PGPM
Lean Hospitals Case Studies.pdf

Initially the team had not planned to make changes to

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The team ran into challenges and needed to make adjustments to the project plan. Initially, the team had not planned to make changes to the pediatric appointment scheduling template to improve clinic flow but then realized the template made it difficult to provide continuity of care. Phantom slots were put on the schedule to hold appointments for same day and next day availability. At first, the goal was for 90 percent of patients to be seen by their assigned primary care doctors, but the goal was later raised to 100 percent when the definition of the metric changed. The project team realized that it would be impossible to reach 100 percent if walk-ins were included, because including them would have required that all doctors be available at all times. Thus, walk-ins were excluded from the measure and the target was raised to 100 percent. The project team formed provider teams to facilitate continuity of care so that patients would see the same resident(s) and/or attending physician at each visit. Monitoring, Control, and Sustainment The RIE process owner monitored data on a weekly basis to determine whether pediatric patients were seen by their assigned primary care physician and to assess clinic productivity. Clinic productivity was measured as the ratio of the number of patients actually seen to the total slots available per provider. This process was initially completed by hand, but the floor manager and former process owner helped develop a spreadsheet for entering the data to calculate the measures more efficiently. The following measures were reviewed on a weekly basis: Verification completed to determine whether physicians were on the primary care physician list with the patient’s managed care insurer . Verification of patient insurance coverage 72 hours before the visit. Cleaning of the clerical area. Patients seen by the assigned primary care physician. In addition, ambulatory care administration tracks: Clinic productivity, which was calculated as the number of patients actually seen by each provider as a rate of total scheduling slots available per provider. Staff absenteeism. Time to third, next-available appointment. Once the project ended and the team reported on the data after 90 days, no formal tracking or reporting was completed. However, all of the interviewees reported that the changes from the project had been sustained and had become ingrained in the department. During our visit in October 2010, the standard work process was still posted and being followed by the staff, and the process owner continued to follow up with staff to make sure they were following the new process. Project Outcomes The project team members and process owner/assistant director felt the project was very successful because, as We've had a number of events that haven't been as successful and I think that it's been a learning process. We might not have seen the success in their 30-, 60-, or 90-day reports, but they've definitely taught us lessons for how to move forward and what events we're going to do in the future and how we're going to approach different problems.” Department leader
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  • Fall '17
  • Shankar Purbey

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