Saturday, January 12, 2013

Focus and Leverage Part 182

The Emergency Department team has completed their work and presented their findings to the executive staff.  Unfortunately I wasn’t there to hear their final presentation as I fell victim to the flu bug and had to fly back to my home in Kennesaw, GA.  I did manage to piece together their presentation and send it to them from my hotel room before I left.  I heard later from the VP of Continuous Improvement that the presentation went very well.  It was also clear to the VP that this project was a complex one.

The team performed very well together and seemed to grasp the tools, techniques and intentions of our improvement methodology.  Figure 1 is their completed SIPOC diagram with estimated average cycle times with the total average time being approximately 88 minutes.  The SIPOC is intended to demonstrate the process being improved at a high level depicting the Suppliers, Input, the Process, the Output of the process and the Customer all on one page.  The team estimated the current times for each step as shown in Figure 1.

Figure 1
            PG Question                                    Score         # of Respondents
Waiting time to treatment area                79.5                           285
Waiting time to see doctor                       70.4                           285
Informed about delays                             68.8                           260
How well pain was controlled                  76.9                           234
Staff sensitivity to pain                             78.5                           240
How quickly your pain was treated          76.2                           223
The team also reviewed the most recent Press Ganey scores that fell below 80% as seen in the following table.

The team reasoned that if they could reduce the time it took the doctor to see the patient that probably all or most of these scores would improve.  The team then created their first iteration of the current state process map and then rated each activity as either Value-Added (VA, coded as Green),  Non-Value-Added (NVA, coded as Red), and Non-Value-Added but Necessary (coded as Yellow).  Figure 2 is the Process Map they created.  The team concluded that of the 26 steps, 17 were considered NVA (red).

Figure 2
The team then created an Ideal State map which represents what the process would look like if there was no waste (see Figure 3).
Figure 3
Because the team had previously identified the constraint as the Doctor’s availability to see the patient, their improvement focus would be directly on ways to reduce waste with respect to the Doctor’s time.  In my last posting I shared the Interference Diagram (ID) that the team created, but in Figure 4 you’ll see their final ID which not only has additional interferences, but now has some recommended solutions.  The boxes in green were designated by the team as ones that should be given the most attention.  The information in the green boxes and other observations by the team would form the basis for the improvement plan to be presented to the staff.

Figure 4

The team also created two Future State maps.  One map assumed that a bed would be available for the ED patient and the other assumed there would not be a bed available.  Figures 5 and 6 are those maps.  In the case where the bed is available (Figure 5), the team believes that the Door to Doc time can be reduced from an average of 88 minutes, to 18 minutes.  When the bed is not available, the team believes that the new Door to Doc time will be approximately 42 minutes.  The team believes that with the new changes, the average Door to Doc time will be somewhere around 30 minutes.

Figure 5

Figure 6
Using the Theory of Constraints as part of the hospital’s improvement methodology is new for everyone here, but we have an additional 4 VSA events already scheduled, so the methodology has been well-received.  For the next two weeks I’ll be working with a manufacturing company that produces surgical tools for healthcare and I’ll report as many as my findings as I am permitted to report.  Of course, like this posting, I will refrain from identifying the name of the client.
Bob Sproull

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