Increase Patient Access Cleveland Clinic Foundation November 12, - - PowerPoint PPT Presentation

Designing Lean Processes to Increase Patient Access

Cleveland Clinic Foundation November 12, 2012

The Burning Platform

• NDSC statistics :

Over 100 employees 30 Providers 27,000 patients visits a year 450 children waiting for appointments

• Our patients have significant challenges with:
• physical limitations
• emotional fragility
• large mobility equipment
• behavioral issues

• The facility challenges:
• linear design with long hallways
• walls obstruct flow and visibility
• 60% of the facility is made up of offices
• just 40% is clinic space for the patients
• long walks for patients from the front door
• staff spent time looking for each other

What were the Facility Issues?

Define - What is the issue?

• Problem Statement: The length of the NDSC

appointment is too long

• The Goal: Reduce the length of the NDSC

appointment from an average of 66 minutes to an average of 56 minutes by November, 2012

Measure- Current State Value

Stream Map

The Analysis

• Spaghetti Diagram: Showing motion for each staff

member, patient, and family

• Cause and Effect Matrix:

The team weighted and scored those things that they felt added time and delay to the average

• appointment. Items included:

1) incomplete supplies in exam rooms 2) late policy application inconsistencies 3) scheduling inconsistencies 4) triage process delays

More Analysis – Flow & Schedules

The difference between Provider Exam Time not Statistically Significant

2 4 6 8 10 12 14 9 5 4 9 7 12 9 7 2 4 7 7 14 12 8 11 10 5 3

Waiting Room – 136 scheduled

More Analysis – Causal Mapping

Project Targets A3 Projects Out of Scope

Improvement - Standardization

• Standardization of Patient Prep
• Pocket cards made for medical

assistants

• Standardization of Room Content
• - Restocking completed at
• 7 and noon daily
• Draws standard in rooms
• - Photo Kanbans in place
• Par level Kanbans in place

Improve – Late Policy Standardization

Complete Agreed to by all Providers

Improvement – Level the Schedule

Creates a balanced, even workflow

Goal March, 2012 ACTUAL Oct., 2012

Improve – A3 Inventory Project

• Inventory 5S
• Right Content
• Right Sized
• Visual Management
• Kanban Placement
• Standard Work for
• Ordering Supplies
• Restocking the Exam Rooms

Sarah Shaffer, MA A3 Project Lead

The Current Floor Plan

The Current State

Long Walking Distances Long Hallways 200 ft. from one end to another Walls everywhere

Improve – Work Cell Design

Option #1 – internal work space Option #2 – Embedded clerical staff

One Day Rapid 3P – September 28, 2011

Mapping It Out – Getting It Right

Orange = Exam Rooms Green = Provider Offices Yellow = Nurses & Social Work Pink = Work Space

We Are Ready To BUILD !!

From Concept to Drawings

Improve – Mock Up of Design The Warehouse

Waiting Room Physician Offices Physiatry Entrance Exam Rooms

Parent Involvement

• Visioning Sessions with parents
• Scenario Testing with parents
• Members of the full team
• Gave Tours to fellow parents

Our Parent Team Members of Parent Advisory Council Volunteers from NDSC parents Members of NDSC FAC Group

Communication to all staff

Newsletters sent to all NDSC staff daily

• Photos
• Daily accomplishments and findings

Staff Tours and Feedback

What needs changed:

• We need sinks ! !
• Can we have blinds?
• Let’s lock the med room
• Waiting Room is small
• Where is Check In ?
• Where is the Trash Bin?

What Looks Good ?

• We can see everything and everybody !!
• “ I love the interior team space !”
• I can find the provider immediately !
• Everyone is on the “playing field”
• The team neighborhood idea will really help

with communication and teamwork

• This will be easier for our families

The Anticipated Benefits

• Increase the satisfaction of patients and

families by reducing wait time and motion and providing a pleasant, less stressful environment for the visit

• Increase the satisfaction of the providers and

staff by reducing their transportation and motion throughout the day allowing time to see patients rather than trying to finding patients

• Increase the number of visits available by

2,500 annually for an increase in gross revenue of $727,000 (pending Decision Support approval)

Where are we Now?

• Portions are moving into swing space
• Actual renovation will be in stages with each of

the 5 subspecialties going one at a time

• Anticipated completion Summer, 2013
• Already seeing increased patients with

standardization and level loading

• Are creating staffing “neighborhood teams”
• Moving clerical and clinical in one space
• Creating lots of excitement and team spirit

svalentine@chmca.org