL TIMES for all PATIENT
TRACERS (in minutes)
Mean = 91.7
UCL = 175.5
LCL = 7.9
Mean 91.7
Standard Deviation 27.9
UCL 175.5
LCL 7.9
TOTAL TIMES for
all PATIENT
TRACERS (in
minutes) Mean = 91.7 UCL = 175.5 LCL = 7.9
94 91.7 175.5 7.9
82 91.7 175.5 7.9
122 91.7 175.5 7.9
146 91.7 175.5 7.9
54 91.7 175.5 7.9
94 91.7 175.5 7.9
67 91.7 175.5 7.9
124 91.7 175.5 7.9
52 91.7 175.5 7.9
90 91.7 175.5 7.9
140 91.7 175.5 7.9
114 91.7 175.5 7.9
73 91.7 175.5 7.9
73 91.7 175.5 7.9
63 91.7 175.5 7.9
85 91.7 175.5 7.9
99 91.7 175.5 7.9
78 91.7 175.5 7.9
Standardizing Process Recommendations
• Patient Handoff Resident-to-Nurse
• Patient Handoff Registrar-to-Nurse / MA
• Standardizing exam room based on visit type
• In-room Supplies
• Dopplers
Target State
• Assign flag colors
• Schedule training
• Provide training
• Determine sleeve locations / submit purchase order
• Submit work request
• Install sleeves
• Monitoring
• "Approval / ordering of ASCOM Phones
• Training
• Implementation"
• "Identify standard exam procedures (equipment / supplies per
procedure). Instrument manual created by team. Manual listing picture
and proper name. Similar to using shadow boards
• Schedule Training - in process
• Provide training - weekly
• Monitoring
• Create list
• Develop Process for stocking
• Assign staff
• Schedule training
• Training of staff on new process
• Monitoring
• Determine quantity
• Submit purchase order
• Receive materials
• Submit work request
• Installation of doppler units
• Monitoring
• WHAT?
• WHO?
• WHEN (Implementation
Date)?
• WHEN (Actual
Implementation Date)?
• WHEN (Status Update)?
30-Day follow-up
• Possible impact to clinic
flow & process
• Action Items
• Potential barriers
Business Case: Patient satisfaction scores are below the goal, with the greatest dis-satisfier being increased wait times which are greater than the goal.
Ultimately affecting patient retention, incentives and Pay-for-Performance Measures
Stakeholders and Customers Impacted by this Project: Senior Leadership, Project Champions and Project Team
Registration Patients Staff-Mas and nurses Residents Faculty Check-out Interpreters Specialty Connection
Patient Presents
Registration
Patient work-up
Rooming &
Assessment
Patient waiting in exam
room for provider
Patient waiting for
checkout
Checkout
Treat PT
Provider Exam Discharge
PT waiting for
registration
Waiting for
rooming
OBGYN Six Sigma Project – Patient Flow
Chart
Complete
Nurse / MA has to locate provider to
see if chart is complete and orders
written. Creating a visual trigger that
“SHOWS PATIENT IS READY” could
be helpful here
Patients spend time waiting
because Staff are looking
for specific exam tools (ex.
speculum, doppler..etc),
equipment and supplies for
specific visitsPatient
waiting for
extended
periods of
time to
register
Patient sitting
here waiting to
be called
back. Waiting
at this stage
can be lengthy
Patient will sit in the exam
room and wait until the
communication is given that
patient is ready for
checkout / discharge
Communication delay
Prepping rooms for the day,
with needed resources
based on visit type (by clinic
visit schedule), could help
with this delay
Communication delay
Patient waits excessively in
exam room until provider is
notified that patient is
ready
Communication delay
Process delay: searching for
supplies. In-room supplies
may help here
Site leadership will monitor the following metrics post-project implementation:
1. Communication from Registration->Nurse / MA ->Provider-> Checkout-Discharge with use of flip-phones, then ASCOM Phones
once the wireless remediation is complete.
2. Consistency of exam rooms being setup according to visit type as a result of daily patient scheduling: minimizing patient wait
for labs, vitals, work-up and staff searching for supplies and equipment
3. Consistent / daily use of colored flags above doors to serve as visual cue to Nurse/MA/Provider that patient is ready for
transition to the next stage of the clinic process
4. Consistent / daily use of hanging file folder (with privacy sleeves to protect HIPPA info) outside of provider workroom to serve
as visual trigger that chart is complete and patient is ready for check-out / discharge
5. Consistency of using Master Instrument Manual listing picture and proper tool name (ie. Shadow boards). Also creating a
“Critical Supplies “ that are operationally necessary for each exam room
6. Consistent monitoring of door-to-door visit times, patient feedback and satisfaction scores
7. Short-term feedback gathered from on-site visit to OBGYN gave way to some very good feedback from staff and Check-out /
Discharge:
a. Providers are actively using COLORED FLAGS when the exit the exam room
b. Hanging baskets are being used and increase the speed of getting the patient from the exam room to Check-Out /
Discharge. Nurse / MA sees the completed chart in basket or flag flipped, then they began transitioning the patient