Transforming Health Care Scheduling and Access Getting to Now (2015) / Chapter Skim
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3 Systems Strategies for Continuous Improvement
3 Systems Strategies for Continuous Improvement
Pages 33-48
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From page 33... ...
and the N ational Academy of Engineering (NAE) , working both independently and collaboratively, have released publications calling attention to the growing concerns of patient safety, the quality of care delivered, and the cost of health care and also identifying potential solutions based on systems engineering approaches that have been widely adopted in technology and service industries (IOM, 2000, 2001a; IOM/NAE, 2005; Kaplan et al., 2013)
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From page 34... ...
Systems-based engineering approaches have also been employed successfully by a number of health care organizations to improve quality, e fficiency, safety, and customer experience, and these approaches have great potential for enabling further improvements in health care delivery (IOM/NAE, 2005)
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From page 35... ...
Queuing theory has begun to be applied to multiple processes in health care involving groups or queues of patients. Six Sigma is a quality management and continuous process improvement strat egy.
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From page 36... ...
Another business management and continuous process improvement strategy that has been widely adopted across service industries is Six Sigma.1 Originally developed in Motorola, the approach is rooted in statistical process control and is aimed at dramatically reducing errors and variation. The term Six Sigma refers to achieving a level of quality so that there are no more than 3.4 defects per million parts produced.
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From page 37... ...
. Most notably, the checklists used in preoperative team briefings to improve communication among surgical team members are indicative of the potential that checklists have to improve patient safety (e.g., reduce complications from surgery)
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From page 38... ...
The model uses a PDSA cycle to test a proposed change in the actual work setting so that changes are rapidly deployed and disseminated, and it is best suited for a continuous process improvement initiative that requires a gradual, incremental, and sustained approach to process improvement changes that are not undermined by excessive detail or unknowns (Huges, 2008)
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From page 39... ...
Using techniques of production planning from industry, CCHMC combines management and staff to set operating rules, monitor supply, measure delays, and make decisions about how shared resources are deployed. FIGURE 3-1 System capacity management roadmap.
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From page 40... ...
With additional research and testing, these elements of health care scheduling could potentially serve as general principles for improving primary, secondary, hospital, and post-acute care. Although these elements are discussed independently, the central premise lies in their interplay; health care organizations are not discretely separated environments or services, but they are complex groups of processes, personnel, and incentives.
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From page 41... ...
FIGURE 3-2 Framework for patient and family engagement: Care scheduling, delivery, and follow-up.
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From page 42... ...
Systems strategies require ongoing assessment of supply, demand, work flow, and patient flow, adjusting capacity across days and services, and continuous improvement. In ambulatory primary care settings, temporary supply deficiencies can often be overcome by flexing or adjusting supply to keep up with demand, by temporarily increasing office hours, or adding another provider.
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From page 43... ...
In that respect, the design elements that can enhance the capability of specialty care practices include a logic that offers appointment to the first available new patient slot for any provider among the entire set of interchangeable providers, a commitment to continuity once a new visit is completed, and fully developed contingency plans to address demand or supply variation. Creating the Infrastructure for Data Analysis and Measurement A health information technology infrastructure, including the creation and implementation of electronic health records (EHRs)
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From page 44... ...
Furthermore, given the need for flexibility of measures to assess the goals and performance of indi idual v organizations, developing a measurement infrastructure for operational data will require inter-organization coordination to ensure harmony of reporting instruments and reference resources across the nation. Once standards and benchmarks for access and wait times and corresponding patient experience measures have been identified, such performance data should be accompanied by analytic tools that can continuously monitor current conditions, including the scheduling measures of supply and demand.
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From page 45... ...
Creating a Culture of Service Excellence and Leadership Stewarding Change Implementing systems approaches in health care, including strategies to address scheduling and access issues, requires changes not only in opera tional processes but also a fundamental shift in thinking. All members of a health care organization must transition from the siloed, independent, and fragmented mentality of traditional health care culture to a culture of service excellence, an integrated approach with shared accountability in which physicians, employees, and patients treat one another with respect and as partners, and patient satisfaction and employee engagement are high.
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From page 46... ...
This places a high premium on the need for systems to effectively manage the flow of information, but it also requires a commitment by the organization to build and incorporate processes for continuous learning, knowledge sharing, and innovative change. Such characteristics are shared by health systems, including Denver Health, Geisinger Health System, Kaiser Permanente, Seattle Children's Hospital, ThedaCare, and Virginia Mason Hospital and Medical Center, who have adopted methods of continuous improvement such as Lean, the IHI Model for Improvement, and Six Sigma to empower teams to question how things are done and recommend operational changes to improve efficiency (Brandenburg et al., 2015)
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From page 47... ...
, the lack TABLE 3-1 Possible Barriers to Implementing Systems Approaches in Health Care Practice and Infrastructure Challenges Data Metrics for organizational performance and clinical outcomes and systems Technology Digital health records designed for data needed, patient portals, telephone consultation systems Flexibility to accommodate variable information technology uptake and use by patients Staff retraining and rescheduling for telephonic and digital communication with patients Staffing needs Need for intervention design teams Availability of trained nurses, other non-physician clinicians Patient interface personnel, reframing responsibilities, training Regulatory Health Insurance Portability and Accountability Act (HIPAA) standards (facility and process redesign standards)
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From page 48... ...
48 TRANSFORMING HEALTH CARE SCHEDULING AND ACCESS of systems expertise, and the procurement and training of the necessary clinicians and staff (Coleman et al., 2006; Dhar et al., 2011; Jack et al., 2009) , and the pressures of organizational and national regulations (Lee et al., 2015; Pearl, 2014)
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