Business Process Reengineering in Health Care IT

Types of BPRProject Management Implications

Examples from the Field

04/19/23 1Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow

Introduction of Members• Lee Farabaugh• Susan John• Larry Katzovitz• Eric Lott• Ashwini Patki• Jessica Pearce• Josh Snow

04/19/23 Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow 2

Group 4: Project Agenda • Overview of Business Process Redesign models

used in healthcare. • Applicability of principles of Business Process

redesign related to overall Project Management methodologies.

• Effectiveness of such models as part of a Healthcare IT initiative.

• Examples where organizations have used such a model as part of a Healthcare IT initiative.

• Class exercise and questions.

Business Process Redesign(BPR) in Healthcare

• What?• Why?• How?• Methods• Relation to project management

BPR – What & Why?• BPR is a set of activities undertaken to make

sustained improvements in the …

• SPEED(lead time)• QUALITY• COST OF PROCESS

HELPS AN ORGANIZATION STAY

COMPETITIVE IN THE

MARKETPLACE

BPR – How?HIGH LEVEL ASSESSMENT

•BUSINESSS MISSION•GOALS•CUSTOMER NEEDS

RESULTS IN

NEW PRODUCT REDESIGN

(FOR EFFICIENCY & ALIGNEMENT OF MUTUAL GOALS)STRUCTURED ORDERING OF

WORKSTEPS

•MEASURED•IMPROVED•(OR) ELIMINATED

BPR - Methods• LEAN• SIX SIGMA• TOTAL QUALITY MANAGEMENT (TQM)• KAIZEN• PLAN, DO, STUDY ACT (PDSA)• CLINICAL MICROSYSTEM MODEL• TALENT PROFILING

Health Care Challenges that encourage BPR

Expectations from BPR models

Highlighted solutions

Applications of BPR models

BPR Obstacles

Expectations from BPR models• Increase in efficiency• Reduce medical and medication errors• Health care cost reduction• Better access and quality in healthcare• Procedure optimization• Time effectiveness• Customer and health care provider

satisfaction

Highlighted solutions• Automating and monitoring processes in

healthcare• Redesigning or improving clinical processes

where necessary and possible• Identifying patient expectations and improving

patient care processes for better customer services.

BPR models: The business process redesign (BPR) models are the processes that target improvisation and optimization of process outputs while maintaining quality.

LEAN• What?• How?• What helps ?• Conclusion

LEAN – What?RETHINKING & REDESIGN OF BUSINESS

PROCESS

SHORTENED LEAD TIMES

REDUCED PROCESS WASTES

IMPROVED CUSTOMER SATISFACTION

EFFICIENCY IMPROVEMENTS

PROCESS COST REDUCTION

REVENUE INCREASE

LEAN – How? HIGH LEVEL ASSESSMENT

WHO ? PRODUCT DELIVERED ?

LEAN – How?

STEPS THAT HAVE NO

VALUE

WAITING TIME

PROCESS WASTE

Improving Processesby eliminating…

LEAN – How? (Six steps)1. Value – Who is the customer?2. Value Stream – What is the service or product being

provided to the customer?3. Flow – Did the team identify the non-value added distances

traveled by parts?4. Pull – Waste elimination steps identified at every step of the

process, to produce more than before in a way that is value added at the time of delivery.

5. Perfection - Optimize your process for what you are trying to achieve.

6. Replication – Can this process improvement be replicated in other parts of the business.

LEAN – What helps?

LEAN IMPLEMENTATIONS

STRONG MANAGEMENT SUPPORT & SPONSORSHIP

COMMUNICATION OF SHARED GOALS

LEAN - Conclusion• Can be applied to any business process or service

industry.• Can be used to dramatically reduce lead times

– HR recruitment– New product development– Customer development

TO GAIN COMPETITIVE ADVANTGE OVER OTHER COMPANIES

Six Sigma (Six sigma was invented by Motorola in the 1980s)

• Analytical approach to indentify the inefficiencies and inadequacies in the process and provide a step by step solution based on analysis of real time data.

• Process must have < 3.4 defects per million occurrences (Carrigan, 2006)

• Statistical calculation that suggests customer needs /satisfaction to meet 99.99997% or 6-Sigma level. (Caldwell 2006)

• Focuses on customer satisfaction, process improvement and cost reduction. (Breyfogle, 2003)

• Uses structured methodology and powerful statistical tools that provide a scientific approach to process improvement and patient safety. (http://www.medscape.com)

Six Sigma Sub methodologies• DMAIC: Define, Measure, Analyze, Improve, and

Control; (improve existing processes ) • DMADV: Define, Measure, Analyze, Design,

Verify; (develop new processes or products at Six Sigma quality levels) (http://www.isixsigma.com/sixsigma/six_sigma.asp)

• Implementing 6sigma: “Black Belt” = organize of Six Sigma project “Green belt” = implement and monitor the

project.

What is TQM?• Total Quality Management (TQM) is a philosophy that says

uniform commitment to quality in all areas of an organization promotes an organizational culture that meets consumers' perceptions of quality.

• TQM philosophy focuses on teamwork, increasing customer satisfaction, and lowering costs.

04/19/23 Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow 20

The concept of TQM rests largely on five principles:1. Produce quality work the first time. 2. Focus on the customer. 3. Have a strategic approach to improvement. 4. Improve continuously. 5. Encourage mutual respect and teamwork.

TQM Process/Benefits• Process begins by listening to customers' wants and needs

and then delivering goods and services that fulfill these desires.

04/19/23 Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow 21

Http://www.cliffsnotes.com/WileyCDA/CliffsReviewTopic/Total-Quality-Management-TQM-.topicArticleId-8944,articleId-8931.html#ixzz0WJep9lSX

An effective TQM program has numerous benefits:• Financial benefits (lower costs, higher returns on sales and investment, and the ability to charge higher rather than competitive prices)• Improved access to global markets• Higher customer retention levels• Less time required to develop new innovations• Reputation as a quality firm

What is Kaizen?• Philosophy/practices focusing on continuous improvement in

manufacturing activities, business activities, & life in general. • Refers to activities that continually improve all functions of a

business, – Manufacturing to management – CEO to assembly line workers

• Kaizen aims to eliminate waste .

04/19/23 Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow 22

Kaizen Cycle• The cycle of kaizen activity can be defined as:

• Standardize an operation • Measure the standardized operation• Gauge measurements against requirements • Innovate to meet requirements and increase

productivity • Standardize the new, improved operations • Continue cycle add infinitum

04/19/23 Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow 23

Kaizen

04/19/23 Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow 24

http://www.valuebasedmanagement.net/methods_kaizen.html

Other BPR Methods

•PDSA – Plan, Do, Study, Act•Clinical Microsystem Model•Talent Profiling

04/19/23 25Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow

PDSA – Plan, Do, Study, ActThree Questions

• What are we trying to accomplish?

• How will we know that a change is an improvement?

• What changes can we make that will result in improvement?

04/19/23 Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow 26

The PDSA Cycle

04/19/23 Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow 27

PDSA – UW Rheumatology Office Visit Data Collection

• Cycle 1 - Standardized Database & Dictation Template

• Cycle 2 - Disease Activity Scoring• Cycle 3 – CPT Visit Coding Level• Cycle 4 – Full Implementation

04/19/23 Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow 28

PDSA – UW Rheumatology Office Visit Data Collection

Improvements• More Complete Data• 40% Time Savings• More Effective Patient/Physician Visit• Improved Therapeutic Decision Making• Research Study Revenue

04/19/23 Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow 29

Clinical Microsystem Method• Smallest Replicable Unit• Building Blocks to Larger System• 5 P’s - Purpose, Patients, Processes, Professionals,

and Patterns • Improvements – Transformation of Workforce

and Culture• Hospital Quality = Quality of Microsystem 1 +

Quality of Microsystem 2 + Quality of Microsystem 3 and Microsystem (n)

04/19/23 Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow 30

Talent Profiling

• Worker rather than Process• Right Person – Right Job• Important Characteristics to be Successful

04/19/23 Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow 31

Project Management Methodologies (Traditional)

• Waterfall• Spiral• Build and Fix

Traditional Methodology Model• Identify Deficiencies• Define Specific Proposals for Improvement• Proposed System is Designed• New System is Developed• System is Implemented• System is Continuously Evaluated and

Maintained

Traditional Methodologies Characteristics

• Looked to improve existing systems or implement new systems

• Task oriented• Processed based• Step-by-step approach

Business Process Redesign Characteristics

• “Clean Slate” • Outcomes oriented• Priority based• Cyclical approach

Business Process Redesign Model

• Envision New Processes• Initiate Change• Diagnosis Process• Process Redesign• Reconstruction• Process Monitoring

Project Management Methodologies (Agile)

• Scrum• Six Sigma• Lean

Agile Manifesto• Individuals and interactions over processes

and tools• Working software over comprehensive

documentation• Customer collaboration over contract

negotiation• Responding to change over following a plan

Agile Principles• Projects built around self-organized teams• Rapid adaptation to changing circumstances• Continuous attention to technical design• Working product is the measure of progress

Business Process Reengineering and Health Care IT

• IT often plays a support role in BPR in health care

• “What has to happen when you design the new process, you find how information technology is going to be used to support that new process, and if you don’t have that technological capability, you’re going to have to go and get it.” (George W. Whetsell)

04/19/23 Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow 40

Denver Health (Lean)• Pure IT project: patient scheduling application

development• Project timeline reduced 50%, outside

consulting cost reduced 36%.• IS had previously sat “on the sidelines” in lean

initiatives, but sought to use lean to make the department more efficient

• Challenge was to fit lean concepts to a longer term IT project.

04/19/23 Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow 41

Denver Health (Lean)• Rapid Improvement Event (RIE) model was

tweaked to fit this specific project– Embedded into project cycle, redefining how

project was managed– Custom templates created– Special attention given to lean tools, activity flow,

and frequency of RIE events

• Involvement of end users• “Red phone” mentality04/19/23 Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow 42

VA’s VistA QUERI system (TQM)• Quality Improvement initiative within the VA,

where data from the organization’s nationwide interoperable VistA EMR system is integral to the total process of improving patient outcomes.

04/19/23 Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow 43

04/19/23 Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow 44

Hynes, D. M., Perrin, R. A., Rappaport, S., Stevens, J. M., & Demakis, J. G. Informatics Resources to Support Health Care: Quality Improvement in the Veterans Health Administration. Journal of the American Medical Informatics Association. 2(5), 344-350.

Virginia Mason (Lean)• IT served as a support role to improve areas

identified as cost-centers– Implementation of CPOE to reduce unnecessary

prescriptions and reduce ER visits due to low refill allowances

– Implementation of decision support to alert clinicians when tests fall into the “not useful” category

04/19/23 Group 4: Farabaugh, John, Katzovitz, Lott, Patki, Pearce, Snow 45

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