Eastern Health Urology OPD

1
Eastern Health Urology OPD

• Fran Brockhus Assistant Director of Nursing

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Project Aim Plan

• Project aim Reduce decrease the waiting time for
  Urology Outpatients by 50
• Project Plan
• Develop Value Stream Map
• Identify Wastes with staff

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Current State Value Stream Map
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Key Wastes Identified

• Motion nurses moving backwards and forwards as
  no link between clerical area patient care
  area.
• Non-standardised work letters handwritten,
  details not checked, details not known prior to
  arrival, history not available
• Rework Failed to Arrive system over booking,
  excess history pulling, queuing of patients,

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Kaizen Blitz Actions
,Reduce Time / MOTION Waste -of nurses moving
from back to front to get pt cards - taken away
from patient care

• Showed staff Kaizen Toast video and then
• Played the push pull game with OPD staff
• Discussion with staff to select area for Kaizen
  Blitzdecided to try changes to log in process/
  preparation of history on arrival.
• Trialled new process with 1 clinic AM/PM to begin
  with.
• 5S to improve efficiency in clerical area. Re
  arrange clerical area to enable better work flow.
• Next steps look at systems/process for getting
  all histories in correct place prior to clinic
  start.
• Discussion with HIS about processes for history
  collection

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• Measured Improvements Ave. Waiting for history
  to be sorted reduced from 50munites to 22
  minutes. Walking time of nurse per clinic
  reduced by 250 metes

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Best Outcomes to Date

• Setting up the system to mail merge and print all
  appointments.
• This has reduced time and error rates. On one of
  the hand written letters a patient had a day and
  month but no year, and arrived a year early for
  his orthopaedic out patient appointment!
• Changing the check in process for patients
• This was initiated by the clerical staff and
  provided benefits in waiting time for patients by
  28 minutes and decreased the motion for the
  nursing staff (decreased distance walked by
  250m). They did not have to cross the floor as
  often. Although this was a small change, it was
  owned and acted upon by the staff. It was a small
  step but proved to them that the concepts
  discussed could work. It was a change that they
  had control of.
• Staff have made the change,
• They understand why they have done it are
  willing to look at other small changes that they
  can manage

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Outcomes

• Used the new process for 4 clinics with very good
  outcomes only a few small issues.
• Decreased times nurse has to cross the floor (
  av of 23 pts x 10 metres across Department).
  Nurses were happy to be ale to stay in Pt Care
  area felt less busy.

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Next Steps

• Look at systems/process for getting all histories
  in correct place prior to clinic start.
• Discussion with HIS about processes for history
  collection
• Processes for unexpected arrivals similar to
  process used in ED

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Next Steps still to be done

• The phone survey showed that most people did not
  arrive because they forgot, or had made other
  arrangements to be seen. This has not yet been
  followed up.
• Analysis of the booking process showed that the
  batch booking was severely overbooked and there
  was no way to avoid waits. This also needs
  further follow up, and discussion, as reducing
  the failure to arrives will only make the clinics
  more overbooked and frantic, if the booking
  process is not looked at as well.
• Ideas to be Tested
• Trial calling patients prior to day of
  appointment to remind them and confirm
  appointment.
• Review appointment schedule and refill any vacant
  positions by phone avoiding overbooking
• Arrange to get histories for patients closer to
  time of appointment.
• Look into other systems for reminding patients eg
  SMS.

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Personal Reflections on Lean

• The opportunity to learn the principles of Lean
  Management was a great opportunity, and has given
  me skills that I can apply in my everyday work.
  Many of the concepts make good sense, even if not
  applied in a formal lean project.
• Lean has given me some valuable thinking and
  process tools to use in planning and implementing
  change.
• It was great to use the tools we were taught, eg
  the paperclip game, and then discuss with the
  staff how the concepts really applied to their
  issues. They were able to understand and grasp
  the different concepts that we were discussing. I
  felt that I had enough material and support to
  teach something that was still a new concept to
  me, and do it well. We were given a lot of
  support.
• The weekly teleconferences were good for keeping
  me on track. It gave me a deadline to work to so
  that there was some steady progress in my
  project. The
• It is hard to start on your own, and in an area
  where you are coming in as an outsider. Although
  I could see some of the issues clearly with fresh
  eyes, I was just another outsider coming in and
  telling them how to do things better.
• One of the best Ah ha moments for me was when I
  realised that the staff in OPD needed to make the
  change not me. I needed to listen to them and not
  let my project get in the way of a small real
  step for them in reducing waste.
• Trying to do a project as an extra to my work was
  both a positive and a negative. I came into the
  OPD with fresh eyes, was non-threatening to the
  staff and had to really work with the staff to
  get them to work with me and trust me.
• As it was outside my normal work
  responsibilities, it stretched my work time and
  often left me feeling that I was not doing
  anything properly. In hindsight, I could perhaps
  have chosen a project from within one of my areas
  of responsibility.
• It is hard to continue on your own. There have
  been several discussions recently about process
  issues, and I have suggested that some Lean
  thinking might help here perhaps even some
  process mapping to help make the processes and
  waits more obvious. I was told it had been done
  before, and I felt that some frustration that
  there is learning and tools that we could use in
  the organisation, but not a mass of people with
  the understanding to use the lean tools. It can
  be hard feeling like you a lean ranger. I am
  not sure how to get the next project started, but
  am keen to go over what I have learnt and use the
  lean thinking again.