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+
DA Patient Flow Project – What have we achieved?Dr Andy CO Cheng (Assoc Cons) Dr Ben NM Lam (Cons)WISER HKEH
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+Acknowledgement
All involved / affected staff in HKEH Administrative Appointment Finance / Shroff Medical MRO Nursing Optometry OT appointment
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+ Morning DA (SOPD)
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+Define
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+Project Charter Scope
Morning DA old cases
Aim Streamline patients’ flow in HKEH Reduce patients’ “in-hospital” time
Overcrowding – conflicts Infection control issues Patients’ safety / hospital responsibility
Methods TOCLSS (Theory Of Constraints, Lean, Six Sigma)
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+Team Project Sponsor:
Dr Stanley Chi (DHCE)
Project Leader: Dr Ben Lam (Cons)
Facilitator: Dr Theresa Li (CM,
Cons)
Members: Dr Andy Cheng (Assoc
Cons) Ms Phyllis Yim (WM, OPS) Ms Eva Lui (FO i/c) Ms June Kwok (DM,
Optom) Mr Keith Lee (HM) Mr Ryan Fung (AHM) Mr Tony Lam (PSO / PRO)
Special thanks: Dr L Wong (RS) Dr N Chan (Resident)
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+Measure
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+ Current state flowchart
Pharmacy
Registration
VA
Investigation Doctor’s consultation room
MP
Treatment
Appt booking
OT booking
Shroff
Average time in HKEH = 1:35:00 (0:45:00 – 2:36:00)Average number of stations = 6 (range 4 – 8) *% patients <90 minutes = 43%
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+ Current state (selected variables + exclude outliers)
Inventory Waiting time Process time
No. Mean Range No. Mean Range No. Mean Range
Registration 37 380 - 118
34 0:15:47 0:01:15 – 0:31:34 37 0:00:210:00:08 – 0:00:40
VA 36 56 0 - 99 35 0:42:04 0:00:18 – 1:10:20 35 0:03:390:01:58 – 0:12:00
Consultation
- Total 49 7 0 - 24 35 0:36:12 0:00:05 – 1:33:30 36 0:06:150:01:00 – 0:25:45
- (No MP) 18 0:23:41 0:00:05 – 0:52:40 18 0:05:110:01:00 – 0:25:45
- (With MP) 17 0:49:28 0:19:01 – 1:33:30 18 0:07:200:01:00 – 0:10:55
Treatment 22 3 0 - 10 23 0:03:25 0:00:05 – 0:11:20 25 0:01:160:00:17 – 0:06:40
Appointment 26 31 0 - 62 24 0:08:48 0:00:04 – 0:20:26 30 0:00:530:00:09 – 0:03:09
Pharmacy 14 14 1 - 25 15 0:08:26 0:01:30 – 0:28:55
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+
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+Analyze
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+Possible reasons (selected)
Unnecessary stations
Unnecessary / overdoing investigations (over-processing)
Unpredictable workload
Huge patient load
Clinic design for patient flow
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+Waiting time for VA
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+Waiting time for doctors consultation
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+Waiting time for Appointment booking
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+
Improve
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+What have we done for the bottleneck (TOC) - VA? Leveling
Quota for VA / no VA for each time slot DA FU checklist
Decide what investigations to be done next visit before seeing doctor
Major change of work pattern in many parties!
TL clinic
Add 1 ECA
VA only if necessary
Change of optometrist break time (prn)
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+What have we done for the bottleneck (TOC) - VA?
Enhanced IT system for appointment booking Allow checkbox for investigations next visit
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+Other improvements
OT appointment counter help booking next appointment Less one station for patients
OT appointment staff take up PM DSC admission Free up one more appointment staff at 11 am
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+Other improvements
MP allergy data entry into record Risk management
Drug payment Kiosk (Finance) Less one station for patients Nursing / ECA staff help promote Utilization rate now 18.9%
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+ Current state flowchart
Pharmacy
Registration
VA
Investigation Doctor’s consultation room
MP
Treatment
Appt booking
OT booking
Shroff
•Exclude rebook cases
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+Barriers
Change of workflow!!
Staff acceptance
More work initially
Results not immediately seen
Results not easily seen
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+Results for in-premises time
Pre-Change Post-change p-valu
e
Diff
Mean total time in HKEH
1:35:00(0:45:00 – 2:36:00)
1:19:00(0:23:00 – 2:22:00)
0.66 20%
% less than 90 minutes
43% 64% 0.04 21%
Stations (excluding pharmacy)
6 (4 – 8)
4.4 (3 – 7)
0.01 27%
Total number of old cases booked
615 597
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+Results for in-premises time
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+Results for VA
Pre-Change(n=36)
Post-change(n=21)
p-valu
e
Difference
VA inventory 56(0 – 99)
25(0 – 48)
<0.01
(?) 55%
VA waiting time 0:42:04(0:00:18 – 1:10:20)
0:14:15(0:00:00 – 0:31:00)
<0.01
(?) 66%
VA process time 0:03:39(0:01:58 – 0:12:00)
0:05:20(0:03:00 – 0:13:00)
0.15 46%
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+Results for VA
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+Results for doctors consultation
Pre-Change(n=49)
Post-change(n=39)
p-valu
e
Dr consultation inventory
7(0 – 24)
6(1 – 12)
0.09
Dr consultation waiting time
0:36:12(0:00:05 – 1:33:30)
0:39:08(0:03:00 – 1:16:00)
0.26
Dr consultation process time
0:06:15(0:01:00 – 0:25:45)
0:06:40(0:02:00 – 0:33:00)
0.53
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+Results for doctors consultation
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+Results for other stations
Pre-Change(n=33 / 28)
Post-change(n=38)
p-valu
e
Diff
Registration process time
0:00:21(0:00:08 – 0:00:40)
0:00:27(0:00:15 – 0:01:52)
0.08
Appointment inventory
31(0 – 62)
3.82(0 – 14)
<0.01
Appointment waiting time
0:08:48(0:00:04 – 0:20:26)
0:01:17(0:00:00 – 0:03:36)
<0.01
Appointment process time
0:00:53(0:00:09 – 0:03:09)
0:00:18(0:00:09 – 0:01:05)
<0.01
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+Results for other stations
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+How do our patients react?
No. of complains received / month
Optometry Department in DA
DA waiting time Total
Jan 2009 to Jun 2011 3.7 2.1 5.8
Jul 2011 to Dec 2011 0.8 0.3 1.1
* Including both written and verbal complaints to PRO
Complaints reduced by 81%
** Appreciations by patients
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+Control
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+Monitoring
Yearly review Waiting time / in-premises time Complaints
DA total quota
Breakdown of systems No stat VA Incorrect transfer / data entry of DA FU checklist VA measurement in children Stat trial lens
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+Challenges
Expect more and more patients
New / expanding services e.g. Lucentis injection
Manpower – down 3 doctors
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+
Thank you