Collaborative Technologies

Critical analysis of cycle time involved in consulting a doctor in the outpatient department of a hospital. Information system, measured for average time and percent compliance with cycle time goals.

The outpatient areas reviewed were very different in design and location within the hospitals. Hospitals had multiple outpatient areas, which made it difficult to establish a minimum standard for the provision of general amenities.

The team made a variety of changes in staffing and procedures to eliminate issues that caused processing bottlenecks; we decided a team based approach. The group also reconfigured workspace layouts. To avoid loss of capacity during staff overlap times at shift transitions, assignment of specific duties to staffs arriving and leaving. Regular meetings to review the metrics and address the operating issues

Strategies are developed by hospitals to maximize the efficiency of consumer flow through waiting and treatment areas to prevent appointment delays. Clear signage to be displayed by hospitals to notify consumers of the process for registration.

* STAGE 1: DEFINE THE PROBLEM

Define the services provided, such as registration revisit of the patients and measure current turn times overall. Ask the customer to define her expectation and analyze the gap. Use the smallest measurement increment available, such as seconds or minutes. For example, the customer wants a turn time of 20 minutes for a registration, and right now you are yielding 45 minutes. The objective in this case would be to reduce current turn time by 25 minutes.

* Stage 2: MEASURE

Remove variation first. Define each major step of the process such as customer intake, computer update, sample drawn, sample labeled, previous consultation records, customer notified, and customer billed. Visualize entire process by creating a top-level flow chart. Instruct employees to handle every patient with a uniform first-in/first-out process so that when a problem occurs it receives visibility. Those who have taken prior appointment should be called simultaneously. Focus on flow and do not allow employees to put work aside for clarification as these "exception situations" cause 80 percent of the variation in the outputs. Concentrate efforts on ensuring a consistent process even if the process isn't yet yielding the results you need.

* Stage 3: ANALYSIS STAGE

Measure each sub-step in the process to see how long it takes. In this case, we find we have 20 minutes for customer intake, 30 minutes waiting, 15 minutes of consulting and 20 minutes waiting for getting medicines. In this case, the waiting or queue time is what is eating up turn time. Adjust process to minimize wait time. To do this, identify areas that exhibit waste, such as registration, delays (waiting) and wasted motion (walking).

* Stage 4: IMPLEMENTATION

Investigate opportunities to apply new software, new technologies and methods to improve speed and responsiveness of the outpatient department system.

Make sure measurement systems are consistent between provider and customer. For example, the customer may measure the process up to the point that they receive the consultation whereas a provider may measure the process up to the point of payment. Examine the real needs of the desire to drive down turn times and address these specific areas each time.

Stage 5: CONTROL

Control the process by measuring inputs to make sure steps within the process remain consistent. Be proactive against variation by improving