Using this information and the tools from the lean

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Using this information and the tools from the Lean training to design the project, the team began looking for ways to increase the efficiency of the inpatient cardiology discharge process and the accuracy rate for followup appointments. The specific Lean tools used and associated activities included: Voice of the customer interviews with patients and department staff verified hypothesized gaps in service and followup that needed to be addressed as part of the project. Swim lane flow chart of the cardiology inpatient discharge process identified process responsibilities by role. Seiketsu (standardization): changes were made to the scheduling process and template, and to staffing assignments, including shifting to a single scheduler handling the followup appointments. Initially, two rapid tests of change were conducted to see if the changes to the schedule process were effective. Using “mistake proofing,” it was detected that 75 percent of medical residents’ discharge orders contradicted the scheduling guidelines proposed as part of this project. A third rapid test of change was completed to correct for issues discovered in the mistake proofing process. Quick changeover : To improve the efficiency of the process, the team implemented an instant messaging program between the inpatient and outpatient staff handling discharge and followup scheduling, respectively. Using visual management techniques , the team created a cardiology discharge checklist for use on the inpatient floor. The project team lead reported that the department chair (the physician champion) set broad goals for improving patient experience in the transition from cardiology inpatient to cardiology outpatient care. He was described as being accessible, collaborative, and easy to talk to. The chair was instrumental in selecting the scheduler, a key member of the team who was critical in being able to put in place the new scheduling system from the inpatient side. The team ran into structural challenges related to scheduling and had to adjust the project plan. There were not enough followup slots in the timeframe needed to meet patient safety requirements, or there were slots available but they were not for the right type of appointment. The team made some small changes to the physician scheduling templates but could not implement all the changes proposed because of a freeze on changes to Grand ’s IT system. In the meantime, the team found a workaround that allowed certain staff to make changes to the template on an as needed basis.
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120 In addition, the project team changed the scheduling process dramatically, shifting the responsibility from a group of schedulers in the inpatient area to a single scheduler in the outpatient area. To make this change work, the team lead worked with scheduling supervisors to get approval and educated all of the schedulers on the new process. However, when the scheduler responsible for followup appointments is out of the office, the scheduling process is
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