SKMC TRANSFORMATION PROJECT : VACCINE BAR

Transcription

2011 TRANSFORMATIONAL EVENT
SHEIKH KHALIFA MEDICAL CITY:
BULL’S EYE
HITTING THE MARK WITH A NEW APPROACH TO
VACCINE MANAGEMENT
SKMC TRANSFORMATION PROJECT : VACCINE BAR-CODING
2
Contents
Introduction ............................................................................................................................................................... 3
1. Project Selection and Purpose ............................................................................................................................... 4
2. Current Situation Analysis .................................................................................................................................... 10
3. Solution Development ......................................................................................................................................... 13
4. Project Implementation & Results ....................................................................................................................... 16
5. Team Management .............................................................................................................................................. 30
Appendix 1 – Bar-Coded Vaccination Process ......................................................................................................... 31
Appendix 2 – In-House Developed Patient Education Materials ............................................................................. 32
Figures
Figure 1 – 2010 Average Clinic Visit Time Sept-Nov (Minutes)................................................................................ 10
Figure 2 – Current State Clinic Patient Process Flow ............................................................................................... 11
Figure 3 – Erroneous Record Book Pre-Bar-Coding Implementation ...................................................................... 16
Figure 4 – Nurse Bar-Coding Training Process ......................................................................................................... 18
Figure 5 – Bar-Code Mapping Sheets ....................................................................................................................... 19
Figure 6 – Reduced Appointment Time Impact (One Clinic).................................................................................... 20
Figure 7 – Post-Implementation Clinic Patient Process Flow .................................................................................. 21
Figure 8 – Post-Implementation Patient Wait Time Reductions ............................................................................. 22
Figure 9 – Post-Implementation Patient Visit Increase ........................................................................................... 23
Figure 10 – Potential Revenue Increase Due to Increased Patient Visits ................................................................ 24
Figure 11 – Patient Education Materials Developed for Clinic ................................................................................ 25
Figure 12 – Post-Implementation Nurse Efficiency ................................................................................................. 25
Figure 13 – Post-Implementation Data Improvements ........................................................................................... 26
Figure 14 – Post-Implementation Record Keeping Improvements ......................................................................... 27
*Word count does not include Introduction, Criteria Questions or Image/Table Titles and Content
3
Introduction
Sheikh Khalifa Medical City (SKMC) is committed to providing outstanding patient experience, superior clinical
outcomes, and improved quality of life for the people it serves. The foundation of this commitment is built on
the cornerstones of quality and patient experience. As a healthcare provider on the forefront of medicine, SKMC
is always examining and implementing new processes and procedures that will benefit the patient and ensure
quality outcomes.
In January 2011 SKMC transformed the way it delivered care to patients receiving vaccinations. In order to
accommodate the immense volume of patients seeking vaccinations, SKMC founded the Nurse Vaccination
Clinic. The clinic provides patients with a direct avenue to receive vaccinations and allows physicians more time
to see patients with more critical health issues.
As was the practice for all vaccination treatments, nurses working in the Vaccination Clinic were required to
manually administer and record all information specific to the patient’s visit for record keeping and billing
purposes. This antiquated process was time and labor intensive, ultimately pre-occupying the nurses with
administrative work and removing the emphasis on patient care. Thus was the case until the Nurse Vaccination
team determined that bar-coding a longstanding technology used in other non-healthcare industries, could be
adopted to improve their efficiency and accuracy, ultimately improving both patient care and the patient
experience.
Bar-coding has transformed the way vaccinations are administered at SKMC facilities, ultimately improving
patient care and quality outcomes, aligning to the core commitments of SKMC.
4
1. Project Selection and Purpose
1A. Explain the methods used to choose the project.
1Aa. Describe the types of data and quality tools used to select the project, and why they were used
The vaccination process in the Nurse Vaccination Clinic was slow and full of errors. When looking into
how we could improve the process, potential solutions were evaluated using the following tools:
Tool/Data
Financial Feasibility
Replication
Results Focused –
Measurable Data
Patient Satisfaction
Employee
Satisfaction
Cause for Use
A financial review of each solution would ensure that the solution we
choose would produce the greatest return on investment versus the cost of
the solution
A solution that is replicable throughout SKMC and all of SEHA would
positively affect the largest number of patients and caregivers
The ideal solution would improve the quality of care in a manner that could
be easily measured and reported
The ideal solution would have the greatest effect on patient care,
experience and satisfaction
The ideal solution would have the greatest effect on employee experience
and satisfaction
1Ab. Explain the reasons why the project was selected
The vaccination bar-coding project was selected because it performed the best against all of the above
criteria. The matrix below highlights the reasons behind the selection of this project.
Tool/Data
Financial Feasibility
Replication
Results Focused –
Measurable Data
Patient Satisfaction
Cause for Use
The bar-coding solution would have no cost to the organization, maximizing
return on investment.
 Internet contains free bar-coding software, uploaded to each
workstation at no cost
 Patient Registration had several boxes of scanners in storage not
being used
 No formal outside training on system
 SKMC- IT created an interface between bar-coding system and
Cerner
 SKMC- IT created an interface between bar-coding system and
Quality Department in-house
 Great financial returns through a more efficient, less time consuming
process that allows more patients to be seen throughout the day
Zero cost, in-house IT adjustments and utilization of similar equipment and
software by system nurses created a great opportunity for replication
Easy interfacing with other IT applications creates the opportunity to
capture real-time, accurate data. More accurate and timely data helps the
institution determine breakdowns in process and patient care, helping to
prevent unwanted outcomes. It also produces tangible results that can be
measured and benchmarked across the organization.
If successful would efficiently stream-line patient throughput, allowing
patients greater accessibility to appointments and more timely care. More
Employee
Satisfaction
5
accurate data capture would ensure patient records were correct and
retrievable in real-time should patient lose their documentation
If successful would make work less manual- reducing errors and allowing
nurses more time for direct patient care. More time focused on direct
patient care resulted in better patient education and more efficient
appointments
1Ac. Describe the involvement of potential stakeholders in project selection
The stakeholders involved in the decision-making process were mainly internal SKMC staff, comprised of
multi-disciplinary leadership team and nursing teams and patients, while a key stake-holder, were not
directly involved in the selection process. They were, however, always first and foremost when
developing the project. More detailed involvement by the stakeholders was as follows:
Stakeholder
Leadership Team
Nursing Team
Patients
Involvement/Responsibilities
The leadership team was responsible for reviewing solutions proposed by
the nursing team and reviewing the quality/data results to determine the
most effective solution. After implementation the leadership team would
track the success of the solution and determine if it should…
1. Continue to be utilized
2. Be replicated across the enterprise
3. Be shared with external facilities as best practice
The nursing team was responsible for coming up with the idea and
effectively testing the selected solution, develop training curriculum,
educate patients on the process, track results and train other nursing teams
if implemented organization wide.
In order for the project to be a success patients must benefit directly from
it. The project must seamlessly anticipate and accommodate the patients’
needs, with easily measured results. Their waiting times, the accuracy for
receiving the proper vaccination, and the number of visits must all show a
quantitative improvement. Qualitatively, they must have a positive
impression of the project as measured in patient satisfaction
surveys/scores.
1B. Explain how the project supports/aligns with the organization’s goals, performance measures, and/or
strategies.
1Ba. Identify the affected organizational goals, performance measures, and/or strategies.
1Bb. Identify the types of impact on each goal, performance measure, and/or strategy.
1Bc. Identify the degree of impact on each goal, performance measure, and/or strategy, and how this was
determined.
SEHA and SKMC have identified several key priorities focused on data integrity, patient access and
provider productivity. This program successfully addresses all of these key priorities.
Degrees of Impact:
● = Significant; ● = Insignificant; ● = No Impact
Goal/Measure/Strategy
SEHA Initiative Code
SKMC priority Code
SEHA-1/1-2
SKMC- 01 1.1.5
TYPE
Degree
Positive
●
Negative
●
N/A
SKMC-01 1.6.1
Positive
●
Negative
●
N/A
SKMC-01 1.6.2
Positive
●
Negative
●
SEHA-3/1-12
SKMC-03 1.4.1
Positive
●
Negative
●
N/A
6
SKMC-02 2.3.1
Positive
●
Negative
●
Alignment Reasoning
Goal/Measure/Strategy
Identify & Resolve IT issues that affect data integrity and
impact revenue and/ or expense
Justification
Could have a great impact on the process and collection
of more accurate, real-time data and revenue
Unsuccessful implementation would not result in
significant changes compared to current data collection
Exceed OSC volumes by 10% over budgeted by
improving access, throughput and productivity
Could have great impact on improving access,
throughput and productivity
significant changes to current throughput results
Increased FMC volumes by 10% over budgeted volumes
by improving access, throughput and productivity
Could have great impact on improving access,
throughput and productivity
Meet productivity targets
Could have great impact on productivity as a result of
improved process and throughput
Create signature programs/marketing for all areas that
care for children.
Could become a signature program for our FMCs that
drastically improves patient education/throughput in
these areas
significant changes to current process; could look for
other ways to meet goal
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1C. Identify the potential stakeholders (who may be impacted by the project) and explain how they may be
impacted by the project.
1Ca. Identify potential internal and external stakeholders and explain how they were identified.
1Cb. Identify the types of potential impact on stakeholders and how these were determined.
1Cc. Identify the degree of potential impact on stakeholders and explain how this was determined.
The potential stakeholders of this solution could ultimately be affected in a positive way on grand scale
or a small scale; therefore the types of impacts have been categorized based on the roles and
responsibilities of each stakeholder group (each affected by financial impact, process impact and the
care delivery model) and the degree of impact.
●
●
Degrees of Impact:
= Significant;
= Insignificant;
Types of Impact: Financial, Process, Care Delivery
●= No Impact
Internal Stakeholders
Stakeholder
Leadership
Team
Type
Stakeholder Reasoning
Responsible for approving implementation, the leadership team would ultimately have to
track the success of the solution and determine if it should
1. Continue to be utilized
2. Be replicated across the enterprise
3. Be shared with external facilities as best practice
Degree
Justification
Process
●
●
Care Delivery
●
Financial
Nursing Team
Financial
Process
Care Delivery
Other SKMC
Facilities
Could be adopted across system resulting in a significant improvement in
system’s current process
Could revolutionize delivery model and all code –able items used for patient
care
Required to test the solution, develop training curriculum for internal team, and educate
patients on new process. Develop new patient education tools/opportunities. Track results
and if successful, train other nursing teams and implement across the organization.
●
●
●
No implementation or removal costs
Could adopt across system requiring team to train all nurses
Could revolutionize vaccination delivery model and have significant effects on
patient interactions/experience
Could adopt new solution proved successful in the Nurse Vaccination Clinic. All
stakeholders in other SKMC facilities would then be impacted.
Process
●
●
Care Delivery
●
Financial
Could be adopted across system requiring all facilities to be trained and
implement new solution.
Could revolutionize vaccination delivery model and have significant effects on
patient interactions/experience
SKMC Quality
Department
Responsible for capturing the data transmitted by the bar-coding system and analyzing the
results of the data. Department would also be responsible for transmitting data to all
requesting governing bodies. If used successfully, it could revolutionize the data capture
process.
Process
●
●
Care Delivery
●
Financial
Clinic
Physicians
Financial
Process
Care Delivery
Clinic
Registration
Financial
Process
Care Delivery
Clinic Security
Minimal costs associated with interfacing with bar-coding applications.
Could increase Quality team’s interface with all nursing workstations, capturing
real-time, accurate data from all departments.
Successful implementation and interfacing could result in more accurate data,
analysis, and better informing strategic decision-making.
A more efficient throughput model could reduce patient waiting time between seeing
nurses and physicians resulting in increased patient satisfaction, better patient care, and
more patient encounters.
 Improved patient throughput could increase number of patients seen each
day
 Vaccination by nurses also allows physicians to be occupied by more
complex cases.
Improved patient throughput could require physicians to streamline their
process of seeing patients.
Improved patient throughput could allow physicians to focus on more complex
cases and devote their time to the most critical patients.
●
●
●
A more efficient throughput model could minimize waiting times and reduce overcrowding
making patient registration more manageable, efficient, and pleasant
 Improved patient throughput could increase number of patients
registered/ seen each day
 Registration Des employees would need to be able to support the
increased patient volume
Improved patient throughput could increase patient volumes and require the
registration team to adopt a more seamless, efficient process in order to keep
up with increased demand.
Required to keep up with the increased demand and shortened intervals
between appointments to maintain efficiency in the waiting areas. Success in
keeping up has significant positive effect on patient experience and care
deliver.
●
●
●
A more efficient throughput model could minimize waiting times and reduce overcrowding
which can result in the need for Security assistance due to patient frustration.
No change, a security guard must be on duty during working hours
Process
●
●
Care Delivery
●
Financial
8
Could face significantly less issues in the waiting areas if patient throughput
improves and coinciding patient registration moves seamlessly.
Less security issues could significantly improve the overall patient experience
as it begins when the patient walks through the doors.
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External Stakeholders
Stakeholder
Patients
Type
Financial
Process
Care Delivery
Other SEHA
Facilities
Financial
Process
Care Delivery
Health
Authority-Abu
Dhabi
Financial
Process
Care Delivery
Insurance
Companies
Financial
Process
Care Delivery
Stakeholder Reasoning
Patients could either benefit or not benefit from implementation of the solution. Their
ability to adapt to the new system could greatly affect both the quantitative and
qualitative results of the new solution. Their waiting times, accuracy for receiving the
proper vaccination, and number of visits would affect the quantitative numbers. While
qualitatively, their perception of the new system could affect patient satisfaction surveys/
scores.
Degree
Justification
Could increase efficiency and number of nurses tasked with administering
vaccines, costing patients less as nurse visits are less expensive than physician
visits.
Could significantly cut patient waiting times, improve patient access and overall
patient experience
Could significantly alter vaccine administration allowing for greater patientprovider interaction, more time for patient education and a greater feeling of
satisfaction by the patient.
●
●
●
Other SEHA facilities could benefit from/adopt the new solution given its zero cost, ability
to be replicated, uniqueness to the market and opportunity to improve patient experience.
Implementation of a similar solution could cost nothing (like SKMC) or could
cost a minimal amount (mainly for the scanner) – depends on current
technology capabilities.
Would need to be trained and adopt process and technology, but could benefit
from more efficient patient throughput and satisfaction.
Could revolutionize care delivery model and significantly affect patient
interactions and experience.
●
●
●
Conveyance of more accurate, real-time data could improve the data collected by HAAD
for SKMC. Adjustments in data capture process could also require HAAD to adjust its IT
systems in order to accommodate SKMC’s data transfer.
Depending on current technologies in place, may be required to update/adjust
IT systems to accommodate data transfer from SKMC/other SEHA facilities.
Significant change/increase in data capture could increase volume and quality
of data captured, improving reporting, data analysis, and forecasting.
Changes/increases in data capture effecting reporting and data analysis could
significantly influence the care model and care delivery
●
●
●
More accurate patient registration, documentation and coding could mean more efficient
claims processing and diminishing rejection volumes.
More accurate encounter data, improved patient throughput, and increased
volumes could significantly increase the number of cases paid by insurance
institutions
Must be able to adapt to increase in volume and timely payment of claims
●
●
●
Timely payment of claims helps overall financial record keeping and budgeting
of the institution being paid.
10
2. Current Situation Analysis
The new process created a more stream-lined workflow, as before two nurses were assigned to each patient,
but with the new system it was reduced to one nurse resulting in improved nursing utilization and productivity.
2A. Explain the innovative approach/process the team used to identify the potential root cause(s) or
improvement opportunity(s).
2Aa.Describe the innovative methods and tools used to identify possible root causes/improvement
opportunities.
2Ab. Describe the team’s innovative analysis of data to identify possible root causes/improvement
opportunities.
The nurse vaccination team’s creation of the Nurse Vaccination Clinic led to an increase in the number
of vaccinations administered by non-physicians, improving patient access to vaccination appointments,
and opening up more physician appointments for sick patients.
Aided by the Quality Department, the nurse vaccination team took raw data from the current state and
previous year, and examined it to see if there were any significant changes in patient throughput.
The team found that patients in the Vaccination Clinic in Family Medicine Clinics were spending an
average of 75 minutes per vaccination before the project. This time has now been reduced to 45
minutes, reducing the time that patient spend in the clinic by 30 minutes.
Figure 1 – 2010 Average Clinic Visit Time Sept-Nov (Minutes)
100.0
90.0
86.3
79.9
80.0
65.0
70.0
75.1
77.5
Al Zafranah
Mushrif
61.9
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Al Bateen
Al Khaleej
Al Manhal
Al Rowdha
2Ac. Describe how or if any of the stakeholders were involved in identifying the possible root
cause/improvement opportunities.
As a result of these findings, the nurse vaccination team took it upon themselves to map the patient
process flow in the clinic as a way to determine waiting times and the opportunity for improvement.
Figure 2 displays their findings.
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Figure 2 – Current State Clinic Patient Process Flow
Women’s and Men’s Waiting
Area:
21 Minutes
(after Registration)
Registration: 4 Minutes
Nurse
Vaccination Visit:
21 Minutes
Vaccination Site
Review:
20 Minutes
(required)
The team discovered that the bottleneck was the administering of vaccines/nurse visit. The nursing
team, with the support of the leadership team, needed to develop a solution that was more efficient
both in process and time. If successful, it would reduce both the waiting room time and the nurse
vaccination visit time.
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2B. Describe how the team analyzed information to identify the final root cause(s)/improvement
opportunity(s).
2Ba. Describe the methods and tools used to identify the final root cause(s)/improvement
opportunity(ies).
A crosswalk of the quality data (average times per appointment) and the patient flow map served as the
main sources for determining the processes bottleneck.
2Bb. Describe the team’s analysis of data to select the final root cause(s)/improvement opportunity(ies).
Review of quality data, coupled with insight into current visit process, lead the nursing team to
determine the bottleneck was manual recoding of all patient vaccine information by hand. The manual
nature of recording all patient and vaccine information by hand significantly delayed the patient and all
subsequent patients and opened the door for errors to occur. Additionally, parent vaccine education
was haphazard with no control over whether it was done or not, because the nurses were so busy with
manual documentation.
2Bc. Identify the root cause(s)/improvement opportunity(ies) and explain how the team validated the
final root cause(s)/improvement opportunity(ies).
The nursing team continued to examine their findings and validated their hypothesis with Quality
Department testimonials from patients who stated that the process was too long with too much waiting
in both the waiting and exam rooms. These findings were presented to the leadership team who
confirmed their hypothesis by examining all available evidence.
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3. Solution Development
3A. Explain the methods used to identify the possible solutions/improvement actions.
3Aa. Describe the methods and tools used to develop possible solutions/improvement actions.
The nursing team brainstormed a number of ideas that could have a positive affect on both the patient
visit and the administering nurse’s work. They identified several ideas that could work toward meeting
or exceeding both the patient’s and nurse’s expectations.
3Ab. Describe the team’s analysis of data to develop possible solutions/improvement actions.
The nursing team also brainstormed ideas that could affect data capture, including:
1. Number of patients seen per day
2. Average duration of patient visits
3. Accuracy of patient records
4. Patient satisfaction in regard to wait times and quality of service
Their final solutions were as follows:
Solution
Shortened
Appointment Times
Vaccine Bar-Coding
Effect on Data Capture Points
Shortened appointment time meant that we could increase the number of
patients seen per day. Previously the waiting time for an appointment was
3 weeks. This was reduced to 10 days with the new system. The new
system allowed better use of the parents’ time enabling us to begin
education about the vaccination at registration and continuing through
the vaccination and waiting area to allow opportunity for questioning etc.
Would require education and adoption on the part of the nursing staff, but
could significantly improve patient throughput and satisfaction as it would
be a more efficient, faster, and smoother process. It could also
significantly improve the accuracy of patient records by engineering out a
lot of manual work which could result in human error.
3Ac. Indicate the criteria the team decided to use in selecting the final solution(s)/improvement action(s).
When looking into the opportunity to improve the process, potential solutions were evaluated against
the same criteria used in section 1Aa – Financial Feasibility, Replicability, Results Focused, Patient
Satisfaction and Employee Satisfaction.
3B. Explain how the innovative final solution(s)/improvement action(s) was/were determined and how
replicable the solution is.
3Ba. Describe the innovative methods and tools used by the team to select the final
solution(s)/improvement action(s).
As highlighted in table 1Ab, the vaccination bar-coding project was selected because it resulted in:
 Improved patient access (decreased waiting times, more available appointments)
 Improved patient satisfaction
 Improved patient safety
 Improved patient education
 Improved employee satisfaction
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In addition to all of this, bar coding is easily replicable across both SKMC and SEHA and it was essentially
free.
3Bb. Describe the team’s analysis of data to select the final replicable solution(s)/improvement action(s).
The team compared each solution against the requirements from section 1Aa. As evidenced by the table
below, vaccination bar-coding was documented as the solution that would have the greatest impact on
current state, although the final decision was left up to the leadership team.
● Significant Positive Effect ● Minimal to No Effect
Tool/Data
No Process Change
● Continuing to frustrate
Financial
Feasibility
Replication
Medication
Error
Results
Focused –
Measurable
Data
patients could have longterm implications on
patient visits and
associated revenue
● N/A
● Significant Negative Implications
Shortened Appt Times
● Shortened appointments ● No price for solution;
mean more patient visits,
mean more revenue
change
than favorable situation
with more vaccination
appointments available
● Errors in documentation
favorable situation with
patient visits increasing
and patient appt times
decreasing
would likely increase due
to more pressure on the
staff
show a less than
vaccination
appointments
improvement in patient
satisfaction related to care
received, but not
necessarily overall
experience
● Data would continue to ● Data may show that
Employee
Satisfaction
system-wide
● Data would show a more ● Data should show a
● Data would continue to ● Data may show an
Patient
Satisfaction
success means more
patient visits
● Can easily allow for more ● Replication is possible
appointments
● Data would show no
Vaccine Bar-Coding
show a less than
vaccination
appointments
employees’ accuracy
improves and they feel less
rushed while working
● Data should show a
patient satisfaction, care
and experience increasing
● Data may show that
employees’ accuracy
improves and they feel
less rushed while working
3Bc. Describe the involvement of stakeholders in the selection of the final solution(s)/improvement
action(s).
The nursing team worked with the Quality Department to gather all of the required data to support their
ideas and current state, these findings were presented to the leadership team. Their findings are
captured in section 3Bb. The benefits to the patient and staff were so clear, that they decided to
proceed immediately with the project.
15
3C. Explain the final solution(s)/improvement action(s), validation, and the benefits expected to be realized
by implementing the team’s solution(s)/improvement action(s).
3Ca. Describe the final solution(s)/improvement action(s) and explain how the team validated the final
The initial idea for vaccine bar-coding stemmed from its use in the consumer market. For years stores
have successfully used bar-codes as an automated way of capturing information needed for pricing and
inventory tracking. The nursing team felt the same theory could be applied to bar-coding vaccinations, in
that it would help them to accurately capture patient information required for patient records and
coding and better keep track of inventory. They knew that successful implementation of a bar-coding
system could yield real-time, accurate results in the electronic medical records system much like price
tallying at the grocery store. Additionally, the team knew the solution would be successful if they could
increase the number of patient visits and shorten the patient waiting time.
3Cb. Indicate the types of tangible and intangible benefits that are expected to be realized by
implementing the team’s solution(s)/improvement action(s).
The benefits expected to be realized by implementing the bar-coding solution were:
Tangible
•Decreased patient wait times
•Decreased medical errors
•Increased patient safety
•Increased patient visits
•Increased productivity
•Decreased errors in coding
•Zero cost
•Real time data capture
Intangible
•Increased patient satisfaction
•More focus on the patient and patient
education
•Increased employee engagement and
satisfaction
•Increased productivity
•Replicable model
3Cc. Explain how the team used data to justify the implementation of the team’s
The nursing team used existing data and practices to determine that several key factors justified
implementation of the bar-coding solution, including:





No associated costs and all necessary IT upgrades conducted in-house
Used for years in countless other industries, for essentially the same purpose (proven
technology)
Patient experience would improve with greater accessibility and shorter wait times
Extensive patient waiting times (evidenced in 2Ab), if reduced, could result in more patient visits
and revenue (AED 45/nurse vaccination visit)
More accurate, real-time data compared to the current erroneous process (see figure below)
16
Figure 3 – Erroneous Record Book Pre-Bar-Coding Implementation
Red squares highlight
whiteout blotches
which indicate errors
in record keeping by
nurse performing
manual process
4. Project Implementation & Results
4A. Explain how buy-in/agreement was achieved for implementation.
4Aa. Indicate the types of internal and external (if applicable) stakeholder involvement in
implementation.
4Ac. Explain how stakeholder buy-in was ensured.
Stakeholder
Buy-In Achieved
Implementation Involvement
Internal
Leadership Team
 Approved solution
Nursing Team



IT Team

Quality
Department

Patients

 Provided with updates
 Monitored implementation and
success of program
Encouraged to accept solution
 Developed education materials
for team
Provided lengthy education on
process and implementation
 Trained team
Told it was a pilot and did not have to  Implemented solution with
continue if it did not work
patients
 Monitored team success
Free IT solution discovered by nursing  Uploaded free internet software
team – only needed to upload to
to all nurse workstations
numerous computers
 Developed interface with Cerner
Nursing Quality team worked with IT  Ensured that data was
to develop interface with Cerner
successfully being loaded into
Cerner by bar-coding software
External
Informed of improved wait times and  Served as recipients of piloted
greater accessibility to appointments
solution
17
4Ab. Describe how various types of resistance were identified and addressed.
Resistance
Nursing Team
Identified
 Nurses expressed discouragement
in the change of process and
mastering of the new system
Other SKMC
Facilities Nursing
Teams
 Once implemented and successful
in FMCs, implemented in other
SKMC facilities where nurses
expressed discouragement in the
change of process and in mastering
the new system
Addressed
 Shown the benefits of accurately
recording data, quickly recording
data and more time spent with
patients
 Informed that program would not
continue to exist if it was not
successful
 Shown the benefits of accurately
recording data, quickly recording
data and more time spent with
patients
 Provided contact information of
original nursing implementation
team for any outstanding
questions as a result of using
 Monitored six weeks later by
original nursing implementation
team to ensure accuracy and
appropriate procedure
4B. Explain the approach used by the team to implement its solution(s)/improvement action(s) and to ensure
the results (which should be sustained for six months).
4Ba. Describe the plan developed by the team to implement its solution(s)/improvement action(s).
The Nurse Vaccination team developed the bar-coding solution. The nursing team began by working
with IT to upload the free internet application to the nurse workstations. Then the team collected barcode scanners (that were not being used) from Patient Registration. Once the workstations were fully
equipped, the team mapped out the process for bar-coding. This included the steps for labeling
vaccines, checking bar-codes and administering vaccinations using bar-code tracking. The process also
included steps on ensuring the bar-code was accurately scanned and entered correctly into Cerner. The
team decided it was best to map these steps to a PowerPoint presentation so that it could easily be
shared (see Appendix 1).
The team adopted the following training approach to help other departments adopt this technology:
18
Figure 4 – Nurse Bar-Coding Training Process
Day 1
• Review of
current process
with nursing
team
• Review of
benefits of barcoding process
with nursing
team
• PowerPoint
presentation on
process
Day 2
• Practice new
process with
oversight by
original nursing
team member
• Given contact
information of
original nursing
team should any
outstanding
questions exist
or issues arise
6 Weeks Later
• Review of
nursing teams
progress by
original nursing
team member to
ensure
successful,
accurate
implementation
and procedure
4Bb. Describe the procedure, system, or other changes that were made to implement the
solution(s)/improvement action(s) and to sustain the results.
At the outset of implementation the team quickly learned that we could capture more data than simply
what vaccine was given into the electronic medical record system. To leverage this, the team developed
a mapping tool that linked injection sites and vaccine sequencing to bar-codes. These codes would easily
allow nurses to scan the vaccine, body part and the series number into the system, swiftly and efficiently
capturing all of the required information. This tool was laminated and distributed to the entire nursing
team, ensuring that the process was smooth, efficient, and easily replicable across the system (SKMC
and SEHA).
19
Figure 5 – Bar-Code Mapping Sheets
Mapping to
body parts
Mapping to
vaccine series
number
20
Additionally, the team realized that while using bar-coding the average patient encounter only lasted 15
minutes, where they previously took 20 or more minutes). This resulted in at least a 25% increase in
available appointments, so patient loads were increased and appointments made more readily available.
Figure 6 – Reduced Appointment Time Impact (One Clinic)
33% increase
33% increase
4Bc. Describe the creation and installation of a system for measuring and sustaining results.
The system for measuring results was already in place. All data on patient visits and wait times, etc. was
already captured through the appropriate IT systems. The SKMC stakeholders (Nursing, Quality, IT)
simply had to ensure that this data was being accurately captured in real-time with the new system and
that the results were being communicated to the appropriate teams. In this way, we could ensure
effective and timely implementation, monitor the results, and find-time the system as needed. The
results are highlighted in the next section, 4Ca.
4C. Describe the results achieved.
4Ca. Indicate the types of tangible and intangible results that were realized.
1. Decreased Patient Wait Times (Tangible) – The new patient waiting times map (figure 7) reflects the
new times and the improvement over the old times.
21
Figure 7 – Post-Implementation Clinic Patient Process Flow
Women’s and Men’s Waiting
Area:
2-3 Minutes
(after Registration)
Before: 21 Minutes
After : 2-3 Minutes
Saving 18 Minutes
90%.
Registration: 5 Minutes
Nurse
Vaccination Visit:
15 Minutes
Before: 21 Minutes
After : 15 Minutes
Saving 6 Minutes
25%.
Vaccination Site
Review:
20 Minutes
(required)
Data recorded from the bar code scanners into the electronic medical records system substantiates
these findings as evidence by the graphs below:
22
Figure 8 – Post-Implementation Patient Wait Time Reductions
“Well Baby” Vaccination Visits (3 Month Average: Sept-Nov)
100.0
90.0
86.3
79.9
80.0
77.5
75.1
70.0
65.0
60.0
61.9
54.5
52.8
50.0
44.1
41.7
37.7
40.0
30.0
35.7
31.1
27.3
33.5
35.8
This
paragraph
shows an
average
saving of
33minutes,
or 44.9 %
30.7
20.0
20.6
10.0
0.0
Al Bateen
Al Khaleej
2010 Average Clinic
Visit Time (Min)
Al Manhal
Al Rowdha
2011 Average Clinic
Visit Time (Min)
Al Zafranah
Mushrif
Average Clinic Time
Savings per Appt (Min)
All Patient Vaccination Visits (3 Month Average: Sep-Nov)
100.0
90.0
87.9
82.0
79.6
77.3
80.0
70.0
65.3
62.4
61.3
60.0
55.1
50.0
46.2
42.0
40.0
34.3
31.1
30.0
20.0
37.7
31.4
35.8
30.9
26.5
22.2
10.0
0.0
Al Bateen
Al Khaleej
2010 Average Clinic
Visit Time (Min)
Al Manhal
Al Rowdha
2011 Average Clinic
Visit Time (Min)
Al Zafranah
Average Clinic Time
Savings per Appt (Min)
Mushrif
This
paragraph
shows an
average
saving of
31.4
minutes, or
41 %
23
2. Increased Patient Visits (Tangible) – As a result of decreased patient waiting times the nursing
teams were now able to see more patients. On average, patients volume increased by xx number of
visits or yy%. This is reflected in the graphs below.
Figure 9 – Post-Implementation Patient Visit Increase
1600
1400
This
paragraph
shows
average
patient
volume
/clinic
increased by
approximate
ly 460
visits/85%
1200
1000
800
600
400
200
0
Al Bateen
AL Khaleej
Al Manhal
2010 Average Patient per Month
Al Rowdha
Al Zafranah
Mushrif
Average Patients Added per Month in 2011
1600
This
paragraph
shows
average
patient
volume
/clinic
increased
by
approximat
ely 595
visits/79%
1400
1200
1000
800
600
400
200
0
Al Bateen
AL Khaleej
Al Manhal
2010 Average Patient per Month
Al Rowdha
Al Zafranah
Mushrif
Average Patients Added per Month in 2011
24
A direct result of increased patient visits is a commensurate increased in revenue. The chart below
highlights the increase in revenue that we expect, given that each vaccination visit with a nurse is
charged at a rate of AED 45.
Figure 10 – Potential Revenue Increase Due to Increased Patient Visits
SKMC Facility
2010 Average
Monthly
(Revenue)
2011 Average
Monthly
(Revenue)
Al Bateen
Al Khaleej
Al Manhal
Al Rowdha
Al Zafranah
Mushrif
MONTHLY AVERAGE PER CLINIC
ANNUAL AVERAGE PER CLINIC
MONTHLY TOTAL
ANNUAL TOTAL
AED 19,785
AED 19,515
AED 51,780
AED 14,625
AED 23,670
AED 16,110
AED 23,670
AED 284,040
AED 145,485
AED 1,745,820
AED 40,380
AED 33,255
AED 61,095
AED 47,295
AED 48,150
AED 38,955
AED 48,150
AED 577,800
AED 269,130
AED 3,229,560
Average
Monthly
Additional
(Revenue)
AED 20,595
AED 13,740
AED 9,315
AED 32,670
AED 24,480
AED 22,845
AED 24,480
AED 293,760
AED 123,645
AED 1,483,740
Percentage
Monthly
Additional
(Revenue)
104%
70%
18%
223%
103%
142%
103%
103%
85%
85%
SKMC Facility
Al Bateen
Al Khaleej
Al Manhal
Al Rowdha
Al Zafranah
Mushrif
MONTHLY AVERAGE PER CLINIC
ANNUAL AVERAGE PER CLINIC
MONTHLY TOTAL
ANNUAL TOTAL
2010 Average
Monthly
(Revenue)
2011 Average
Monthly
(Revenue)
Average
Monthly
Additional
(Revenue)
Percentage
Monthly
Additional
(Revenue)
AED
30,435
AED
22,305
AED
54,720
AED
16,215
AED
28,440
AED
17,850
AED
28,328
AED 339,930
AED 169,965
AED 2,039,580
AED
55,755
AED
42,900
AED
61,545
AED
52,395
AED
49,500
AED
41,115
AED
50,535
AED 606,420
AED 303,210
AED 3,638,520
AED
25,320
AED
20,595
AED
6,825
AED
36,180
AED
21,060
AED
23,265
AED
22,208
AED 266,490
AED 133,245
AED 1,598,940
83%
92%
12%
223%
74%
130%
78%
78%
78%
78%
3. More Time for Patient Education (Tangible & Intangible) – As a result of having to worry less about
record keeping, the nurses found that they had more time to spend with the patient, an opportunity
to provide more education on the importance of vaccinations. In addition, they found more time to
answer patients questions related to other medical issues. The document in Appendix 2 was
developed by the nursing team the nursing team. The materials are handed to each patient at
registration and reviewed by the nurses with the patients. In addition, the team has found time to
distribute and review other patient education materials placed throughout the clinics.
25
Figure 11 – Patient Education Materials Developed for Clinic
The swift process of scanning bar-codes also increased the efficiency of nurses giving vaccinations. The
nurses have improved their speed in giving vaccinations by an almost unbelievable 900%.
Figure 12 – Post-Implementation Nurse Efficiency
26
Increased efficiency gives the nurses more time to work with patients and ensure they’re receiving the
care they need, as evidenced by this patient quote:
4. Data Tracking Benefits (Tangible) – The automated system of bar-coding has significantly cut down
the amount of time staff have to spend gathering, recording and analyzing vaccination patient data,
as data appears in real-time throughout the SKMC system.
Figure 13 – Post-Implementation Data Improvements
350
300
300
250
200
150
100
60
60
60
50
0
0
20
0
0
Time taken to receive the
Time taken to insure of Time taken to enter the data Time taken for Validating
documents by messengers receiving the all documents in the system by the quality
the data and closing
from nurses.
from the clinics
statistician.
Before bar coding and Computerization in mins / day
After bar coding and Computerization in mins / day
Overall time for running the report in mins / day
600
500
Paragraph shows a
stunning 96% reduction in
administrative time
480
400
300
200
100
20
0
Before bar coding and Computerization in mins / day
After bar coding and Computerization in mins / day
27
Additionally, the accuracy is now better:
 Percentage of defects in the bar-coding system is 0%
 There is no need for correction after extracting the data
And there are significant paper savings: [A Green Initiative]
 Reduced number of reports with data all in central location
 No lose files used for collating data
 No need for copying data to send to other clinics and entities
5. Electronic Record Keeping (Tangible & Intangible) – The automated system of bar-coding allows
clinicians to immediately identify the vaccines previously administered to the patient. Additionally,
patient records can now easily be retrieved for patients should they need proof of vaccination.
Figure 14 – Post-Implementation Record Keeping Improvements
6. Improved Employee Satisfaction and New Opportunities (Intangible) – With more time to work
with the patient and less time focused on paperwork, the nursing team has become much more
satisfied with their work. Encouraged by the success of the system they are more engaged at work
and are even proactively looking into other ways of using bar-coding as evidenced by this letter to
the Unit Manager:
28
4Cb. Explain how the project’s results link with the organization’s goals, performance measures, and/or
strategies.
As shown by the table below, this project has helped SKMC become better aligned with many of
SKMC’s and SEHA’s patient-focused key performance indicators
29
4Cc. Explain how results were shared with stakeholders.
Stakeholder
Leadership Team
Nursing Teams
Results Communication
 Provided with quarterly updates by nursing implementation team
 Provided with data reports from Quality Department on patient visits,
appointment durations and process improvements
 Provided with data reports from Quality Department on patient visits,
appointment durations and process improvements
 Provided with Patient Satisfaction Survey results at the end of each
appointment
30
5. Team Management
5A. Explain how the team members were selected and how they were involved throughout the project.
The team was comprised of nurse vaccination leadership and staff, spearheaded by the Unit Manager.
The pilot group was located at Manhal Clinic and the staff from that team was selected by the Unit
Manager. The collaborative nursing team at Manhal Clinic was responsible for:










Securing the free internet bar-coding application
Securing IT resources to install the bar-coding application
Notifying the IT department if the technologies did not interface correctly
Collecting unused bar-code scanners from within FMC
Mapping out the bar-coding process (see Appendix 1 for PowerPoint presentation)
o Labeling vaccines
o Checking bar-codes during shifts
o Administering vaccinations, ensuring the bar-code was accurately scanned and interfaced
correctly with Cerner
Developing the bar-code mapping sheet (see section 4Bb)
Developing training curriculum for other nursing departments (see section 4Ba)
Creating patient education tools (see Appendix 2 and section 4Ca result 3)
Mapping current state and post-implementation state patient process flow (see sections 2Ac
and 4Ca result 1)
Monitoring implementation success and adjusting the process where needed (e.g., reducing
patient appointment times from 20 minutes to 15 minutes)
5B. Explain how the team was prepared to work together in addressing the project.
The team was initially brought together by the Unit Manager and responsibilities were distributed. The
team continued to meet on a weekly basis to provide status updates and work through issues. It was at
these meetings that any member of the team could voice questions, concerns and provide insightful
ideas on the new solution. From these meetings came the development of off-shoot projects like the
patient education materials and reduction of patient appointment times. The team worked
collaboratively to continually monitor efficiency and effectiveness of the project. Today they continue to
educate new nursing teams as we continue to replicate this process throughout SKMC and review the
success of the bar-coding process.
5C. Explain how the team managed its performance to ensure it was effective as a team.
The team used quantifiable data to ensure its’ effectiveness. The results tracked and presented in
section 4 highlight the effectiveness of the team and new process. The team internally managed itself by
reviewing that data, mapping current and post-implementation patient flow and tracking error rates.
Rates in recording patient information were communicated to the team regularly.
As they began to replicate the bar coding throughout SKMC, they also had to track the progress of the
departments they had trained. In order to ensure their effectiveness outside of the pilot team, they
would return to each trained unit six weeks after their education period to ensure that the trained
department was following the right process and achieving results similar to or exceeding those of the
pilot group.
Appendix 1 – Bar-Coded Vaccination Process
(Most recent version – November 2011)
31
Appendix 2 – In-House Developed Patient Education Materials
32
33

SKMC TRANSFORMATION PROJECT : VACCINE BAR

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