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    Efficiency Practice

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    srsureshrajan
    1) Improving office efficiency requires balancing capacity and demand, synchronizing patients, providers and information, anticipating patient needs, optimizing exam rooms and equipment, and managing constraints. 2) Key strategies include matching capacity to daily demand, starting and staying on schedule, standardizing processes, improving communication, and allowing no idle time for constrained resources. 3) Concepts from industry like identifying value from the customer perspective, eliminating waste, improving workflow, optimizing the work environment, and managing variation can also increase efficiency in medical offices.

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    Efficiency Practice

    Uploaded by

    srsureshrajan
    59 views36 pages
    1) Improving office efficiency requires balancing capacity and demand, synchronizing patients, providers and information, anticipating patient needs, optimizing exam rooms and equipment, and managing constraints. 2) Key strategies include matching capacity to daily demand, starting and staying on schedule, standardizing processes, improving communication, and allowing no idle time for constrained resources. 3) Concepts from industry like identifying value from the customer perspective, eliminating waste, improving workflow, optimizing the work environment, and managing variation can also increase efficiency in medical offices.

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    1) Improving office efficiency requires balancing capacity and demand, synchronizing patients, providers and information, anticipating patient needs, optimizing exam rooms and equipment, and managing constraints. 2) Key strategies include matching capacity to daily demand, starting and staying on schedule, standardizing processes, improving communication, and allowing no idle time for constrained resources. 3) Concepts from industry like identifying value from the customer perspective, eliminating waste, improving workflow, optimizing the work environment, and managing variation can also increase efficiency in medical offices.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    59 views36 pages

    Efficiency Practice

    Uploaded by

    srsureshrajan
    1) Improving office efficiency requires balancing capacity and demand, synchronizing patients, providers and information, anticipating patient needs, optimizing exam rooms and equipment, and managing constraints. 2) Key strategies include matching capacity to daily demand, starting and staying on schedule, standardizing processes, improving communication, and allowing no idle time for constrained resources. 3) Concepts from industry like identifying value from the customer perspective, eliminating waste, improving workflow, optimizing the work environment, and managing variation can also increase efficiency in medical offices.

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    © All Rights Reserved
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    of 36

    Efficiency In Office

    Practice
    Barbara S. Boushon, RN, BSN
    Mark Murray and Associates
    Office Efficiency (work flows)
    The right person doing the right task at
    the right time
    Barrier-free
    Patient-centered
    Predictable, standardized
    Based on systems, not people
    Based on team structure
    Capacity: The Link Between
    Access and Efficiency

    Increased capacity leads to improved


    access
    Improved access leads to more efficient
    office processes
    More efficient processes increase
    capacity
    Cycle Time Measurement
    Check in MA to Room MD Enters MD Leaves Check out

    Process
    •Greet •Vital signs •Greet interview •Prepare information
    •Check in/registration•Interview •Exam •Closure
    •Get chart •Prepare information•Closure
    •Prepare information
    Over-arching
    •Information transfer
    •Communication, pre, during, post visit
    •Synchronize patient, provider, information, equipment
    •Standardize rooms
    •Choreography
    Measurement- cycle time
    Audit
    The Metrics
    Lead Time = start to end
    The sum of the cycle times + delays
    For the whole process
    The visit
    The referral
    Medical record retrieval
    Each segment of the process = cycle time
    Appointment booking, reminder, registration, greeting,
    waiting room, rooming, vital signs, value added vs non-
    value added time
    Terms
    System:
    Group of processes working together to achieve aim
    Process:
    Group of tasks working in an orderly fashion to
    achieve an aim
    Tasks:
    A specific job or piece of work
    Tools:
    Workflow analysis/work task analysis
    Flow Through the Office
    Check-in to Nurse
    Dr. in to Dr. out

    Nurse to Room Check-out to leave

    Lead Time
    How Processes Support Flow
    1 1
    1 1
    P r o c es s P r o c es s
    P ro c es s P ro c es s

    Check-in to Nurse Dr. in to Dr. out

    Nurse to Room Check-out to leave

    1 1

    P r o c es s P ro c es s 1 1 1

    P ro c es s P ro c es s P ro c es s
    Check-in to Nurse
    Greet
    Register
    Routing slip
    Update information
    Obtain directions to clinic nurse
    Obtain chart
    Go to clinic
    Wait
    RN/MA/LPN to Exam Room
    Greet
    Gather chart
    Review/update preventative health
    information
    Educate/treat for prevention as
    indicated
    Go to clinic room, vitals
    Wait
    Doctor In to Doctor Out
    Greet
    Open chart/computer
    History
    Exam
    Assessment
    Education
    Plan
    Documentation
    Check Out to Leave

    Review orders
    Pharmacy education?
    Nurse education?
    Send for more lab/XR?
    Set up referrals?
    Set up next appointment?
    How Processes Support Flow
    1 1

    P ro c es s P r o c es s 1 1

    P ro c es s P r o c es s

    Check-in to Nurse Dr. in to Dr. out

    Nurse to Room Check-out to leave

    1 1

    P r o c es s P ro c es s
    1 1 1

    P ro c es s P r o c es s P ro c es s
    Lead Time Example
    Cycle Time
    Average Goal
    70
    60
    50
    Min u te s

    A M HUDLE
    40 Align Patients, Pr oviders, Staff
    30
    Decr eased Appointment Ty pes
    20
    Real Time Work
    10
    Separated Tasks Lab in Exam Room
    0

    We e k Ending
    How do we decrease the
    waiting in the office….

    And keep the value added time?


    Frameworks
    High Leverage Changes
    Change Concepts
    Medical Office Efficiency High
    Leverage Changes
    Balance Capacity and Demand
    Synchronize Patient, Provider, and
    Information
    Predict and Anticipate Patients Needs
    Optimize Rooms and Equipment
    Manage Constraints
    Balance Capacity and Demand
     Predict daily demand for non-appointment services
     Understand the components of demand for services:
    -documentation
    -medication refills
    -lab review
    - messages
    -referrals
    -forms management
     What is the matching process?
     Batch vs. one piece flow
     Match the demand to the correct resource
     For all non-appointment services
    Synchronize Patient, Provider,
    and Information
    Start on time and stay on time
    Identify and maximize the value stream
    Synchronize Patient
    Synchronize Provider
    Synchronize information
     Registration process
     Closure of last visit
     Chart check
     Rooming criteria

    Document, do work in real time


    Synchro nizatio n T im e fo r O ffic e V isit

    E qu ipm en t
    P a tient
    R oo m

    10:00 10:30 11:00


    Staff

    Info rm atio n P ro v ide r


    Synchronization “Truisms”

    The whole process can only go as fast as the


    slowest step
    If the process starts 15 minutes “late” each
    session (AM and PM), a full time clinic can
    “waste” 400+ appointments per year.
    Must work “backwards” from sync time to
    make sure everything is ready on time.
    Predict and Anticipate Patient Needs
    Practice level approach:
    Plan for seasonal demand changes
    Flu season, Vacation season, Snowbird season
    Plan for the unexpected but predictable daily
    demands
    Admissions, procedures, consults, information needs
    Understand and standardize common
    procedures
    Align expertise of care teams with patient
    needs; plan the visit
    Predict and Anticipate Patient Needs
    Visit level approach
    Communication is harder than you think
    “Huddle” – dialogue among team intended to
    get everyone “on the same page”
    Stand up meeting of less than 5 minutes
    Used to plan clinic session; prior to procedure; at
    a “hand off”
    Promotes familiarity, shared expectations
    Communication Overview
    14% of each 40 hour work week is wasted in
    miscommunication
    Over 50% of errors in VA’s Root Cause
    Analysis traced back to miscommunication
    Communication basics
    Familiarity of staff – call each other by name
    Listen to understand, not to plan next comeback
    Communicate what you see and know
    Explicitly ask everyone for input
    Optimize Rooms and Equipment
    Adequate number of rooms
    Optimize Rooms
    Open rooming
    Fully stocked rooms
    Standardize layout, supplies
    Move equipment to the patient
    Optimize Space
    Signals for equipment
    Identify and Manage Constraints
    Person constraint for non-appointment work
     Maximize the care team: “what is the work?”
     Put inspection step in front of the constraint

     All work to highest level of skill, expertise, and licensure

     Standard Protocols

    Process constraint
     No idle time
     Separate phone flow, patients flow, and paper flow

     Continuous flow

    Specific processes
    Identify the Constraint
    Constraint= the rate limiting step
    (Theory of Constraints-TOC)

    Who is the person (role) in front of


    whom most waiting occurs?
    What is the process in front of which
    most waiting occurs?
    Maximize the Constraint
    Put resources around the constraint to
    optimize their output
    Even if other steps work below their
    maximal capacity
    Allow no down-time for the constraint
    Change Concepts from Industry
    Identify value, then eliminate waste
    Improve the flow of work
    Optimize the work environment
    Manage variation
    Identify Value (from customer
    view), then add value ……
    Patients say:
    “Treat me with respect”
    “Be friendly and caring”
    “Give me a long-term healthcare
    relationship”
    “Make your services convenient”

    (Education, skill, and training are assumed)

    Focus Group
    …and Eliminate Waste (Lean
    Thinking)
    Eliminate
    Things that aren’t used
    Multiple entry
    Overkill
    Intermediaries
    Sample
    Improve the Flow of Work
    Synchronize
    Minimize hand-offs
    Move steps closer together
    Automate
    Do tasks in parallel
    Practice continuous flow
    Use pull systems
    Optimize the Work Environment
    Improve access to information
    Train
    Cross-train
    Reduce set-up time
    Manage Variation

    Standardize
    Create contingency plans
    Manage peak demand
    References
    VA Delays Manual
    The Improvement Guide: A Practical
    Approach to Enhancing Organizational
    Performance.
    G. Langley, K. Nolan, T. Nolan, C.
    Norman, L. Provost. Jossey-Bass
    Publishers., San Francisco, 1996,
    Chapter 7 and Chapter 13

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