Division of Vascular & Endovascular Surgery

Optimizing Patient Throughput & Increasing Patient Satisfaction:

Lean Six Sigma

Christopher M. Banoub, MPA

Certified Lean & Six Sigma Green BeltDivision Administrator

Vascular & Endovascular SurgeryNYU Langone Medical Center

Christina Veith, BA

Division of Vascular & Endovascular Surgery

Financial Disclosure

None

Division of Vascular & Endovascular Surgery

Defining Lean Six Sigma

I. Leano Analysis and streamlining of processeso Break down process’ steps into

• Value-Add• Non-Value-Add

o Value Stream Mappingo Current (Broken) State vs. Future (Repaired) Stateo Collect data on chosen endpoints

II. Six Sigmao Repeatabilityo Expectations = Outcomeso Cost reductiono Quantitative measures

Lean + Six Sigma = Lean Six Sigma

Division of Vascular & Endovascular Surgery

Lean + Six Sigma = Lean Six Sigma

Division of Vascular & Endovascular Surgery

Division of Vascular & Endovascular Surgery

Current (Broken) State Observations

I. Patient Experienceo Visit Length: 90-210 minuteso Repeatedly undress and dresso Not aware of financial responsibility

• Cancellations• Poor collection rate (68%)

o Difficulty with phone access (1,600 voicemails per month)

II. Practiceo 8-week lead time to book venous procedureso Maximum 12 cases per 10.5 hour dayo Wasted time on paper charts (EMR)

Division of Vascular & Endovascular Surgery

Future (Repaired) State

I. Patient Experienceo Roomed once, undress onceo Ultrasound machines in each exam roomo Aware of financial responsibility during schedulingo ACD Phone System

II. Practiceo Electronic tracking of insurance submissions

• Allows for more accurate lead time analysiso Maximum 16 cases per 8 hour dayo Use of EMR (no paper)

Division of Vascular & Endovascular Surgery

Division of Vascular & Endovascular Surgery

Endpointso Total Visit Length

o Copay Collection Rate

o Procedure Lead Time

o Patient & Staff Steps

o Call Abandon Rate

o Voicemails Left

Division of Vascular & Endovascular Surgery

Results

Sep-13

Oct-13

Nov-13

Dec-13

Jan-1

4

Feb-14

Mar-14

Apr-14

May-14

Jun-1

4Ju

l-14

Aug-14

Sep-14

Oct-14

Nov-14

Dec-14

Jan-1

5

Feb-15

Mar-15

Apr-15

May-15

Jun-1

5Ju

l-15

Aug-15

40

45

50

55

60

65

70

75

80

85

90

95

R² = 0.332415477531862

Average Visit Time (min)Implementation

Current (Broken) State Future (Repaired) State90-210 minutes 70 minutes

Division of Vascular & Endovascular Surgery

Results

Sep-13

Oct-13

Nov-13

Dec-13

Jan-1

4

Feb-14

Mar-14

Apr-14

May-14

Jun-1

4Ju

l-14

Aug-14

Sep-14

Oct-14

Nov-14

Dec-14

Jan-1

5

Feb-15

Mar-15

Apr-15

May-15

Jun-1

5Ju

l-15

Aug-15

40

45

50

55

60

65

70

75

80

85

90

95

100R² = 0.775144054994543

Copay Collection Rate

Current (Broken) State Future (Repaired) State68% Collection Rate 92% Collection Rate

Implementation

Division of Vascular & Endovascular Surgery

Results

Current (Broken) State Future (Repaired) State8-week Lead Time 13-day Lead Time

Division of Vascular & Endovascular Surgery

Current State Future State

Division of Vascular & Endovascular Surgery

Current State Future State

Current (Broken) Future (Repaired)Staff 350 steps 125 steps

Staff Time Spent Walking: ~ 12 minutes ~ 4 minutes

This is a ~ 64% reduction in staff movement per patient

Patient movement reduced from 210 steps to 50 steps.

Division of Vascular & Endovascular Surgery

Results

Calls Received Per Week: 800

Average Abandon Rate: 1%

Voicemails Per Month: 4

Annual Savings: $101,000 (2 FTEs)

Division of Vascular & Endovascular Surgery

Conclusions

I. Application of Lean Six Sigma tools in venous practice can increase:o Revenueo Patient Throughputo Patient Satisfactiono Staff Retention Rate

II. Lean Six Sigma improves process efficiency for venous practice