Practical Applications on Efficiency

Transcription

1 Practical Applications on Efficiency Maryland MGMA September 19, 214 Owen J. Dahl, FACHE, LSSMBB Objectives To offer practical scenarios for the application of Lean Tools in YOUR practice To discuss and challenge YOU to seek new and/or improved ways to take care of YOUR patients on an every day basis Principles of Lean Value as defined by the customer & delivered by the producer Value Stream identify set of actions required to bring the product or service to the customer Flow smooth movement Pull the downstream customer triggers the need Perfection no defects 3 1

2 A - new B C D E F G H - new I J K L M N O P Q R S T U V W - new X Y Z A B C D E F G H I J K L M N - Inj 9/17/214 Continuous Process Improvement Continuous Process Improvement, CPI, is a program of activities designed to improve the performance and maturity of an organization s process with regard to a set of goals The key to successful CPI Finding the best approach to meet the business goals of the organization 4 3 doctor group Senior sole owner, Associate (aggressive), and Part time associate (stay at home mom) Few meetings Rheumatology specialty Single new office location Staff turnover Control Chart Actual time Target Monitor and Set Control Limits 3 Sigma above and below mean 1 above 12 below 45% in range 2

3 Control chart Measurement Center line = average Upper and lower control limits = 3 sigma Those involved when seeing results should know Special cause Why or what happened 7 Run vs. control chart Run single line that displays observed data in a time sequence, shows trends, exceptions, shifts or patterns Control based on a run chart but adds upper and lower control limits with a centerline. Addresses the question: is my process stable or in control 8 Scheduling Access Indicators Time to Next Available New or established Patient Appointment No-Show Rate New Patient Appointments as a Percent of Total Appointments Surgery/Procedure Yield Cancellation Conversion Rate Template for seeing patients Changing schedule to accommodate personal activities 9 3

4 Scheduling (mura unevenness) Single interval One time period per slot: 1, 2, etc. minutes Multiple interval 1 for acute; 2 for new, etc. No right way to schedule Appointment Slot Average Time to See a Patient 1 Scheduling Wave (block) scheduling 9 a.m.; 1 p.m. Not recommended Modified wave scheduling Schedule in small waves throughout the day 5% at top of hour 3% 2 minutes after 2% 3 minutes after Recommended for patient population with limited compliance Affinity visits Group visits 11 Key concept... The Andon Cord Recognize that there is a problem Empower Accountable 12 4

5 Actions Doctors talked Staff trained Developed template for each doctor Assessed in two months with some minor revisions Outcomes seen Two more patients per day Additional revenue with little cost Less stress on providers and staff More satisfied patients Decreased wait time More effective communication 14 6 Doctor ENT with allergy and audiology 5

6 Motion Study Reviewing and tracking how work is done, the motions required to do the work 16 Time Study Direct and continuous observation of a task, recording the time it takes to accomplish Fredrick Winslow Taylor late 18 s early 19 s Used to set standards for task Planning for work effort 17 Purpose General Eliminate unnecessary motions Identify the best sequence of motions for maximum efficiency and productivity Standardization Organization Performance evaluations Predict the level of output that may be achieved Used to uncover problems and create solutions Used for time cost analysis 18 6

7 Steps for Time Study Define what is to be studied Identify tasks done in the study Measure the time (stop watch, log, computer) Evaluate the worker s performance, performance rate Consider exceptions, factors needed to accomplish the task and compute a standard time 19 Task Normal time for Triage Time (minutes) Rating factor Normal time Weight Temperature Blood Pressure/pulse Interview Escort to exam room Normal time Calculate Standard Time Normal time = 1.25minutes PFD =.2 - percentage Standard time = 12.3 minutes PFD = Personal rest room, phone call, water Fatigue physical, mental, environmental (light, heat) Delay clean up, supplies, malfunction, random events 21 7

8 Cycle Times D 2 15 Dickey F 2 15 Franklin B R Roark 4 2 CR Brauchle 8 15 Prichard P CH Chelius Craddock Analysis of Value Add Time Review of patient Value Add time during a routine visit to the practice PFD calculated at +2% P = personal F = fatigue D = delay Cycle Time = 55 Minutes Total Value Add Time = Motion time of 6 Total time in office = 35 Minutes What happens the other 2? More importantly what happens during the 29.2 that could be redesigned to remove WASTE 23 Takt Time Analysis 36 patients per hour (6-1 minute slots for 6 providers) Check in 3 minutes +2% PFD = 3.6 minutes Triage 7 minutes + 2% PFD = 8.4 minutes Follow up same as check in Check out same as check out 24 8

9 Staffing requirements Check in 3.6 * 36 = minutes/6 = 2.16 FTE s Triage 8.4 * 36 = 32.4 minutes/6 = 5.4 FTE s Follow up 3.6 * 36 = minutes/6 = 2.16 FTE s 7.2 FTE s Check out Same for check in 25 Recommendations Create project teams to review patient flow Master team Tanya, Laura, one receptionist, and 2 MA s Sub teams Tanya team Laura team Review, recommend, change, and review again doctor group Thirteen owners, 2 employed Medical oncology Utilized information from NCCN Track through specialized EMR 9

10 Value Based Payment (Clinical) - Cause and Effect People Practice Agree on Patient Care protocols Staff Knowledge Culture Contracts Compliant Philosophy Care Plan Information Order available Monitor Process Contract Payer 28 Monitor Expectation Value Based Purchasing Do you have care plans? What is the % used? Complied with? Outcomes measured? Care plans Source of Evidence Agreement between providers Compliance with what percentage, e.g., 8% acceptable How to allow and monitor exceptions Carrot or stick Compensation Peer pressure Treatment expertise Training Denial or removal 29 Big issue Compensation Compliance Set standard of 35% first year 8 of 1, 5 not participating Moved up to 5% second year Keys Reported at each meeting the group Bonus seemed to work better than penalty Involved docs in developing care plans in their area of interest, e.g, breast, colon, etc. 1

11 Cost - Cause and Effect People Right skills Accountable Compliant Commitment Practice Training Culture Strategic Plan Commitment Integration Reporting Contract software Supplies Lean Purchase Inventory CPI Time sheets Expectation Process Return on Investment 31 Cost to provide care How much does it cost to see a patient? Keys Know where you are current state What does your customer want, need, expect Identify key issue Make first effort a small win Employee involvement Use of key tools Flow chart C & E 5 why s Communication Physician champion Culture developed for improvement Contact Information Owen J. Dahl odahl@owendahlconsulting.com Check out my new blog: