28 October 2016

Preadmission Testing Kaizen at Memorial West: Part I

For an outsider looking in, a clinical Kaizen event may appear chaotic. Consisting of individuals well-versed in the sequence and flow of clinical processes, clinical Kaizen teams are charged with the task of deconstructing, analyzing and reconstructing critical workflows to maximize the creation of value for the patient. With its roots in the Toyota Production System, Kaizen provides cross-functional teams with a structured approach to process decomposition and waste reduction by allowing the team to systematically analyze process performance in an objective and comprehensive fashion. In practice, this typically involves engaging in activities, such as value-stream mapping, “trystorming,” simulation and direct observation – all facilitated by low-cost, low-tech tools utilizing simple flipchart paper and post-it notes. 

In April of this year, Sheridan’s clinical Kaizen team traveled to Memorial Hospital West in Pembroke Pines, Florida to guide a team of anesthesiologists, nurses and patient care professionals through a three-day, focused event aimed at improving the flow of patient information leading up to surgery. Prior to the event, the preadmission testing (PAT) process at the hospital had delivered adequate performance, with case cancellations varying slightly from an average of 2.5%. However, due to the disjointed nature of the process, nurses and patient care professionals often found themselves scrambling to get into contact with patients or their surgeons in order to verify that the appropriate tests had been ordered and performed. 

Over the course of the three-day event, the team observed, mapped and unraveled a patchwork of operational bandages that had been applied and reapplied by members of the staff in an attempt to bridge the gap between patients, their surgeons and the hospital. The resulting improvements – conceived and implemented by the team, and sustained by the champion – stemmed from a clear understanding of the process flow rather than from external pressure or internal strife. As a result, the team left the event with a renewed sense of ownership over their workflow, which is critical to ensuring the implementation of standard work. 

The Challenge & the Opportunity

From a patient’s perspective, scheduling an outpatient surgical procedure should be a relatively painless process (no pun intended). However, in practice, coordinating even the most routine procedures can prove challenging. Inconsistent ordering patterns, poor communication, lack of standardization, incompatible electronic health records (EHR) platforms and ambiguous patient instructions all serve to complicate matters greatly. To overcome these challenges, the hospital’s staff applied in-the-moment fixes to mitigate the risk of a same-day case cancellation. As a result, each individual began to develop his or her own practices, further complicating matters by making it nearly impossible to identify waste and variability in the process. However, despite the ambiguity and complexity that had plagued the process prior to the event, there was a significant opportunity to leverage the expertise of a highly skilled, experienced perioperative team.

In the coming blog posts, the reader will be given a unique look into the process and practice of clinical Kaizen. Along the way, we will introduce some of the core concepts that drive the success of clinical process improvement events. For more information on how Sheridan is working to improve the clinical operations of our partner facilities, please contact our dedicated Anesthesia Practice Development Team at (888)-722-5430.