In the long term the team planned to renegotiate

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pillows could be used instead at a lower cost. In the long term, the team planned to renegotiate contracts with the implant providers to further reduce costs. Workplace organization (5S) on storage areas to reduce inventory waste. PDSA (Plan-Do-Study-Act) on discharge time to identify opportunities to streamline the discharge process. s A spaghetti map is a Lean tool that shows the flow of people or information through systems. Exhibit 3.14. Project Team Composition Hip and Knee Replacement Costs The team included 11 staff : Physician champion: clinical department chair Coach: Systems and Procedures staff member Team lead: operations administrator Team members: seven staff from the orthopedics department, including a physician assistant and nursing staff; one staff from the financial analysis and planning department
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116 Rapid test of change using a whiteboard to record notifications of the time of the next surgical case with the purpose of reporting and recording operating room changeover time (the period of time between surgeries required to prepare the operating room for the next patient). Monitoring, Control, and Sustainment During the 100-day implementation period, the team met on a weekly basis for an hour before the surgical schedule started. This process helped keep the project moving forward. The team periodically collected updated data from the Financial Services Department on the total cost of hip and knee replacement surgeries and the gap in Medicare reimbursement. In addition, the team monitored data on operating room changeover time t and discharge time using information technology software that routinely tracks this information. Decision Support System (DSS) data, as well as medical and surgical records, were used to examine anesthesiology costs, supply costs, and resource costs from other medical specialty departments. Further, staff conducted rounds to monitor use of unnecessary supplies. Once the 100-day monitoring period was complete, the team lead and team champion revisited the project on a quarterly basis to examine whether new processes established to decrease changeover and discharge time, along with costs (for example, review of surgical supplies being used), were being maintained. A quarterly update comparing Medicare reimbursement to costs incurred, both for total volume of hip and knee replacements and on a per case basis, was compiled and provided on an ongoing basis to the EOT. In addition, the team monitored special orders per case; a special order indicates that special and expensive equipment that is not part of the plan is being purchased. The team also continued examining ways to save costs; some were implemented as described in the next section. The primary physician who played a role sustaining this project after the 100-day report out was the department chair and physician champion.
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