Paper Example on Scheduling MRI: 21-Day Wait Time at Cleveland Clinic

MRI (magnetic resonance imaging)

Scheduling a patient for an MRI (magnetic resonance imaging) was proving to be an arduous task at Cleveland Clinic and, physicians were complaining that it was a long wait time (average of 21 days) for their patients to get an MRI, even though there were numerous imaging devices (30) running throughout distributed to the entire Cleveland Clinic and its affiliated hospitals. The long wait time affected the patients physically and psychologically since they were often awaiting an MRI as a vital piece of the puzzle in a diagnosis. After analysis of the SPCI team on the MRI procedures, they pointed out numerous areas of improvement.

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One of the regions was a delay due to the injection of contrast agents, which allowed the MRI results to be analyzed more easily. Many patients who were getting MRIs required the intravenous contrast agents. Still, the MRI technicians were stopping the scan halfway through the procedure to place the intravenous lines that were necessary for injection of the contrast into the patient. This interruption of the process was adding an average of (7 minutes) to each MRI scan, resulting in backups and scheduling problems. The solution for these was not to interrupt the scan process by assessing the need for contrast and start the intravenous line at the initialization of the MRI procedure only if required, and the project team also identified key opportunities better to utilize existing equipment and off-site locations to schedule and serve patients. The MRI efficiencies resulted in an overall decrease of the MRI procedure lead time from about 21 days to an average of 12 days. Between 2008 and 2009, there an annual increase of 1,560 completed exams which is approximately (4.7%).

Drawbacks

• This is a costly method due to the technology involved in it and also requires skilled operators to handle the machine.
• The machine can only capture a clear image of the patient being scanned only stays completely, which is difficult in most cases.
• Researchers globally are not yet very familiar with this technological method of body imaging.

Reducing the Variance to Standard for Hospital Stays

Initially, the pre-operative procedures averaged seven days for surgery to be performed on one surgical service that dealt with certain complex cases. During these days, patients underwent numerous checks and tests to prepare them for the surgery, but the tests and analysis came slowly. There were multiple steps in the pre-operation process such as; checkup by the nurse to determine the criteria required, the performance of the tests by the lab technicians, physicians analyzing the results and sometimes requesting additional tests, scheduling of surgery and finally performing of surgery operation. With these, the staff felt that these processes were unnecessarily long (long lead times), which cost the patient and the hospital precious time.

To deal with the problem, the SPCI team combined efforts to create a matrix board that was prominently displayed for staff review with rows of patients and columns with the required tests after examining the situation. Nursing staff placed colored dots in the boxes to indicate whether a patient needed a test or not, and the status of the required tests such as waiting for the test, waiting for analysis and completion. With the new system in place, it became clear when unnecessary or multiple, and overlapping tests were being requested. It also became apparent when physician review of the test results needed to be expedited to make decisions on the need for additional testing quickly or to order more testing. After the implementation of the checklist, the staff worked on training and actively managing the other aspects of the pre-operative evaluation process. Following these changes, the number of overall tests being ordered and significantly completed reduced, and the average in-hospital wait time for patients before surgery for this particular service dropped to 6 days. Staff members said they were working on achieving further efficiency gains to reduce the pre-operative wait time to five days.

Drawbacks

• It requires enough time for the involved parties to adapt to the changes in improvement processes.
• The changes to the standard way of doing things may not fit all of the employees or patients.

The Kaizen Method

The implementation costs of these methods are minimal. The Kaizen technique has a significant contribution to the reinforcement of the relationship between the organization manager and employees at Cleveland clinic since the achievements of the company are the results of the combined efforts of each employee. This kaizen method as a technique of process improvement has brought together all the employees of the Cleveland Clinic which has, in turn, led to the advancement of the communication process and the reinforcement of the feeling of membership of the improvement process. The project team and Cleveland clinic management have motivated the whole company staff to implement the concept of performance-oriented organization. Kaizen has been used to achieve and overcome the company's objectives of the improvement in surgery processes. The Kaizen method has increased productivity of the Cleveland clinic since now operations such as surgery can be done within a short period. The overall business performance of the Cleveland clinic has risen to a greater extend.

Drawbacks

• Requires engaging of the involved members
• The project team brought in representatives from each of the three shifts to contribute to finding solutions. Stanicki says that the team wanted to engage the people who were doing the work stating that the employees were the closest to it, and without their buy-in, he and his team would never make any progress. Leonard also said that workforce engagement is significant, and if they did not believe in it, it would not last for more than a couple of weeks.
• A proper analysis needs to be done before implementing the process.
• The project team decided to hold Kaizen events to analyze each sub-process after realizing the arising problems.
• The method depends on the willingness of the involved members to cooperate
• If the Cleveland employees would not have assisted, then it would have been challenging to implement the kaizen project of process improvement.

Use of FMEA at the Cleveland Clinic

Defining existing problems at the Cleveland Clinic

FMEA, which is an inductive engineering technique of improvement process, has been used at Cleveland clinic by the PSI team to define the existing problems facing the members and patients of the hospital. The issues raised by the surgeons, such as the inability to start operating rooms on time and instruments that were not immediately available when requested were defined to know where to start from in the improvement process.

Identifying existing problems at the Cleveland Clinic

FMEA has been used to determine the existing challenges faced mostly by the surgery processing department, the workers and the patients and eliminate any known failure or potential failures, problems, and the various errors from the Cleveland clinic system. Design, process, and serviced the failures before reaching to the patients who are customers. Cleveland Clinic has made use of risk assessment to identify and evaluate risks to support decision-making regarding actions to ensure the safety of the employees and patients. Earlier on, Stanicki and the surgery processing department (SPD) realized that errors in its processes were negatively impacting the surgeons' abilities to do their work. Stanicki came up with the conventional solution of purchasing more instruments or hire more employees, but he chose to institute new practices to manage the situation. He told the teams that they had the right resources but were not being adequately utilized. With this in mind, he turned to guidance from Cleveland Clinic's PSI team to analyze the current practices and partner in process improvement efforts. He told the team that his staff was frequently running into cases of missing instruments, and also had a hard time adequately preparing tools in emergencies which were a risk to the patients and the doctors.

FMEA has been used to evaluate the different processes at Cleveland clinic

It has pointed out the areas of concern and at the same time, reduce development time and cost. FMEA was able to evaluate the following areas of interests and improvement from Cleveland clinic; delayed cases and even cancellations which would result in discomfort for patients, the clinic suffering financial loss due to inefficient resource utilization, high costs from delays originating in the SPD which were conservatively estimated at hundreds of thousands of dollars annually due to; lost time in the operating rooms and processing fees for incorrect instrument trays, patient dissatisfaction and cancellations, and overall loss of goodwill. These intangible costs were more challenging to estimate and were difficult to account for in strictly financial estimates of cost. Still, FMEA came with solutions for the reductions and proper utilization of the available resources.

Transitioning among improvement processes in members involved

FMEA is necessary when the intention is to move a process of one service to another. The workers of the Cleveland clinic were required to transform to new ways of doing things such as decontamination whereby the carts containing used surgical instrument entered the SPD area were scanned into an electronic database and decontaminated automatically contrast to their traditional methods, prepping and packing after decontamination, sterilization, case cart assembly, delivery and Sterile Storage after sterilization.

An effective way to identify the means of improving areas where there is a decline in performance such as an employee or customer dissatisfaction

FMEA was able to identify the following areas of concerns and improvement from Cleveland clinic, delayed cases, and even cancellations would result in discomfort for patients. The clinic also suffered financial loss due to inefficient resource utilization. Costs from delays originating in the SPD were conservatively estimated at hundreds of thousands of dollars annually. The estimate included lost time in the operating rooms and processing fees for incorrect instrument trays. In addition to revenue loss, costs also resulted from patient dissatisfaction and cancellations, and overall loss of goodwill; these intangible costs were more challenging to estimate and were difficult to account for in strictly financial estimates of cost.

Drawbacks of FMEA use at the Cleveland Clinic

If the team forgets to list some basic failure modes, then the ways will be ignored. The project team at Cleveland Clinic might have left some of the failure modes required for the techniques needed for the improvement process.

FMEA may not prioritize failure modes according to their risk. This means that it will not be able to eliminate the required specific failure modes and may need other actions outside of the FMEA procedures and the project team conducting it.

Too many details make the analysis seem a much-involving task. The Cleveland Clinic employees, at some point, viewed the FMEA as much demanding, but they later adapted to the process. This problem can be solved by breaking the analysis into manageable segments.

FMEA should regularly receive updates since new potential failure modes arise at different circumstances. From the Cleveland Clinic, we have seen how unplanned problems such as the workers being affected by inefficiencies inside and outside the department at several levels. There was a c...