Denver Medical Diagnostics is trying to streamline its operations. A problem-solving team
consisting of a nurse, a technician, a doctor, an administrator, and a patient is examining
outpatient procedures in an effort to speed up the process and make it more cost-effective.
Listed here are the steps that a typical patient follows for diagnostic imaging:
1. Patient enters main hospital entrance
2. Patient registers at central reception by filling out a 3-page questionnaire on a
clipboard
3. The first few lines of this information is keyed into the computer and a wrist ID
is prepared
4. Patient is banded with wrist ID that identifies patient’s name and specific
allergies, needs
5. Patient waits for assistant
6. Patient is taken to diagnostic imaging department
7. Patient registers at diagnostic imaging reception by filling out a 2-page
questionnaire
8. Patient sits in department waiting area until dressing area is clear and
assistant arrives
9. Patient is taken to dressing area
10. Patient changes in dressing area
11. Patient waits in dressing area for assistant
12. Patient is taken to exam room
13. Exam is performed
14. Patient waits in exam room for assistant
15. Patient is taken to dressing area
16. Patient dresses
17. Patient waits in dressing area for assistant
18. Patient is escorted to diagnostic imaging reception
19. Patient signs out
20. Patient leaves
21. The remainder of patient’s registration information is keyed in along with
specific billing codes
22. Invoices are generated and transmitted to the patient’s health insurer and to
the patient
(2) Which of the above 22 steps are operations (there are seven and two could be
considered preparations rather than operations)? Registrations are analogous to
inspections and should be treated as such. 3, 4, 10,13,16,21 and 22
(2) What would be the design goals of your reengineered process? According to the
problem statement--1) GET COST OUT OF THE PROCESS
2) SHORTEN TIME-IN-THE-SYSTEM (SPEED UP THE PROCESS)
(2)What impact would an on-line reservation/registration system have on this process?
Patients could fill out the two questionnaires electronically and off-line which would
cut down on registration times and inputting times in the hospital—often the hospital
has to wait on the patient to finish filling out these forms. By having the patient enter
this information directly, accuracy is likely to be better. An automated system can
check the accuracy after the patient has entered it. There may not be a need for a
telephone reservationist, or that persons’ time could be partially used elsewhere.
Patients could choose their own reservation slot from a list without having to rely on
a reservationist to tell them what times are available over the phone. No hospital
clerk has to key-in the handwritten script, resulting in cost savings and improved
accuracy. The system can examine the health information for any possible problems,
like a pacemaker that might stop from the magnetic imaging and inform the
physician/technicians. The system might also suggest additional precautions or
additional tests.
(1) What questions would you ask about this process? For example, you might want to ask
why the patient can’t dress and undress in the exam room (this would eliminate seven
steps!). The reason is: in the exam room you have a multimillion-dollar examination
instrument (like an MRI machine) and its technicians that you want to keep busy. Having
the equipment (and its technicians) wait for you to undress/dress would be a huge waste of
time (time is money) when it/they could be used during that time to examine another patient.
A practice of having the patient dress/undress in the exam room would likely cut throughput
and revenues in half or more.
Why does an assistant have to ‘walk’ or escort the patient everywhere? Why must
the patient register twice—in two different locations? Why can’t the hospital
‘remember’ in its database all the patients’ information?
(8) How would you re-engineer this process? List the steps in sequence required by your
re-engineered process to effect the same result as above (diagnostic examination of the
patient).
1) Patient registers online
2) Patient arrives at diagnostic imaging reception
3) Patient signs in and is banded (band includes RFID tag)
4) Patient walks to dressing room
5) Patient undresses and signals he/she is ready
6) Patient waits for green light signaling he/she can enter examination room
7) Patient enters exam room
8) Exam is conducted
9) Patient returns to dressing room
10) Patient dresses
11) Patient returns to reception
12) Patient signs out and returns band with RFID tag
13) Invoice is generated and given to patient as well as sent to insurance provider
14) Patient’s co-pay is collected or patient agrees to a payment schedule.
15) Patient leaves.
{No escorts are used because that increases cost and slows the process down as often the
patient is waiting on an escort, or the escort is idle waiting on the patient. Instead the patient
is given a map or told to follow a line in the floor. If the patient gets lost his RFID tag will
enable him to be found. This process can be pipelined so that while one patient is
undressing another is being examined and still another is dressing, so that throughput is
maximized for the machine and it along with its technicians are not sitting idle. Three
dressing rooms should be provided in close proximity--adjacent to—the examination room.
Patient leave clothes in dressing room during examination; the dressing room is idle during
that time.}
(3) Extra Credit: Why do you think the patient is required to register twice?
Two different computer applications/databases are involved and these do not ‘talk’ to each
other. Centralized reception connects to the computer that does all of the billing but also
contains general health information. Diagnostic imaging reception contains all of the
diagnostic results along with specific health-related information.