CASE STUDY
CLIENT: Columbia Orthopedics New York, NY
Rapid process analysis helps organizations determine where to focus improvement efforts. Through observation and shadowing, a team of lean process experts can quickly assess the current flow and patient experience. These activities lead to a summary of potential steps the organization can take to move toward their ideal future state - as a means to define scope, both of improvement work and physical design, if appropriate.
SERVICE: Transformation
EXECUTIVE SUMMARY
METHOD: Process Analysis
Columbia Orthopedics is a patient-focused, outpatient orthopedic physician practice. They desired to improve the patient experience by reducing waiting time and improving flow throughout their process. The administrative team at Columbia knew
Challenge
about process improvement, but were unsure of where they should start and which
The client recognized a patient flow problem, and needed assistance pinpointing the trouble areas and creating a path to future improvement.
improvements would provide the most value. Array saw this as the perfect opportunity to analyze the patient flow process at the clinic and offer suggestions for future improvements. In this case, the process analysis was a swift, targeted multidisciplinary series of one- to two-hour workshops in which we observed the process, collected preliminary data, briefly interviewed staff and developed suggestions for improvements as appropriate. •
Process Mapping: Staff gave a general overview of the process from patient arrival to departure.
Solution A brief and rigorous assessment format co-led by healthcare architects and systems engineers identified clear areas of scope, staffing model, communication and interdepartmental orders as imperative to improved throughput.
•
Process Observation: Our team observed the clinic’s patient flow process from the perspective of the patient, physician and MA. We used spaghetti diagrams to track the flow of each population and time-study sheets to capture data regarding length of stay and physician interaction time.
•
Staff Interviews: To gain a better understanding of the daily operations, we spoke with staff from all levels of the organization using a custom interview questionnaire.
Utilizing process analysis and associated tools, we were able to develop a targeted improvement plan that identified a number of specific items that could improve patient flow and reduce waiting times. We provided this plan in a clear format, which included additional detailed information about our study.
PROJECT HIGHLIGHTS
5
FOCUSED PROJECTS IDENTIFIED
10
STAFF MEMBERS INTERVIEWED
2
hr
PATIENT/STAFF OBSERVATION PERIOD
Client Profile COLUMBIA ORTHOPEDICS NEW YORK, NY Columbia’s patient-centered focus has always been the hallmark of their department, and they are proud of the department members who continue that tradition today. Columbia’s orthopedic surgeons are leaders in their respective specialties and provide the most advanced treatments for musculoskeletal conditions in adults and children. While they are on the cutting edge of the most significant advances in orthopedic surgery, they also deliver personalized care to every patient who seeks their expertise. www.columbiaortho.org
OBSERVATION After touring the facility to gain a high-level understanding of the typical patient flow, the team sat down to observe the process. Patient experiences were noted on observation records as they arrived at the facility. The amount of time spent in each process step can be seen in the process map in Figure 1. A spaghetti diagram was also used to capture patient and staff movement through the clinic. Some common themes became apparent after two hours of observation: •
The team noted that, at times, patients were unsure of where to go next when unaccompanied by site staff.
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Segregated staffing roles seemed to create disproportionate down time or burden for some team members.
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Patients who were unable to move around on foot had difficulty navigating the waiting areas’ limited space. Additionally, the team noticed that patients were aware of their arrival time relevant to other patients.
•
At times, the team observed staff members attempting to “fight fires” caused by breaking points in the system.
These observations allowed the team to develop a deeper understanding of how patients flow through the system. Initial analysis of these themes, combined with the remainder of the assessment, led to our proposed improvement plan.
Method PROCESS ANALYSIS You perform processes throughout your day. Our job is to assist with analyzing your work flows and determining where value is added. This helps us see where the waste is and eliminate those non-value-adding, unnecessary activities, allowing your work to flow more effectively. We combine reliable tools, such as spaghetti diagrams, failure modes and effects analysis (FMEA), and process mapping, with expertise to develop a solution tailored to your organization.
EXECUTIVE VISIONING Array’s senior healthcare personnel facilitated this portion of the process analysis. These individuals have specific experience translating healthcare observations into realistic improvement goals. Speaking with senior-level providers and management about daily issues that arise helped us create a detailed implementation strategy that was more client-specific than could ever be accomplished by providing a standard improvement strategy. In one hour, we determined current road blocks, highlighted strategic goals, and established scope boundaries for the improvement initiative.
Figure 1: Current state process map including process time highlights for observed patients. PAGE 2 | case study: Columbia Orthopedics
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Transformation
Figure 2: Waiting room volume over total observation time. FRONT-LINE INTERVIEWS We believe the front-line staff provides the greatest insight for process improvement. These individuals encounter potential areas for improvement in their daily work. Interviews with this staff group allow us to connect with the people who interact most with the patient. The discussions lasted about fifteen minutes and included the following questions: •
What are the most pressing complaints from patients regarding their clinical
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 are establishing a 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 are explored. 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.
experience? •
What major issues do you encounter each day?
HOW CAN WE IMPROVE FLOW?
•
If you could change the way you do one thing in the clinic, what would it be?
There are many tools available to see how work flows through a system. Value stream mapping is a strategic exercise that looks at the flow of work from customer request to fulfillment. Process mapping focuses on detailed work flow elements and can be used to identify non-value-adding steps that reduce efficiency and add to lead time.
We often find that the people who operate in the facility daily have a difficult time seeing the non-value added steps because they either are so familiar with the process or do not have time to stop and think about how to improve it. As individuals who are unfamiliar with the current operating procedures, it’s our job to see potential areas of improvement with an unbiased eye. Once again, we were able to draw upon the staff experiences conveyed in this interview setting to create an implementation plan that was unique to the organization. SUMMARY Upon completion of the process analysis, we provided recommendations for
TOOLS USED: Process Map, Observation, Staff Interviews, Visioning, Spaghetti Diagram
further investigation. We offered these options to the client as separate services with the opportunity to best match services with current needs and resources. The recommendations involved improvements to the patient experience, physical environment and staff interactions. Unlike organizations that focus on conventional improvement strategy elements, our one-day assessment allows us to create a customized list of improvement services that focus on our observations. FINAL REMARKS The observed clinic was a well-run, high-functioning patient services center. The custom improvement suggestions, provided as a result of process analysis, could be used to enhance the patient experience and move the clinic from good to outstanding. This assessment provided our client with an illustration of the improvement work we could deliver and allowed them to get to know our team on a deeper level. After process analysis, the client chooses which services fit with the current strategic goals. We work with them to develop an implementation plan for these improvement projects. The plan will include a more detailed process analysis session, future state process design, and a comprehensive transformation plan.
“Sometimes it takes unbiased eyes to see the potential for improvement.” - Laura Silvoy Healthcare Systems Engineer
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case study: Columbia Orthopedics | PAGE 3
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