Using The Kaizen Process to Address Patient Delays

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Small County Clinic Addresses Patient Delays in Care Using Kaizen

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Client: A progressive acute care facility located in a rural Midwest community
Industry: Healthcare
Service: Kaizen, 5S

Challenge:

The hospital and clinic are struggling to break-even
The health system is weighed down by the Clinic’s cost relative to patient volume
The Clinic supports the Hospital by generating significant technical fees, but the goal is to have it break-even on its own merit

Solutions:

A cross-functional team of doctors, nurses, schedulers and administrators were established to leverage the Sigma Kaizen Breakthrough methodology during a one week dedicated event
The team recognized that much of the patient delay was caused by a lack of balance in work content between the nurse and provider
Implementation of new processes, layouts and protocols

Results:

Eliminated steps in serving the patient from about 100 to 60
Providers went from seeing 2.6 patients per hour to 3.1 patients per hour, a 20% improvement
Patients experienced fewer delays with their visit which resulted in wait-time dropping by almost 40%

Patient flow was not smooth and delays were commonplace. Sigma Kaizen Breakthrough events are a collaborative approach to re-engineering or designing a new process that streamlines the patient experience by applying Lean Six Sigma principles in a “try-storming” environment. The team has one week to not just brainstorm solutions but test or fully implement them.

The team started by mapping the patient experience with particular attention to delay points. They observed nurse and physician activity and used “spaghetti diagrams” to document what activities took them away from direct patient care. The average visit was 43 minutes long, with 25 minutes of waiting time and 18 minutes of nurse or provider contact time.

The team recognized that much of the patient delay was caused by a lack of balance in work content between the nurse and provider. One nurse was paired with each provider but from a patient perspective the nurse only needed six minutes of time to care for the patient. The provider required 12 minutes. The result was a “bottleneck” as the nurse could see patients faster than the provider.

This finding focused the team on finding ways to free the nurses from non-patient activity so that they could take more of the direct patient care responsibilities from the provider thus balancing the workload. The team’s improvements included:

Standard Protocols: Worked with the providers to agree upon clinic-wide protocols for typical visit types. This allowed nurses to take on more patient care responsibility for visits such as URI, Well-Adult, Well-Baby, Sinus infections, etc. This also opened the doors for nurses to work with a variety of physicians – not just one or two.
Standard Rooms: The room set-up and supplies were defined and standardized using 5S techniques to save provider time.
Standard Scheduling: Providers agreed on slot lengths for the common visit types. This simplified scheduling and facilitated standard practices.
Registration: The team created scripts and standard work to reduce waste and streamline the new patient experience particularly related to registration and co-pays.
Other Improvements: Two new metrics were established for the team so that they could track improvement going-forward. Many other physical changes and process simplifications were done to better leverage both patient and staff time.

In one week the team made huge progress in establishing new processes, layouts and protocols. Below are the results of their efforts:

Potential patient delays were reduced from 12 to 5
Eliminated the number of steps in serving the patient from about 100 to 60
Providers went from seeing 2.6 patients per hour to 3.1 patients per hour, a 20% improvement
Patients experienced fewer delays with their visit which resulted in wait-time dropping by almost 40%