Healthcare Case Study Part 3

 

Continuing on with my healthcare case study.  The time data that had been collected was broken down into three separate phases of the D2B process: Door to EKG, EKG to Table and Table to Balloon. This was extremely helpful for the team in their efforts to identify the system constraint. As you can see in Figure 4 from my last posting, the EKG to Table Phase, with a mean value of 36.7 minutes, is clearly that part of the process requiring the most time and was designated by the team to be the system constraint. Table to Balloon time, at 21.2 minutes on average, also consumed a significant amount of time, while Door to EKG only required 4.75 minutes to complete. It is important to remember that this metric (D2B Time) was developed to capture median times rather than mean times, so hospitals are judged (and reimbursed) by a median time and are reported as such. The difference between the median and mean times for EKG to Table (i.e. median = 32 minutes and mean = 36.7 minutes) indicates that the data might be somewhat skewed and not perfectly normally distributed. This, of course, means that there are outliers that must be investigated for cause.

                                                Figure 5 Interference Diagram

After collecting and analyzing this data, the team was instructed to create two Interference Diagrams (IDs), one for Phase 2 (EKG to Table) and one for Phase 3 (Table to Balloon). You may recall from an earlier chapter that the purpose of the ID is to identify any barriers or obstacles (i.e. interferences) that stand in the way of achieving a goal or objective. In the cases for Phase 2 and 3, the goal was identified as reducing the time required to complete each phase. Figure 5 is the Interference Diagram created by this team for EKG to Table.

The following photo (Figure 6) was of the Interference Diagram created for the EKG to Table phase and is presented here only to depict what an Interference Diagram looks like for those of you who may never have used one before. The post-it notes contain a description of the interference with an estimate of how much time the interference might negatively impact the goal of reducing cycle time.  The Interference Diagram can then be used to develop and improvement plan on how to reduce the EKG to Table phase time.

Figure 6 Photo of ID

The team then used their fact-finding “walks” (i.e. observations and conversations) and the Interference Diagrams to create a SIPOC as demonstrated in Figure 7.  The team next developed a current state process map (Figure 8) and then completed a value assessment (Figure 9) of each step with green being seen as an acceptable process step with no improvement required.  Yellow indicates that the step in its current state needs improvement. Red indicates that the step is not adding value and needs to be either removed or improved dramatically!

                                        Figure 7 SIPOC Diagram

                                    Figure 8 Current State Process Map

Figure 9 is the Current State Map after completion of the standard value analysis, and as can be seen, the number of total red steps that exist was quite high.   The team next developed a future state map that reduced the number of decision points, swim lanes and hand-offs. This effort resulted in a dramatic reduction in the number of non-value-added (i.e. red) steps (i.e. 27 to 3).

                                    Figure 9 Current State Map after assessment 

In my next post, we will complete this case study.