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
|
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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