Healthcare Operations Management
© 2008 Health Administration Press. All rights reserved.
1

Process Improvement and
Patient Flow

• Measuring and improving systems
• Systems
– Processes
• Subprocesses
– Tasks
• PI tools can be used at any level
Healthcare Operations Management
© 2008 Health Administration Press. All rights reserved.
3

• Plan : Define the entire process to be improved using process mapping. Collect and analyze appropriate data for each of element of the process.
• Do : Use process improvement tool(s) to improve the process.
• Check : Measure the results of the process improvement.
• Act to hold the gains : If the process improvement results are satisfactory, hold the gains. If the results are not satisfactory, repeat the PDCA cycle.
Healthcare Operations Management
© 2008 Health Administration Press. All rights reserved.
4

4. Act to maintain it.
1. Plan your corrective action.
3. Check to make sure it is working properly.
Healthcare Operations Management
© 2008 Health Administration Press. All rights reserved.
2. Do it.
5

• Theory of swift, even flow
• Process is more productive as:
– Speed of flow increases
– Variability of process decreases
• Example: advanced access
– Decreased time from request to appointment
(speed)
– Decrease in no-shows (variability)
Healthcare Operations Management
© 2008 Health Administration Press. All rights reserved.
6

• Hospital flow is negatively affected by variability in “scheduled” demand:
– Surgical admissions (scheduled)
– Medical admissions (emergency)
– When surgical admissions have high variability, backlogs and waiting occur
• NHS study showed that at 90 percent occupancy, only 60 –70 percent of patients were receiving active care.
Healthcare Operations Management
© 2008 Health Administration Press. All rights reserved.
7

• Establish uniform discharge time
• Write discharge orders in advance
• Centralize oversight of census and patient movements (care traffic control)
• Change physician rounding times
• Coordinate with ancillary departments on critical testing
• Coordinate discharge with social services
Healthcare Operations Management
© 2008 Health Administration Press. All rights reserved.
8

• Provides a visual representation that offers an opportunity for process improvement through inspection
• Allows for branching in a process
• Provides the ability to assign and measure the resources in each task in a process
• Is the basis for process modeling via computer simulation software
Healthcare Operations Management
© 2008 Health Administration Press. All rights reserved.
9

• Assemble and train the team.
• Determine the boundaries of the process (where does it start and end?) and the level of detail desired.
• Brainstorm the major process tasks and list them in order. (Sticky notes are often helpful here.)
• Once an initial process map (also called a flowchart) has been generated, the chart can be formally drawn using standard symbols for process mapping.
• The formal flowchart should be checked for accuracy by all relevant personnel.
• Depending on the purpose of the flowchart, data may need to be collected or more information may need to be added.
Healthcare Operations Management
© 2008 Health Administration Press. All rights reserved.
10

Patient
Arrives
at the ED
Intensive
ED Care
High
Triage -
Clinical
Complexity
Low
Waiting
Triage -
Financial
Admitting
Private
Insurance
Yes
Private
Insurance
No
Admitting
Medicaid
Waiting
Nurse
History/
Complaint
Waiting
Exam/
Treatment
Waiting Discharge End
Healthcare Operations Management
© 2008 Health Administration Press. All rights reserved.
Vincent Valley
Hospital and
Health System
Emergency
Department
(ED) Patient
Flow Process
Map
11

• Capacity of a process : the maximum possible amount of output (goods or services) that a process or resource can produce or transform.
• Capacity utilization : the proportion of capacity actually being used. It is measured as actual output/maximum possible output.
• Throughput time : the average time a unit spends in the process. It includes both processing time and waiting time and is determined by the critical (longest) path through the process.
• Throughput rate : the average number of units that can be processed per unit of time.
• Service time or cycle time : the time to process one unit. The cycle time of a process is equal to the longest task cycle time in that process
.
Healthcare Operations Management
© 2008 Health Administration Press. All rights reserved.
12

• Idle or wait time : the time a unit spends waiting to be processed.
• Arrival rate : the rate at which units arrive at the process.
• Work-in-process (WIP), things-in-process (TIP), patients-in-process (PIP), or inventory : the total number of units in the process.
• Setup time : the amount of time spent getting ready to process the next unit.
• Value-added time : the time a unit spends in the process where value is actually being added to the unit.
• Non-value-added time : the time a unit spends in the process where no value is being added. Wait time is non-value-added time.
• Number of defects or errors .
Healthcare Operations Management
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13

Average throughput time =
People (or things) in the system/Arrival rate
Example
• Clinic serves 200 patients in an 8-hour day (or 25 patients per hour).
• Average number of patients in waiting room, exam rooms, etc., is 15.
15 patients/25 patients per hour = 0.6 hours in the clinic
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14

• Eliminate non-value-added activities
• Eliminate duplicate activities
• Combine related activities
• Process in parallel
• Use load balancing
• Use decision-based, alternative process flow paths
Healthcare Operations Management
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15

• Improve processes on the critical path
• Use information feedback and real-time control
• Ensure “quality at the source”
• Let customers (patients) do the work
• Identify bottlenecks and optimize
(Theory of Constraints)
Healthcare Operations Management
© 2008 Health Administration Press. All rights reserved.
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Healthcare Operations Management
© 2008 Health Administration Press. All rights reserved.
17

End of Chapter 11