Capital Health Medical Outpatient Unit

1. Capital HealthMedical Outpatient Unit April 12th 2007Final Presentation Kyle Brown Hillary Higgins Justin Lang

2. Outline • OverviewMOUThe Problem • Methodology • Analysis and ApplicationAcademic ResearchSurvey ResultsSimulationDesign Layout • ST RecommendationsImplementations • LT RecommendationsImplementations • Implementation Steps

3. Overview PROBLEM: • Increased demand • Poor facility • Inadequate layout design • Nature of treatments procedures • Scheduling “The MOU needs a more effective layout, and better utilization of resources” OverviewMethodology Analysis and Application Short-TermLong-Term Steps

4. Overview OverviewMethodology Analysis and Application Short-TermLong-Term Steps

5. Methodology From Understanding to Insight • Extensive time in the MOU • Surveys • Academic research • Layout measurements (AutoCAD) • Hospital investigation • Staff presentation & feedback Overview MethodologyAnalysis and Application Short-TermLong-Term Steps

6. Analysis and Application ACADEMIC RESEARCH • Focus on patient experience • Reducing perceived procedure times - Low cost, high benefit solutions • Layout Design - Focus on decreasing clutter and improving work-flow Overview Methodology Analysis and ApplicationShort-TermLong-Term Steps

7. Analysis and Application ACADEMIC RESEARCH • Specific Techniques • Told wait times, procedure/treatment durations • Distractions: posters, TV’s, soft music, portable DVD’s, library collection Overview Methodology Analysis and ApplicationShort-TermLong-Term Steps

8. Analysis and Application SURVEY RESULTS (Staff) • Increased safety for staff and patients • Reduce clutter • Better organization • Improve the working environment • Need more suitable area for charting and medication mixing • Need increased privacy for patients Overview Methodology Analysis and ApplicationShort-TermLong-Term Steps

9. Analysis and Application SURVEY RESULTS (Patients) • Need better scheduling system for advance booking and appointment changes • Need better privacy • Need more information on wait time and duration of appointment • Would like more entertainment while waiting Overview Methodology Analysis and ApplicationShort-TermLong-Term Steps

10. Analysis and Application SURVEY RESULTS (Doctors) • Long wait time to get patients in for treatment (1 month) - Checking Out-patients in as In-patients • Desire a private medical assessment area Overview Methodology Analysis and ApplicationShort-TermLong-Term Steps

11. Analysis and Application SURVEY RESULTS (Overall) • Top Priorities • Improve safety in the MOU • Improve organization of the layout and organization of work space • Need more capacity for procedures • More space allocated to the MOU • Enhanced privacy for assessments and for procedures Overview Methodology Analysis and ApplicationShort-TermLong-Term Steps

12. Analysis and Application DESIGN LAYOUT • Measured entire MOU - As well as surrounding units - Also measured all furniture and equipment • AutoCAD Model - To scale replica of the MOU - Permits experimentation with various layouts and designs Overview Methodology Analysis and ApplicationShort-TermLong-Term Steps

13. Analysis and Application CAPACITY • Issues • Wide range on procedure times • No recorded patient out-times • Daily procedure hours difficult to calculate • Undocumented patients • Electronic Scheduling System - Would resolve many of these problems Overview Methodology Analysis and ApplicationShort-TermLong-Term Steps

14. Analysis and Application CAPACITY • Utilization Rates - Minimum utilization rate:26% Minimum daily procedure hours 16 hours of unrestricted capacity - Maximum utilization rate:74% Maximum daily procedure hours 10 hours of unrestricted capacity Additional 30 hours of daily procedures(To account for undocumented patients) Overview Methodology Analysis and ApplicationShort-TermLong-Term Steps

15. Analysis and Application CAPACITY • Daily procedures - Average week day procedures: 58 - Minimum week day procedures: 41 - Maximum week day procedures: 76 - Does not account for undocumented visits Overview Methodology Analysis and ApplicationShort-TermLong-Term Steps

16. Analysis and Application CAPACITY • Seasonality - Typical procedure hours on Monday: 120 - Typical procedure hours on Wednesday:150 • Main have implications toward more efficient scheduling - Both staff and patients Overview Methodology Analysis and ApplicationShort-TermLong-Term Steps

17. Analysis and Application CAPACITY • Seasonality • Electronic Scheduling System - Would resolve many of these problems Overview Methodology Analysis and ApplicationShort-TermLong-Term Steps

18. Short Term RECOMMENDATIONS • Assuming current facility layout… • Short term: • Safety • Clutter & Reorganization • Patient Wait Time • Patient Privacy Overview Methodology Analysis and Application Short-TermLong-Term Steps

19. Short Term IMPLEMENTATION • Safety -Centralized utility outlets - Hillrom - Stools - Hand Sanitizers • Reorganization - Chemical mixing station • Exchange large desks for shelves and charting tables Overview Methodology Analysis and Application Short-TermLong-Term Steps

20. Short Term IMPLEMENTATION • Reduce Perceived Wait -Patient told wait and appointment duration - Wall posters - DVD personal players and library - Book library • TV suspensions • Soft music and personal lighting • Patient Privacy • Isolation room for assessments Overview Methodology Analysis and Application Short-TermLong-Term Steps

21. Long Term RECOMMENDATIONS • Layout Design - 2 possibilities • Scheduling • Increase capacity • Better patient care (pre MOU) • Increased morale Overview Methodology Analysis and Application Short-TermLong-Term Steps

22. Long Term ROOM NEGOTIATION: Overview Methodology Analysis and Application Short-TermLong-Term Steps

23. Long Term VARiS Overview Methodology Analysis and Application Short-TermLong-Term Steps

24. Implementation Steps STEP:I STEP:II STEP:III STEP:IV STEP:V • Regulations • Room Negotiations • Inquiries • Short Term • Layout • Short Term • Distractions • Long Term • Layout • Long Term • Scheduling Overview Methodology Analysis and Application Short-TermLong-Term Steps

25. Implementation Steps STEP ONE: • Regulations- budgetary approval - work orders - hospital order catalogue • Room Negotiations (Benefit of chairs & beds) - X-ray Room (3 chairs) - ETU Room (4 chairs, 2 beds) Overview Methodology Analysis and Application Short-TermLong-Term Steps

26. Implementation Steps STEP ONE: (continued) • Inquiries- ‘Artists on the Ward’ - Safety disposal - Sanitization stations - VARiS software (focus long term) Overview Methodology Analysis and Application Short-TermLong-Term Steps

27. Implementation Steps STEP TWO: • Short Term (layout)- Chair movement - Remove old equipment (Desks) - Purchase shelving & install - Install new mixing station - Purchase new stools - Reorganize supplies Overview Methodology Analysis and Application Short-TermLong-Term Steps

28. Implementation Steps STEP THREE: • Short Term (distractions)- Nurse assignments Posters Book/magazine library Personal DVD players DVD library - Overhead music (no vocals) - TV installation Overview Methodology Analysis and Application Short-TermLong-Term Steps

29. Implementation Steps STEP FOUR: • Long Term (layout)- New room assigned to MOU - Create weekend plan to change layout - Renovations to waiting/office space - Installation of lockers - Other ... (depends on room) Overview Methodology Analysis and Application Short-TermLong-Term Steps

30. Implementation Steps STEP FIVE: • Long Term (scheduling)- Obtain funding - Obtain software - Schedule trainingOut of house In house - Run software with paper scheduling concurrently Overview Methodology Analysis and Application Short-TermLong-Term Steps

31. Questions