by Joanna Wyganowska, MBA, PMP | VP of Marketing at Infinite Leap
Driving Process Improvement is not easy, and it starts with the difficult task of pinpointing the exact reasons why specific processes are deficient.
To provide you with some best practices for identifying the “why’s” in process improvement, I asked Dr. Brian Gregory, an expert in clinical workflow and capacity optimization and the founder of ORTimes, to share his advice on this topic.
Infinite Leap: Dr. Gregory – how did your journey with driving process optimization in healthcare begin?
Dr. Gregory: In the mid-eighties, when I finished my anesthesia residency, I immediately joined a private anesthesia group in Florida. However, just few years later, driven by a need to explore management concepts, I started a full-time MBA program with a triple focus of studies in finance, data management, and risk management. During that program I was introduced to the Theory of Constraints (TOC), and by 1990 I was using TOC as an anesthesiologist performing and coordinating cases in and outside the OR. In the late nineties, while working as a consultant at King Faisal Specialist Hospital and Research Centre in Saudi Arabia, I did an extensive data analysis to identify causes of overtime cases. I also developed a GANTT chart-based computer program to schedule cases in the OR and let PACU know when their next patient was coming out. This work led to the hospital’s ability to to better organize and expedite caseloads.
Infinite Leap: Did any other concepts influence your views on process improvement in healthcare?
Dr. Gregory: Yes, one of the defining moments for me was the opportunity to discuss with James Womack, the founder of the Lean Enterprise Institute, how to apply Lean to healthcare. His book “Lean Thinking: Banish Waste and Create Wealth in Your Corporation” mirrored and complemented what I had already implemented in the OR.
Infinite Leap: What in your view is the main reason for waste in healthcare?
Dr. Gregory: In my view, the main reason for waste in healthcare is process variation. Unfortunately, organizations often do not realize they have deviations in their processes, because they don’t collect data to measure it, or they don’t make the data available to clinical personnel or other departments potentially affecting the process, such as Environmental Services (EVS) or the Sterile Processing Department (SPD).
Infinite Leap: How do you get started with data collection?
Dr. Gregory: First, the organization needs to do an inventory of what data they already have. The data points can come from a hospital scheduling system, an accounting system, or in ORs even an anesthesia system. The goal of this first step is to see what you have and how you can use it to identify process variances. When I started my process improvement adventure, many data points where collected manually. The issue with manual collection is that these data points are often tainted by human error. Now, organizations can leverage systems that collect data continuously and accurately, like a Real-Time Locations System (RTLS), which can provide precise information on patient, staff, and medical equipment location and status. This information can immensely improve the quantity and quality of data.
Infinite Leap: Yes, RTLS systems are goldmines for those who drive process improvement initiatives. What do you do next, once you have the data?
Dr. Gregory: The next step is to understand what this data means—what points in the process it illustrates. Then you can move to data aggregation and data analysis.
Infinite Leap: What are some common pitfalls you see when organizations analyze the data?
Dr. Gregory: I have mentioned it before—the key is to have “good” data – data you can trust. If you have “bad” data, you will make bad decisions, it is as simple as that. The other common pitfall is “flat” data. If you are analyzing problems from a single dimension, you might make incorrect assumptions, which will lead to wrong conclusions, and therefore bad decisions. You need to use a multi-dimensional analysis to find the “why.”
Infinite Leap: I agree. If you look at data in a single dimension, you will never be able to get to the core of the problem.
Dr. Gregory: Exactly. Let’s take the analysis of OR procedure time as an example. If you combine the total time of procedure with another data point, such as the name of the surgeon performing the procedure, you might get some insights into which surgeon performs specific procedures faster or slower than others, but you will not get a comprehensive view of all ancillary factors, such as the on-time presence of an anesthesiologist or availability of proper surgical instruments. So again, the more data dimensions you can collect, the more insights you are able to gain, which will lead you to seeing a problem in a comprehensive view and finding the right solutions.
Infinite Leap: How do you measure the effectiveness of your process improvement initiative?
Dr. Gregory: In order to measure the change, you need to establish your key metrics. This allows you to evaluate if applied process changes improve the outcomes. However, I must warn you – you need to think through all process dependencies and pick the right Key Performance Indicator (KPI) or set of KPIs. For example, your organization might decide to work on improving throughput by reducing OR room turnover time. As you know, this measure is calculated from the time the patient leaves the OR following surgery until the next patient is wheeled in “The Wheels Out/Wheels In” KPI. However, if you measure your progress by looking just at this single KPI, you might encourage a negative behavior, when staff will wheel in a patient to an OR room before an operating team is ready to perform a procedure. Yes, your room turnover times will decrease, but your total procedure time will increase, and the capacity utilization of your resources – personnel, equipment, or rooms – could suffer. And, if you incentivize your team based on the wrong KPIs, your patients and your organization will experience a negative impact from what, on the surface, looks like a positive change. This could dramatically affect the profit and other economics of your organization.
Infinite Leap: I completely agree. To solve the problem, you cannot look at issues in isolation. You need to look at them holistically. You might decide to tackle one problem at a time, but you cannot ignore the impact the change might have on interrelated processes.
Dr. Gregory: Precisely. You need to have a good understanding of all process interconnections to start any process improvement initiative. Only then can you expect to drive long-term results from your process change efforts.
Infinite Leap: In closing, what is your best advice for hospitals working towards workflow optimization?
Dr. Gregory: Invest in training! Your clinical team needs to have formal, integrated training in all concepts that influence capacity utilization, and your non-clinical team, which often drives process improvement initiatives, needs a better understanding of the clinical aspects of workflows, so collectively they can make proper process changes.
Infinite Leap: Dr. Gregory – I appreciate sharing your insights today and I look forward to our future conversations.
If you would like to share your thoughts and best practices on optimizing healthcaree drop me a note – I’d love to chat with you to capture your experiences: www.linkedin.com/in/joannawyganowska