measure: current state

Purdue Research Foundation© 1

Measure: Current State Spaghetti Diagram

Registration

Triage

Nursing Station

Walk In Patient

Total Time - 4:52

Entry to Triage – 45min

Triage to Bed-1:30

Bed to Disposition-2:35

Ambulance Patient

Total Time - 6:20

Entry to Triage – 30min

Triage to Bed 15 min

Bed to Disposition-5:35

Visual representation of process


Measure: Data Collection Plan

Data Collection

Plan

Proposed

Graph

Data to be

Collected

Data

Source*Operational Definition Sample Size Who?

ED Turn Around Time Daily Wellsoft

Patient arrival to leaving the ED

(Arrival-triage; Triage-

Registration; Registration-bed;

Triage-bed; Bed-Time seen by

Dr.; Dr. to Disposition;

Disposition to leave ED, hrs of

diversion

All ED Patients 100% ED Patients ZB

ElopementsDaily / Segregate by

monthWellsoft LWOT, LWTC, LWBS, AMA, All ED Patients 100% ED Patients ZB

ED Volume PatternsDaily / Segregate by

monthWellsoft Time of Day and Day of Week All ED Patients 100% ED Patients ZB

RadiologyDaily / Segregate by

month

Cerner /

Manual

Turn around time for ER

SurveyAll ED Patients 100% ED Patients MJ Casey

LabDaily / Segregate by

monthSunquest?

Turn around time for ER

SurveyAll ED Patients 100% ED Patients Rose

EVS

Avg. by Day and

Q2 hr intervals by

time of day

Daily / Segregate by

monthManual

Rec'd room request to room

ready by housekeeping

All discharges and

transfers100% of rooms Michelle

Risk MgmntDaily / Segregate by

month

Incident

reports /

STARS

# & type of incidents r/t wait

time delays and risk

ED incidents incl

elopments and AMA's

100% of ED

incidents r/t wait

times delays,

elopments &

AMA's

Rob

Patient ComplaintsDaily / Segregate by

month

Patient

complaint

Excel vs. UHC

# & type of complaints r/t wait

time delaysED Complaints

100% of ED

complaints r/t wait

time complaints

Kathy W

Data Collection Plan

Metrics Are Specified


Measure: Discharge Process Weekend Delays

Procedure & Testing Denials Q3 '07

1112

33

67

15

18

98%96%

95%91%

86%

81%

70%

58%

32%

0

10

20

30

40

50

60

Stress Test General Sx MRI Cardiac Cath GI Sx Colonoscopy Endoscopy Podiatric OR Consult

Cause

Da

ys

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

n=57

89% occurred

on weekend

100% occurred

on weekend

100% occurred

on weekend

Data Provided

To Describe

the Problem ?


Measure: Housekeeping Delay’s Pareto

Count 41 29 24 19 18 12 8 6

Percent 26.1 18.5 15.3 12.1 11.5 7.6 5.1 3.8

Cum % 26.1 44.6 59.9 72.0 83.4 91.1 96.2 100.0

Dela

ys >

30

Min

Perc

ent

Nursing Unit

Other

Unit 3 C

OBS

Unit 3 B

unit 2A

Unit 4 B

Unit 3 A

Unit 2B

160

140

120

100

80

60

40

20

0

100

80

60

40

20

0

Nursing Delay's in notification to Housekeeping

Data Provided

To Describe the

Problem ?


Measure: ED AVG Patients by Day of Arrival Patient Arrival by Time of Day

A verage Pat ient s by Hour and D ay

1

2

3

4

5

6

7

8

9

10

M on 4.153846154 3.461538462 2.153846154 1.692307692 2.153846154 1.846153846 2.307692308 3.076923077 4.384615385 7.923076923 7.692307692 10 9.307692308 9.230769231 9.076923077 8.769230769 8.461538462 8.076923077 7.615384615 7.846153846 6.461538462 5.307692308 4.153846154 4.230769231

T ue 2.846153846 2.846153846 1.538461538 1.461538462 1.615384615 1.230769231 1.538461538 2.769230769 4.615384615 5.769230769 7.538461538 7.923076923 8.846153846 7.307692308 8.307692308 8.230769231 8.076923077 8.923076923 7.615384615 7.384615385 6 5.153846154 4.769230769 4.076923077

Wed 2.769230769 1.769230769 1.769230769 1.692307692 1.230769231 1.307692308 2.230769231 2.923076923 4.692307692 5.769230769 7.461538462 7.384615385 8.230769231 7.923076923 8.076923077 8.384615385 7.384615385 8.384615385 7.230769231 7.538461538 7.615384615 5.769230769 5 3.769230769

T hu 2.769230769 1.923076923 1.692307692 1.923076923 2.153846154 1.461538462 1.230769231 2.769230769 4.538461538 7.230769231 6.692307692 8.923076923 8.461538462 7.230769231 8.153846154 8.615384615 7.384615385 9.461538462 9.230769231 7 6.307692308 5.538461538 3.923076923 3.230769231

Fr i 2.461538462 2.923076923 2.307692308 1.692307692 1.461538462 1.384615385 1.769230769 2.153846154 4.769230769 8.538461538 7.923076923 9.153846154 8.230769231 8.153846154 8.153846154 7.923076923 8.076923077 7.307692308 6.307692308 6.307692308 6 6.769230769 5.230769231 4.076923077

Sat 3.384615385 3.230769231 2.076923077 1.769230769 2.230769231 1.769230769 2 3.076923077 3.692307692 5.230769231 7.846153846 7.076923077 7.307692308 8.153846154 6.846153846 7.615384615 8.307692308 7.153846154 7 6.769230769 5.769230769 6.461538462 6.846153846 4.769230769

Sun 3.666666667 3.666666667 2 2.583333333 2.5 2.083333333 2.166666667 2.75 4.416666667 6.583333333 8.916666667 7.666666667 8.666666667 7 6.833333333 6.5 6.833333333 6.666666667 5.916666667 6.75 5.75 6.333333333 5.333333333 5.083333333

0 100 200 300 400 500 600 700 800 900 1000 1100 1200 1300 1400 1500 1600 1700 1800 1900 2000 2100 2200 2300

Data Provided To

Describe the Problem ?


Measure: Average ED Arrival Time of Day

Pt arrival by time of day

0

200

400

600

800

1000

1200

1400

1600

1800

0000 0100 0200 0300 0400 0500 0600 0700 0800 0900 1000 1100 1200 1300 1400 1500 1600 1700 1800 1900 2000 2100 2200 2300

Arrival time

Pat

ien

ts

Data Provided To

Describe the Problem ? May need to update charter

with more defined goal as

you get data !!!!


Date: Project Title and Area: Organization:

Authors:

Def

ine

Mea

sure

Imp

rove

C

on

tro

l

Pre

-

Set Goal – “SMART”

Define the problem

Understanding the waste & variation

Preventing recurrence of the waste and variation

Select Project

Removing the waste & variation

An

alyz

e

What x’s and processes were measured to understand the stated problem?

Why this problem?

How does this project move the organization to its goals?

Quantifying the waste & variation

1. Business case has been explained 2. Problem statement in measureable terms

3. Data provided to describe the problem 4. Performance gap is described

5. Metrics are specified

1. Current state performance is described

2. Visual representation of process is shown

3. Data describing problem/process is provided 4. Project objectives/goals are specified

Grading Criteria

Grading Criteria


Key A3 Define Grading Criteria

1. Business case has been explained 2. Problem statement in measureable terms 3. Data provided to describe the problem 4. Performance gap is described 5. Metrics are specified


Key A3 Measure Grading Criteria

1. Current state performance is described 2. Visual representation of process is shown 3. Data describing problem/process is provided 4. Project objectives/goals are specified


Anthony Veasey, MA,CPHQ , LSSBB | Senior Advisor – Lean Six Sigma 708-790-5541 (office) | 708-790-5541

(mobile) | [email protected] Purdue Healthcare Advisors | Purdue University

mailto:[email protected]


Appendix


Radiology Test Turnaround Time ( Case

Example)


Define: Charter Project Statement St. Martin’s Hospital in Richmond has a goal for radiology report

turn around time of 24 hours for outpatient and emergency room procedures and 8 hours for inpatient procedures. Currently, 70% of the inpatient reports and 56% of outpatient reports are not complete within the expected time frame. The hospital would like to improve test result turnaround time to gain market advantage over their competitors.

Project Scope The hospital’s administration has given directives to a multi-

disciplinary team to identify the factors that effect radiology report turn around time and improve the processes. Improvement in this process will facilitate the strategic growth of the services, improve customer satisfaction and reduce length of stay. The team will identify the processes or procedures that cause delays in report completion, identify process changes to improve performance, meet specified customer expectations, and determine how to implement the improvements.

Why Is This A

Problem ?

Performance GAP


Define: Charter

Key Deliverables – Implementation plan for all identified solutions – Increase in the number of reports completed within the goal of 24 hours for outpatient and ER

and 8 hours for inpatient to 80%. – Increase in outpatient volume. – Improve customer satisfaction.

Financial and Operational Benefits – Increase annual radiology volume by 10% which equates to 18,000 procedures at $100 per

procedure annually for a total of $1,800,000. – Reduce length of stay in the ER and on inpatient units. – Increase customer satisfaction to 65% excellence by reducing wait time for procedure and

results. – Improve relations with referring physicians. – Decrease unbilled procedures by having reports in patient’s chart within 24 hours.

Champion

Jane Doe

Process Owner

Jim Doe

Project BB/GB

Ken Doe

Roles and Responsibilities

Members

Sam Morton

James Dean

Arnold Adam

ROI

Project Objectives/Goals

Specified


Define: SIPOC S

SUPPLIER

Patient

Radiologist

Ordering Physician

Unit RN’s

Radiology Tech

Transcription

Procedure Type

Physician Orders

Patient Location

Radiologist availability

Transcription Services

Test Results

Final Report

Accurate Final Report

Timely Final Report

Patient care delivery

Patient

Ordering

Physician

Radiologist

Coding

CTQ CRITICAL TO QUALITY

Final radiology report is

completed within 24 hours for

OP and ER and 8 hours for IP.

Final radiology report is

accurate and complete.

I INPUT

P PROCESS

O OUTPUT

C CUSTOMER

Radiology Test Ordered

Procedure Performed

Film Developed

Report Dictated

Report Signed by Radiologist

Report Transcribed

Film Read by Radiologist

Report Placed in Chart

measure: current state

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