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© 2010 The Detail Person LLC
Lean and Meaningful Workflow Redesign
Pat SchererCEO, The Detail Person LLC
© 2010 The Detail Person LLC
Why Bother with Workflow Redesign?
Catch Errors Before They Happen
Control/Reduce Costs
Do More with Less
Satisfy the (Im)patient
Prepare for EHR Installation
Improve Communication
© 2010 The Detail Person LLC
Process List
Recording Workflows
Workflow Diagrams
The 7 Wastes
Other Tools
Summarize Workflow Redesign Process
Workflow Redesign Basics
© 2010 The Detail Person LLC
1.Patient scheduling
2.Patient check-in
3.Patient exams, procedures and clinical recording
4.Patient check-out
5.Referrals
6.Call handling
7.Prescription refills
8.Claims and billing
9.Lab orders
10.Patient follow-up communications
11.Wellness/outreach
List Processes
4
© 2010 The Detail Person LLC
Action Who Start Stop Elapsed
(min)
W Notes
Check-in P1 7:28a 7:32a 4 ? Queued behind 2 check in.
Fill out forms P1 7:32a 7:44a 12 ? Could forms be stream-lined?
Wait in waiting room P1 7:44a 8:00a 16 W Why?
Move to exam room P1/MA 8:00a 8:02a 2 ? Efficient layout?
Wait in exam room P1 8:02a 8:10a 8 W Why?
Take vitals & info P1/MA 8:10a 8:16a 6 ? Has to retrieve “good gauge” from another
room
Wait in exam room P1 8:16a 8:28a 12 W Why?
Exam P1/MD 8:28a 8:44a 16 ? MD repeats questions asked by MA
Wait to check out P1/R1 8:44a 8:50a 6 W R1 finishes a call, searches for patient folder,
finds it left in exam room
Check-out P1/R1 8:50a 9:00 8 ? R1 has difficulty locating copay info, takes
another call, printer is in another room
Total elapsed 90
Recording the 15 Minute Office Visit
T
h
e
1
5
m
© 2010 The Detail Person LLC
?
Start (1st process step)
Process step
Decision
Document Data
Predefined process
End (last process step)
Workflow Diagrams
© 2010 The Detail Person LLC
1st Visit?Yes
Move to room
Forms
Vitals
Exam
Office Visit Workflow
Check in
Check out
No
© 2010 The Detail Person LLC
Over-production
Too much or too early
© 2010 The Detail Person LLC
Unnecessary Stock
Stashes of inventory and
supplies; “stuff” waiting to
be worked
© 2010 The Detail Person LLC
Inefficient Transportation
Moving people,
information and “stuff”
from one place to
another.
© 2010 The Detail Person LLC
Unnecessary Motion
Unnecessary movement
or strain including
walking, bending,
reaching and twisting.
© 2010 The Detail Person LLC
Waiting
Delays caused by
shortages, approvals or
downtime.
© 2010 The Detail Person LLC
Rejects & Defects
The costs associated with
making and correcting
mistakes.
© 2010 The Detail Person LLC
Inappropriate Processing
Stuff we do that doesn’t
add value to the patient.
© 2010 The Detail Person LLC
Swim Lane Diagrams
Value Stream Maps
Layouts and Spaghetti Diagrams
A3 Implementation Plan
Other Tools
© 2010 The Detail Person LLC
Swim Lane Diagrams
© 2010 The Detail Person LLC
Value Stream Map
Move to room
Forms Vitals ExamCheck in Check out
R1
PT: 0.1
WT: 1.9
WT: 2 min
PT: 8
WT: 4
MA
PT: 2
WT: 0
WT: 16 min WT: 8 min WT: 12 min WT: 6 min
MA
PT: 4
WT: 2
MD
PT: 14
WT: 2
R1
PT: 2
WT: 6
2
M
T
M
M
Total PT: 30.1
Total WT: 59.9
© 2010 The Detail Person LLC
Spaghetti Diagrams
Lab Exam 1 Exam 2
MD OfficeBillingCheck
InWaiting
MA
Patient
MD
Legend
© 2010 The Detail Person LLC
A3 Problem Solving Format
© 2010 The Detail Person LLC
Workflow Redesign Process Summary
Identify Processes
Record Workflow
Diagram Workflow
Identify Waste
A3: Plan, Do,
Measure Continuous
Improvement
© 2010 The Detail Person LLC
Links “Lean Health Care: Lower Costs, Better Outcomes”, Wharton Health
Economics; 11/11/2009
http://knowledge.wharton.upenn.edu/article.cfm?articleid=2374&specialid=95
NHS (UK) Tools & Techniques http://www.tin.nhs.uk/index.asp?pgid=1134
DIY Lean (free A3 templates)
http://www.diylean.com/A3%20Materials/A3_Materials.htm
Presentation slides and other resources
http://www.thedetailperson.com/resources
Books Hadfield and Holmes, The Lean Healthcare Pocket Guide; 2006
Chalice, Improving Healthcare Using Toyota Lean Methods: 46 Steps for
Improvement; 2007
Jimmerson, A3 Problem Solving for Healthcare: A Practical Method for
Eliminating Waste; 2007
Jimmerson, Value Stream Mapping for Healthcare Made Easy; 2009
References
© 2010 The Detail Person LLC
Questions?
Contact:
Pat Scherer
The Detail Person LLC
www.thedetailperson.com
512-415-3473
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