CLIENT:
Confidential Client CASE STUDY
South–Central Region
Reviewing current conditions provides an opportunity for the optimization of workflows and processes. As an urban public health system averaging over one million patient visits annually, the client needed to address a major capacity issue within their medical records storage department. The System hired Array to understand the space implications of bringing their health information management team from two separate buildings to a single location.
CHALLENGE
EXECUTIVE SUMMARY
While seeking to relocate their medical
A hospital in the southwest needed to relocate their medical records storage
records storage department, the client
department. The planned move allowed them to consolidate their health information
realized there was limited storage
management team into a single location, but limited storage was available at the new
available at the new location for records
location. The team had a goal of destroying enough records to move into the new
that were ultimately going to be destroyed.
space without extending their lease on storage space.
SOLUTION Throughput Analysis
Initially, the Health System focused on the architectural piece of this project – what needed to happen to the physical space to successfully move from one building to another? While the architecture team was reviewing the space, they also observed the workflow, noticing that there were some inefficiencies. The team recommended
The Array team recognized that this was
that Array’s consulting team join for a virtual call to better understand the workflow
not a storage issue, but an opportunity
and provide feedback about improving the record destruction process.
to improve the client’s ability to destroy
When the Advisors team reviewed the current state, it became clear where the
medical records more efficiently.
process could be improved. As the record destruction team described the process, Array’s team noticed how much a patient record was being moved throughout the process. The destruction process was re-imagined to reduce excess transportation and handling of the records, leading to nearly twice as many records being destroyed each day. This impressive increase in process capacity allowed the client to confidently move forward with their architectural plans, knowing they would be able to move into their new space with little, if any, need for securing additional storage space for records slated for future destruction.
PROJECT HIGHLIGHTS
45%
Increase in destruction rate
2.5 Additional FTEs
50%
Reduction in transportation distance
CLIENT PROFILE Confidential Client The System first opened its doors in 1894 and is now one of the largest public hospital systems in the country. The hospital averages more than one million patient visits annually. Services include a Level I Trauma Center, the second largest civilian burn center in the U.S. and a Level III Neonatal Intensive Care Unit. The system also includes 20 communitybased clinics, including primary care and women’s clinics, 12 school-based clinics and numerous outreach and education programs.
TOOL
Figure 1: Current space for medical records storage.
Current Conditions Architects from Array met with team members at the current storage building (figure 1) and walked through the building, noting architectural solutions to help improve the space. They also walked through the future space planned for the health information management team and identified architectural improvements. On average, the record destruction team was processing about 22,000 records each month. A major concern for the client was the inability to destroy enough records
Throughput Analysis The processing rates of each step combine to create total throughput time. Steps with longer durations that occur later in the process create bottlenecks, and nonvalue-added waiting time will increase the time it takes to get through the system. Array’s experienced team works with our clients to determine the optimal processsteps configuration that maximizes the value quotient in your system.
in time for the move which would lead to a need for additional leased space. Team leaders at Array realized this wasn’t really about architecture; it was about how quickly the records could be destroyed. Array suggested mapping the current state (figure 2) to better understand the workflow and highlight specific bottlenecks and opportunities to improve the destruction process. One key factor that limited the possible rate of destruction was the need to identify and produce a record that was in the middle of the destruction process if a provider should request that file. To meet their standard turnaround time for producing records, the staff’s solution was to shelve the records between each step in the destruction process, so they knew exactly where the record was at all times. To help facilitate record shelving and re-shelving, they would utilize a cart for record transportation throughout the facility, moving the records long distances (figure 3) to different areas of the building to complete each step. This method led to excess transportation and overhandling of the records. The storage issue for the medical records had less to do with how much physical space there was for storage and more about reducing inefficiencies in the medical record destruction process.
Figure 2: Current state map. Page 2 | Case Study
Data Before meeting with Array’s industrial engineer, the destruction team processed about 1,500 records each day. It was estimated the client would need to destroy approximately 46,500 records a month to reach their goal of destroying 1.3 million records by September 2021. This means approximately 2,200 records would need to be destroyed each workday, nearly double what they were currently processing. Additional meetings were held to better understand the current capacity of each process step and the throughput rate for each team member. Using this additional data, Array calculated the estimated capacity and throughput rate for each step and suggested some changes that could help improve flow. Through this analysis, the client was also able to determine the appropriate number of staff necessary in each phase of the destruction process to reduce bottlenecks, which further increased destruction rates.
TRANSFORMATION Our core mission is the same as that of our clients: improve the quality of our work, increase our efficiency, and motivate our staff to reach for success. At Array, we have an established culture of continuous improvement at all levels of our organization. We seek to empower team members to be agents for good change. We begin all endeavors by considering process before exploring solutions. Our team can guide your organization through pre-design, ensuring clear goal-setting; target outcomes; process analysis and design; and decision support. Our Lean-led approach to project definition provides a clear path to the right project before you begin to design.
How can we ensure effective resource utilization? Figure 3: Current transportation path of record destruction process.
Every aspect of the healthcare industry relies on resources, including staff, equipment and space. It’s imperative
Future State To accommodate these changes, the team recommended that the Department transition to one-piece flow with the use of a cart, which holds approximately 36 records. The medical records destruction team would require 40 carts to hold half a day’s worth of records for destruction, eliminating the need for pre-destruction shelves and high-density destruction shelves. These shelves could then be re-purposed if necessary. It was also suggested they add retriever workstations near where pre-destruction carts will be staged for cleaners and screeners. The expected output for these process changes would improve capacity to 2,200 records a day. The client was initially hesitant to move to the cart model, fearing they would not be able to produce a record if requested within the required turnaround time.
that organizations utilize their resources effectively. Our skilled and experienced consulting team can help your organization develop a strategy for utilization optimization, ensuring that every resource is providing the highest value while improving process flow.
Tools used: Capacity & Utilization Assessment, Current State Assessment, Observation, Collaboration
However, once they transitioned to the cart model, they found the new process achieved its expected output, nearly doubling their capacity for destroying records. By eliminating the non-value added time of shelving and re-shelving the records throughout the facility, we believe the client will be able to meet their goal of destroying enough records to move into the new space without needing to lease additional space.
“Sometimes it takes unbiased eyes to see the potential for improvement.” Laura Silvoy Healthcare Systems Engineer
Cast Study | Page 3
DISCOVERING YOUR HEALTHCARE SOLUTIONS TOGETHER We are innovators who specialize in the areas your system seeks out to leverage its valuable operational and facility resources. Array Advisors has the expertise and skills to reach beyond your milestones and provide you the decision support you need.
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We are Array Advisors, your trusted partners in Strategy Development, Organizational
individuals lead our efforts, which focus on your unique place in the healthcare delivery spectrum. Our knowledgeable staff can help you solve strategic business problems and develop a method to improve efficiency and utilization.
Transformation, and Facility Informatics. The challenges you face are not unique, but your solutions should be. Through a partnership of Strategy and Transformation we help you achieve and sustain. Our process begins by understanding your current operations and clearly defining your system’s goals before generating options. We employ a variety of integrated methods tailored to your strategic challenges, such as process mapping; operational planning; and healthcare real estate portfolio optimization, to help position your organization for future success.
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Informatics Building Information Model management (BIM) is an enabler of most other technology trends in the Architecture, Engineering, Construction, Operations (AECO) industry, including but not limited to: sustainable design, offsite fabrication, LEAN construction, and energy efficient operations. Carefully considering how best to leverage virtual/digital representations of physical buildings can provide significant returns on innovation throughout the entire lifecycle of your facilities.
Strategy The need for healthcare real estate portfolio optimization has never been greater. With the acceleration in mergers and acquisitions, as well as the evolution of clinical models, healthcare organizations must continuously evaluate their physical assets and maximize the value they derive from them.
Transformation Transformation and lean methods are very useful when focusing on operational process improvement. By bringing all constituents together and giving them the tools to experiment and test new ideas, current state barriers can be identified and transcended.
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Published: March 2020