Redesign Based on your analysis and conclusions, identify possible root causes for the process dissatisfactory performance. Next suggest a new or redesigned process that would overcome those problems. If needed create a new process chart and explain how your new process would meet the desired performance criteria. Final Report Your final task is to take all the information you have acquired in the redesign process and describe your recommendation as the Operations consultant. Your report should be in the A3 report format which is a concise way of presenting a process improvement project proposal. (A3 is another process improvement approach used by many organizations, most notably by Toyota.) A good book explaining the A3 approach is "Understanding A3 Thinking: A Critical Component of Toyota's PDCA management System" by Sobek & Smalley. You can find the first 18 pages of "Chapter 4: The proposal A3 Report," which describes how to create a proposal report before proceeding to the actual redesign implementation, in the Table of Contents -> Learning Modules -> Week 6 area of D2L. The book is available as an e-book from the University of Arizona Library at http://ezproxy.library.arizona.edu/login?url=http://www.myilibrary.com?id=140106. THEME: Increasing efficiency while controlling costs to improve patient outcomes BACKGROUND: The Pediatric Orthopedic Clinic at Children's Hospital of Western Ontario (CHWO) is a large regional health care center that specializes in services to children. Approximately 400,000 children fall within their population radius. By all accounts they are a busy center. CHWO was experiencing long patient wait times in their clinic. Patients were spending an average of 2 hours in the clinic. These waits led to frustration by parents and increased stress levels by patients. In addition to long wait times and patient stress, staff at the clinic felt overextended and on the verge of burnout. Budgetary issues prevented them from adding more staff. In addition, federal and provincial governments were concerned about the economic impact that long wait times had on economic productivity. Worker hours were being impacted by patients or parents having to spend too much time waiting. CURRENT CONDITION: R=80 pt/hr= 0.480 (N)+0.680 (F)= 32 New +48 Follow-up Arrive Front Desk 3 nurses 255 minutes [8:30-12:45] Registration Verification 3 clerks 180 minutes [8:30-11:30) Radiology Department R-32 (N) + 0.85*48 (F)=32 (N) + 40.8 (F) Developme X-ray imaging nt of X-ray 6 technicians 160 minutes 3 radiologist 160 minutes 2/3*18:30-11:30 Diagnostic reading 2/3 8:30-12:30] Hand-off X-ray to Clinic 3 nurses (same as Verification) 255 minutes (8:30 12:45] Collection of X-ray R = 0.15*48-7.2 (F) Bottleneina mination Room 1 surgeon R-32 (0.348 (F) 255 minutes [8:45-1:00] 32 (N) + 14.4 (F) Prepping Surgeon | R = 0.25 * 32 (N) + 0.1548 (F) = (N)+7.2(F) Cast Technician Filing & R-0.7 48 (F) 33.6 (F) 1 techniden 1 nurses 255 minutes [8:45-1:00] Senior Residents 255 minutes (8:45-1:00] "I resident of the 25 255 minutes [8:45-1:00] Flow time efficiency approx. 10% for new Scheduling Depart Arrive Patient Front Desk Registration (3 clerks) Front Desk Verification and filing (3 nurses) Front Desk exam room prep (1 nurse) Radiology Department (1 clerk, 6 Technician Radiology Department (3 radiologists) Examination (Surgeon) Examination (2 senior residents) Cast Technician Registration Verification Yes New Patient or new X-ray ned? No Collecting X-ray image Develop Review & No Fing room prep New or comple Yes Exam Schedule next appointment Cast alterations No Yes or removal Yes Cast Exam alterations Another appointm No or removal? No Yes Cast Leave ROOT CAUSE ANALYSIS: The main issue we are seeking to address in this case is the long wait times that patients at CHWO are having to deal with when they visit the hospital. This is an issue because longer wait times have led to an increase in customer dissatisfaction as well as potentially significant negative economic impacts. After doing a robust analysis of the case, we came to the conclusion that a root cause of the extended time patients spend in the clinic under the current system is the examination room step of the process. More specifically, the lack of sufficient manning for the amount of patients they receive in this step. The status quo of four examination room workers (nurse, surgeon, senior resident, and a technician) is insufficient to effectively move patients through the system in a timely manner. The utilization rates for all four members of the examination room are above 90% and are as high as 110% for the surgeon. Also, the flow time efficiency for new patients is 10% and is 13% for returning patients. This lack of manpower is leading to a bottleneck in the entire process at the examination room and will be addressed in our recommended plan going forward. TARGET CONDITION: Patient Arrive Front Desk Registration (3 clerks) Front Desk Verification and filing (3 m 8 nurses) Front Desk exam room prep (1 nurse) Radiology Department (1 clerk, 6 Technician Radiology Department (3 radiologists) Examination (2 Surgeons) Registration Patient No Verification or new X-ray Yes Develop image Review & annotate Filing x-ray room prep Fingray & exam room prep Yes Schedule Next Appl Cast Alterations Exam or Another Acot? Removal No No Yes Cast Technician Figure TC1: Proposed Flow Diagram Cast Leave Figure TC1: Proposed Flow Diagram Available Time Activity Time Step 180 3 255 Activity Resource Resource Unit Resource Pool New Patient Follow-Up New Registration 3 Front Desk Verification # of Patients Follow-Up Required Processing Times New Follow-Up Utilization 540 5 5 32 48 160 240 74.07% 765 9 4 32 48 288 192 81.78% X-Ray 3 255 765 2 2 32 40.8 64 81.6 Imaging 6 160 960 11 11 32 40.8 352 448.8 83.42% Radiology Developing 6 160 960 7 7 32 40.8 224 285.6 53.08% Diagnosis 3 160 480 5 5 32 40.8 160 204 75.8396 Exam Room 1 255 255 2 2 32 48 64 96 62.7596 Examination Surgeon Casting 2 255 510 7 4 32 48 224 192 81.57% 1 255 255 17 13 8 7.2 136 93.6 90.04% Table TC1: Expected Processing Times & Utilization With New Process Flow We propose implementation of the new flow illustrated in Figure TC1 above (associated processing times and utilizations calculated in Table TC1). This proposed flow eliminates the senior resident function and replaces them with a second surgeon, meaning a surgeon will now see all patients regardless of complexity. This brings a two-fold advantage: First, surgeons are able to process follow-up patients almost twice as quickly as a senior resident can, which is predicted to bring the average flow time of the examination/consultation down from 11.33 minutes/patient to 10.07 minutes/patient. Second, adding the additional surgeon will eliminate the over- utilization bottleneck in the flow. As calculated in Table TC2 below, this over-utilization bottleneck causes an average wait time of 23.67 minutes per patient which will now be eliminated. In summary, this change is expected to reduce the average total time a patient spends in examination from 35 minutes to 10.07 minutes, a 24.93 minute savings. Avg Process Time Current Total Time Current Walt Time New Flow Time New Walt Time| New Total Time Time Saved #Patlents (min) New 32 13.25 Follow Up Avg 48 10.05 N/A 11.33 (min) 38 33 35 (min) 24.75 22.95 23.67 (min) 13.25 (min) (min) 13.25 (min/patient) 24.75 7.95 7.95 25.05 10.07 10.07 24.93 Table TC2: Expected Time Savings With Proposed Process IMPLEMENTATION PLAN: Action Action 1: Hire 2nd Surgeon Responsibility Deadline Dr. Kellie Leitch ASAP Action 2: Dismiss or Reassign Senior Residents Dr. Kellie Leitch ASAP COST: Total Cost will be the new surgeon's salary minus the salaries of the dismissed senior technicians. FOLLOW-UP: Plan Note the plan to measure the effectiveness of the proposed change. whom. Actual Leave blank initially After follow-up, record the results of Record the date of actual follow-up Indicate when it will be measured, and by implementation