Designing Lean Processes to Increase Patient Access Cleveland Clinic Foundation November 12, 2012
The Burning Platform • NDSC statistics : Over 100 employees 30 Providers 27,000 patients visits a year 450 children waiting for appointments • Our patients have significant challenges with: - physical limitations - emotional fragility - large mobility equipment - behavioral issues
What were the Facility Issues? • The facility challenges: - linear design with long hallways - walls obstruct flow and visibility - 60% of the facility is made up of offices - just 40% is clinic space for the patients - long walks for patients from the front door - staff spent time looking for each other
Define - What is the issue? • Problem Statement: The length of the NDSC appointment is too long • The Goal: Reduce the length of the NDSC appointment from an average of 66 minutes to an average of 56 minutes by November, 2012
Measure - Current State Value Stream Map
The Analysis • Spaghetti Diagram: Showing motion for each staff member, patient, and family • Cause and Effect Matrix: The team weighted and scored those things that they felt added time and delay to the average appointment. Items included: 1) incomplete supplies in exam rooms 2) late policy application inconsistencies 3) scheduling inconsistencies 4) triage process delays
More Analysis – Flow & Schedules 14 14 12 12 11 12 10 9 9 9 10 8 7 7 7 7 8 5 4 5 6 4 3 4 2 2 0 The difference between Provider Exam Time not Waiting Room – 136 scheduled Statistically Significant
More Analysis – Causal Mapping Project Targets A3 Projects Out of Scope
Improvement - Standardization • Standardization of Patient Prep - Pocket cards made for medical assistants • Standardization of Room Content • - Restocking completed at • 7 and noon daily - Draws standard in rooms • - Photo Kanbans in place - Par level Kanbans in place
Improve – Late Policy Standardization Complete Agreed to by all Providers
Improvement – Level the Schedule Goal March, 2012 ACTUAL Oct., 2012 Creates a balanced, even workflow
Improve – A3 Inventory Project • Inventory 5S - Right Content - Right Sized - Visual Management - Kanban Placement - Standard Work for Sarah Shaffer, MA A3 Project Lead - Ordering Supplies - Restocking the Exam Rooms
The Current Floor Plan
The Current State 200 ft. from one end to another Long Walking Distances Long Hallways Walls everywhere
Improve – Work Cell Design Option #1 – internal work space Option #2 – Embedded clerical staff One Day Rapid 3P – September 28, 2011
Mapping It Out – Getting It Right Orange = Exam Rooms Green = Provider Offices Yellow = Nurses & Social Work From Concept to Drawings We Are Ready To BUILD !! Pink = Work Space
Improve – Mock Up of Design Waiting Room Physician Offices Physiatry Entrance Exam Rooms The Warehouse
Parent Involvement -Visioning Sessions with parents - Scenario Testing with parents - Members of the full team - Gave Tours to fellow parents Our Parent Team Members of Parent Advisory Council Volunteers from NDSC parents Members of NDSC FAC Group
Communication to all staff Newsletters sent to all NDSC staff daily • Photos • Daily accomplishments and findings
Staff Tours and Feedback What needs changed: • We need sinks ! ! • Can we have blinds? • Let’s lock the med room • Waiting Room is small • Where is Check In ? • Where is the Trash Bin? What Looks Good ? • We can see everything and everybody !! • “ I love the interior team space !” • I can find the provider immediately ! • Everyone is on the “playing field” • The team neighborhood idea will really help with communication and teamwork • This will be easier for our families
The Anticipated Benefits • Increase the satisfaction of patients and families by reducing wait time and motion and providing a pleasant, less stressful environment for the visit • Increase the satisfaction of the providers and staff by reducing their transportation and motion throughout the day allowing time to see patients rather than trying to finding patients • Increase the number of visits available by 2,500 annually for an increase in gross revenue of $727,000 (pending Decision Support approval)
Where are we Now? • Portions are moving into swing space • Actual renovation will be in stages with each of the 5 subspecialties going one at a time • Anticipated completion Summer, 2013 • Already seeing increased patients with standardization and level loading • Are creating staffing “neighborhood teams” • Moving clerical and clinical in one space • Creating lots of excitement and team spirit
svalentine@chmca.org
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