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Patient Flow

Caldwell Butler & Associates expertise extends to improving:

  • Surgical flow, capacity, and satisfaction of surgeons

  • ED Flow, Reduced Wait Times and Left Without Treatments (LWOTS)

  • Admissions / Discharges of patients

Caldwell Butler & Associates offers proven processes for improving patient flow throughout your organization. The classic Lean-Six Sigma approach tends to focus on departments and projects. True strategic gains in patient flow require a systematic approach that transcends departmental boundaries. Success requires multi-disciplinary teams that can work along process continuum.

Step 1: Preparation and Data Summit

The statistical toolbox of Six-Sigma can provide rich insights into where and which improvements can provide the most gains for a hospital. However, the traditional DMAIC process can be tedious and actually slow progress and perpetuate analysis paralysis. Six Sigma methods are very powerful but this must but their application must be balanced with the value of speed and action. In contrast, Lean provides the framework for rapid action but is frequently criticized for its lack of analytical tools. So what's the best place to begin?

CBA offers modifications structure call Accelerated DMAI2C, which strikes a balance between tribal knowledge and industrial DMAIC. Our recommended approach provides for a rapid start but with the structure to ensure that your team is working on the right process improvements. CBA's approach takes into consideration the current readiness of each group of process owners, their current bank of ideas and balances the need for speed with the probability of success.

When data is required, unfortunately useful data is frequently trapped in disparate legacy IT systems. CBA developed the Data Summit Process as a proprietary approach for maximizing the data and information contained in the hospital's legacy IT system. The Data Summit begins with the creation of a Value Map combined with an exercise to link each critical step of the work process to a time stamp field generated in one of the legacy IT systems. Once completed, the process provides a rich source of data for Six Sigma analysis and provides valuable insights into workflow.

Occasionally manual data collection is a necessary part of completing a valid analysis. CBA has developed a proprietary method known as the 14-Day Longitudinal Study as a means of collecting this vital information for collecting the data that is frequently missing from hospital IT systems. This process usually involves training and strategies for observing and collecting data on the actual patient flow and processes.

Step 2: SIPOC Structure For Team

CBA recommends that patient flow oriented100-Day Workout Structure be organized as multi-disciplinary teams working in a process continuum "SIPOC method". CBA has a high success rate when using these methods to break down departmental barriers and improve patient flow. This involves:

Creation of Cross Functional Teams: Organized by Sub Processes: CBA recommends that organizations create multi-disciplinary teams based on addressing each of the sub processes related to patient flow. Each of these teams will be chartered with making a specified number of changes (Activity Goals) and will be accountable for completing their 100-Day Action plans. Some of these teams may already be chartered, however all teams would be placed in the workout structure. This structure may incorporate existing initiatives, which will increase the probability of a successful completion.

Example of Surgical Team Proposed Goals and potential team structure:

  • Incision Time No Later Than < 7:40 am Start Time (USL)
  • Room Turn-Around-Time (TAT) < 15 Minutes
  • To-Follow Case Scheduling Variance +/- 15 Minutes
  • Surgeon Preference Card Accuracy > 95% (USL)
  • Surgeon In-Room to Scheduled Time +/- 10 Minutes

SIPOC Concept (Process Continuum): Below is a diagram of the SIPOC (process continuum) structure. CBA has transformed this concept into a six-step SIPOC method described below.

CBA provides expertise and support in organizing the teams for maximum success. SIPOC is an acronym for Lean-Six Sigma term that stands for:

  • Supplier: The people or organization that provides information, material, and other resources to be worked on in the process.
  • Inputs: The information / materials provided by the supplier that consumed or transformed in the care process.
  • Process: The series of steps that transform and add value to the output.
  • Output: The product or service used by the customer
  • Customer: The people, company, or another process that receives the output from the process

The SIPOC method is an excellent method for having people develop a high level understanding of the issues from a process perspective. The plan is to avoid excessive data analysis and move team members into a process where they can make educated guesses about which process elements warrant additional investigation. The goal is to promote lively participation from everyone on the team and get your staff focused on potential solutions to long-standing problems. It also will provide structure for cross team collaboration in an effort to make real improvements. The SIPOC structure will provide the framework for the teams to develop 100-Day Action Plans.

Benefits of SIPOC Structure

  • Improves interdepartmental collaboration
  • Improves skills for identifying opportunity in the white spaces; those areas that occur during the handoff in work
  • Introduces additional skills from the Lean-Six Sigma tool set
  • Strengthens managers’ sense about how their work processes affect those who consume their work as well as supply their department with information, inputs

CBA's Six Step SIPOC Process

Step 1: Identify and Graph Critical-to-Quality Metric

As a first step, CBA recommends that leadership provide managers with an improvement challenge or goal to which to aspire. An example of an effective goal is to ask each department managers; "What change or improvement in work process would result in improved patient flow?" "What change will allow us to add 1 more case per day per OR?" In addition, CBA recommends that leadership establish firm activity targets for each participants and each team such as "implement 8 changes during the 100-Day process."

Step 2: SIPOC Method

CBA recommends that managers be organized in cross-functional teams and be empowered to improve a specific element of the core processes selected. Groups will consist of suppliers, process owners, and customers of the process. Each team will develop a high level flow map of the process being studied; in this case, processes that have the potential of altering staffing levels.

Experience and research has consistently shown that the vast majority, greater than 50%, of waits, rework, and errors happen during the handoffs in care that occurs between departments. This fact makes interdepartmental SIPOC teams highly effective at identifying issues and improving workflow.

Step 3: Identify Lean Opportunities

  • Eliminate Non – Value Added Activities
  • Re-sequence Business Value Added Activities
  • Increase cycle time of Value Added Activities
  • Reduce harmful variation
  • Improve Use the 7 Categories of Quality Waste

During the 100-Day Workout teams and their participants should only be exposed to the tools relevant to work to be completed in the next 100-Days.

Step 4: Create Action Plans

Managers will create action plans denoting "Do Now", 30 Day, 60 Day, 90 Day, and 120 action items. Each plan will specify specific deliverables and tasks to be completed over the next 100 days. Plans will then be entered into EXCELerator and updated on a regular basis as critical tasks are completed. CBA recommends that such a session be completed in a computer training lab to ensure team members successfully create and enter their plans.

Step 5: Rapid Cycle Testing

Teams should be familiar and encouraged to use Rapid Cycle Testing at every opportunity. CBA provides a Rapid Cycle Testing training module for accelerating the rate of implementing and testing change concepts. Teams should be provided with easy to use templates for testing the effectiveness of any changes to a work process or procedures. Training in Rapid Cycle Testing reduces human barriers that reinforce the status quo. In addition, it also reduces the amount of time your team requires to test a new concept, thereby reducing the risk that your team wastes time and resources on concepts that will not produce results.

Step 6: Hardwire Variable Solutions

Based on the results of rapid cycle testing, participants will receive coaching in hard wiring changes and be challenged to develop controls and alarms in order to maintain gains in performance. CBA provides coaching in 84 change concepts to engineer and imbed methods for holding the gains.

CBA offers the following support and resources for Patient Flow

  • SIPOC 100-Day Workout
    • Data Summit Process
    • Lean-Six Sigma analytical tools
    • Quality Waste Coaching Guide
    • If-Then-Then-Then Guide
    • Rapid Cycle Testing
    • 84 Change Concepts
  • Idea Data Bank
    • Successful change strategies
    • Best Practices
  • 100-Day Workout Implementation Guide
    • Apprenticing in 100-Day Workout
    • Key Roles
      • Executive Champion
      • Communication Coordinator
      • Finance Liaison
      • Workout Coordinator
  • One-on-One Manager Coaching by CBA’s expert staff
  • EXCELerator