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Appendix B: IOM Workshops in Brief
Pages 123-134

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From page 123...
... Appendix B IOM Workshops in Brief 123
From page 124...
... The workshop convened leading authorities on care delivery, operations management, systems engineering, and patient engagement and satisfaction to • Better understand the current practices and standards in appointment scheduling and reasons for variation; • Consider optimization strategies and experiences in health care and other industries; • Discuss the role of patients and family as catalysts for achieving operational excellence in health care; • Explore the changing mental model for frontline personnel involved with scheduling improvements; and • Examine the disciplined structure for change and a strategic and scalable approach to continuous improvement. The workshop included four panels: current best practices, patient experiences and expectations, technical approaches to wait time improvement, and an overview of the day's discussion.
From page 125...
... Continuing the notion of using a systems approach to improve access and wait times, Andrew Gettinger, of the Office of the National Coordinator for Health IT, stated in his presentation that managing outcomes goes beyond managing IT. He outlined the variation in the scheduling systems at the Dartmouth Hitchcock Hospital and Lahey Clinic, explaining that neither system was better, but rather built to produce outcomes specific to their unique environments.
From page 126...
... A Roadmap for the Nation William Pierskalla of the UCLA Anderson School of Management facilitated a discussion on developing a short term roadmap for institutions to address scheduling issues and to begin transitioning to an optimal method of scheduling and access to care. He highlighted the major components of the care delivery process: the pre-visit period of scheduling and patient arrival to the care facility, the waiting period prior to connecting with the provider, 3
From page 127...
... The goal was the clinical interaction." Speaking from her expertise in operations research, Zelda Zabinsky of the University of Washington provided several anecdotes of the consequences related to a segmented approach to improving patient flow, thus emphasizing the importance of maintaining a systems view when tackling these issues. Determining the specific bottleneck in the system is difficult, said Zabinsky, describing the phenomenon: "You have a big balloon, and you squeeze one place, and it pops out another place." Judy Worth, of the Lean Transformations Group, LLC, provided strategies for creating sustainable organizational change across a value stream according to Lean principles (see Figure 2, page 5)
From page 128...
... Robert Dittus of Vanderbilt University reviewed the players and resources that health care organizations need in order to fully implement systems engineering methods. He advocated for more coordination among health care teams, and for redefining these teams to include industrial engineers, mathematicians, and most importantly, patients as equal contributors.
From page 129...
... REVIEWERS: To ensure that it meets institutional standards for quality and objectivity, this workshop in brief was reviewed by Brian Denton, University of Michigan; Michael Dinneen, U.S. Department of Defense; and Robert Dittus, Vanderbilt University Medical Center.
From page 130...
... , the aim of the session was to explore appropriate standards for access, triage, and scheduling of health care services across the continuum of care to inform the work of the committee and to shape the content of their forthcoming consensus report. As outlined in introductory comments by committee chair Gary Kaplan, CEO of Virginia Mason Health System, the workshop convened leading authorities on care delivery, operations management, systems engineering, and patient engagement and satisfaction.
From page 131...
... "You may find that by talking a little to patients if you can spare the time, they may be able to withstand longer wait times and be as or more satisfied," said Puglisi. Optimization Strategies and Experiences in Health Care Mark Hallett from ThedaCare Center for Healthcare Value discussed patient-centered scheduling and the practices to improve capacity of their system: Our scheduling process actually begins with a single question when we get a patient calling on the phone.
From page 132...
... Examples of approved uses of this document include the following: • copies may be provided to anyone involved in the organization's process for developing and implementing improved scheduling and access • the model may be adopted or adapted for use within the organization, provided that Cincinnati Children's Hospital Medical Center receives appropriate at tribution on all written or electronic documents; and • copies may be provided to patients and the clinicians who manage their care. Notification to Cincinnati Children's at childrens-quality@cchmc.org when this document is being adopted, adapted, implemented, or hyperlinked to by your orga nization is appreciated.
From page 133...
... the conversation focused on broader organizational changes possible by implementing and embracing systems engineering techniques. Davies and Berwick discussed the potential benefits of identifying baselines and benchmarks for scheduling and wait-time performance, as a tool for both understanding the causes and consequences of wait times and for monitoring progress as interventions are undertaken at the VA.


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