Radiology Imaging Centers - Taking an Imaging department to a New Level
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With the U.S. In its current economic retreat and President Barack Obama's promise of addressing healthcare reform in 2009, eliminating waste is going to be a key factor in the survival of non-profit hospitals, inexpressive custom physicians, for-profit free standing clinics, and imaging departments. Lean can help imaging practices enhance their contribution margins by re-evaluating "how they have always done business."
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Many regulatory agencies (e.g. Jcaho, Acr, National capability and the U.S. Government) are pushing for great outpatient care, improved outpatient flow, safety, and quality. As a result, healthcare as an business must take an introspective look at how they meet outpatient needs along with the safety and capability of care they provide. Jcaho requires the reporting of capability data to retain the National outpatient safety Goals and the National capability Forum is pushing condition data technology.
In light of the national economic trends, healthcare reform and the changes in pay for performance regulations within healthcare, Lean tools can be a partner with imaging facilities to view work differently by identifying possible savings of time, resources, and the elimination of errors; thereby increasing the viability of capability healthcare.
Issue
The current imaging departments at Kootenai curative center did not have a defined arrival to retell changes. Furthermore, changes (not improvements) were not articulated to all staff because they were based on current trends and quick decisions. This resulted in wasted time, rework, miscommunication and staff frustration.
Background
Kootenai curative Center's Imaging Services provides Radiology, Interventional, Mri, Nuclear Medicine, Ct and Short Stay services. Each branch has a "working" supervisor who is responsible for the budgeting and staffing of their respective areas. The turnover rates in each branch were sporadic. Imaging Services' outpatient satisfaction scores were low and also sporadic. Lastly, laborer engagement was one of the bottom in the organization.
Current Condition
The imaging branch is fortunate to have radiologists who are some of the most developed in their field. In addition, the branch is 100 percent digital, allowing a turnaround time from minutes to 2 hours. There are over 140 Fte's along with 13 Fte radiologists. The department, divided into four locations, maintains a total of three Computed Tomography Scanners (Ct), two Interventional Radiology suites, five Ultrasound suites, two Mammography suites, five X-ray rooms, a mobile Positron Emission Tomography (Pet) and two Magnetic Resonance Imaging Machines (Mri).
Target Condition
The director and branch supervisors decided they wanted to be the benchmark in their organization for all measures. The entire team is committed to provide today's outcomes by determining the need for a consistent way of decision making for processes within the departments that was both easy and easy to learn by the front line staff and supervisor. They wanted to provide a tool that would also enhance laborer satisfaction. Most importantly, the team made a commitment to enhance outpatient satisfaction.
Counter Measures
During the months of May and June of 2008, the Imaging Services supervisors were trained in Lean tools to enhance their processes. As a group, each supervisor participated in a seven week procedure once a week for two hours. The facility behind the training was to aid the supervisors in comprehension the tools of Lean and understand an entire process from the patients' perspective prior to making any change. They were asked to "throw away" the axiom "we have always done it that way".
While in the process of work, they learned to generate and document a value stream map as in example 1. The value stream map allowed everyone to understand how a request is made, the private steps which occur along the way, and the data collected. The value stream map assists in identifying non-value added time for the outpatient by identifying waste, as defined by Toyota yield Systems, in the following areas:
o Overproduction - producing more than, faster than, or sooner than is required
o Waiting - idle time that could be used more productively
o Transporting - unnecessary vehicle of parts, materials, or people
o Inappropriate processing - operations that add no value from the customer's perspective
o Unnecessary list - exceeding one-piece flow
o Unnecessary/excess motion - any movement by habitancy or tool that does not add value
o Defects - rework, repair or waste in its simplest from outcomes
The supervisors of the imaging branch were able to perfect seven projects. As one views the outcomes he or she may assume these issues should be easy to identify and easy to solve. However, the reader is not privy to comprehension that the issues, albeit seemingly simplistic, did not have the predicted mental as the supervisors initially thought. An foremost part the supervisors learned is not to solution jump, i.e. Make a uniformed decision, before they fully understood the entire process. Only when a process is understood from the very start to very end can an informed convert be made.
For example, the Ct branch discovered that patients were getting conflicting data from their referring physician, the Ct department, and the Rn who provided a pre-procedure call. This transportation process confused the patients and in turn decreased outpatient satisfaction scores.
The Mri branch decided an eight day wait period for an Mri scan is neither sufficient (not sufficient) nor competing in today's environment. Therefore, the supervisor, technologists, and front office staff utilized Lean. They designed a more sufficient way to program patients, immediately reducing the wait period from eight days to one day.
The Ultrasound branch identified a need to enhance the vehicle mechanism for patients' safety. The initial portion showed 42% of patients were transferred with the allowable device. This was foremost not only for outpatient safety but staff safety while transfer. After applying Lean to this process the percentage immediately increased to 90%. It is foremost to know that this project, although not trying to identify vehicle issues, discovered that the vehicle times were in fact sufficient. Prior to this project, one could hear anecdotal statements such as, "it takes vehicle 45 minutes to an hour to get patients to us". Now, we thank the vehicle team.
The Nuclear treatment branch considered that it takes longer than predicted for patients to gift to the branch due to check-in procedures. When a outpatient arrived for their appointment they were required to travel to one location to register then to a separate location to check in and finally to the Nuclear treatment branch for their appointment. This process, once identified using Lean, was regarding because the majority of Nuclear treatment patients are elderly and/or very ill. Isotopes decay at a rapid rate, so decreasing the time it took patients to gift at Nuclear treatment was significant. Patients were being registered in concert with all emergency room patients, sometimes triaged, and were asked to wait in the emergency waiting room.
The outcome was an immediate success for the patients because they now register in the Mri branch which is adjacent to the emergency branch and over the hall from Nuclear Medicine. Patients no longer have to walk past the Nuclear treatment branch to check-in for their appointment. This resulted in a 24 minute revising in outpatient wait time.
Cost Benefit
At the time of writing this text, the benefits are still being identified. As stated earlier, not only are the patients satisfied, the results are in the numbers.
The imaging branch went from one of the bottom scoring departments in the hospital for laborer satisfaction to the highest in laborer satisfaction in one year (Avatar/Gallup). The branch went from a negative contribution margin to +3.8% in one year. In addition, the branch achieved the 96th percentile in outpatient satisfaction (Avatar). Dropping to a 4.5% turnover rate in 2008 was a huge success. To date in 2009, we have experienced 0% turnover and zero vacancies. The branch now has a pool of applicants waiting for a possible opening.
Follow Up
Imaging organizations should embrace the benefits of implementing Lean. They should convert the feeling of, "we don't have time", "we don't have adequate staff" or "it costs too much" to "what is ideal for our patients". If enhancing process in an organization is simple, then why hasn't it already been done? Engaged employees are the key to your organizations success and providing them the occasion to learn and use tools is a start. If you are questioning the relevance of Lean in your organization then rejoinder the following questions:
1. Are patients complaining about your services?
2. Is your organization's turnover not meeting benchmark?
3. Is your organization duplicating processes?
4. Are habitancy in your organization performing identical task differently?
5. Are you seeing processes in your organization are not standardized?
If you answered yes to any of these questions then you should reconsider Lean in your organization. With decreases in repayment for imaging services, having to provide the same services for less dollars is a reality. The choices are to either decrease staffing or eliminate waste.
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