Enviar búsqueda
Cargar
Lean Process Improvement In Outpatient Clinics
•
14 recomendaciones
•
8,183 vistas
L
laganga
Seguir
MHCD’s Lean Process Improvement Program in Clinical Outpatient Mental Health Services
Leer menos
Leer más
Denunciar
Compartir
Denunciar
Compartir
1 de 50
Descargar ahora
Descargar para leer sin conexión
Recomendados
Quality Improvement Through Effective Staff Handover
Quality Improvement Through Effective Staff Handover
anne spencer
outpatient satisfaction survey
outpatient satisfaction survey
AAYUSHI SAHA
Patient satisfaction
Patient satisfaction
Nc Das
Demo of NABH Documentation Kit for Pre Accreditation
Demo of NABH Documentation Kit for Pre Accreditation
Global Manager Group
Emergency Department Quality Improvement
Emergency Department Quality Improvement
DrAbdulaziz Saddique
Clinical pathway
Clinical pathway
Mahmoud Shaqria
Quality Management of Hospital Services
Quality Management of Hospital Services
Zulfiquer Ahmed Amin
Hospital Process Improvement - Lean Six Sigma Methodology
Hospital Process Improvement - Lean Six Sigma Methodology
Armando Martinez, MD, MBA-HA, MS
Recomendados
Quality Improvement Through Effective Staff Handover
Quality Improvement Through Effective Staff Handover
anne spencer
outpatient satisfaction survey
outpatient satisfaction survey
AAYUSHI SAHA
Patient satisfaction
Patient satisfaction
Nc Das
Demo of NABH Documentation Kit for Pre Accreditation
Demo of NABH Documentation Kit for Pre Accreditation
Global Manager Group
Emergency Department Quality Improvement
Emergency Department Quality Improvement
DrAbdulaziz Saddique
Clinical pathway
Clinical pathway
Mahmoud Shaqria
Quality Management of Hospital Services
Quality Management of Hospital Services
Zulfiquer Ahmed Amin
Hospital Process Improvement - Lean Six Sigma Methodology
Hospital Process Improvement - Lean Six Sigma Methodology
Armando Martinez, MD, MBA-HA, MS
Quality in hospital
Quality in hospital
Mmedsc Hahm
Accreditation as a Strategy / Tool for Hospital Quality Service Improvement
Accreditation as a Strategy / Tool for Hospital Quality Service Improvement
Reynaldo Joson
Healthcare Operation Management
Healthcare Operation Management
Ahmad Thanin
Quality Management in Healthcare Services
Quality Management in Healthcare Services
Zulfiquer Ahmed Amin
Patient satisfaction in nursing managementppt
Patient satisfaction in nursing managementppt
Mawii Khiangte
Project report on Time and motion study and OPD questionnaire survey.
Project report on Time and motion study and OPD questionnaire survey.
DR RITA SINGH
Patient Satisfaction
Patient Satisfaction
DirkRhodes
Hospital Information System
Hospital Information System
Annamalai University
ppt on patient satisfaction
ppt on patient satisfaction
AnkurAnkit3
Planning and management of clinical service department
Planning and management of clinical service department
Dr.Priyanka Phonde
Quality in hospital
Quality in hospital
Dr.Chitra Mukadam
Quality in health care
Quality in health care
Mariam AlDosari
Design and Management of Opd
Design and Management of Opd
Dr. Divya Khandelwal
Engineering Services in Hospital
Engineering Services in Hospital
Vaibhav Saxena
Out-Patient Department
Out-Patient Department
IpsitaGhosal2
Key Performance Indicator
Key Performance Indicator
Joven Botin Bilbao
Process Improvement in OPD billing by observing Billing Errors and thereby in...
Process Improvement in OPD billing by observing Billing Errors and thereby in...
Angela Kaul
Energy simulation for hospitals
Energy simulation for hospitals
Hamzah Meraj, Faculty of Architecture, Jamia Millia Islamia, New delhi
Patient satisfaction
Patient satisfaction
Ayshathul Femitha
NABH-Nursing resource management
NABH-Nursing resource management
Siva Nanda Reddy
Lean manufacturing
Lean manufacturing
Vinny Monteiro
Lean manufacturing in apparel industries
Lean manufacturing in apparel industries
Bharath Krishna
Más contenido relacionado
La actualidad más candente
Quality in hospital
Quality in hospital
Mmedsc Hahm
Accreditation as a Strategy / Tool for Hospital Quality Service Improvement
Accreditation as a Strategy / Tool for Hospital Quality Service Improvement
Reynaldo Joson
Healthcare Operation Management
Healthcare Operation Management
Ahmad Thanin
Quality Management in Healthcare Services
Quality Management in Healthcare Services
Zulfiquer Ahmed Amin
Patient satisfaction in nursing managementppt
Patient satisfaction in nursing managementppt
Mawii Khiangte
Project report on Time and motion study and OPD questionnaire survey.
Project report on Time and motion study and OPD questionnaire survey.
DR RITA SINGH
Patient Satisfaction
Patient Satisfaction
DirkRhodes
Hospital Information System
Hospital Information System
Annamalai University
ppt on patient satisfaction
ppt on patient satisfaction
AnkurAnkit3
Planning and management of clinical service department
Planning and management of clinical service department
Dr.Priyanka Phonde
Quality in hospital
Quality in hospital
Dr.Chitra Mukadam
Quality in health care
Quality in health care
Mariam AlDosari
Design and Management of Opd
Design and Management of Opd
Dr. Divya Khandelwal
Engineering Services in Hospital
Engineering Services in Hospital
Vaibhav Saxena
Out-Patient Department
Out-Patient Department
IpsitaGhosal2
Key Performance Indicator
Key Performance Indicator
Joven Botin Bilbao
Process Improvement in OPD billing by observing Billing Errors and thereby in...
Process Improvement in OPD billing by observing Billing Errors and thereby in...
Angela Kaul
Energy simulation for hospitals
Energy simulation for hospitals
Hamzah Meraj, Faculty of Architecture, Jamia Millia Islamia, New delhi
Patient satisfaction
Patient satisfaction
Ayshathul Femitha
NABH-Nursing resource management
NABH-Nursing resource management
Siva Nanda Reddy
La actualidad más candente
(20)
Quality in hospital
Quality in hospital
Accreditation as a Strategy / Tool for Hospital Quality Service Improvement
Accreditation as a Strategy / Tool for Hospital Quality Service Improvement
Healthcare Operation Management
Healthcare Operation Management
Quality Management in Healthcare Services
Quality Management in Healthcare Services
Patient satisfaction in nursing managementppt
Patient satisfaction in nursing managementppt
Project report on Time and motion study and OPD questionnaire survey.
Project report on Time and motion study and OPD questionnaire survey.
Patient Satisfaction
Patient Satisfaction
Hospital Information System
Hospital Information System
ppt on patient satisfaction
ppt on patient satisfaction
Planning and management of clinical service department
Planning and management of clinical service department
Quality in hospital
Quality in hospital
Quality in health care
Quality in health care
Design and Management of Opd
Design and Management of Opd
Engineering Services in Hospital
Engineering Services in Hospital
Out-Patient Department
Out-Patient Department
Key Performance Indicator
Key Performance Indicator
Process Improvement in OPD billing by observing Billing Errors and thereby in...
Process Improvement in OPD billing by observing Billing Errors and thereby in...
Energy simulation for hospitals
Energy simulation for hospitals
Patient satisfaction
Patient satisfaction
NABH-Nursing resource management
NABH-Nursing resource management
Destacado
Lean manufacturing
Lean manufacturing
Vinny Monteiro
Lean manufacturing in apparel industries
Lean manufacturing in apparel industries
Bharath Krishna
LEAN MANUFACTURING IN APPAREL INDUSTRY
LEAN MANUFACTURING IN APPAREL INDUSTRY
JAGADISH REDDY KP
just in time and lean manufacturing
just in time and lean manufacturing
Akhil Bhatia
Improving Productivity
Improving Productivity
ScottMadden, Inc.
Lean manufacturing concepts and tools and quality management1
Lean manufacturing concepts and tools and quality management1
hgalinova
Business Process Management in IT company
Business Process Management in IT company
Dhrubaji Mandal ♛
Productivity
Productivity
J.T.A.JONES
segmentation & indian automobile industry
segmentation & indian automobile industry
Sanjay Verma
Lean manufacturing
Lean manufacturing
Deepesh Singh
Lean Manufacturing
Lean Manufacturing
johncleveland
Lean six sigma (green belt)new
Lean six sigma (green belt)new
Hakeem-Ur- Rehman
Lean Manufacturing 2009 - By Jerry Helms
Lean Manufacturing 2009 - By Jerry Helms
Non Stop Portals
Lean project management
Lean project management
John Bun
Lean Process Improvement Techniques
Lean Process Improvement Techniques
Jeremy Jay V. Lim, MBB, PMP
Improving Productivity by Lean
Improving Productivity by Lean
ANITHA BALA
different techniques to productivity improvement
different techniques to productivity improvement
Hemant Patil
Productivity, Productivity, Productivity
Productivity, Productivity, Productivity
Fabian Alcantara
Factors affecting productivity
Factors affecting productivity
Waleed Attalla
Productivity
Productivity
Jay Parekh
Destacado
(20)
Lean manufacturing
Lean manufacturing
Lean manufacturing in apparel industries
Lean manufacturing in apparel industries
LEAN MANUFACTURING IN APPAREL INDUSTRY
LEAN MANUFACTURING IN APPAREL INDUSTRY
just in time and lean manufacturing
just in time and lean manufacturing
Improving Productivity
Improving Productivity
Lean manufacturing concepts and tools and quality management1
Lean manufacturing concepts and tools and quality management1
Business Process Management in IT company
Business Process Management in IT company
Productivity
Productivity
segmentation & indian automobile industry
segmentation & indian automobile industry
Lean manufacturing
Lean manufacturing
Lean Manufacturing
Lean Manufacturing
Lean six sigma (green belt)new
Lean six sigma (green belt)new
Lean Manufacturing 2009 - By Jerry Helms
Lean Manufacturing 2009 - By Jerry Helms
Lean project management
Lean project management
Lean Process Improvement Techniques
Lean Process Improvement Techniques
Improving Productivity by Lean
Improving Productivity by Lean
different techniques to productivity improvement
different techniques to productivity improvement
Productivity, Productivity, Productivity
Productivity, Productivity, Productivity
Factors affecting productivity
Factors affecting productivity
Productivity
Productivity
Similar a Lean Process Improvement In Outpatient Clinics
DAMA Webinar - Big and Little Data Quality
DAMA Webinar - Big and Little Data Quality
DATAVERSITY
Dama webinar-little-data-in-a-big-data-world-160217211043
Dama webinar-little-data-in-a-big-data-world-160217211043
SeilaIglesiasDomngue
A Preliminary Evaluation of Patient Recruitment Models to an Electronic Share...
A Preliminary Evaluation of Patient Recruitment Models to an Electronic Share...
Health Informatics New Zealand
Healthy Behaviors Are Contagious
Healthy Behaviors Are Contagious
ShapeUp
Quality Improvement Models: PDSA
Quality Improvement Models: PDSA
ljmcneill33
Pp teaser 01202014_w
Pp teaser 01202014_w
jensenml
Best practices for data analysis 16 jan12
Best practices for data analysis 16 jan12
Wayne Pan
What it takes to build a model for detecting patients that defaults from medi...
What it takes to build a model for detecting patients that defaults from medi...
Olga Zinkevych
CYP IAPT: Children & Young People's Improving Access to Psychological Therapies
CYP IAPT: Children & Young People's Improving Access to Psychological Therapies
CharlotteCYPIAPT
Sustainability in Software Companies
Sustainability in Software Companies
Justin Yuen
Mullins 2012 05_30
Mullins 2012 05_30
CUE - Consumers United for Evidence-based Healthcare
Transformation of a Service Operations System through Lean Process Improvement
Transformation of a Service Operations System through Lean Process Improvement
laganga
New Tools for Tracking, Visualizing and Interpreting Complex Data
New Tools for Tracking, Visualizing and Interpreting Complex Data
Sustainable Brands
Supreme Court Ruling: Implications For The Field Of Health Promotion with Pau...
Supreme Court Ruling: Implications For The Field Of Health Promotion with Pau...
HPCareer.Net / State of Wellness Inc.
Making our practice open and transparent: the potential of electronic data ca...
Making our practice open and transparent: the potential of electronic data ca...
Health Informatics New Zealand
Practicum presentation nidhi 2013
Practicum presentation nidhi 2013
Carolina Health Informatics Program @ UNC
Data Defensibility
Data Defensibility
Trihydro Corporation
The Future of Mobile Healthcare
The Future of Mobile Healthcare
Ruder Finn UK Ltd
Health-evidence.ca to Healthevidence.org: What's New in Public Health Reviews?
Health-evidence.ca to Healthevidence.org: What's New in Public Health Reviews?
Health Evidence™
Sharing and standards christopher hart - clinical innovation and partnering...
Sharing and standards christopher hart - clinical innovation and partnering...
Christopher Hart
Similar a Lean Process Improvement In Outpatient Clinics
(20)
DAMA Webinar - Big and Little Data Quality
DAMA Webinar - Big and Little Data Quality
Dama webinar-little-data-in-a-big-data-world-160217211043
Dama webinar-little-data-in-a-big-data-world-160217211043
A Preliminary Evaluation of Patient Recruitment Models to an Electronic Share...
A Preliminary Evaluation of Patient Recruitment Models to an Electronic Share...
Healthy Behaviors Are Contagious
Healthy Behaviors Are Contagious
Quality Improvement Models: PDSA
Quality Improvement Models: PDSA
Pp teaser 01202014_w
Pp teaser 01202014_w
Best practices for data analysis 16 jan12
Best practices for data analysis 16 jan12
What it takes to build a model for detecting patients that defaults from medi...
What it takes to build a model for detecting patients that defaults from medi...
CYP IAPT: Children & Young People's Improving Access to Psychological Therapies
CYP IAPT: Children & Young People's Improving Access to Psychological Therapies
Sustainability in Software Companies
Sustainability in Software Companies
Mullins 2012 05_30
Mullins 2012 05_30
Transformation of a Service Operations System through Lean Process Improvement
Transformation of a Service Operations System through Lean Process Improvement
New Tools for Tracking, Visualizing and Interpreting Complex Data
New Tools for Tracking, Visualizing and Interpreting Complex Data
Supreme Court Ruling: Implications For The Field Of Health Promotion with Pau...
Supreme Court Ruling: Implications For The Field Of Health Promotion with Pau...
Making our practice open and transparent: the potential of electronic data ca...
Making our practice open and transparent: the potential of electronic data ca...
Practicum presentation nidhi 2013
Practicum presentation nidhi 2013
Data Defensibility
Data Defensibility
The Future of Mobile Healthcare
The Future of Mobile Healthcare
Health-evidence.ca to Healthevidence.org: What's New in Public Health Reviews?
Health-evidence.ca to Healthevidence.org: What's New in Public Health Reviews?
Sharing and standards christopher hart - clinical innovation and partnering...
Sharing and standards christopher hart - clinical innovation and partnering...
Lean Process Improvement In Outpatient Clinics
1.
Lean Process Improvement
in Outpatient Clinics Decision Sciences Institute Annual Meeting New Orleans, Louisiana – November 15, 2009 Linda LaGanga, Ph.D. Director of Quality Systems & Operational Excellence Mental Health Center of Denver Denver, CO, USA Additional information available at: http://www.outcomesmhcd.com/Pubs.htm http://Leeds.colorado.edu/ApptSched © 2009 – Linda LaGanga 1 DSI 2009 – New Orleans © 2008 – Linda LaGanga and Stephen Lawrence 2009
2.
Agenda 1. Background on
the Organization 2. Lean Approaches 3. The Lean Improvement Projects 4. Insights and Recommendations 5. Contributions and Future Directions 2 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
3.
1. Background on
the Organization 3 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
4.
The Mental Health
Center of Denver (MHCD) is a private, not-for-profit, 501 (c) (3), community mental health care organization Providing comprehensive, recovery-focused services to more than 11,500 residents in the Denver metro area each year. Founded in 1989, MHCD is Colorado’s leading provider and key health care partner in the delivery of outcomes- based mental health services. “Enriching lives and minds by focusing on strengths and recovery.” 4 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
5.
MHCD Recent Innovation
Awards Effective Programs The U.S Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) Science to Service Award 2009 GROW (Growth and Recovery Opportunities for Women) program. Evidence-based interventions shown to prevent and/or treat mental illnesses and substance abuse. Read more at http://www.samhsa.gov/scienceandservice/cod2009.aspx. Efficient Systems Our Lean Process Improvement in Outpatient Healthcare Project won recognition of the Colorado Behavioral Healthcare Council (CBHC) and received the 2009 Golden Abacus Award for Best practices in the Non-Clinical Arena www.cbhc.org. Environment Leadership MHCD and its Together Green Team were nominated by the Governor’s Energy Office for a Colorado Environmental Leadership Program and were named a Bronze Award winner for its commitment to environmental leadership. Visit http://www.cdphe.state.co.us/oeis/elp/index.html Awards based on measurable results and outcomes Services, Evaluation & Research, Quality & Operational Excellence 5 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
6.
Healthcare: Research
and Operational Excellence Accountability Tracking and data availability Outcomes Quality management Efficiency Effectiveness Evidence-based practices 6 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
7.
Research Capacity
Clinical and Rehabilitation Service Effectiveness Quality Systems & Operational Excellence Ph.D. Staff: 4 + 1 Ph.D. Candidate OR, Statistics, Psychology Master-level Licensed / Certified Clinicians Evaluation & Research Team Sponsor and analysis of Lean Process Improvement Action Research 7 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
8.
Action Research “Research
in action, rather than research about action; participative; concurrent with action; a sequence of events and an approach to problem solving.” (Coughlan and Coghlan, 2002) Field study situation in which there was active communicating with practitioners, reporters, and the public in response to the initial study (LaGanga and Lawrence, 2007 & 2008) Concurrently applying the emerging recommendations and insights to a real change process -- the lean process improvement program The author was a direct sponsor and active participant in solving an operational problem and effecting change in an actual organization 8 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
9.
2. Lean Approaches
9 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
10.
Motivation
Healthcare Capacity Funding restrictions Demand exceeds supply Serve more people with limited resources Manufacturing Scheduling Resource utilization Maximize throughput Healthcare Scheduling as the point of access Maximize appointment yield 10 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
11.
2007 Consumer Reports
survey of 39,000 patients and 335 primary care doctors (Hitti, 2007) Top patient complaint was about time spent in the waiting room (24% of patients) Followed by 19% of patients who complained that they couldn’t get an appointment within a week Fifty-nine percent of doctors in the survey complained that patients did not follow prescribed treatment and 41% complained that patients waited too long to schedule appointments. 11 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
12.
Literature: Access to
Healthcare Institute of Medicine (2001) Crossing the quality chasm: A new health system for the 21st century. Murray & Berwick (2003) Advanced access: Reducing waiting and delays in primary care. Journal of the American Medical Association, 289(8). Green, Savin, & Murray (2007) Providing timely access to care: What is the right patient panel size? The Joint Commission Journal on Quality and Patient Safety, 33(4). 12 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
13.
Lean Approaches
Reducing Waste Underutilization Overtime No-shows Patient Wait time Customer Service Choice Service Quality Outcomes 13 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
14.
Lean Process Improvement
in Healthcare Documented success in hospitals ThedaCare, Wisconsin Prairie Lakes, South Dakota Virginia Mason, Seattle University of Pittsburgh Medical Center Denver Health Medical Center Influences Toyota Production System Ritz Carleton Disney Hospitals to Outpatient Clinics run by hospitals Collaborating outpatient systems 14 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
15.
3. Lean Projects
Lean Process Facilitator and Sponsor at 15 DSI 2009 – New Orleans Lean Program Exhibit Booth, October, 2009© 2008 – Linda LaGanga 2009
16.
Field Work: Interviews
Lean Event Process at the Mental Health Center of Denver 11/14/2009 Kovach & Fredendall - DSI 16 16 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
17.
Lean Projects Overview
Rapid Improvement Capacity Expansion Express Intake Human Resources Hiring Process Grants Financial Management New Clinician Training 17 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
18.
First Lean Project
Rapid Improvement Capacity Expansion (RICE) Team January, 2008 18 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
19.
Lean Process Improvement:
One Year After Rapid Improvement Capacity Expansion RICE Results Analysis of the1,726 intake appointments for the one year before and the full year after the lean project 27% increase in service capacity from 703 to 890 kept appointments) to intake new consumers 12% reduction in the no-show rate from 14% to 2% no-show Capacity increase of 187 additional people who were able to access needed services, without increasing staff or other expenses for these services 93 fewer no-shows for intake appointments during the first full year of RICE improved operations. Annual cost savings (avoidance): $90,000 - $100,000 for staffing and space 19 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
20.
Lean Process Improvement:
RICE Project System Transformation Appointments Scheduled and No-Show Rates 450 20% 400 Appointments 350 15% 300 250 10% 200 150 100 5% 50 0 0% Mon Tue Wed Thu Fri Mon Tue Wed Thu Fri Year Before Year After Lean Improvement Lean Improvement Appointments No-Show Rate 20 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
21.
How was this
shift accomplished? Day of the week: shifted and added Tuesdays and Thursdays Welcome call the day before Transportation and other information Consolidated steps Orientation to Intake Assessment Eliminated an opportunity for no-show Group intakes Overbooking Flexible capacity 21 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
22.
Lean Scheduling Challenge
Choice versus Certainty Variability versus Predictability Sources of Uncertainty / Variability No-shows Service duration Customer (patients’) Demand Time is a significant factor Airline booking models? 22 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
23.
Second Lean Project
Express Intake Team August, 2008 23 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
24.
Motivation for Fast
Track Intake More rapid access to targeted populations Special grants and contract funding No state CCAR needed 7 pages 25 outcome domains Scarcity of intake appointment slots Lengthy intake process Average 2.07 hours Many forms 17 for adults 19 for children/adolescents 24 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
25.
Current State (Before
Lean Event) Approximately 2/3 seeking services turned away If admitted, up to two week wait for intake appointment All slots filled early in the week Three or more staff required Access center clinical / call taker MIS staff Intake clinician 25 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
26.
Target State
Provide high-quality services Provide access to more people seeking services Start service delivery promptly Match work time to reimbursement rate Positive consumer experience Valuable clinical outcomes 26 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
27.
Gaps
Treatment delays Perception that center is not accessible Inadequate reimbursement Redundant data collection Unnecessary work and data collection Errors in recording and processing data 27 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
28.
Solutions
Identify appropriate payer/contract sources Identify value-added intake information Reduced data items/forms from 17 (or 19) to 4 No state CCAR outcome form Focus on appropriate outcome measures 28 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
29.
Solutions
Bypass Access Team Direct to designated clinicians Continuity of care Contact & Triage form Halved from 4 to 2 pages Completed by clinicians Eliminate waiting for MIS staff to complete form Use for all new intakes, not just special grants and contracts 29 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
30.
Electronic Health Record
Opportunities to streamline clinical work flow Improve quality of care Structures and standardizes work processes Menus Programmed logic and forms Data validation and feedback Lean Paradox Bottleneck in programming Implementation delays in some projects New forms and intake processes within 90 days 30 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
31.
Results with Department
of Corrections Prison parolees Rate of intakes tripled Duration appeared unchanged Standard versus actual time recorded 3 hours > 2.07 average of other clinicians 31 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
32.
Lean Process Improvement:
(First 3 months) Express Intake: Fast Track Project Clinician Time to do Intake 70% 60% 50% Cases 40% 30% 20% 10% 0% 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 Before Fast Track Hours After Fast Track 32 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
33.
Summary of Results
In the first three months of operation, the average service time decreased from 2.06 to 1.98 hours Effect small but significant (p < .05). More encouraging is the change in the distribution of service time, Percentage of total intakes that were completed within two hours increased from 67.5% to 75% so the percentage of intakes exceeding two hours decreased from 32.5% to 25%. 33 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
34.
Results
Service times shortening Decreased range and variability Room for more intakes Increased access to services 34 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
35.
Other Efficiencies
Elimination of “Hidden factory” of MIS Not captured in EHR system Data entry Checking and correcting clinician errors Not visible in productivity measures More profitable enrollment Ensure correct billing to appropriate payers Appropriate outcome measures 35 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
36.
Third Lean Project
Human Resources Hiring Project October, 2008 36 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
37.
Hiring: Improving a
Business Process Delays and bottlenecks in communication Automated communication Built on Electronic Health Record Required systems analysis and programming Six months to implement Reduced time to fill positions by 3 days Harder to measure than clinical improvement 37 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
38.
Fourth Lean Project
Grants Financial Management Team December, 2008 38 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
39.
Financial Management:
A Business Process Initial state: Lack of feedback and reporting Requires technology and programming About a year to implement Dependent on completion of prior lean project for staff tracking and allocation 39 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
40.
Fifth Lean Project
New Clinician Training Team January, 2009 40 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
41.
New Clinician Training:
A Business Process Target State: Clinicians trained to be productive within 3 days of hire Job requires use of Electronic Health Record Quickly determined how to achieve target Designed new training program Implemented initial computer training within 1 month Development of on-line training modules: Little progress due to other staff commitments 41 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
42.
4. Insights and
Recommendations 42 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
43.
The Right People
Talents Credibility Stakeholders Ownership Motivation “People are our product” What’s in it for me? “Why am I being punished?” “Can I come back tomorrow, too?” 43 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
44.
The Right Problems
The first project was a perfect fit Immediate change Energized and committed participants Technology was valuable for measurement Didn’t require reprogramming EHR Success fueled interest Not everything could or should be a lean project Lean paradox Bottlenecks Rapid improvement: Not! 44 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
45.
The Lean Paradox:
Projects by Functional Area Electronic Health Record Programming and Enhancements 45 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
46.
Project Management
and Organizational Discipline Assigning ownership and follow-through Critical mass Project management systems Selective about lean projects Improving measurement processes Working on financial analysis 46 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
47.
7. Contributions &
Future Directions 47 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
48.
Contributions
Outpatient services crucial to cost-effective healthcare delivery Lots of hospital research but little in outpatient Lean can greatly expand direct service capacity Room to leverage lean outpatient business process improvement 48 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
49.
Future Work
Ongoing analysis and improvement of lean approaches Continued action research on Quality Improvement in outpatient settings Lean Learning Collaborative Find other outpatient organization using lean Gather and share ideas through on-line group Lean Leaders and Catalysts for Improvement on LinkedIn 49 DSI 2009 – New Orleans © 2008 – Linda LaGanga 2009
50.
Questions? Comments? Discussion?
Lean Process Improvement in Outpatient Clinics Decision Sciences Institute Annual Meeting New Orleans, Louisiana – November 15, 2009 Linda LaGanga, Ph.D. Director of Quality Systems & Operational Excellence Mental Health Center of Denver Denver, CO, USA Additional information available at: http://www.outcomesmhcd.com/pubs/publications.htm http://Leeds.colorado.edu/ApptSched 50 DSI 2009 – New Orleans © 2008 – Linda LaGanga and Stephen Lawrence 2009
Descargar ahora