Material and Supplies
This area has significant opportunity especially under management of inventory and use, standardization of product, contract management of vendors, and maintaining best practice standards in the organization. High use areas would be the primary focus and would include:
Operating Rooms Cath Labs
Emergency Services
Pharmacy
ICUs
Patient Care Delivery
Process Redesign begins with care delivery. The design must have two guiding principles:
- (1) Patient Centered
- (2) Error Free
The patient care delivery process improvement models focus need to be at the front end and requires optimal completion of components required to process patient admissions. These components include:
Physician
Nurse
APP-NP or PA
Pharmacist
Process improvement results in immediate institution of care delivery with timely administration of medications for the patient’s acute needs but also addresses the patient's needs for medications used for chronic conditions. Medication reconciliation can be completed promptly and correctly.
A complete head to toe nursing assessment is completed and eliminates duplication on the med/surg floors.
The second component is the patient movement in a timely fashion to the area of the hospital that can best serve the patient's needs. This process needs to adhere to organizational priorities and would include focus on:
ED to ICU transfers (sickest first philosophy)
ED to OR transfers
ED to Floor Transfers
Operational metrics would drive the process improvement to provide ED patients to exit to the proper care delivery area in a timely fashion once a bed has been acquired.
The third component is the care delivery provided on the hospital units. The concept of team-based care needs to be understood and will be most successful if a geographic model is utilized to allow staffing of team members to maintain availability on the unit where care is being delivered. Construct of a geographic model may vary from one institution to another but the primary focus of managing rooms which contain a patient with a team is most important.
This provides multiple positive impacts including precise and consistent communication, timely interventions, and a non-silo approach to care delivery.
The last process is one of consistent and standard discharge plans which will communicate to the patient any changes in the management of their disease, communicate with the follow-up physician or facility and the effectiveness is measured with metrics that are defined as key to organizational success—30-day readmissions, discharges before noon, and patient satisfaction.
Ancillary Care Delivery Redesign
The components which impact care delivery are many times ancillary in nature and may impact all or a subset of patients cared for. These components are:
Lab
Radiology Pharmacy Cardiac Testing
Non-Provider Consults-PT, ОТ, nutritional Provider Consults-GI, Cards, ENT, etc.
Each should have standard benchmarks for providing defined service to patients being cared for. The use of Lean in their evaluation is of utmost importance.
Phase IV: Complex Process Redesign
The components of this phase require the organization to have reached a mature level of managing change and utilizing Lean to improve the organizational efficiency. The components to focus on for complex design will have significant financial impact surrounding demand level staffing, space utilization, and leveling. The areas of focus would be as follows:
Demand Level Staffing
ED
Cath Lab Operating Room Clinics
Inpatient Providers Staffing
Space Utilization
ED
Cath Lab Rooms Operating Rooms Other procedural rooms
Leveling (Elective Scheduling)
Cath Lab Schedule Operating Schedule Other elective schedule
These complex processes will require significant resources and clearly defined metrics to monitor success. Profound changes in behavior and current processes will be required to achieve the impact that these areas could have on operational efficiency and costs.
