-
8/12/2019 Process Improvement and Patient Flow
1/18
Healthcare Operations Management 2008 Health Administration
Press. All rights reserved.
1
-
8/12/2019 Process Improvement and Patient Flow
2/18
Chapter 11
Process Improvement
and
Patient Flow
-
8/12/2019 Process Improvement and Patient Flow
3/18
Healthcare Operations Management 2008 Health Administration
Press. All rights reserved.
3
Process Improvement (PI)
Measuring and improving systems
Systems
Processes
Subprocesses
Tasks
PI tools can be used at any level
-
8/12/2019 Process Improvement and Patient Flow
4/18
Healthcare Operations Management 2008 Health Administration
Press. All rights reserved.
4
PDCA
Plan: Define the entire process to be improved usingprocess
mapping. Collect and analyze appropriatedata 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 improvementresults are
satisfactory, hold the gains. If the resultsare not satisfactory,
repeat the PDCA cycle.
-
8/12/2019 Process Improvement and Patient Flow
5/18
-
8/12/2019 Process Improvement and Patient Flow
6/18
Healthcare Operations Management 2008 Health Administration
Press. All rights reserved.
6
Flow
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)
-
8/12/2019 Process Improvement and Patient Flow
7/18
Healthcare Operations Management 2008 Health Administration
Press. All rights reserved.
7
Patient Flow
Hospital flow is negatively affected byvariability 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 percentoccupancy, only 6070 percent
ofpatients were receiving active care.
-
8/12/2019 Process Improvement and Patient Flow
8/18
-
8/12/2019 Process Improvement and Patient Flow
9/18
-
8/12/2019 Process Improvement and Patient Flow
10/18
Healthcare Operations Management 2008 Health Administration
Press. All rights reserved.
10
Process Mapping Basics
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 inorder.
(Sticky notes are often helpful here.)
Once an initial process map (also called a flowchart)has been
generated, the chart can be formally drawnusing standard symbols
for process mapping.
The formal flowchart should be checked for accuracyby all
relevant personnel.
Depending on the purpose of the flowchart, data mayneed to be
collected or more information may need tobe added.
-
8/12/2019 Process Improvement and Patient Flow
11/18
Healthcare Operations Management 2008 Health Administration
Press. All rights reserved.
11
Triage -
Financial
Complexity
End
Patient
Arrivesat the ED
Triage -
Clinical
Intensive
ED Care
Low
High
Private
Insurance
Admitting
Private
Insurance
Admitting
Medicaid
Waiting
Waiting
Yes
No
Nurse
History/
Complaint
Exam/
TreatmentDischargeWaiting Waiting
Vincent Valley
Hospital and
Health System
Emergency
Department(ED) Patient
Flow Process
Map
-
8/12/2019 Process Improvement and Patient Flow
12/18
Healthcare Operations Management 2008 Health Administration
Press. All rights reserved.
12
Process Metrics
Capacity of a process: the maximum possibleamount of output
(goods or services) that a processor resource can produce or
transform.
Capacity utilization: the proportion of capacityactually being
used. It is measured as actualoutput/maximum possible output.
Throughput time: the average time a unit spends inthe process.
It includes both processing time andwaiting time and is determined
by the critical (longest)path through the process.
Throughput rate: the average number of units thatcan be
processed per unit of time.
Service time or cycle time: the time to process oneunit. The
cycle time of a process is equal to thelongest task cycle time in
that process.
-
8/12/2019 Process Improvement and Patient Flow
13/18
Healthcare Operations Management 2008 Health Administration
Press. All rights reserved.
13
Process Metrics (cont.) Idle or wait time: the time a unit
spends waiting to be
processed.
Arrival rate: the rate at which units arrive at theprocess.
Work-in-process (WIP), things-in-process
(TIP),patients-in-process (PIP), or inventory: the totalnumber of
units in the process.
Setup time: the amount of time spent getting ready toprocess the
next unit.
Value-added time: the time a unit spends in theprocess where
value is actually being added to theunit.
Non-value-added time: the time a unit spends in theprocess where
no value is being added. Wait time isnon-value-added time.
Number of defects or errors.
-
8/12/2019 Process Improvement and Patient Flow
14/18
Healthcare Operations Management 2008 Health Administration
Press. All rights reserved.
14
Littles Law
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 hoursin the clinic
-
8/12/2019 Process Improvement and Patient Flow
15/18
Healthcare Operations Management 2008 Health Administration
Press. All rights reserved.
15
Basic Process Redesign Techniques
Eliminate non-value-added activities
Eliminate duplicate activities
Combine related activities Process in parallel
Use load balancing
Use decision-based, alternative processflow paths
-
8/12/2019 Process Improvement and Patient Flow
16/18
-
8/12/2019 Process Improvement and Patient Flow
17/18
Healthcare Operations Management 2008 Health Administration
Press. All rights reserved.
17
Advanced Process Redesign Techniques
Six Sigma (Chapter 8)
Lean (Chapter 9)
Discrete event simulation (Chapter 10)
-
8/12/2019 Process Improvement and Patient Flow
18/18
