LEAN project on Rehabilitation Admission at SCVMC Using LEAN Six-Sigma Principles

Admission to Rehabilitation services at SCVMCa LEAN Six-Sigma approach

Presented by: Date:Mamata Sanagowdar 12/13/2016

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Goal StatementThe project aimed at analyzing the root causes that are inducing the delay in the admission process for Rehabilitation services in SCVMC and finding the solution using LEAN Six-Sigma principles, DMAIC methodology.

DMAIC MethodologyA

> Define the > Data Collection > Failure Mode > Value Stream Map > Implement Current process Effects Analysis Future State Improvements > Voice of > Value Stream Map > Root Cause > Establish Customer of current state Analysis Control Plan

DefineMeasureAnalyzeImproveControl

DMAIC is a roadmap for problem solving and process improvementIt is a 5 step data driven model3

Define Phase

Current State Process Map Voice Of Customer (VOC)

Current Process MapReferrals are received from various sourcesPatient information is loaded to All ScriptsInsurance check is done by adminCase is reviewed by Case Manager/ LiaisonInsurance authorization is obtainedPrescreen, Medical review are done in parallelLetter of Acceptance is requested from contract departmentPre admission is carried out and the admission is given at the Rehabilitation center

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Voice Of CustomerVoice of customer is a process where the requirement or feedback is collected from both internal and external customer to provide the best service quality.Insufficient admin supportLack of back-up in the absence of the adminAdmin not available to respond to the request by LiaisonThe staff get distracted by conversation since the office room is small and it adds delay to the processUnwanted phone calls

Measure Phase

Data Collection Value Stream Map of Current Process

Develop data collection plan7

Data CollectionThe goal of Measure phase is to get as much as information possible. Data collection is the key step in this phase

Data was collected for over 3 weeksProcess was monitored at admission office and in field with Liaison

VSM current stateReferral received through Right Fax

Cycle Time: 2650 minutes

VSM is a tool to identify VA and NVA steps in the process. 9

Explanation

Loading All scripts from Right Fax: 28 minutesRe-work on insurance authorization: 870 minutesPhysician Review delayed due to delay in authorization: 570 minutesPre-screen: 45 minutesGiving verbally information to part time employees: 15 minutesTotal Cycle Time: 2650 minutes

Analyze Phase

Failure Mode Effects Analysis (FMEA)Root Cause Analysis (RCA)

Failure mode effects analysisType of FailureModeEffectAnalysis(Score) Seriousness 1-10Referral by LiaisonDelayed to follow up due to other cases Patient dissatisfaction due to delay10Reworking on emailAdmin did not have complete informationDelay in loading all scripts9Wastage of time on Re-reading all the information to staffPart timers are not completely aware of every caseDelay in the entire case7

Failure Modes and Effects Analysis (FMEA) is a step-by-step approach to identify the severity of possible failures in the present system.

Root cause analysis (RCA)

RCA is a systematic way of identifying the highest-level problem and finding a solution to it. Focusing on corrective measures of root causes is more effective than simply treating the symptoms of a problem or event. There are several tools or methods for the development of root cause; one of it is Ishikawa diagram.

Ishikawa diagram

Improve Phase

RecommendationsValue Stream Map for Future State with Recommendations

Recommendations

Getting Referrals only through All-scripts saves 25 minutesMaintaining the progress of each patient in online datasheet saves 15 minutes of time wasted in explaining status of the patient admission to part time employeeMaking sure to give admission before 3 pm avoids patient admission slipping to next dayIf the insurance authorization was taken care of, Medical review would have been fasterThe total cycle time is reduced to 1707 minutes

Value stream map future state

Cycle Time: 1707 minutes

Control Phase

Implement the ImprovementsEstablish the Control Plan

Implementation

The process should be monitored to make sure suggested changes are in actionMonitoring the new issues that rise in each case and generating action plan is very importantExpand the improved process throughout the organization

Conclusion

The overall cycle time is reduced by 35% from the scenario takenThe DMAIC approach can help the organization to find the areas of improvement and time reduction, which is proved by the use of Value Stream Mapping. Lean Six Sigma continuous improvement can increase the utilization of resources in a measurable way

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RecommendationsAddressing the referral request from Liaison can be faster Assigning an employee from admin office to Liaisons requestInitiating insurance check and medical clearance on time will make liaisons work easier on the field.If the Liaison can send the referral through All Scripts, the process would result in a less cycle time.

Scope for improvementAddition of staff at the intake office can reduce the total cycle time in admissionsConsidering the Cost-Benefit analysis, increase in staff can generate an increase in the revenue