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Process And Value Stream Mapping Exposed Hidden Bottlenecks After COVID-era Disruption
Overview
What was the reason for the change?
After three major disruptors to our practice: COVID, electronic health record implementation, and staffing shortages, we noticed decreasing efficiency throughout the spectrum of patient care. Specifically, delays in starting on time were highlighted as a major opportunity for improvement. Understanding that multiple teams were involved, we needed a more collaborative, team-based approach to improve workflows.
What were we trying to accomplish?
The maps were intended not only to help staff see where bottlenecks happened in the process, but to help them visualize the work of their upstream and downstream care team partners. They highlighted how defects can be passed down through a process to different teams.
How will we know that a change is an improvement?
Efficiency data is pulled weekly and communicated to all stakeholders. Additionally, staff were provided with pre and post project surveys to evaluate their satisfaction with the work being done to reduce delays.
Implementation
How long did it take to get up and running?
It took about three months to do the root cause analysis, and a six-month long pilot of the changes.
How was readiness assessed & required resources identified?
This was discussed with the various multidisciplinary leaders. Project champions at each point of the value stream were selected to help with implementation.
What were the missteps and lessons learned along the way?
The effect of rotating staff members was not originally anticipated and resulted sudden drops of efficiency when new staff came on. This led us to incorporate the teachings into orientation materials. Physician engagement also played a major role in an operating room’s success.
Solution Design
What changes can we make that will result in an improvement?
Implement standard work processes for tasks leading to an operating room. Standard work improves both safety and efficiency by providing staff with more structure to follow. With everyone following the same procedure, there is less chance for variation, interruptions, and errors. These processes are designed with the staff, to ensure that they realistically fit into their workflow.
What was your implementation strategy and critical steps?
The standard work processes were communicated to all staff both virtually and in in-person meetings. Posters detailing the new processes were placed on each operating room door. Wherever relevant, training on these processes were incorporated into orientation for rotating staff.
Adoption & Sustainability
How did you communicate the tactic to those affected by it?
The effect of rotating staff members was not originally anticipated and resulted sudden drops of efficiency when new staff came on. This led us to incorporate the teachings into orientation materials. Physician engagement also played a major role in an operating room’s success.
How did you design for sustainability of the change?
A champion in the department was selected to review that data monthly. If metrics decrease for a sustained period, they are to follow an escalation plan within their department.
- process mapping
- workflow
