How To Improve Your Workflows

Transcription

1 Workflow: Effective EHR Project Management Webinar Ravi Lote

2 About PMC Established in 1979; 30+ years of excellence in Productivity Solutions Employees: 80 plus - with a number of PhD and Master Degree holders Projects Completed, 600+ Clients Served across many industry verticals Lean Workflow for EHR- 2

3 PMC s Locations Headquarters: Dearborn, MI, USA Other Offices: Texas, California, Seattle, Sweden, India, Thailand, Turkey, Honduras For further info: Lean Workflow for EHR- 3

4 PMC s Expertise Lean training & implementation Value Stream Mapping Kaizen workshops Line Balancing, Layout Planning & Work station design Simulation and Optimization Time Studies Work Sampling Theory of Constraints Applications CAD and 3D Modeling Business Process Re-engineering Continuous improvement initiatives Project Management & Support Production Management IT - Customized and standard (COTS) solutions Quality improvement, training & certification Scheduling systems Full scale implementation Integration with ERP & technology infrastructure Lean Workflow for EHR- 4

5 PMC s Experience Projects Completed 600+ Clients Served across many industry verticals Lean Workflow for EHR- 5

6 What is EHR The Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Contains information such as: past medical history laboratory data and radiology reports. patient demographics, progress notes, medications, vital signs Source: HIMSS Source: HIMSS Lean Workflow for EHR- 6

7 Background Electronic Health Records (EHRs) can create practice workflow efficiency by enhancing: Office communication Improving patient flow Increasing and improving provider-patient interaction Making patient information available to providers in real time Source: Maryland Healthcare Commission Lean Workflow for EHR- 7

8 Drivers and Constraints Drivers Emphasis by federal government on EHR adoption Offering a EHR solution is part of an organization s competitive strategy Gradual transition of patient from passive to active role in care process Increasing prevalence and Incidence of chronic diseases Restraints Limited awareness & comprehension Privacy & security concerns Slow migration from paper to digital storage Lack of interoperability between clinical data systems Additional cost burden Limited adoption of EHRs Source: Frost and Sullivan Lean Workflow for EHR- 8

9 Workflow Analysis and EHR An EHR can be utilized as a workflow tool giving the practice the ability to collect and present information in one integrated view. During the selection and implementation of an EHR, conducting a workflow analysis will help a medical practitioner to: Identify the ways to streamline a process Improve the efficiency of a practice s clinical workflow Provide an understanding of the complexity in completing a specific task Gain a better appreciation of how these complex tasks are accomplished resulting in better automation results. Source: Maryland Healthcare Commission Lean Workflow for EHR- 9

10 Dealing with Processes Key to success of EHR implementation is effective Process mapping Technology is an enabler, not the answer Some of the common methodologies used to develop Current state and future state maps are: Business Process Management (BPM) Business Process Automation (BPA) Extension of Current IT Systems Business Driven Development (BDD) Lean Workflow for EHR- 10

11 Experience has proven Lack of planning in integrating high volume workflow activities into the implementation of the EHR can cause problems More time and emphasis into documenting the existing paper workflows by the staff needs to be done Workflow Analysis and Redesign are the Keys to a successful EMR implementation Lean Workflow for EHR- 11

12 EHR Implementation Methodology Pursuit of Perfection People Technology Processes Source: HIMSS Lean Workflow for EHR- 12

13 PMC-Healthcare: Our Approach There is a way to increase the effectiveness of an EHR system by improving the processes that it affects through the utilization of Lean principles Lean can help an organization save time and money by enhancing workflow throughout the organization and optimizing EHR implementation and usage Lean Workflow for EHR- 13

14 PMC-Healthcare: Our Approach Form cross-functional team to develop current state Value Stream Map (VSM) Develop future state VSM with focus on design of electronic forms Emphasize on: Customer-centric process design Standardized work Quality at Source Reduction in process time Visual workplace Lean Workflow for EHR- 14

15 PMC-Healthcare: Our Approach Conduct lean training sessions for all the stakeholders (including physicians) and communicate the future state processes with the following goal(s) Increase OR throughput Reduce patient wait times Improve quality of care Shorten revenue cycle Streamline admissions Select department for pilot launch of new processes and roll out the organization wide implementation plan based on lessons learned Lean Workflow for EHR- 15

16 Salary: x$10/hr. = $4580 x $15/hr. = $6870 x$20/hr. = $9160 x$25/hr. = $11,450 x$30/hr. = $13,740 1 second to look for or do something X 200 = 200 sec. (3.33 mins) X 11 = mins X 3 = 110 mins X 250 = 27,500 mins / 60 = 458 hours /8 = 57 days or approx. 1 month Lean Workflow for EHR- 16

17 How Do We Define and Measure Value? Lean Methodology gives us specific rules to use in determining what activities are value-added (VA) or non-value-added (NVA): RULE 1: The customer must be willing to pay for the activity RULE 2: The activity must transform the product or service in some way RULE 3: The activity must be done right the first time Lean Workflow for EHR- 17

18 Value-Added vs. Non-Value-Added Department Role VA Activity Example NVA Activity Example Operating room Surgeon Operating on patient Waiting for delayed procedure or performing unnecessary steps Pharmacy Pharmacy technician Creating an IV formulation Reprocessing medications that were returned from patient units Inpatient unit Nurse Administering medications to Copying information from one a patient computer system into another Radiology Radiology technician Performing MRI procedure Performing a medically unnecessary scan Laboratory Medical technologist Interpreting a test result Fixing a broken instrument Department Product VA Activity Example NVA Activity Example Emergency room Patient Being evaluated or treated Waiting to be seen Clinical laboratory Patient specimen Being centrifuged or tested Waiting to be moved as a batch Pharmacy Perioperative services Prescription Sterilized instruments Nutrition services Patient food tray Medication being formulated or prepared Time when instruments are being sterilized Time when food is being cooked or tray is being assembled Being inspected multiple times Instruments being sterilized repeatedly without ever being used from a standard kit Being reworked because the tray was made incorrectly Lean Workflow for EHR- 18

19 Value & Waste Focus of traditional improvement programs Work longer Work harder Add people Add equipment Focus of Lean: Eliminate Waste Lean Workflow for EHR- 19

20 Understanding WASTE Identification and elimination of WASTE is the central focus of a LEAN system Success requires all employees to be trained to identify & eliminate WASTE from their work areas Lean Workflow for EHR- 20

21 Understanding WASTE WASTE exists in ALL work... and at ALL levels of the organization! Lean Workflow for EHR- 21

22 Understanding WASTE Waste is anything other than the minimum resources absolutely necessary to add value to the product: Equipment & tooling Direct & indirect labor Material Floor space Energy Lean Workflow for EHR- 22

23 Why use Lean for Workflow Analysis? Increase value for internal and external customers by Eliminating waste Intellect Not using employees full intellectual contribution Overproduction Producing more than what the customer needs Waiting Employees waiting for another process or a machine/tool Over-processing Adding excess value when the customer does not require it Motion Extra physical/mental motion that doesn t add value Rework Reprocessing, or correcting work Inventory Building and storing extra services/products the customer has not ordered Transportation Moving product from one place to another Improve your processes first, otherwise, all the automation does is speed up the mess!!! Lean Workflow for EHR- 23

24 Lean Workflow for EHR- 24

25 Inventory Hides Problems Work in process inventory level (hides problems) Unreliable Vendors Scrap/ Obsolescence Capacity Imbalances Lean Workflow for EHR- 25

26 Lowering Inventory Reveals Problems Accommodate lower inventory levels by: Reducing variability Eliminating waste Streamlining flows Having Accurate information Unreliable Vendors Scrap WIP Capacity Imbalances Lean Workflow for EHR- 26

27 Lean Healthcare Kanbans Lean Workflow for EHR- 27

28 Kanban Card Unique Part # Yellow Sticky Notes Description Where to find replacement part Qty 6 Stock Loc: Central Storage Shelf 1 Return to: Supply Room B Refill Quantity Where to return filled Kanban Lean Workflow for EHR- 28

29 Kanbans Controls a linear flow of inventory with a static quantity Lean Workflow for EHR- 29

30 Current State Enter Hospital Move signs to front to direct PT s Holly (L,H) Time Savings ED Patient Flow: Current State Planning and Implementing Lack of signage directions I Wait Move Move triage to front office Stephanie Sherry Training Issues Lack of Copy Machine New Copy Machine C,fax,scan Stephanie Wait pre registration Pre registration -- CC -- Consent form -- ID (1-3 mins) Collection of correct information, correction of incorrect information Time Savings 2-3 mins Cant ask for Insurance Info before Triage? Wait after pre registration Nurse sees Pt 1 st. Triage Eliminate Guidelines consistent, Sign in sheet doesn t match face sheet layout Sherry, retraining (?,?) PT registration Sherry, Stephanie Donna Revamp saving Develop std flow collection Cost to Regs, train form to match due correct for employees face sheet all Steph,Donna Cost (L,H) Time (L,H) savings, Savings Quality min savings 3 I Wait Move Relocate copier Sherry, Donna (L,M) Time Labels,arm bands, only print in triage Triage (5 min) Standard work for Triage Donna (L,H) Savings 5S Triage Donna (L,H) Time Savings, Savings $ Electronic info flow I Wait Move to ER Room Savings, 600K /yr I Lab,Rad Nurse/MD assessment MSE s? patient leaves Call Holly on MSE s not done Holly, Bonnie M,H) ED Patient Flow: Future State Radiology Electronic info flow Lack of electronic document-- ation Capital project for doc document promed Multiple steps to register& -- Pre reg -- Reg -- Co s collect Complete registration process(5-10 mins) Return to patient to collect copay Full bedside Stephanie (L,H) Lack of completion of insurance verification 5 S the Regist. area Steph, Cherry (M,H) I Time savings, Quality savings Pyxis not close to patients, high traffic area Treatment ~60 mins (15mins-3 hrs) Life packs Walk not alike around for Capital for supplies new ED Standardize Roy (L,H) rooms, set par levels Donna, Sherry,Linda (L,M) Time savings, $ savings & inventory I Patient disposition I Patients discharged Discharge that should instructions be admitted only printed CM to train ED in 2 areas nsg on bluebook+ Guideline process for admit Bonnie, Donna bluebook (M,H) $$$ creation 80K/mo Staff education Donna, John (M,H) Holly to educate physicians Holly (H,H) Discharge 75% ~10 min Transfer 10% ~60 min Admit 15% ~30 min Future (Ideal) State Enter Hospital 1 min 1 min Electronic monitor Triage I I Go to nurse Lab 3 min Electronic 5 order min lab returns Electronic order lab 3 min 1 min Nurse Medical assessment screening I I Wait Wait Promed 20 visual min Complete registration (Pt pays if non emergent) I Wait 60 min 5 min Treatment I Wait 15 min 10 min Collect money & disposition 10 min I Patient Total Time 134 min Discharge Transfer I Patient leaves Admit Radiology I 1 min 1 min 5 min 1 min 5 min 1 min 5 min 1 min 5-10 min 5 min 60 min 10 min 15 min 10 min Patient Total Time min Action Plan to guide continuous improvement effort and monitor implementation Lean Workflow for EHR- 30

31 Brown Paper Mapping Shows the Big Picture Describes a process as it works today; an as-is model High touch, low-tech Identifies strengths and opportunities Captures the complexity and disconnects of key operational issues Identifies outside areas involved in the process Lean Workflow for EHR- 31

32 Action Item List Task Responsible Due Date Reduce Errors by implementing Kanban on Workstation 6 Mario 10/25/2007 Reduce Headcount by implementing Takt Time on Workstation 2 JoAnn 8/26/2007 Reduce Cycle Time by implementing One-piece Flow on Workstation 3 Mario 10/30/2007 Reduce Cycle Time by implementing One-piece Flow on Workstation 3 Frank 8/19/2007 Reduce Repair Time by implementing 5 S on Workstation 4 Joe 9/13/2007 Increase Quality by implementing Six Sigma on Workstation 8 Sanjay 8/26/2007 Reduce Cost by implementing Takt Time on Workstation 3 Joe 9/29/2007 Reduce Number of Failures by implementing Process Route Table on Workstation 2 Wilbur 8/8/2007 Increase Quality by implementing Process Route Table on Workstation 3 Wilbur 10/24/2007 Increase Quality by implementing Quick Changeover on Workstation 5 Rocco 8/23/2007 Reduce Repair Time by implementing Six Sigma on Workstation 6 Sanjay 9/23/2007 Reduce Cost by implementing Error Proofing on Workstation 10 Frank 8/23/2007 Increase Quality by implementing Lean Metric on Workstation 4 Randy 9/13/2007 Increase Efficiency by implementing JIT on Workstation 1 Mickey 9/25/2007 Reduce Cost by implementing Process Route Table on Workstation 3 Mario 10/22/2007 Reduce Cycle Time by implementing Standardized Work on Workstation 2 Marcelo 8/8/2007 Reduce Repair Time by implementing Takt Time on Workstation 1 Rocco 9/7/2007 Reduce Headcount by implementing Kaizen on Workstation 3 Sandy 10/16/2007 Increase Efficiency by implementing Lean Metric on Workstation 3 Joe 10/15/2007 Increase Efficiency by implementing Visual Management on Workstation 10 Randy 10/13/2007 Reduce Cycle Time by implementing One-piece Flow on Workstation 6 Mario 9/18/2007 Reduce Cycle Time by implementing Kanban on Workstation 7 Sandy 8/23/2007 Increase Efficiency by implementing One-piece Flow on Workstation 5 Sanjay 9/28/2007 Reduce Cost by implementing Workplace Organization on Workstation 5 Rocco 10/17/2007 Increase Quality by implementing Six Sigma on Workstation 11 Wilbur 9/19/2007 Increase Quality by implementing Error Proofing on Workstation 5 Frank 8/15/2007 Reduce Number of Failures by implementing Kanban on Workstation 10 JoAnn 9/17/2007 Reduce Errors by implementing Standardized Work on Workstation 5 Frank 8/9/2007 Increase Quality by implementing Takt Time on Workstation 1 Joe 9/17/2007 Increase Quality by implementing Error Proofing on Workstation 10 Rami 10/25/2007 Reduce Headcount by implementing Kanban on Workstation 10 Randy 10/4/2007 Reduce Headcount by implementing Kanban on Workstation 5 Sanjay 10/28/2007 Increase Efficiency by implementing Visual Management on Workstation 2 Rami 8/8/2007 Reduce Number of Failures by implementing Six Sigma on Workstation 5 Frank 9/12/2007 WHO will do WHAT, by WHEN? Prioritize based on resources. Thus what to do first. We can prioritize by: the task that will generate the most Net Profit or The easiest or The fastest or Will take the fewest people Least amount of money or Etc. Find the bottleneck (constraint), and then find the solution that has the most impact on it! Lean Workflow for EHR- 32

33 Change Management Success of change management hinges on: Well defined, documented, and communicated change Strong support from leadership Active participation from stakeholders Training to build awareness, commitment Lean Workflow for EHR- 33

34 Lean Change Management Awareness Desire Knowledge Source: Workflow Redesign in Support of the Use of Information Technology Within Healthcare HIMSS, Lean Workflow for EHR- 34

35 J. P. Kottler s 8 Steps 1. SET THE STAGE Create A Sense of URGENCY - Help others see the need for change and the importance of acting immediately (i.e. SWOT Analysis, Discussion) 2. Pull Together the Guiding TEAM Make sure a powerful group is leading the change (ie. leadership skills, bias for action, credibility, authority and communication and analytical skills 3. DECIDE WHAT TO DO Develop The Change VISION And Strategy - Clarify how the future will be different to the present, and how to make the future a reality 4. MAKE IT HAPPEN COMMUNICATE For Understanding and Buy-In - Make sure that as many others as possible understand and accept the change 5. EMPOWER Others To Act - Remove as many barriers as possible so that those who want the vision to become a reality can do so 6. Produce SHORT TERM WINS Create some visible successes ASAP. Spread short term success stories so that morale is raised, and employees feel a sense of achievement, because they can see evidence of the change's success 7. DON'T LET UP Be relentless with implementing change, ensuring that the initiation is pushed harder and faster after each Short Term Win 8. MAKE IT STICK CREATE A NEW CULTURE - Make sure that the new ways of behavior succeed, so that they become apart of the very culture of the group Lean Workflow for EHR- 35

36 Conclusions Organizational culture is a better indicator of EHR implementation projects Workflow processes must be re-engineered by involving stakeholders from the start of the project. Physician involvement is key to success. Dispel the myth that an EMR will make physicians work faster. Develop a plan to manage change and provide governance to ensure rapid decision making Demonstrate the support of senior leadership, communicate frequently and build consensus Train end users by hospital staff members who understand the culture and workflows Lean Workflow for EHR- 36

37 Questions? Lean Workflow for EHR- 37