Clinical Process Analysis
Ambulatory Operations Project:
Endoscopy Center Summary
April 6, 2013
STAFF
Laurie Kaufman MSN, RN Manager
Gina Aranzamendez MS, RN-BC
Courtney Barnes MBA
Beverly Hayes
Valerie Haywood MBA, BSN, RN
Duke Rohe, IE
Marvetta Walker, MHA, RN Manager Endoscopy
Time Driven Activity Based Costing
(TDABC)
• Harvard University Business School
– Michael Porter, PhD
– Robert Kaplan, PhD
• Institute for Cancer Care Excellence (ICCE)
– Thomas Feeley, MD
– Heidi Albright, Director
– Head & Neck Center Pilot
• Office of Performance Improvement
– Process Flow Charting
TDABC & Clinical Process Analysis
MDACC’s Framework for Improving As A System
Based on W. Edwards Deming’s “Profound Knowledge”
Adapted From: A Framework for the Continual Improvement
of Health Care. Batalden PB. Journal of Quality Improvement
Vol 19 No. 10 1993
2. HOW WE IMPROVE
WHAT WE DO
Vision:
Making Cancer
History
Design and
Redesign Plans to Improve Our:
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1.
2.
3.
4.
Performance as a System
Knowledge of Variation
Use of the Theory of Knowledge
Application of Psychology
Patients
Families
Staff
Suppliers
Equipment
Supplies
Partners
Etc.
I
N
P
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T
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1. WHY WE DO WHAT WE DO
To Cure Cancer
To Provide Patient Care
To Develop Our Workforce
To Maintain Financial Viability
Processes that produce:
Research
Patient Care
Work Force Development
Financial Viability
3. HOW WE PERFORM OUR SERVICES
O
U
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P
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Outcomes
Costs
= Value
4. WHAT WE DELIVER
Clinical Process Analysis
Program Aim: Create a comprehensive visual display of current work processes for
analysis to drive improvement in clinical quality & financial performance.
Why do this?
How to do this?
• Create a shared sense of the future
• Align with strategic goals
• Develop clearly defined aim and scope
• Engage all levels of leadership support
• Avoid competing priorities w/optimal scheduling in roll-out
• Create two-way communication
• Instill psychological safety for staff to share current processes
• Mobilize clinicians to make changes needed for healthcare
(Berwick, 2011)
• Capture the voice of the patient
(Institute of Healthcare Improvement)
• Illustrate frontline reality (James, 2012)
• Align data reporting to frontline processes
(James, 2012)
The Process
INPUTS
PHASE I
PHASE II
Current Work Activities
Clinical Leadership
Content Experts
Clinical Process Analysis Team
Precursory
Work
Weekly
Interviews
PHASE III
Summary
&
Evaluation
OUTPUTS
Process Flow Charts
In-sync Data Reporting
Direct Labor Costs
Opportunities for Improvement
Embed QI Knowledge
Performance Improvement
Phase
Workforce Engagement
PI Projects
CPA Methodology
Process Flow Chart, Direct Labor Cost & Opportunities for Improvement
Performance Improvement Phase
Weeks 4 - 14
Participants:
• Clinical Lead: Designated clinical point person for the project
• Clinical Leadership: Clinical Administrative Director; Center Business Manager;
Nurse Manager; Medical Director; Quality Officer
• Content Experts: Frontline staff
• CPA Team: Clinical Process Analysis Team, Performance Improvement
• SOT: Senior Operations Team
• Center Process Flow Charter: Maintains process flow charts for the Center after
CPA Project is completed
The Office of Performance Improvement, © 2012 The University of Texas MD Anderson Cancer Center
Background: Endoscopy Center Project
• Center Variation
• Scope Development
The Office of Performance Improvement, © 2012 The University of Texas MD Anderson Cancer Center
The Office of Performance Improvement, © 2012 The University of Texas MD Anderson Cancer Center
The Office of Performance Improvement, © 2012 The University of Texas MD Anderson Cancer Center
The Office of Performance Improvement, © 2012 The University of Texas MD Anderson Cancer Center
Process Flow Charts
Aligning Data to Frontline Processes
&
Elements of a Process Flow Chart
Direct Labor Cost
Process Flow Chart converted to
Excel for Direct Labor Costing
Costing
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Salaries based on FY 2012 from ResourceOne
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Data based on information captured in process flow charts from
10.17.2012 – 12.12.12
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Based on estimated times given by frontline staff in the Endoscopy
Center
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Salaries in this report are average adjusted hourly rates including fringe
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Salaries for each Job Code Group are blended by utilizing FTEs to
weight the averages:
• MD- Professor, Associate Professor, Assistant Professor
• PSC- Lead Services Coord, Patient Services Coord
• MLP- APN and APN supervisor
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Data is reported per patient
Costing Summary:
Direct Labor Costs
Costing Summary:
Estimated Times in Minutes
OFIs
(Opportunities for Improvement)
Waste, Delays, Inconsistencies, Rework…
Phase II Week 4
Precursory Work
Meet with CAD:
validate OFI
Categories,
Control level, &
Prioritize
Phase II Week 5 to 8
Precursory Work
PI Week 1
PI Week 2
PI Week3
PI Week 4
PI Week 5
PI Week 6
Summary Meeting
Staff (2) assigned
to OFIs complete
PDSA 101
Quick Fix 1
(scope: 1 wk
turnaround)
4hr/staff member
Quick Fix 2
(scope: 1 wk
turnaround)
4hr/staff member
PDSA Mtg 1
Aim Statement/
Baseline Measure
4hr/staff member
PDSA Mtg 2
Cause Analysis/
Intervention
4hr/staff member
PDSA Mtg 3
Implementation/
Post Measure
4hr/staff member
PDSA Mtg 4
Document/
Presentation prep
4hr/staff member
Staff present OFI
improvements at
Summary Mtg
SharePoint Site for Project Storage
• Provides storage for project work-ups
• Available for bench-marking
• Easy placement in Quality Project database
OFI Summary
• Total OFIs: 53
• OFIs in department's control: 6
• OFIs out of department's control: 14
• OFIs within department's influence: 33
OFI Projects
 6 Quick Fixes  8 PDSA
 1 CS&E
1. Ready Call pagers
2. Consult processing/patient check-in
3. Optimization of Endoscopy Online Consult
Health questionnaire
4. Bedside consenting
5. Nurse sedation practices
6. Guidelines for scheduling an Endoscopy
procedure
7. Physician notification process for patient
cancellation or reschedule
OFI Projects
8. iConsent
9. PYXIS medication availability
10. Anesthesia sedation & recovery charge
reconciliation
11. Endoscopy safety procedure checklist
12. Room standardization