Abstract
In the current healthcare system, poor patient throughout (flow) causing delays and frustration for both the patient and the family is very common. Poor flow also leads to quality issues. Very few healthcare systems have a systematic way to improve flow using robust improvement methodologies (e.g., Lean). In this chapter, a series of cases are utilized to illustrate the perils of poor flow and the improved quality of care with an improved flow construct. A systematic guideline for improvement is presented discussing leadership, Lean Healthcare, system redesign, and analytics to drive improvement. A vision for patient-centered flow will be defined.
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References
Pedroja AT. The tipping point: the relationship between volume and patient harm. Am J Med Quality. 2008;23(5):336–41.
Rutherford PA, Provost LP, Kotagal UR, Luther K, Anderson A. Achieving hospital-wide patient flow. IHI while paper. Cambridge, MA: Institute for Healthcare Improvement; 2017.
Singer AJ, Thode HC Jr, Viccellio P, Pines JM. The association between length of emergency department boarding and mortality. Acad Emerg Med. 2011;12:1324–9.
Liu SW, Chang Y, Weissman JS, Griffey RT, Thomas J, Neugui S, Hamedani AG, Carmago CA Jr, Singer S. An empirical assessment of boarding and quality of care: delays in care among chest pain, pneumonia, and cellulitis patients. Acad Emerg Med. 2011;18:1339–48.
Litvak E. Managing patient flow in hospitals: strategies and solutions. Oakbrook Terrace: Joint Commission Resources; 2010.
Liker JK. Developing lean leaders at all levels: a practical guide. San Bernadino: Lean Leadership Institute Publications; 2014.
Wince R Top 5 leadership characteristics for process improvement. Retrieved from https://www.govloop.com/community/blog/top-5-leadership-characteristics-for-process-improvement-success/
Crane J, Noon C. The definitive guide to emergency department operational improvement. New York: Productivity Press; 2011.
Chalice R. Improving healthcare using Toyota lean production methods. Milwaukee: ASQ Quality Press; 2007.
Sundarapandian V. 7. queueing theory. Probability, statistics and queueing theory. PHI Learning; 2009. ISBN 978-8120338449.
Song H, Tucker A, Murrell K. The diseconomies of queue pooling: an empirical investigation of emergency department length of stay. Manag Sci. 2015;61(12):3032–53.
McChrystal S. Team of teams: new rules of engagement for a complex world. New York: Penguin Publishing Group; 2015.
Gawande A. The checklist manifesto: how to get things right. New York: Metropolitan Books; 2010.
Sen S, Sarros JC. Servant leadership: its origin, development, and application in organizations. Organizational Studies. 2002;9(2):57–64.
Kenney C. Transforming healthcare: Virginia Mason medical Center’s pursuit of the perfect patient experience. New York: Productivity Press; 2011.
Baker G, MacIntosh-Murray A, Porcellato C. High performing healthcare systems. Toronto: Longwoods Publishing Corporation; 2008.
Song H, Tucker A, Murrell K, Vinson D. Closing the productivity gap: improving worker productivity through public relative performance feedback and validation of best practices. Management Sci. 2018;64(6):2473–972.
Chettipally UK. Punish the machine: the promise of artificial intelligence in health care. Charleston: Advantage Media Group; 2018.
Morris Z, Wooding S, Grant J. The answer is 17 years: what is the question: understanding time lags in translational research. J Royal Soc Med. 2011;04(12):510–20.
Kuppermann N, Holmes JF, Dayan PS, et al. Pediatric emergency care applied research network (PECARN). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160–70.
Potraj J. The quality of US healthcare compared with the world. 2015. Retrieved from: https://www.ajmc.com/contributor/julie-potyraj/2016/02/the-quality-of-us-healthcare-compared-with-the-world
Scoville R, Little K, Rakover J, Luther K, Mate K. Sustaining improvement. IHI white paper. Cambridge, MA: Institute for Healthcare Improvement; 2016. (Available at ihi.org).
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Chapter Review Questions
Chapter Review Questions
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1.
What is the definition of Lean Healthcare?
Answer: Lean Healthcare is a set of operating philosophies and methods based on the Toyota Production System principles designed to create maximum value for patients. It uses basic tools and methods to systematically reduce waste and therefore wait times for patients. It emphasizes what is value-added from the patient perspective, employee involvement, and continuous improvement.
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2.
What are the two known impacts on patient care and hospital operations found with boarding patients in the emergency department?
Answer: Increased mortality and longer length of stay after admission.
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3.
Describe two examples of segmentation in the emergency department and one example for the inpatient units.
Answer: (a) In the ED, a streamlined low-acuity treatment area and a vertical treatment area for mid-acuity, well-appearing patient, and (b) on the inpatient unit, an observation unit with defined patient pathways.
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4.
True or False: The role of a leader is to direct frontline staff on their daily work.
Answer: False. The role of the leader is to create a vision for the staff and support the process improvement work in process.
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5.
Does transparent data improve physician performance?
Answer: It depends. If transparent data is paired with sharing of best practices, physician performance can improve. Sharing of transparent data is not a panacea, but there is broad subjective sentiment that transparency drives improvement.
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6.
What is the definition of Kaizen?
Answer: Continuous improvement. A Kaizen event brings a group of people together in a structured way to solve a well-defined problem.
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7.
Describe two ways that analytics will help improve flow and patient care in the future.
Answer: Analytics can help with retrospective review of issues, real-time “pushes” to staff to assist with workflow, and prospective predictions of high volume with recommendations to plan for it. On the clinical side, analytics can bring best practices up to the clinician and allow shared decision-making with patients and family.
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8.
Describe a basic framework for process improvement in healthcare
Answer: Process improvement is best when leadership sets the vision. Lean education of frontline staff ensures everyone uses the same methodology for projects. This combined with multidisciplinary teams for process improvement, Kaizen events, and clear metrics using technology create a robust framework for improvement.
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Murrell, K. (2021). Patient Flow in Healthcare: A Key to Quality. In: Shah, R.K., Godambe, S.A. (eds) Patient Safety and Quality Improvement in Healthcare. Springer, Cham. https://doi.org/10.1007/978-3-030-55829-1_18
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