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Clinical Process Analysis Ambulatory Operations Project: Endoscopy Center Summary April 6 , 2013

Clinical Process Analysis Ambulatory Operations Project: Endoscopy Center Summary April 6 , 2013. STAFF. Laurie Kaufman MSN, RN Manager Gina Aranzamendez MS, RN-BC Courtney Barnes MBA Beverly Hayes Valerie Haywood MBA, BSN, RN Duke Rohe, IE

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Clinical Process Analysis Ambulatory Operations Project: Endoscopy Center Summary April 6 , 2013

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  1. Clinical Process Analysis Ambulatory Operations Project:Endoscopy Center SummaryApril 6, 2013

  2. STAFF Laurie Kaufman MSN, RN Manager Gina Aranzamendez MS, RN-BC Courtney Barnes MBA Beverly Hayes Valerie Haywood MBA, BSN, RN Duke Rohe, IE Marvetta Walker, MHA, RN Manager Endoscopy

  3. Time Driven Activity Based Costing (TDABC) • Harvard University Business School • Michael Porter, PhD • Robert Kaplan, PhD • Institute for Cancer Care Excellence (ICCE) • Thomas Feeley, MD • Heidi Albright, Director • Head & Neck Center Pilot • Office of Performance Improvement • Process Flow Charting

  4. TDABC & Clinical Process Analysis

  5. MDACC’s Framework for Improving As A System Based on W. Edwards Deming’s “Profound Knowledge” Adapted From: A Framework for the Continual Improvement of Health Care. Batalden PB. Journal of Quality Improvement Vol 19 No. 10 1993 2. HOW WE IMPROVE WHAT WE DO Vision: Making Cancer History 1. WHY WE DO WHAT WE DO • Design and • Redesign Plans to Improve Our: • Performance as a System • Knowledge of Variation • Use of the Theory of Knowledge • Application of Psychology To Cure Cancer To Provide Patient Care To Develop Our Workforce To Maintain Financial Viability Processes that produce: OUTPUTS I NPUTS • Patients • Families • Staff • Suppliers • Equipment • Supplies • Partners • Etc. Research Outcomes Value = Patient Care Costs Work Force Development Financial Viability 4. WHAT WE DELIVER 3. HOW WE PERFORM OUR SERVICES

  6. Clinical Process Analysis

  7. CPA Methodology Process Flow Chart, Direct Labor Cost & Opportunities for Improvement Weeks 4 - 14 Performance Improvement Phase Participants: • Clinical Lead: Designated clinical point person for the project • CPA Team: Clinical Process Analysis Team, Performance Improvement • Clinical Leadership: Clinical Administrative Director; Center Business Manager; • SOT: Senior Operations Team Nurse Manager; Medical Director; Quality Officer • Center Process Flow Charter: Maintains process flow charts for the Center after • Content Experts: Frontline staff CPA Project is completed

  8. Background: Endoscopy Center Project Center Variation Scope Development

  9. Process Flow Charts

  10. Aligning Data to Frontline Processes &Elements of a Process Flow Chart

  11. Direct Labor Cost

  12. Process Flow Chart converted to Excel for Direct Labor Costing

  13. Costing • Salaries based on FY 2012 from ResourceOne • Data based on information captured in process flow charts from 10.17.2012 – 12.12.12 • Based on estimated times given by frontline staff in the Endoscopy Center • Salaries in this report are average adjusted hourly rates including fringe • Salaries for each Job Code Group are blended by utilizing FTEs to weight the averages: • MD- Professor, Associate Professor, Assistant Professor • PSC- Lead Services Coord, Patient Services Coord • MLP- APN and APN supervisor • Data is reported per patient

  14. Costing Summary:Direct Labor Costs

  15. Costing Summary:Estimated Times in Minutes

  16. OFIs(Opportunities for Improvement)Waste, Delays, Inconsistencies, Rework…

  17. SharePoint Site for Project Storage • Providesstorage for projectwork-ups • Available for bench-marking • Easy placement in Quality Project database

  18. OFI Summary • Total OFIs: 53 • OFIs in department's control: 6 • OFIs out of department's control: 14 • OFIs within department's influence: 33

  19. OFI Projects  6 Quick Fixes  8 PDSA  1 CS&E 1. Ready Call pagers2. Consult processing/patient check-in3. Optimization of Endoscopy Online Consult Health questionnaire 4. Bedside consenting 5. Nurse sedation practices 6. Guidelines for scheduling an Endoscopy procedure 7. Physician notification process for patient cancellation or reschedule

  20. OFI Projects 8. iConsent 9. PYXIS medication availability 10. Anesthesia sedation & recovery charge reconciliation 11. Endoscopy safety procedure checklist 12. Room standardization

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