The document discusses conducting a business process review of the MRI section at a hospital. It includes mapping the current patient workflow, identifying bottlenecks, and assessing the impact of changes implemented. Key issues noted were long wait times, lack of communication, and delays in scheduling and patient preparation. Changes tested included streamlining forms, standardizing schedules, adding signage for patients, and defining staff roles. A time motion study on 150 patients was planned to analyze the impact of the changes.

1. MRIDU SINGH
PGDM – HEALTHCARE MANAGEMENT
GOA INSTITUTE OF MANAGEMENT , GOA
1MRIDU_GIM

2. WHYBusiness
ProcessReview?
 Business process review/ analysis is
an assessment tool to identify the
bottlenecks in the existing business
system and the opportunities for
improvement in the same. It
generally comprises of three stages
namely review, proposal for change
and implementing change.
 This tool can be applicable to both
simple , small level processes as well
as the large and complex
businesses.
 It provides both the 360° panoramic
overview and in depth
understanding of the existing
system which is necessary for
considering improvements.
 Thorough understanding
of the existing system
 Identification of the
roadblocks/bottlenecks
 Identification of scope of
improvement and
designing of the
appropriate intervening
tools
 Assessment of the impact
of implementing change
EXPECTED
OUTCOMES
2MRIDU_GIMReference :cics-ppu@sheffield.ac.uk

3. To conduct the business process analysis of MRI section ,
Department of Imaging , P.D. Hinduja Hospital and
Medical Research Centre and to assess the impact of
changes implemented.
This summer project includes all the three stages of
business process analysis and additionally assess the
implemented changes intended for improvement of the
existing business process.
3MRIDU_GIM

4. 4MRIDU_GIM

5. UNDERSTANDING WORK PROCESS-WORK
SHADOWING
Waiting area
MRI Room
Doctor’s room
Console room
IN SEQUENCE
Registration desk
Changing room
Waiting area
Nursing station
Technical Room
5MRIDU_GIM

6. THEWORKFLOW
APPOINTMENT
TAKEN – SLOT
ALLOTED
PATIENT ARRIVAL
CONSENT FORM
FILLING,
CHECKLIST
MARKING AND
MAKING PAYMENT
PATIENT
HISTORYTAKEN
( MRI REQUEST
FORM IS USED)
DRESS
CHANGE
PREPARATION (IN
CASE OF
GA/CONTRAST
STUDY)
STAY INWAITING AREA
MRI EXAMINATION
( PRECEDED BY
TECHNICIAN’s
INSTRUCTIONS AND
SETTINGTIMETAKEN)
RECEIVING
REPORT
6MRIDU_GIM

7. Factsaboutthedepartment
•For appointment ,scheduling and
payments , a module of CARE 2000 is used
for the MRI Department. During
appointment following details are filled:-
•Patient no. ( HH No. /EX NO. )
•Name
•Telephone No.
•Service provided (based on the
prescription submitted)
•Sex/ age
•Time allotted
•Status
•Remarks ( any further specifications )
•The allotments are given certain status like
tentative ( yellow ), confirmed ( red ), purple
, light blue ( available ), pink ( holding ) ,
grey ( OT book )
•Instructions are conveyed to patients orally
as displayed on the desktop screen
Philips Ingenia-1.5 T
& 3 T
1 slot= 45 minutes
(total 20 per machine
per day )
UNDER GA – 8:30 AM
TO 1 PM
APPOINTMENT
SYSTEM
WORKING HOURS
- 7 AM TO 11 PM
TIME TO WALK FROM
MRI TO CONSOLE =5
SECONDS
2 PATIENT TROLLEYS –
USED FOR PREPARATION
& RECOVERY
7MRIDU_GIM

8.  The record files that are
maintained – inventory of
medicines and consumables ( weekly
indent ) , post anesthetic care (
recovery room data ), crash cart ,
working of suction and O2 supply ,
pharmacy enquiry ( to be charged
separately from the patient ),
contrast checking , thermometer
checking , daily consent forms
record, anesthesia charge sheet
 Claustrophobia or other
unprecedented factors making
patient uncomfortable delays the
scan time
 Patient seems highly dissatisfied
due to long waiting time
 Real time communication is
missing to patients’ relatives
 Patient flow is not uniformly
distributed over different time of
day and across days in a week
 For every patient, one folder is
used for keeping report ; a
sticker with the patient details is
printed and pasted on it.
8MRIDU_GIM

9. The intrusion of emergency cases
creates the backlog of already
scheduled slots
 Location next to emergency and in
front of the patient lift –
transportation time minimum for
both inpatient & casualty cases
Around 3 -9 minutes it takes to
shift IPD patients to patient table /
change the patient table in case of
Breast MRI
Sometimes , staff’s absence for a
short while or being busy with other
patient adds to the waiting time for
the respective patient
MRIDU_GIM 9
Unidirectional movement of patient in the
department setup – not present
Schedule for IPD & casualty patients
directly handled by technicians
Examination protocol for different kinds
of studies followed by technicians
Consent form is not explained in detail
Third party option may be used while
making voucher if the patient is employee
of organization mentioned on the panel
( for reimbursement)
System for formal feedback/complaints
not present

10. THETEAM…humanresource
•The number of staff present in a
shift – 2 technicians, 1 resident
radiologists, 1 nurse , 1attendant , 2
registration desk staff
•Working hours : for technicians &
registration staff – 7 to 3, 3 to 11
•For nurses – 8 to 4, 2 to 10 (reliever
from CT scan dept from 2 to 4
•Pager system for nursing and
attendant staff ( only used in
emergency)
MRI
STUDY OF
PATIENT
TECHNICIAN
NURSE &
SUPPORT
STAFF
FRONT
DESK
STAFF
RADIOLOGIST
10MRIDU_GIM

11. 11MRIDU_GIM

12. MappingtheProcess…
The process map included here
shows the patient flow throughout
the process of MRI
12MRIDU_GIM

13. 13MRIDU_GIM

14. 14MRIDU_GIM

15. PARAMETER GA CASES NON GA CASES
Average MRI examination
time
( time taken for one scan)
46 MINUTES 51 MINUTES
Average turnaround time
( time taken from when
patient arrives till patient
exits )
193 MINUTES 104 MINUTES
Average preparation time
( time taken to prepare the
patient for MRI scan )
41 MINUTES 35 MINUTES ( OPD)
13 MINUTES ( IPD)
Average recovery time 49 MINUTES 43 MINUTES
Average idle time 12 MINUTES 8 MINUTES
Average waiting time 116 MINUTES 80 MINUTES
KEY HIGHLIGHTS
15MRIDU_GIM
% above 45 minutes 59 MINUTES 56%
% within 45 minutes 35 MINUTES 45%

16. Average no. of examinations per day
Average no. of working hours per
week
31 examinations
96 hours
Average access time ( time duration
between appointment request and
allotment )
1 DAY (VARIABILITY 1TO 22 DAYS)
% of IPD cases 16%
% of OPD cases 84%
% of walk in appointments 7.6%
Utilization rate 73.8 %
16MRIDU_GIM

17. Typesofstudiesconducted
MRI Brain plain 25.17%
MRI Angiography abdomen 6.99%
MRI Angiography brain 2.09%
MRI Cervical plain 4.89%
MRI musculoskeletal 13.98%
MRI Lumbar spine 12.58%
MRI Brain spectroscopy 0.69%
MRI RT planning pelvis 6.99%
17MRIDU_GIM

18. MRI Brain with contrast 10.48%
MRI Dorsal spine 4.19%
MRI Neck with contrast 1.39%
MRI Enterography 0.69%
MRI Cochlea 2.79%
MRI Para nasal sinuses 0.69%
MRI Breast MRI 0.69%
MRI MRCP 1.39%
18MRIDU_GIM

19. RACIanalysis
FunctionsRoles Receptionist Nurse Technician
Resident
Doctor Anesthetist Attendant Radiologist
appointment R C I
reminder/ information call to patientR I
consent & other forms R I A/C C
transferring the patient folder A I R
payment R I
change into patient dress C I C A SELF
consent for anesthesia* R A I C
patient history I A R C
preparation R C I
pharmacy billing R
machine set up & instructions R
processing I R C
transportation I A C R
recovery / IV removal R A I C
patient's dress change C A SELF
report making I R
report bringing C I R
report dispatch R I
maintenance of linen I A C R
maintenance of films & blank CDs I R A
maintaining file records R
maintaining pharmacy supplies R A
*only for certain patients
19MRIDU_GIM

20. CAUSE&EFFECTANALYSIS
20MRIDU_GIM

21. 1
2
2
3
3
Interaction at registration desk
staff not available
staff busy with other
patient
staff busy on phone call
patient arrives late
Pediatric patient
start from 8:30 ,
anesthetist
might be late
.
21MRIDU_GIM
1%
2%
3%
Patient arrival
patient arrives late
prepond
emergency case
2
2
3
4
5
6
7
changing room
dresses not available in
changing room
not in the stock
size not available
attendant not available
to provide dress
changing room
occupied
very old immobile
patient
patient not informed
0 0 0
1
1
4
preparation
nurse not available
nurse busy with other
patient
coordination amongst
staff not timely,
anesthetist not available
problem of finding the
patient's vein ( GA)

22. MRIDU_GIM 22
0
2
2
2
45
6
patient history
not asked before
imaging
need repetitive
interaction
unable to convey the
problem
files not brought
not taken at this time
0
1
3
4
setting time
technicians' time to
plan the scan
non cooperation /
claustrophobia
instruction of metal
removal not followed
attendant not
available
0
3
5
7
8
scanning
machine's potential
(technical)
non cooperation /
movement
test not done
completely
repeat scan
relatives not informed
1
5
5
6
9
IV removal / recovery
nurse not available
nurse busy with other
patient
instruction not followed
to press for 5 mnts
nurse busy with her own
errands
patient not well during
recovery
0
1
3
4
exit
report receiving info
not given
IPD patients file
update
may have query about
the report receiving
further discussion by
doctor

23. Cause&effectanalysisresult
Problem Cause Solution
Overall delay due to the delay
in changing room
•Patient dress not available
• stock over
•patient not asked well in time
to change
All patient dresses kept in the
changing room with shelves
properly labeled
Patient forgets to bring
previous records or do not fast
properly
Instructions are communicated
orally only
Brochure be given at the time
of appointment
With high patient flow , task
becomes chaotic
Less organized method of
handling forms
All forms kept together as set
Patient enquires often to
technician & nurse about
reports
Patient does not have enough
information
Report collection information
displayed for patients .
Patient may not follow all
instructions properly
Patient information is not
sufficient
Certain posters/labels in
changing room
Extension of study – more
waiting for next patient
Many reasons responsible like
patient movement
Informing patient before 30
minutes (reminder calls)
23

24. 24MRIDU_GIM

25. MRIDU_GIM 25
PROBLEM ADDRESSEDCHANGE / SOLUTIONSTATUS
DELAY IN ARRANGING AND
SENDING CONSENT AND
REQUEST ( PATIENT HISTORY )
FORMS
THREE FORMS IN TOTAL CLUBBED
TOGETHER (CONSENT FORM ,
SCAN REQUEST FORM & MRI
CHECKLIST ) AS DIFFERENT
SETS
ALL GA PATIENTS ARRIVED AT
8:30 AM
2 PATIENTS CALLED AT 8:30 AM,
NEXT TWO AT 9:00 AM AND REST
OTHER PATIENTS CALLED AT
10:00 AM ONWARDS
THE CHECKLIST OF CHANGES IMPLEMENTED
YET TO BE DISCUSSED
TO BE IMPLEMENTED SOON
ON HOLD
IMPLEMENTED

26. MRIDU_GIM 26
PATIENT DRESSES NOT
AVAILABLE FOR SEVERAL
PATIENTS AS ONE PIECE
KEPT AT A TIME
• SHELVES LABELLED
• ALL PATIENT DRESSES
KEPT IN CHANGING ROOM
DIRECTIVE
COMMUNICATION FOR
PATIENT IS MISSING IN
CHANGING ROOM
THREE ADDITIONAL
SIGNBOARDS DISPLAYED
PATIENTS MAY NOT BE
CLEAR ABOUT REMOVAL
OF ALL METALLIC ITEMS
POSTER TO INFORM
PATIENTS REMOVAL OF
METALLIC THINGS
MANY ENQUIRIES ABOUT
REPORT COLLECTION
NOTICE FOR REPORT
COLLECTION INFORMATION

27. MRIDU_GIM 27
SOME PATIENTS GET
DELAYED IN ARRIVING -
CURRENTLY PATIENTS
CALLED 15 MINUTES BEFORE
THE ALLOTTED TIME
● CALLING PATIENT 30 MINUTES
BEFORE THE ALLOTTED TIME
COMMUNICATION NEEDS TO
BE MORE EFFICIENT
BETWEEN TECHNICIAN ,
DOCTOR AND FRONT DESK
STAFF
● ON THE CHECKLIST , TO BE
MENTIONED WHO IS
INFORMED ABOUT THE
PATIENT NEXT IN TURN
FEEDBACK FORMS FOR ANY
COMPLAINTS AND
COMPLIMENTS FROM
PATIENTS
● FEEDBACK FORM TO BE
CREATED FOR RADIOLOGY
DEPARTMENT ( AS ALREADY
USED IN HEALTH CHECK AND
OPD)
TECHNICIAN BEING INVOLVED
IN PATIENT CARE - LEADS TO
ADDITIONAL DELAYS
● JOB ENHANCEMENT - TASK OF
PATIENT BEING SET ON
PATIENT TABLE DONE BY
ATTENDANT ONLY

28. MRIDU_GIM 28
CLEAR DESCRIPTION OF
WORK CAN HELP STAFF BE
ORGANISED
● SOPs FOR ALL STAFF BE
DISPLAYED ON NOTICE
BOARD INSIDE CONSOLE
ROOM ( FOR THEIR OWN
REFERENCE)
NEED OF MAKING PATIENT
MORE INFORMATIVE
● BROCHURES TO BE GIVEN AT
THE TIME OF APPOINTMENT
COORDINATION BETWEEN
THE STAFF HOLDS
POSSIBILITY OF
IMPROVEMENT AND THUS
OCCASIONAL FRICTIONS CAN
BE AVOIDED
● MOTIVATING REWARDS AND
PROFESSIONALISM
ENHANCEMENT
(LEARNING/TRAINING
SESSIONS FOR STAFF)
FOR SOME PATIENTS VERY
LONG WAITING TIME
(SPECIALLY WALK IN
WITHOUT ANY REFERENCE)
● STANDARDISED DURATION
OF WAITING , ACCESS TIME
EXAMPLE - NOT MORE THAN
30 MINUTES , 2 DAYS
RESPECTIVELY

29. MRIDU_GIM 29
CERTAIN TIMES SCHEDULING
ITSELF IS NOT PROPER DUE TO
MIS-COMMUNICATION ( OPDs
HANDLED AT REGISTRATION &
IPDs HANDLED BY TECHNICIANS
DIRECTLY )
● ALL SCHEDULING BEING DONE BY
SINGLE PERSON
CERTAIN PATIENTS NEED
APPOINTMENT URGENTLY
● PREFERENCE BASED ON
URGENCY OF THE CONDITION
AND NEED OF THE PATIENT
PATIENT NEEDS TO BE
MENTALLY WELL PREPARED -
TO INCREASE THE POSSIBILITY
OF COOPERATION DURING MRI
SCAN
● AUDIO - VISUAL TO BE SCREENED
IN THE WAITING AREA
● ALL THE INFORMATION CONTENT
IN BROCHURE AND DEMO VIDEOS
BE UPLOADED ON WEBSITE
REAL TIME COMMUNICATION
AMONG STAFF CAN BE
IMPROVED WITH
TECHNOLOGICAL
INTERVENTION
● USE OF RFID AND OTHER NEW
TECHNOLOGIES FOR TRACKING
INVENTORY ( LINEN , DRUGS AND
OTHER MEDICAL SUPPLIES ) AND
STAFF

30. The “CHANGES” implemented in the
department
The signages that are being used now in MRI department.
MRIDU_GIM 30

31. MRIDU_GIM 31

32. 32MRIDU_GIM

33. FURTHERPLAN–Datacollection
methodologyandanalysis results
TIME MOTION
STUDY FOR
N=150
OBSERVATION
33MRIDU_GIM
RESULTS

34. COMPARATIVE DATA–GA CASES
MRIDU_GIM 34
0
50
100
150
200
46 41 49
12
193
116
68
20
53
9
161
97
AVERAGE 1
AVERAGE 2

35. EXPLANATION
 MRI EXAMINATION
TIME
PREPARATIONTIME
 RECOVERYTIME
IDLETIME
TURNAROUND TIME
WAITINGTIME
 MORE CASES OF MRI BRAINTHAN OTHER
SMALLER STUDIES
 PREPARATIONTIME SIGNIFICANTLY GOT
DECREASED BY 51.2 %
 RECOVERYTIME WAS MORETHAN EARLIER
; REASON PATIENT SPECIFIC
 IDLETIME (TIMEGAP BETWEEN
COMPLETIONOF SCAN OF 1 PATIENTAND
START OF ANOTHER) DECREASED BY 25%
 TURNAROUNDTIME DECREASED BY 16.58 %
PROBABLY DUETOTHE DECREASE IN
PREPARATION ANDTURNAROUNDTIME
 WAITINGTIME DECREASED BY 16.37%
MRIDU_GIM 35

36. COMPARATIVE DATA–NONGACASES
MRIDU_GIM 36
0
20
40
60
80
100
120
51
35
8
104
80
52
21
11
98 99
AVERAGE 1
AVERAGE 2

37. EXPLANATION
MRI EXAMINATION
TIME
PREPARATIONTIME
IDLETIME
TURNAROUND TIME
WAITINGTIME
 MRI EXAMINATIONTIME IS ALMOST SIMILAR
 PREPARATIONTIME SIGNIFICANTLY
DECREASED BY 40%
 IDLETIME HOWEVER WAS INCREASED BY
37.5% PROBABLY DUETO LESS PATIENT FLOW
ON CERTAIN DAYS OFTHE STUDYTHAT LED
TO HIGHERVANANTTIME
 TIME DECREASED BY 5.76% DUETOTHE
REDUCTION IN PREPARATIONTIME
 WAITINGTIME INCREASED BY 23.75% DUETO
HIGHER NUMBER OFWALKIN PATIENTS
( SEASONAL IMPACT)
MRIDU_GIM 37

38. SPECIFIC OBSERVATIONS DURINGEVALUATION
STUDY
•Attendant had to be asked to keep patient
dresses in changing room . some of them
needs to be more responsive to the patient
needs
• Scheduling becomes difficult if many
walk in patients are there- longer waiting
time for them and more clarity required in
communication between technician and
front desk staff in this regard.
• Once ventilator was found to be not
working properly when patient had been
already taken for MRI – maintenance
should be more robust to avoid such
incidences
•Sometimes no staff is present in waiting
area
 In certain instances , scan could not
be done ; reasons were metal stents
inside body, no fasting before GA
(ICU patient) , patient could not lie
down comfortably
 Some days both the machines were
vacant for more than 30 minutes
owing to less patient flow
 Number of lockers given for patients’
use be increased to 4 instead of 2
 Absence of billing staff makes the
patients go to the first floor for
payment specially during lunch
breaks ; probable reason is shortage
of staff
MRIDU_GIM 38

39. CONCLUSION
 THE PROJECT UNDERTOOKTHE ANALYSIS, IMPLEMENTATION
AND EVALUATION
 THE ANALYSIS PART LEDTOTHETHOROUGH UNDERSTANDING
OFTHE BUSINESS PROCESSAND IDENTIFICATIONOFTHE
EXISTINGGAPS
 THE IMPLEMENTATION ( RESEARCH , DESIGNANDAPPROVAL) IS
AN ONGOING PROCESS ; ONLY CERTAIN RECOMMENDATIONS
COULD BE IMPLEMENTED DUETOTHETIMECONSTRAINED
FEASIBILITY
 THE IMPLEMENTEDCHANGESTHATWERE CONFINEDTOTHE
FRONT DESKAND GUIDINGTHE PATIENTSTHROUGH SIGNAGES
SHOWEDTHE RECUCTION INTIME SPENT FOR PREPARATION
 THE SCHEDULINGCHANGES DROPPEDTHEWAITINGTIMEALSO
HOWEVERTHE DATA MAY SHOW SLIGHT IMPACT OF
SEASONALITYOF DEMAND
MRIDU_GIM 39

40. • “Introduction to business process review and implementation”;
cics-ppu@sheffield.ac.uk
• “ The business process review”, Pennington Dennis P. , Total resource Management
MRIDU_GIM 40
ACKNOWLEDGEMNT :-
Due gratitude is conveyed to Dr. Swapnil Kharnare for guiding throughout the
project and the whole MRI staff for helping achieve successful completion of the
project. Further , gratitude is also extended to Dr. Preeti Goraksha for providing
this opportunity and Mr. Deepak S. Kuvlekar for providing requisite support from
Marketing department.

41. 41MRIDU_GIM
THANKYOU