MRI Process Improvement
by Tyler Speck, Administrative
Director, Medical Imaging Program
HSN MRI – Prior to PIP
• MRI service operational for over 12 years
• Fully compliant with MIS standards (Management Information
System)
• Productivity level in excess of 140% (based on MIS standards)
• Below the 50% percentile (good) in benchmarking
• Routinely fielding calls from peer hospitals asking how we achieve
productivity performance
Provincial MRI Lean Project - 2011
• Ministry of Health requested all MRIs in the province go through a
LEAN Process Improvement Project to maximize limited resources
• Performance of MRIs inconsistent across the province
• Ministry wanted to improve access to MRI services for patients
• HSN MRI considered top efficiency performer
Provincial MRI Lean Project - 2011
Project Objectives:
• To positively impact MRI wait times by optimizing existing
resources while providing patient centered care
• To create a commitment to continuous improvement
Project Structure
PreEngagement
(6 weeks)
Initial
Assessment
(1 week)
Process
Diagnosis
(2 weeks)
Process
Optimization
(7 weeks)
Evaluation
(18 weeks)
Identify & engage
key leadership
Identify & engage key
stakeholders
Collaboratively analyze
current value stream
Analyze time
allocation & revise
scheduling template
Monitor impact &
feasibility of new
processes
Data Sharing
Agreement
Conduct interviews &
observations
Establish targets for key
performance metrics
Collectively identify
bottlenecks within
processes
Iterative solution
development
Memorandum of
Understanding
Analyze quantitative
data
Define desired future
processes
Identify & prioritize
opportunities for
process improvement
Monitor compliance
with new processes
Provide Lean and best
practices training
Analyze quantitative
data
Develop & trial
solutions
Monitor key
performance indicators
& take action as
required
Kick Off
Training
August 2011
September 27, 2011
Value Stream
Mapping
Rapid Improvement
Event
Final Evaluation
Data, Data, Data
February 2012
October 11-13, 2011 October 31-November 2, 2011
Schedule Optimization
Workshop
November 21-22, 2011
7
Metrics and Targets
• One of the principles of the Lean approach is evidence-based
decision-making. MRI PIP stresses the importance of using evidence
to identify improvement opportunities, as well as the importance of
performance measures to assess the success of newly implemented
processes.
• The hospital team identified outcome measures as indicators for
monitoring change and identifying opportunities for improvement. For
each of these indicators, baseline levels were calculated and targets
were established as a projection of what the site would like to
achieve.
Patient Value Statement and
Business Case
One of the main principles of the MRI PIP approach is the importance of the
patient's perspective. The team therefore developed a patient value statement
that summarizes the value they hope to provide to the patient from
implementing new and improved processes.
Patient Value Statement:
My MRI exam will be completed in a timely manner. The environment will be
comfortable, clean, and the staff will be friendly and knowledgeable. Any
questions I have will be addressed. The exam and report will be accurate and
confidential.
From patient value statement the hospital team developed a Business Case,
which defines the reasons for actions and the goals they hope to achieve.
Business Case Statement:
Our Strategic goal is to improve the use of our resources as effectively and
efficiently as possible while maintaining quality of procedure and adhering to
our patient value statement
Lean Journey – Process Diagnosis
(Value Stream Mapping)
Value Stream Mapping Session Overview
• The VSM is a three day session meant to develop a comprehensive
understanding of the current process and identify major areas for
improvement.
• The main deliverable for the VSM is an action plan, which, in
addition to discovering the major areas for improvement, outlines the
structure and timelines for implementing the solutions.
Current State – Flow Chart
In order to ensure a common understanding of the current process and to
identify opportunities for improvement, the team mapped out the process from
receipt of requisition to the time MRI report is sent, during the VSM.
OP Flow
IP Flow
Inpatient Flow
Outpatient Flow
Total Process Steps
56
67
Total Major Wait Periods
11
13
Future State
Measurement Improvements
During the VSM, the hospital team identified an improved future state process
that could be achieved in the next 6-12 months. The RIE has addressed the
wastes captured at the VSM, moving Health Sciences North closer to their
anticipated future state.
Value Added Steps
Non-Value
Added Steps
Flow Time
Touch Time
Current State
3
64
122 days
1h12mins
Future State
3
9
91 days
1h7mins
%
-
-86%
-25%
-7%
Rapid Improvement Event Overview
• Boundaries of a current process are defined, process steps are
reaffirmed, solutions are developed and trialed, and a new standard
process is in place by the end of the week.
The RIE focuses on process improvements in the following areas:
• Booking Process: Streamlining the process and decreasing the wait
time from the point an MRI requisition is received to when an
appointment is booked and the referring physician is notified of the
appointment.
• Patient Flow on Day of Exam: Streamlining the process on the day of
exam and thereby, minimizing scanner idle time.
Issue
Before: 49 wastes
Root
Cause
Lean
Principle
Solution
After: 41 wastes
addressed!
Schedule Optimization Session
Overview
• The Schedule Optimization session is a 2 day event during which the
current scheduling template is reviewed, constraints identified, and a
new scheduling template is developed to reflect actual demand and
maximize patient throughput. New Schedule effective March 2012.
So what’s the verdict?
So what’s the verdict?
• Investment ~700 hours of staff time including involvement from
Technologists, Management and administrative support staff
• Approx. $30,000 (consultants time Ministry funded)
• All aspects of this change were driven by the staff with consultants and
managers acting as facilitators
• Return: Scheduling template predicts access to an additional 40 patients per
week (40 additional hours of scan time per week)
• Ministry funds MRI time at $260.00 per hour
• Potential added capacity has given the MRI over $500,000 worth of extra
scan time
• MRI Department has undergone a shift to sustain continuous quality
improvement
• Weekly mini PIP meetings to review data, ensure they stay the course and
set weekly improvement goals. Nothing is too small
Conclusion
• Throughout MRI PIP at Health Sciences North, numerous
opportunities were identified and solutions developed. Some of these
solutions directly impact the process flow, while other solutions will
have a more significant impact on metrics and patient satisfaction.
Combined, the solutions create a future state that will optimize
throughput, streamline workflow, and create an environment
conducive to promoting patient-centered care and continuous
improvement. The staff should be commended on their dedication to
continuous improvements and open-mindedness to change.
Questions or Comments?