Changing Process and Practice to Meet Patient Demand
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Transcript of Changing Process and Practice to Meet Patient Demand
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Changing Process and Practice to Meet Patient Demand
Sunny Hill Health Centre for Children Child Development and Rehabilitation Program of BC Children’s Hospital
Tracy Conley, MHA and Rita Janke, RN, MSN
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Background
Provincial Autism Resource Centre (PARC)
Tier 3 and 4 Assessments
Targeted 502 onsite
multidisciplinary assessments/per year.
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Background continued
Increased Demand
Increased Waiting
Delayed Access to Funding and Community Services
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Method
LEAN
Value Stream
Map
Opportunity for
improvement
Rapid Process Improvement
Current State Analysis
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Goal To decrease assessment lead time from
8 weeks to 4 weeks.
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Problem Statement
Children are currently waiting longer than 4 weeks to complete their assessments
2.14
11
5.5
9.14
4.14
8.21 9
4.29
7
11.64
4
7.71
9.71 8.86
Weeks, 10
Target, 4 wks
0
2
4
6
8
10
12
14
Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13
Wee
ks fr
om 1
st A
ppt t
o Fa
mily
Con
fere
nce
First Appt to Family Conference Median Weeks Jan 2012 - March 18, 2013 - Under 6 years
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Address Scheduling Workflow
Improve the workflow for scheduling to facilitate the reduction of time from 1st appointment to diagnosis:
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Booking Clerk Process
Unpredictable
Availability
Median 8 weeks (range 2-11 weeks)
Family attends CDA appointment
Family attends Additional
appointments
Family attends Family conference
Next appointment only booked after
previous visit Family receives Multiple phone
calls and letters
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Address Clinician Availability
Set expectations to ensure timely, up-to-date clinician availability.
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The Aims
80% of children will have all appointments booked within a 4 week block booking.
100% of the time, clinician availability will be up to date 3 months in advance to
facilitate booking of appointments
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Future Booking Process
One letter to family
GOAL: 4 weeks
One phone call to family
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Go to the Gemba
Trial of new process
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Shift Gears: Scheduling Demand and Capacity
How much availability should we have?
What is our projected demand?
What is our current capacity?
What is the gap?
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Demand/ Capacity
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Analysis: Why can’t we reach our 4 week target?
• Availability of clinicians is variable
• Availability is not provided in a consistent way or time frame
• The current pace of working is unpredictable
• Current capacity does not meet demand
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Meeting Demand – Predictable Pace Work with each discipline to identify/develop:
Strategies to meet demand.
Develop predictable assessment pace.
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Master Rotation Predictable pace. Pace = projected
demand. Changes to schedule
submitted minimum 3 months in advance.
Predictable room booking.
“One Piece Flow” scheduling process.
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Clinician Improvement Plans
Identify patient streams vs ‘one size fits all’ Master rotation. Report writing. Reduction in demand : Duplication of assessment. ?need for specific disciplines
Assessments based upon child’s needs. Room Set up
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Results
UCL
LCL 0%
20%
40%
60%
80%
100%
120%
6/24
/13
7/1/
13
7/8/
13
7/15
/13
7/22
/13
7/29
/13
8/5/
13
8/12
/13
8/19
/13
8/26
/13
9/2/
13
9/9/
13
9/16
/13
9/23
/13
9/30
/13
10/7
/13
10/1
5/13
10/2
1/13
10/2
8/13
11/4
/13
11/1
1/13
11/1
8/13
11/2
5/13
12/2
/13
12/9
/13
12/1
6/13
12/2
3/13
12/3
0/13
1/6/
14
1/13
/14
1/20
/14
1/27
/14
2/3/
14
2/10
/14
Percentage of children who achieved a 4 week lead time from 1st appointment to diagnosis. P Chart
Percent
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Results
UCL
LCL 0
5
10
15
20
25
6/24
/13
6/24
/13
7/1/
137/
8/13
7/8/
137/
8/13
7/8/
137/
8/13
7/15
/13
7/15
/13
7/15
/13
7/15
/13
7/22
/13
7/22
/13
7/29
/13
7/29
/13
8/5/
138/
12/1
38/
12/1
38/
12/1
38/
12/1
38/
19/1
38/
19/1
38/
26/1
38/
26/1
39/
2/13
9/2/
139/
9/13
9/9/
139/
9/13
9/9/
139/
16/1
39/
16/1
39/
23/1
39/
23/1
39/
23/1
39/
30/1
39/
30/1
39/
30/1
310
/7/1
310
/7/1
310
/15/
1310
/15/
1310
/21/
1310
/28/
1310
/28/
1311
/4/1
311
/4/1
311
/4/1
311
/18/
1311
/18/
1311
/18/
1311
/25/
1311
/25/
1311
/25/
1312
/2/1
312
/2/1
312
/9/1
312
/9/1
312
/9/1
312
/9/1
312
/9/1
312
/16/
1312
/16/
1312
/16/
1312
/16/
131/
6/14
1/6/
141/
6/14
1/13
/14
1/13
/14
1/13
/14
1/13
/14
1/20
/14
1/20
/14
1/20
/14
1/27
/14
1/27
/14
1/27
/14
1/27
/14
2/3/
142/
3/14
2/10
/14
2/10
/14
2/10
/14
Measure
Median 7.8
Median 4.8
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Lessons Learned
Understand current state and the actual problem.
Engage staff.
Commitment to daily management.
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Sustainability
Performance wall meeting.
Ongoing evaluation.
Daily management.
Ongoing continuous improvement.