Six Hospitals address regional ED congestion & improve patient flow through inpatient psychiatric units

BCPSQC, Vancouver: February 28, 2013

Sumeet Kumar, BEng, MBA, LSS Black Belt, PMPLean Transformation Services, Vancouver Coastal Health

• The Problem

• Our approach

• Results & Sustainability Process

• Summary and Lessons learnt

• Q&A

2

Presentation Outline

The Problem

Bed Occupancy rates across six hospitals: Jan 1 – July 31, 2010

4Source: Toyota Kata by Mike Rother

Step 4:Set the Target

Condition/ Future State

Step 2: Understa

nd the Current

State

Step 3: Identify the Ideal

State

Step 1:Set the Vision

Ideal State is a value add

process from the customer’s

perspective

Our Approach

• 100% utilization of inpatient beds in psychiatry at each of the 6 hospitals

– Establish a system to track bed inventory regionally

– Establish a regional standard operating process for inter-hospital transfers

5

The Goal Set the Vision

6

Project Charter

Set the Vision

Current State Process Map

Step that directly involves patient

Step taken by Transport Coordinator at transferring hospital

Step taken by member of a team atTransferring hospital

Step taken by outside stakeholder

Understand the

Current State

Patient arrives in ED and is admitted to

psychiatry but there are no

inpatient bed available

Patient is transferred to

another hospital which

has a bed available and

is handed over to the care

team at that hospital

8

• Australia

• New Zealand

• Netherland

• UK

Literature Review & Best Practices around Inter-Hospital Transfers

Identify the Ideal

State

9

Idea Generation for Future State Set the Target

Condition

10

Process

Responsibility

Document

Future State Process Map Set the Target

Condition

11

Regional Standard Operating Process

Set the Target

Condition

12

Standard Regional Forms

Set the Target

Condition

Google Docs Screenshot

Hosp D

Hosp E

Hosp C

Hosp F

Hosp A+ B

Set the Target

Condition

85 1 1

The Regional Issues Resolution group continue to meet on a 6 monthly basis to address issues, that may arise

Regional SOPStandard Transfer & Repatriation Forms and Transfer Checklist.A system to share their bed inventory levels twice daily across sitesMaintain accuracy of bed inventory

Jan 2011

Mar to May 2011

Jun to Oct 2011

Jun 2011

Feb2011

Jan 2011

Standard Operating Procedure createdNew Forms created for the Inter-hospital TransfersPilot for 12 weeks (Mar 1st to May 31st, 2011)Project rolled-out regionally on June 1, 2011

Establish a Standard Regional System for Inter-hospital Transfers of Mental Health & Addiction Acute patients (across 6 different hospitals namely VGH, UBC, RGH, LGH, SPH & MSJ)

Different process at each hospitalsDifferent terminologiesNo roles & responsibilityDifferent FormsPerson dependent ProcessNot all hospitals participated in Triage callInformation of Bed Inventory not known at each hospital during the day

ProjectDefinition

CurrentState

FutureState

Implementation

Audit/Refine

Sustain

Results: Six Hospitals Combat Regional ED Congestion

94% regional bed utilization

Regional bed inventory updated 87% of time

100% accuracy of bed inventory update

• 30-60-90 days metric tracking by LEAN facilitator and Operations team

• 6 monthly reviews by Operations team

• Issues Resolution Group

15

Regional Sustainability Process

ProjectDefinition

CurrentState

FutureState

Implementation

Audit/Refine

Sustain

Visual Management

Communication, Education, Project Management,Visible Leadership Commitment and Physician engagement

Summary and Lessons learnt