Work Effort Analysis

Transcription

1 Coordinator: Dolorese Umar The University of Michigan, Ann Arbor Special Projects in Hospital Systems Client: Karolyn Brewer Industrial and Operations Engineering 481 Vivek Gupta Sonia Raheja Julie Simmons by Work Effort Analysis Continuing Care Services Department

2 Introduction 2 Executive Summary 1 Appendix 20 Recommendations 17 Conclusions 16 Statistical Database 8 Categorized Summary of Work Effort 10 Results 8 Coordinator Observations and Survey 7 Statistical Database Analysis 4 Methodology 4 Purpose 4 Background 3 TABLE OF CONTENTS

3 support: We would like to thank the following people for their time, effort and H Dr. Richard 3. Coffey, Director Dolorese Umar, Management Systems Programmer/Analyst Management Systems: Karolyn Brewer, Manager Elizabeth Wagoner, Assistant Manager the Continuing Care Coordinators and Louise Cole, Executive Secretary Pamela Wong, Secretary Continuing Care Services Department: ACKNOWLEDGEMENTS

4 Operating Entities: Julie Simmons Sonia Raheja - Industrial and Operations Engineering Consultants Vivek Gupta Management Systems: Dolorese Umar, Management Systems Programmer/Analyst Project Coordinator: Continuing Care Coordinators Elizabeth Wagoner, Assistant Manager Louise Cole, Continuing Care Services Executive Secretary Pamela Wong, Continuing Care Services Secretary Continuing Care Services Staff: Karolyn Brewer, Continuing Care Services Manager Client: Involved Parties: Management Systems Continuing Care Services The University of Michigan Medical Center: PROJECT INTRODUCTION

5 The Continuing Care Services department arranges for post-discharge patient care for the University of Michigan Medical Center. By developing home care, equipment, and facility placement discharge plans, early in a patient s stay, r the work effort of thecontinuing Care Coordinators. future workload based on the units of service and categorized summary of department with a tool to use as a baseline for monitoring and predicting the In summary, this project has provided the Continuing Care Services the weighting factors were incorrectly assessed is true to a point. The hours. analysis has indicated that the actual Standard per Unit of Service is 2.23 The results of this study have indicated that management s assumption that illustrated that the estimation of the Standard per Unit of Service was cost (time) to deliver one unit of service was.99 hours, however, this weighting factors were actually overestimated, but not the cause of the actually the source of the problem. Management estimated that the expected underrepresentation of the department s workload. This project has investigation of elemental times, and Coordinators personal tasks assessment. conducted to obtain coordinator input on the referral processes and tasks. to determine the elemental task times for a referral and identify process of service and revised weighting factors for the units of service calculation from three different perspectives: statistical database analysis, observational Statistical quality control methods were used to determine the standard unit from the Continuing Care database. Coordinator observations were conducted improvements. To supplement the observations, a detailed survey was To create an unbiased work measurement tool, the project was approached placement services. This project has provided the department with a tool to would reflect the change in workload resulting from the addition of facility Services department needed an updated analysis of their work effort that closely the required resources match the expended resources based upon estimates of the units of service and weighting factors. The Continuing Care use as a baseline for monitoring and predicting the future workload. Currently, management uses a standardized variance report to evaluate how department in August 1988, the average number of placement days has declined by 25% resulting in a net decrease of $250,000 in annual costs. Since of the facility placement responsibility to the Continuing Care Services Medical Center, it is necessary that they utilize their resources effectively. the department can reduce the number of placement days. Since the transfer the activities of this department greatly influence the University of Michigan EXECUTIVE SUMMARY

6 INTRODUCTION C I U r 1 University of Michigan Medical Center, Ann Arbor, June 19, 1989 Final Report of Placement Days Study, Management Systems, In order for the Continuing Care Services department to be efficient, management must have a clear understanding of the work effort to utilize its resources effectively. This project was performed to facilitate this need. patient s stay, the department can reduce the number of placement days. the length of a patient s stay. By developing discharge plans early in the Since the transfer of the facility placement responsibility to the Continuing days has declined by 25% (from 2.49 days to 1.86 days). The impact of the The services provided by the Continuing Care Department greatly influence Care Services Department in August 1988, the average number of placement reduction in placement days results in a decrease in net costs of $250,000.1 with the decisions and procedures related to long term placement in a Care Services is prepared to activate and facilitate home care referrals, the acquisition of home medical equipment, and assist the patients and families patient care for University, Mott, Women s and Holden hospitals. Continuing rehabilitation, nursing home, or adult foster care facility. The Continuing Care Services Department arranges for post-discharge

7 Prior to August 1988, the Continuing Care Services department coordinated deliver one unit of service. 3The Standard per Unit of Service is the expected cost consumed to delivered by weighting procedures for resource consumption. 2Thc Units of Service is a method of measuring the amount of service upon comparisons of the department s performance with historical data. and obtain accurate resource consumption figures, statistics for the units of closely the required resources match the actual expended resources based Currently, management uses a standardized variance report to evaluate how Continuing Care has a categorization system which weights patients according to complexity and length of referral (time). These weighting factors are used to determine the units of service upon which to base their Units of Service and standard per unit of service services and Standard per Unit of Service needed to be obtained. recent expansion of services, Continuing Care did not have historical data These measures were estimated by management s impressions of the referral time. In order to correctly utilize the standardized variance report However, due to the Michigan Medical Center. In August 1988, the facility placement responsibility was transferred from the Social Work department to the the home care and equipment needs for patients in the University of Continuing Care Services department. To accommodate the increased workload, management estimated the additional staff required to perform the new services. BACKGROUND

8 PURPOSE L r L 1 classifies a patient by A,. B, C, D, or E, where A is the simplest referral and E is the most complex. 4The type of contact is the rating based on the patient categorization system. It contact only. The Continuing Care Services department s database includes pertinent information on each processed referral such as Coordinator, patient hospital and disposition information was combined and analyzed by type of hospital, and type of contact. The analysis showed little variation between hospital or disposition, in terms of the referral times. Therefore, the and discharge dates, referral response and disposition dates, referral agency, and type of contact 4. The data was initially summarized by disposition, registration number, hospital unit, disposition (type of referral), admission there was little variation in the contact distribution of referrals. In addition, the evaluation of the rest of the months in 1989 indicated that analyzed to obtain referral times. The month of September was chosen because it was the most recent data least affected by the July nursing strike. Five hundred and eighty-six referrals from the month of September were STATISTICAL DATABASE ANALYSIS determine the Standard per Unit of Service and revised weighting factors for the Units of Service calculation from the Continuing Care database. for a referral and identify process improvements. To supplement the observational investigation of elemental times, and coordinators personal tasks assessment. Statistical quality control methods were used to observations, a detailed survey was conducted to obtain Coordinator input on the referral processes and tasks. from three different perspectives: statistical database analysis, Coordinator observations were conducted to determine elemental task times To create an unbiased work measurement tool, the project was approached METHODOLOGY Continuing Care Coordinators. baseline for monitoring and predicting the future workload based on the Units of Service and categorized summary of the work effort of the r The main objective of this investigation was to create a tool to be used as a

9 contact (A, B, C, D, E). The number of days was chosen as the time measurement because it is directly retrievable from the database thereby days per case and the standard deviation were calculated for each type of Using the referral response and disposition dates, the average number of calculated value 6The Upper Control Limit signifies that 99 7% of the cases will fall below the approximate large samples regardless of the underlying distnbuuon 5me Central Limit Theorem states that the nonnal distribution can (The lower control limit was calculated to be zero. However, based upon the data, the minimum time for a referral is one day.) A E D C B of Contact of Cases Days/Case Dev. Control Limit Type Number Avg. Number Std. Upper Table 1. Statistical Oualitv Control Calculations. UCL = Average Number of Cases + (3 x Standard Deviation) control methods were employed in analyzing this data. Due to the large number of samples, the normal distribution was assumed from the Central Limit Theorem normal distribution 5. The upper control limit was approximated using the 6. The formula is In order to obtain a range for the time for a referral, statistical quality days is based on concrete time whereas the number of hours has to be providing an unbiased estimate of the time for a referral. (The number of estimated.) Please refer to Table 1. STATISTICAL DATABASE ANALYSIS. continued

10 is calculated. Please refer to Table 2. The Type A contact was used as the standard so that its weighting factor = The weighting factor formula Using the average number of days per case, revised weighting factors were Average Units of Services=Total Units of Service/Total No. of Cases updated yearly to reflect changes in resource consumption. weighting factors. The formula for estimating the Units of Service is (. The Units of Service formulas has also been revised based on the new This Standard per Unit of Service is based upon September data. It should be +#pfe sxl6.624 #ofd sx 7577 #ofc sx3041 #ofbsx = # of A s x Total Units of Service = E WF x No. of Cases by Type of Contact where Standard per UOS = Total Production Hours itotal Units of Service was computed. The formula for Standard per Unit of Service is Using the revised weighting factors, the revised Standard per Unit of Service E D C B A Type of Contact Weighting Factor Table 2. Standard Weighting Factors. WF = (Average number of days per case)13.88 STATISTICAL DATABASE ANALYSIS. continued

11 n Li Li r L COORDINATOR OBSERVATIONS 1 Appendix. nineteen Coordinators, eight responses were received. Please refer to the survey was developed and distributed to all of the coordinators. From the To obtain additional input on the referral processes and tasks, a detailed COORDINATOR SURVEY methodology was to obtain an unbiased mixture of information. elemental tasks and processes were documented. The Coordinators were chosen to obtain a mixture of seniority levels, hospital unit assignments, and percentages of referrals processed. In addition, the observations were distributed evenly throughout the week and day. The goal of this r. was observed for one-half of a working day during which the times and Coordinators were observed for a total of forty-four hours. Each Coordinator To provide a clearer definition of the work effort, eleven of the eighteen

12 Care Coordinators. Units of Service and categorized summary of the work effort of the Continuing r L The main objective of this investigation was to create a tool to be used as a baseline for monitoring and predicting the future workload based on the E D C B A Contact Weighting Predicted Factor Factor of Weighting Type Actual Table 3. Predicted and Actual Weighting Factors. The weighting factors are shown below. Please refer to Table 3. As illustrated in Figure 1, the current weighting factors were overestimated. Fipri,r I - -- Weithting Factor Comparison. Types of Contact B C D E 0 I Predicted Values Actual Values 20 0 I Through the analysis of the database, revised weighting factors were obtained to use in the Units of Service and Standard per Unit of Service calculations. Please refer to Figure 1. STATISTICAL DATABASE RESULTS

13 Standard per Unit of Service = 2.23 Hours per Unit of Service. deliver one unit of service for the 1990 Fiscal Year is the Standard per Unit of Service was calculated 7. The expected cost (time) to From the computation of revised weighting factors, an updated statistic for The Lower Limit Hours/Case = i x Weighting Factor (by contact) (Assumption: Type A takes at least one hour) The Upper Limit Hours/Case = Average Hours/Case + (3 x Std. Dev.) 8The Average Hours/Case = Std. UOS x Weighting Factor (by contact) yearly. 7The Standard per Unit of Service is a statistic that needs to be updated be effectively utilized. Please refer to Table 4. quantitative method of evaluating the type of contact for a referral. This patient categorization system should be implemented in order for this tool to The new patient categorization system will provide a qualitative and based on the weighting factors. by using the Upper Control Limit calculations. The Lower Control Limit was to update the predicted time per patient referral 8. The range was obtained developed. The Standard per Unit of Service and Weighting Factors were used Based on this information, a revised Patient Categorization System has been For the month of September, the average units of service was found to be + #ofe sx # of D s x #ofb sx #ofc sx = #ofa sx Total Units of Service = WF x No. of Cases by Type of Contact where Average Units of Services=Total Units of ServiceiTotal No. of. Cases Service was obtained. The formula is With the new weighting factors, a revised formula for calculating the Units of STATISTICAL DATABASE. continued

14 TYPE TIME/PATJENT TIME/PATIENT Table 4. Patient Cate2oHzation System PREDICTED ACTUAL and task times. Please refer to Pages 14 and 15. In addition, the Health Supervision referral process was examined and found to vary between Mott/Holden and Women s hospital in terms of processes 13. The Coordinator observations and surveys were used to fmd the times associated with the elemental processes and tasks of a referral. Based upon increase in the facility placement process times. Please refer to Pages 12 and care/equipment and facility placement referrals, there was a significant Although the study indicated little difference between the processes for home in the process times and tasks for a specific referral between the hospitals. Please refer to Page 11 The analysis indicated that there was little variance this information, a flowchart was developed to trace the referral process. CATEGORIZED SUMMARY OF WORK EFFORT (Average: Hours) E Hours Hours (Average: Hours) D 11-20Hours 7-72Hours (Average: 6.79 Hours) C 4-10 Hours 3-31 Hours (Average: 2.50 Hours) B 1-3 Hours 1-16 Hours (Average: 2.23 Hours) A Minutes 1-12 Hours STATISTICAL DATABASE. continued

15 r Formal referral Case finding by 4 C START D Placement Facilities information from Home Community Resources, and Equipment Vendors, Third Coordinator obtains Party Payors, Other Health Agencies, Service!Reimbursement family (Availability of care-giver) Coordinator obtains information from -Acuity -Documentation -Medical Equipment -Third Party Payor assessed: -Other Community Resources Patient needs are -Nursing & Therapy 4 etc... N u rse!pt/rt/ut Coordinator from Physician! Continuing Care HOME CARE REFERRAL. EQUIPMENT REFERRAL. AND FACILITY PLACEMENT cd. Coordinator Discharge Plan revises Proposed Nutritionists, PT, RT, Charge Plan with other UMMC discusses a Proposed Dis Professionals: Coordinator Other Health Team Members CONTINUING CARE SERVICES: Patient Discharge Patient Followup 4 arrangements finalizes the Coordinator Yes decision! Family with of plan Patient! assists Coordinator acceptance

16 Type of Activity Time (Mm) continuing care coordinator. I. Response to formal referral or case finding by 5-30 L 10. Follow up patient s progress after discharge Update statistical sheets upon completion of referral 5-10 B Obtain M D signature 5-30 A Complete CPC and/or Equipment Order Forms discharge. 8 Fmahze arrangements upon notification of issues 7 Maintain patient records and note unresolved care conferences and rounds. (per week) 6. Monitor patient s hospital stay through patient B. Patient and Family A. UMMC medical professionals and discuss with the following people: 5. Develop proposed discharge plan resources. agencies, equipment vendors, and other community 4. Obtain service information from home health resources to receive reimbursement information. 3. Contact third party payors and other community D. Patient and family meetings C. Medical professional meetings B. Documentation A. Chart review acuity. More specifically, the processes involved are therapy, medical equipment, third party payor, other community resources, documentation, and 2. Assess patient needs for nursing and UNIVERSrrY!MOTrIWOMEN S/HOLDEN HOSPITALS HOME CARE AND/OR EQUIPMENT REFERRAL

17 Type of Activity Time (Mm) FACILITY PLACEMENT REFERRAL UNIVERSITYIMOTT!HOLDEN HOSPITAL r r 10.Follow up patient s progress after discharge. 9. Update statistical sheets upon completion of referral. C. Arrange for transportation B. Obtain M.D. signature A. Complete forms and arrange for sending records 8. Finalize arrangements upon notification of discharge. issues. 7. Maintain patient records and note unresolved care conferences and rounds. 6. Monitor patient s hospital stay through patient B. Patient and family (obtain consent forms) A. UMMC medical professionals and discuss with the following people: 5. Develop proposed discharge plan resources. agencies, equipment vendors, and other community 4. Obtain service information from home health resources to receive reimbursement information. 3. Contact third party payors and other community D. Patient and family meetings C. Medical professional meetings B. Documentation A. Chart review acuity. More specifically, the processes involved are other community resources, documentation, and therapy, medical equipment, third party payor, 2. Assess patient needs for nursing and continuing care coordinator. 1. Response to formal referral or case finding by (per week) (max =10 hours)

18 1. Response to formal referral or case finding by Type of Activity Time (Mm) HEALTH SUPERVISION REFERRAL WOMEN S HOSPITAL c H 7. Follow up patient s progress after discharge Update statistical sheets upon completion of referral B. Fill out necessary forms CLi A. Obtain a signature from M.D. H 4. Collect referrals from other clinics Process referral resources to receive reimbursement information. 3. Contact third party payors and other community D. Patient and family meetings C. Medical professional meetings (Patient Care Rounds) B. Documentation (Discharge Summaries) 5-10 L A. Chart review therapy. The processes involved are r 2. Assess patient needs for nursing and continuing care coordinator using census report.

19 Type of Activity Time (Mm) continuing care coordinator. 1. Response to formal referral or case finding by HEALTH SUPERVISION REFERRAL MOTIHOLDEN HOSPITAL C Li Li 1 Ii I Follow up patient s progress after discharge Update statistical sheets upon completion of referral B. Obtain M.D. signature 5-30 A. Complete forms and arrange for sending records Finalize arrangements upon notification of discharge. care conferences and rounds. (per week) 5. Monitor patient s hospital stay through patient agencies, equipment vendors, and other community resources. 4. Obtain service information from home health resources to receive reimbursement information. 3. Contact third party payors and other community D. Patient and family meetings C. Medical professional meetings B. Documentation A. Chart review therapy. The processes involved are 2. Assess patient needs for nursing and

20 work effort that would reflect the change in workload resulting from the The Continuing Care Services department needed an updated analysis of their In summary, this project has provided the Continuing Care Services the work effort of the Continuing Care Coordinators. future workload based on the units of service and categorized summary of department a tool to use as a baseline for monitoring and predicting the determine areas of improvement based on the distribution of the Coordinato?s time. referral processes times and tasks to use for resource allocation. Management wifi now be able to analyze the processes and tasks to In addition, this study provided management a detailed analysis of the C- -- hours. this analysis has indicated that the actual Standard per Unit of Service is 2.23 r the expected cost (time) to deliver one unit of service was.99 hours, however, However, this study has shown that the estimation of the Standard per Unit of Units of Service statistic to underrepresent the workload of the department. Service was actually the source of the problem. Management estimated that Management felt that the weighting factors were underestimated causing the be accurate numbers based on the current workload not estimations. effectively, management must have a clear understanding of the work effort. addition of facility placement services. In order to utilize its resources Currently, the Continuing Care Services department analyzes its work effort through a standardized variance report. To be effective, the statistics need to CONCLUSIONS

21 Project Suggestions: The distribution of processes and tasks should be examined to determine the duties that clerical and other support staff can assume. 3. Elemental Processes and Tasks: (2.23 Hours/UOS) - Utilize the Standard Unit of Service for the 1990 Fiscal Year. ( I - Adopt new weighting factors into Units of Service formula to reflect current situation. 2. Variance Report: effort. The Coordinators should use the new system to determine the type of contact evaluation thus providing a more accurate representation of the actual work for a referral. The new system offers a more qualitative and quantitative 1. Patient Categorization System: following strategies: In order to obtain an accurate representation of the Coordinators work effort and calculate the staffing requirements, management should implement the RECOMMENDATIONS

22 insurance phone verifications (e.g. clerical). 1. Some other resource should assume the responsibility of Blue Cross Process Suggestions: Reduction in referral completion time due to increased contact with patients and medical professionals. More specifically, decreases case finding time and transit time. Result: 2 Investigate placing coordinators on their assigned units permanently Reduction in transit time Result Room) in order to provide convenient access for the coordinators. 1. Move the face sheet computers and printers to a central location (e.g. Copy Layout Suggestions: Increase in actual time spent on referral. Result: A box should be placed in a central location to collect the referrals. 2. The filing of completed referrals should be performed by the clerical staff. Decrease in phone time providing more time for actual patient contact. Result: RECOMMENDATIONS

23 There should be a clearer definition of the responsibilities of related Departmental Suggestion: status. Eliminates time spent updating coordinators of referral and hospital unit Result: to carry the workload. Reduce the number of part-time personnel and hire more full-time people Personnel Suggestion: Provides a more efficient and productive work effort. Result: to distribute the duties effectively. Social Work and Continuing Care should define their relationship in order departments (Social Work, Medical Staff on unit, etc...). More specifically, RECOMMENDATIONS

24 ; r Ea c z

25 L Special Programs Training Seminars Department Meetings: Percentage Time time per week associated with each activity the following activities Please also document the amount of Facility Placements: Equipment Referrals: Home Care Referrals: Percentage performing the following tasks: Unit(s): Hospital(s): Name: return to Louise Cole by Tuesday, December 5, JJankJiu! As a part of Management Systems analysis of the work processes, this survey is being conducted to obtain coordinator input on the tasks being performed. Please be as specific as possible when answering the questions (include meetings, telephone conversations, etc...). Please answer only questions that apply to your job. Please complete this survey and (For example: 5A) 1. Please approximate the percentage of your day spent Health Supervision Referrals: 2. Please approximate the percentage of your week spent doing CONTINUING CARE SERVICES COORDINATOR SURVEY

26 professionals and type of paperwork involved in the referral. describe. and meetings with family, insurance companies, and medical possible by including information such as telephone contact Please give an approximate time associated with the task you Please continue on the back of the page f necessary. Type of Activity Time Care Referral in order of occurrence. Please be as specific as 3. Please document the activities associated with a Home

27 professionals and type of paperwork involved in the referral. describe. possible by including information such as telephone contact Please give an approximate time associated with the task you and meetings with family, insurance companies, and medical L; Pleas,e continue on the back of the page f necessary. Tvne of Activity Time Referral in order of occurrence. Please be as specific as 4. Please document the activities associated with an Equipment

28 professionals and type of paperwork involved in the referral. describe. Please give an approximate time associated with the task you and meetings with family, insurance companies, and medical L Pleas continue on the back of the page f necessary. Type of Activity Time possible by including information such as telephone contact Placement in order of occurrence. Please be as specific as 5. Please document the activities associated with a Facility

29 telephone contact and meetings with family, insurance companies, and medical professionals and type of paperwork associated with the task you describe. involved in the referral. Please give an approximate time I Please continue on the back of the page f necessary. Type of Activity Time specific as possible by mcludrng information such as Supervision Referral in order of occurrence. Please be as 6. Please document the activities associated with a Health