CLIENT: Martin Health System Stuart, FL
CASE STUDY
High volumes of admitted patients waiting for inpatient beds lead to decreased capacity in ED. Knowing that the inpatient capacity will not be increased significantly in the near future and that improvement work is being done to help increase bed availability, the emergency department must assume that they will continue to hold admitted patients until a bed is available.
SERVICE: Transformation
EXECUTIVE SUMMARY
METHOD: Kaizen Event
Array partnered with Martin Health System (MHS) and HKS to facilitate process analysis and process design of an emergency department (ED) renovation. During this engagement, a multi-functional team of stakeholders from MHS participated in current state and future state mapping exercises to define how they would like to
Challenge
work, and developed a plan for reaching their goals.
Due to a need for inpatient capacity, Martin Health System uses the emergency department to hold admitted patients waiting for a room. This decreases their available capacity to treat new patients.
As Array led the team through the mapping exercises, members developed a better understanding of how each patient moves through the ED. Due to the number of admitted patients held in the ED because of limited inpatient capacity, the team wanted to ensure that the new process would focus on providing high-quality, effective care to all patients. Uncertainty around resource utilization resulted in a detailed study of patient flow through the ED, and the effect that holding admitted patients has on resource
Solution
utilization. Array used a simulation model to test different scenarios and determine the best resource allocation plan for the ED. The simulation model’s results
The Martin team focused on delivering efficient and effective emergency care, while providing a safe place to hold admitted patients. Array developed a simulation model to determine the appropriate number of holding and treatment beds for the Martin ED. This led to a new patient flow in the ED.
PROJECT HIGHLIGHTS
<5
min
demonstrate the trade-off between resource capacity and throughput time. Upon completion of the mapping events, key improvement opportinities became apparent to the team. Utilizing the transformation plan to guide these activities, MHS could see potential increases in patient satisfaction and improved emergency care.
EXPECTED AVERAGE WAIT FOR PROVIDER
18
TREATMENT BEDS NEEDED
15
SIMULATION MODEL SCENARIOS TESTED
Client Profile MARTIN HEALTH SYSTEM STUART, FL Martin Health System, a non-profit, community-based system comprises three hospitals, one MediCenter, a free-standing emergency center, and numerous outpatient centers and clinics. The system offers preventive, primary and acute hospital care, as well as cancer care, a heart center, wellness and rehabilitation services, and more.
CURRENT CONDITIONS The engagement kicked off with a leadership listening session, where the group shared key issues related to their current process and layout. Highlights include a need for a more effective and efficient space to support the emergency department (ED) process and improve communication; the desire to provide more private care in the correct location; and better accommodate different patient populations, including geriatric and behavioral health. The team started the day discussing how non-urgent patients moves through the ED, from the time they arrive until they are discharged. Next, the team focused on the process steps for acute patients. They used a single map to record both patient types, allowing them to see where the process steps overlapped. Throughout the mapping activity, the team uncovered numerous opportunities for improvement for all patients moving through the ED.
http://martinhealth.org/
Method KAIZEN EVENTS A kaizen event is a three- to five-day improvement event that brings together an interdisciplinary team to solve a problem and create a lasting change. We facilitate these events using consensus-based decisionmaking to ensure all voices are heard and each stakeholder supports the final decision.
Figure 1: Future state process map including average process times.
FUTURE STATE The multi-functional team gathered for a second time to determine how they should operate in the future. Array provided education to the team about different ways to design a new process flow for their ED. Due to the patient mix in their emergency department, the team decided to develop their own hybrid version of a split flow ED, which took into account their specific patient population. The future state process (Figure 1) also takes into account a large number of patients held in the ED until an inpatient bed is available. Using only a process map, it was difficult to determine how many ED beds were necessary and how many should be allocated for holding patients. Array recommended using a simulation model to determine the appropriate amount of space necessary to meet demand. SIMULATION MODELING The simulation study revealed that the new process, which shifts the traditional triage activities to an intake step and incorporates a pivot nurse, could significantly improve door to doctor time seen in the current state, if they allocated the appropriate resources (Figure 2).
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Transformation
Figure 2: Simulation results showing trade-offs between patient waiting time and necessary department footprint. The goal of this expansion and renovation project was to provide patients with quality care in the appropriate space while accounting for the boarding inpatients that will remain in the ED. To meet this goal, the team determined that no more than 2% of patients should wait longer than 10 minutes before seeing a provider. While the first scenario pushes the boundaries of the currently-allocated space, the team believed that it was the only way for the Martin Emergency Department to provide high-quality,
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. 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.
safe care for their patients using the right resources. The second scenario shows the effects of staying within the currently-allocated space. In this situation, the average door to doctor time is more than five minutes and more than 8% of patients wait more than 10 minutes to see a provider. While this scenario fits within the current space available, the number of resources will not support improved patient care delivered in the appropriate space, resulting in a patient experience that sometimes mirrors the current situation. RECOMMENDATIONS MHS faced a trade-off between available space and acceptable waiting time for their patient population. The two scenarios presented are both very good options and allow
HOW CAN WE ENSURE EFFECTIVE RESOURCE UTILIZATION? Every aspect of the healthcare industry relies on resources, including staff, equipment and space. It’s imperative that organizations utilize their resources effectively. Our qualified consulting team can help your organization develop a strategy for utilization optimization, ensuring that every resource is providing the most value while improving process flow.
the ED to provide a high-level care. Array recommended that MHS renovate their ED to support their newly-developed process.
“The simulation modeling was an excellent suggestion and I am so glad we did it.”
TOOLS USED: Process Mapping, Observation, Simulation Modeling, Capacity and Utilization Assessment, Consensus
- Laurie Daccarett, Manager of Planning, Construction & Real Estate, Martin Health System
Figure 3: Simulation model (right) showing simplified adjacency configuration. Future state mapping session (left) in progress.
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case study: Martin Health System | PAGE 3
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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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