Measure: Current State Spaghetti Diagram

Visual representation
of process
Measure: Current State
Spaghetti Diagram
Registration
Triage
Nursing Station
Walk In Patient
Total Time - 4:52
Entry to Triage – 45min
Triage to Bed-1:30
Bed to Disposition-2:35
Ambulance Patient
Total Time - 6:20
Entry to Triage – 30min
Triage to Bed 15 min
Bed to Disposition-5:35
1
Purdue Research Foundation©
Metrics Are
Specified
Measure: Data Collection Plan
Data Collection Plan
Data Collection
Plan
Proposed
Graph
ED Turn Around Time
Data
Source*
Daily
Daily / Segregate
month
Daily / Segregate
month
Daily / Segregate
month
Daily / Segregate
month
Elopements
ED Volume Patterns
Radiology
Lab
EVS
Data to be
Collected
Avg. by Day and
Q2 hr intervals by
time of day
by
by
by
by
Daily / Segregate by
month
Operational Definition
Who?
Wellsoft
Patient arrival to leaving the ED
(Arrival-triage; TriageRegistration; Registration-bed;
Triage-bed; Bed-Time seen by
Dr.; Dr. to Disposition;
Disposition to leave ED, hrs of
diversion
All ED Patients
100% ED Patients
ZB
Wellsoft
LWOT, LWTC, LWBS, AMA,
All ED Patients
100% ED Patients
ZB
Wellsoft
Time of Day and Day of Week
All ED Patients
100% ED Patients
ZB
Cerner /
Manual
Turn around time for ER
Survey
Turn around time for ER
Survey
All ED Patients
100% ED Patients
MJ Casey
All ED Patients
100% ED Patients
Rose
All discharges and
transfers
100% of rooms
Michelle
ED incidents incl
elopments and AMA's
100% of ED
incidents r/t wait
times delays,
elopments &
AMA's
Rob
ED Complaints
100% of ED
complaints r/t wait
time complaints
Kathy W
Sunquest?
Manual
Rec'd room request to room
ready by housekeeping
Risk Mgmnt
Daily / Segregate by
month
Incident
reports /
STARS
# & type of incidents r/t wait
time delays and risk
Patient Complaints
Daily / Segregate by
month
Patient
complaint
Excel vs. UHC
# & type of complaints r/t wait
time delays
2
Sample Size
Purdue Research Foundation©
Measure: Discharge Process
Weekend Delays
Procedure & Testing Denials Q3 '07
n=57
60
91%
90%
86%
50
81%
80%
Data Provided
To Describe
the Problem ?
70%
40
Days
96%
95%
100%
98%
70%
60%
58%
89% occurre d
on we e ke nd
30
100% occurre d
on we e ke nd
50%
100% occurre d
on we e ke nd
40%
20
18
32%
30%
15
20%
10
7
6
3
3
2
10%
1
1
1
0
0%
Stress Test
General Sx
MRI
Cardiac Cath
GI Sx
Colonoscopy
Endoscopy
Podiatric
OR
Consult
Cause
3
Purdue Research Foundation©
Data Provided
To Describe the
Problem ?
Measure: Housekeeping
Delay’s Pareto
Nursing Delay's in notification to Housekeeping
160
100
80
120
100
60
80
40
60
40
20
20
Nursing Unit
0
Count
Percent
Cum %
4
Percent
Delays > 30 Min
140
B
B
B
A
A
2
2
4
3
3
t
it
t
i
t
t
i
i
i
n
n
n
n
n
U
u
U
U
U
41
26.1
26.1
29
18.5
44.6
24
15.3
59.9
19
12.1
72.0
18
11.5
83.4
S
B
O
3
t
i
Un
12
7.6
91.1
C
8
5.1
96.2
r
e
h
t
O
0
6
3.8
100.0
Purdue Research Foundation©
Measure: ED AVG Patients by Day of Arrival
Patient Arrival by Time of Day
Data Provided To
Describe the Problem ?
A ver ag e Pat i ent s b y Ho ur and D ay
10
9
8
7
6
5
4
3
2
1
5
0
100
200
300
400
500
600
700
800
900
1000
1100
1200
1300
1400
1500
1600
1700
1800
1900
2000
2100
2200
2300
M on
4. 153846154
3. 461538462
2. 153846154
1. 692307692
2. 153846154
1. 846153846
2. 307692308
3. 076923077
4. 384615385
7. 923076923
7. 692307692
10
9. 307692308
9. 230769231
9. 076923077
8. 769230769
8. 461538462
8. 076923077
7. 615384615
7. 846153846
6. 461538462
5. 307692308
4. 153846154
4. 230769231
T ue
2. 846153846
2. 846153846
1. 538461538
1. 461538462
1. 615384615
1. 230769231
1. 538461538
2. 769230769
4. 615384615
5. 769230769
7. 538461538
7. 923076923
8. 846153846
7. 307692308
8. 307692308
8. 230769231
8. 076923077
8. 923076923
7. 615384615
7. 384615385
6
5. 153846154
4. 769230769
4. 076923077
Wed
2. 769230769
1. 769230769
1. 769230769
1. 692307692
1. 230769231
1. 307692308
2. 230769231
2. 923076923
4. 692307692
5. 769230769
7. 461538462
7. 384615385
8. 230769231
7. 923076923
8. 076923077
8. 384615385
7. 384615385
8. 384615385
7. 230769231
7. 538461538
7. 615384615
5. 769230769
5
3. 769230769
T hu
2. 769230769
1. 923076923
1. 692307692
1. 923076923
2. 153846154
1. 461538462
1. 230769231
2. 769230769
4. 538461538
7. 230769231
6. 692307692
8. 923076923
8. 461538462
7. 230769231
8. 153846154
8. 615384615
7. 384615385
9. 461538462
9. 230769231
7
6. 307692308
5. 538461538
3. 923076923
3. 230769231
Fr i
2. 461538462
2. 923076923
2. 307692308
1. 692307692
1. 461538462
1. 384615385
1. 769230769
2. 153846154
4. 769230769
8. 538461538
7. 923076923
9. 153846154
8. 230769231
8. 153846154
8. 153846154
7. 923076923
8. 076923077
7. 307692308
6. 307692308
6. 307692308
6
6. 769230769
5. 230769231
4. 076923077
Sat
3. 384615385
3. 230769231
2. 076923077
1. 769230769
2. 230769231
1. 769230769
2
3. 076923077
3. 692307692
5. 230769231
7. 846153846
7. 076923077
7. 307692308
8. 153846154
6. 846153846
7. 615384615
8. 307692308
7. 153846154
7
6. 769230769
5. 769230769
6. 461538462
6. 846153846
4. 769230769
Sun
3. 666666667
3. 666666667
2
2. 583333333
2. 5
2. 083333333
2. 166666667
2. 75
4. 416666667
6. 583333333
8. 916666667
7. 666666667
8. 666666667
7
6. 833333333
6. 5
6. 833333333
6. 666666667
5. 916666667
6. 75
5. 75
6. 333333333
5. 333333333
5. 083333333
Purdue Research Foundation©
Measure: Average ED Arrival
Time
of
Day
Data Provided To
Describe the Problem ?
Pt arrival by time of day
May need to update charter
with more defined goal as
you get data !!!!
1800
1600
1400
Patients
1200
1000
800
600
400
200
0
0000 0100 0200 0300 0400 0500 0600 0700 0800 0900 1000 1100 1200 1300 1400 1500 1600 1700 1800 1900 2000 2100 2200 2300
Arrival time
6
Purdue Research Foundation©
Project Title and Area:
Date:
Authors:
Analyze
Understanding the waste & variation
Select Project
Pre-
How does this project move the organization to its goals?
Define the problem
Why this problem?
1. Business case has been explained
2. Problem statement in measureable terms
3. Data provided to describe the problem
4. Performance gap is described
5. Metrics are specified
Define
Grading Criteria
Removing the waste & variation
1. Current state performance is described
2. Visual representation of process is shown
3. Data describing problem/process is provided
4. Project objectives/goals are specified
Set Goal – “SMART”
7
Improve
What x’s and processes were measured to
Quantifying the
waste & variation understand the stated problem?
Grading Criteria
Preventing recurrence of the waste and variation
Control
Measure
Organization:
Purdue Research Foundation©
Key A3 Define Grading Criteria
1. Business case has been explained
2. Problem statement in measureable terms
3. Data provided to describe the problem
4. Performance gap is described
5. Metrics are specified
8
Purdue Research Foundation©
Key A3 Measure Grading Criteria
1. Current state performance is described
2. Visual representation of process is shown
3. Data describing problem/process is provided
4. Project objectives/goals are specified
9
Purdue Research Foundation©
Anthony Veasey, MA,CPHQ , LSSBB | Senior Advisor – Lean Six Sigma
708-790-5541 (office) | 708-790-5541
(mobile) | [email protected]
Purdue Healthcare Advisors | Purdue University
10
Purdue Research Foundation©
Appendix
11
Purdue Research Foundation©
Radiology Test
Turnaround Time ( Case
Example)
12
Purdue Research Foundation©
Define: Charter
Why Is This A
Problem ?
Project Statement
St. Martin’s Hospital in Richmond has a goal for radiology report
turn around time of 24 hours for outpatient and emergency room
procedures and 8 hours for inpatient procedures. Currently, 70% of
the inpatient reports and 56% of outpatient reports are not
complete within the expected time frame. The hospital would like
to improve test result turnaround time to gain market advantage
over their competitors.
Project Scope
Performance GAP
The hospital’s administration has given directives to a multidisciplinary team to identify the factors that effect radiology report
turn around time and improve the processes. Improvement in this
process will facilitate the strategic growth of the services, improve
customer satisfaction and reduce length of stay. The team will
identify the processes or procedures that cause delays in report
completion, identify process changes to improve performance,
meet specified customer expectations, and determine how to
implement the improvements.
13
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Define: Charter
Project Objectives/Goals
Specified
Key Deliverables
– Implementation plan for all identified solutions
– Increase in the number of reports completed within the goal of 24 hours for outpatient and ER
and 8 hours for inpatient to 80%.
– Increase in outpatient volume.
– Improve customer satisfaction.
Financial and Operational Benefits
– Increase annual radiology volume by 10% which equates to 18,000 procedures at $100 per
procedure annually for a total of $1,800,000.
ROI
– Reduce length of stay in the ER and on inpatient units.
– Increase customer satisfaction to 65% excellence by reducing wait time for procedure and
results.
– Improve relations with referring physicians.
– Decrease unbilled procedures by having reports in patient’s chart within 24 hours.
Roles and Responsibilities
Champion
Jane Doe
Process Owner
Jim Doe
Project BB/GB
Ken Doe
14
Members
Sam Morton
James Dean
Arnold Adam
Purdue Research Foundation©
Define: SIPOC
S
I
P
O
C
SUPPLIER
INPUT
PROCESS
OUTPUT
CUSTOMER
Patient
Procedure Type
Radiology Test
Ordered
Radiologist
Physician Orders
Ordering Physician
Patient Location
Procedure
Performed
Test Results
Patient
Final Report
Ordering
Physician
Accurate Final Report
Radiologist
Unit RN’s
Radiology Tech
Transcription
Radiologist availability
Film Developed
Transcription Services
Timely Final Report
Coding
Patient care delivery
Film Read by
Radiologist
CTQ
Report Dictated
Report Transcribed
Report Signed by
Radiologist
CRITICAL TO QUALITY
Final radiology report is
completed within 24 hours for
OP and ER and 8 hours for IP.
Final radiology report is
accurate and complete.
Report Placed in
Chart
15
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