Put on hold or reverts back to the inpatient

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put on hold or reverts back to the inpatient schedulers (the process in place prior to Lean improvements). Therefore, the continuity of the new process hinges upon a single individual and has not been institutionalized. This is partly due to limitations in modifying the scheduling system, given the moratorium on IT system changes. Monitoring, Control, and Sustainment During the 100-day project implementation, the team lead and the administrative champion met weekly to discuss project progress. The team lead performed a monthly audit to monitor the followup appointment process by reviewing a subset of charts from the inpatient department. This process was completed by hand, and data were entered into an Excel (Microsoft Corporation, 2003) spreadsheet on a monthly basis by the team lead. Information collected includes whether the followup appointment: Was made within 1-2 days of the discharge order request. Was scheduled with the right provider. Was scheduled for the specified time period. After the project ended, the team continued to audit charts manually and report findings to the EOT on a quarterly basis. The team lead left the organization a few months after the project ended but transitioned sustainability monitoring responsibilities to another member of the project team. Project Outcomes Overall, the Cardiology Follow-up project was regarded as moderately successful by the team members. The project team was able to achieve their goal of 80 percent accuracy in scheduling cardiology followup appointments, doubling the initial 40 percent accuracy rate. The accuracy rate ranged between 72 80 percent as the project moved into the sustainment phase. This progress is impressive in the face of structural challenges. The project team created temporary workarounds to implement their solutions, but they may be able to shift to more permanent solutions as the freeze on changes to the IT systems ends. As new computerized discharge orders can be built and scheduling templates for appointments are revised, the team lead stated that it would be easier to schedule followup visits, since more of those slots would be open rather than being assigned as new patient slots. Improved communication and teamwork was mentioned as an outcome by several Cardiology Follow-up team members. One team member specifically noted that the Lean process and common language promoted collaboration and communication between team members. Another nurse manager and a frontline staff person indicated that this improved communication was facilitated by the instant messaging system implemented as part of this project.
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121 “At the end of the day, it doesn’t matter to me much that, let’s say, there was $2,000 savings, [where] the $1500 came from Lean and $500 came from other areas.” Executive leadership Several interviewees reported that the project had positive effects on patient satisfaction as expressed by patients in interviews when asked about the discharge process and the transition from the hospital to the clinic. Patient survey results showed an increase in satisfaction with the
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