Emergency Department Bottleneck Proposal Middletown Hospital is a 200-bed, not-for-profit-general hospital that has an emergency department with 20 emergency beds. The emergency department handles on an average 100 patients per day. The hospital’s CEO has authorized the Six Sigma Team (SST) to address complaints received from patients seeking treatment between 6:00 p. m. and 10:00 p. m. The complaints are centered on waiting times and poor service.
During this time the data indicates that approximately 70% of the department’s admissions occur (University of Phoenix, 2009, Course Syllabus). To address these complaints and improve performance of the emergency department the Six Sigma Team must understand process improvement proposals. The process must identify the reason of the bottleneck; identify the correct data collection method; the use of capacity planning; accurate analysis of the scheduling and controlling techniques; and identify a recommendation on staffing or alternative sources of care. Process Improvement Proposals
A process improvement proposal is a mechanism to define the opportunities needed to reduce the number of steps, interactions, decision points, reports, and the length of the defined practice (Langabeer, 2008). Three key areas need to be addressed when improving a current practice. According to Langabeer (2008), these areas include increasing capacity, reducing the use of resources, and reducing the amount of variation (p. 79). For example, if the emergency department is currently seeing patients at a rate of four per hour during normal business hours, and this rate drops to one per hour during the period listed a bottleneck will result.
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To address this issue the department needs to provide the resources necessary to avoid the problem. However, when the reason for the bottleneck is known the correction must include steps to preserve resources. These steps must address reducing the cost per patient, removing excessive steps, and exposures that are unnecessary. Because the data shows the bottleneck occurring after normal business hours the third key area is equally important for successful performance. This area involves the development of control tools.
These tools will assist the department when variation occurs, these tools can include the development of contingency plans to use other hospital resources available after normal business hours; for example the use of clinical examination rooms for patient overflow. Process of Improvement Method Edward Deming introduces a method known as the Deming Cycle to identify bottlenecks within organizational structures. The Deming Cycle comprised of a continuous process cycle that involve planning, implementation, assessment and decision-making.
Deming postulated that “business processes should be analyzed and measured to identify sources of variations that cause products to deviate from customer requirement” (Arveson, 1998, para 1). Each step gives operation managers the feedback needed to determine if they are meeting current objectives. Arveson also suggest that this checklist will help reduce bottlenecks from happening while increasing productivity within every department. Comparing the Middleton Hospital use of Six Sigma methodology to Deming Cycle both methods can help reduce bottlenecks issues with waiting time that occurs during interval time of 6:00 p. . to 10:00 p. m. Six Sigma methodology uses phases of defining a problem and provide an alternative solution to the problem. The next phase includes measuring the solution’s outcomes, analyzing the outcomes’ goals and effectiveness, improving any flaws that was identified in the improvement process, and controlling any costs or activities to contain cost and resource deficiency (National Association of Health Care Quality, 2009). The Six Sigma system addresses each problem measuring a quantitative solution to be addressed by upper management and delivered to department heads for implementation.
Appropriate Collection Methods Middletown Hospital needs to look at different ways of collecting data. Data collection can be subdivided into three categories with service type, department, and floor. This collection of data is valuable tool that managers need to have in order to understand the flow of business within each department. With the collection of data it will allow managers to calculate the volumes of patients during specific times. The SST will require data collected from all computers used to monitor access to the admission system.
Additional data will have specific times at which the patient reported to various stations of treatment, and when the patient was discharged. A multivariate trend forecasting method will be more appropriate in this setting; the use of multiple variables about the item being forecasted allows seasons and cycles to be combined with other variables and improve forecast accuracy (Langabeer, 2008). This will give operation managers better forecasting abilities as they will be able to see trends. Finally, the SST will need to analyze the amount of resources or assets available to serve demand (Langabeer, 2008).
Quantitative data needed to measure capacity will include: the number of available beds and treatment rooms, the number of key providers and other staff available at each point of care between 6:00 p. m. and 10:00 p. m. , and availability of key medical technologies and equipment. Examples of key medical equipment are diagnostic imaging, X-ray and laboratory equipment. Methods to Analyze The first step in analyzing the cause of Middletown Hospital’s emergency department bottleneck is to perform a capacity analysis that will help to identify appropriate assets and resources to serve the increased need within each emergency department.
The analysis should capture statistical data in time series format that will show sequential data recorded during different time periods throughout the day. Data should be included from time periods when the emergency room is successful in handling demand as well as occurrences of the bottleneck. Creation of a control chart can also be useful in discovering areas of daily operations that are contributing to the current issue of meeting demand. Middletown Hospital is aware that they can not keep up with the demand placed upon each department with current needs.
In knowing the limitations, data from the other 20 hours in which emergency department is in operation can be used to obtain values for a mean and average to be used to create a control limit. Taking data from the entire day can be used to obtain a standard deviation value as well. Data and observations that show a large deviation from the mean will alert the staff to areas that need to be updated or streamlined. The control data that is being recorded should be able to define staff ratios, numbers of patients seen, time of day, day of the week, equipment or technology malfunctions, ime of patient visit, reason, and duration. A control chart can help Middletown Hospital distinguish normal and abnormal processes within their patient delivery service. Bottlenecks Operation managers need to handle many different jobs at once. These jobs can be dealing with bottlenecks, and forecasting. Operation managers need to look at current flow of business to determine the proper amount of staffing needed to handle problems in the future. By working with an accurate forecast managers are able to see what is expected and when the flow of business will occur.
When increasing staffing in any department the profitability will decrease at start, but soon will rebound as more patients realize they are receiving treatment at a faster pace. According to Langabeer (2008), one of the keys to increase throughput or capacity is to remove these obstacles or bottlenecks, which is called de-bottlenecking (p. 96). Increasing the number of staff on during peak times it will be easy to reduce the number of complaints and increase the profitability of every department. Being able to remove the barriers will allow managers to see the results within days instead of weeks.
Within any department comes demand and being able to predict the demand allows managers to become better forecasters. According to Langabeer (2008), “forecasting is a collaborative process that estimates the volume of patients that will be served over a specific time period. More precisely, it is a projection of demand that will occur along three dimensions: service type, location, and time dimensions” (p. 97-98). Managers will have to better look at the forecasting they are doing in order to make sure they are using the most current data in order to predict flow and handle problems. Recommendation on Staffing
Middletown hospital’s ability to move patients smoothly through the emergency department has become a conversation of complaint for patients. Due to the high volume of patients being seen during the hours of 6:00 p. m. and 10:00 p. m. changes need to be made to optimize waiting times and efficiently treat patients. The emergency department is averaging 100 patients per day which, means that 70 of them are coming through the emergency department between 6:00 p. m. and 9:00 p. m. According to Langabeer (2008), in health care, wait times are frequently a source of poor patient satisfaction and process inefficiency (p. 10). The hospital emergency department is currently plagued with a lack of staff scheduled at key times and needs to look at alternatives to better manage the movement of patients. Creating a solution for Middletown hospital means using multiple channel servers to reduce check in time and maximize on hand staff’s time management. Because a majority of the issues arise at a key time in the day the revision of the patient routing and flow is required. According to Hall (2006), therefore, by altering patient routing and flow, it may be possible to minimize patient waiting times and increase staff utilization (p. 221).
Bottlenecks occur in a hospital emergency department because of the triage concept of putting most significant injuries first. This means many minor care issues will be pushed back. Combating this issue creating a fast track lane to handle minor care issues will decrease patient complaints and wait time. These concepts should reduce the wait time of patients within this three hour block and maximize their experience in the emergency department at Middletown hospital. Conclusion Bottleneck is often the result of an organization lacking the capacity to meet the needs of clients in delivering a particular service.
Middletown hospital was given a recommendation to review its current organization capacity by examining their processes, resources, technology. Middletown hospital was able to define other available resources which could be used to assist with meeting their patient demand. Reference Arveson, P. (1998). The Deming Cycle. Retrieved November 27, 2009, from http://www. balancedscorecard. org/TheDemingCycle/tabid/112/Default. aspx Hall, R. (2006). Patient flow: reducing delay in healthcare delivery. Los Angeles, CA: Springer Science Business Media, LLC. Langabeer, J. (2008).
Health care operations management: A quantitative approach to business and logistics [University of Phoenix Custom Edition e-text]. Sudbury,MA: Jones and Bartlett Publishers, Inc. Retrieved November 28, 2009, from University of Phoenix, OPS/HC571 Health Care Operations Management Web site. National Association of Healthcare Quality. (2009). JHQ 174: Lean Six Sigma in health care. Retrieved November 27, 2009, from http://www. nahq. org/journal/ce/article. html? article_id=250 University of Phoenix. (2009). OPS/HC571 course syllabus. Retrieved November 28, 2009, from University of Phoenix OPS/HC571- Course Materials Web site.
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