OR Manager - February 2020 - 20

Special Series: ERAS
SPECIAL SERIES
Continued from page 19
to complete various steps in this
process
* how long the process (and the steps
within it) takes to complete
* what data are collected during the
process, and what additional data
are needed
* which parts of the process add value
to customers and the business, and
which do not
* which process steps are causing delays,
waste, quality problems, compliance
issues, or frustrations for
the customer.
With the Voice of the Customer and
Voice of the Business in mind, the project
team assessed the current state to
identify customer value-add, business
value-add, and non-value-add process
steps (sidebar, p 19).
Identify and prioritize
opportunities
From the mapping and value-add/nonvalue-add
assessment, a list of improvement
opportunities was identified.
The team then conducted an impact/effort
analysis and prioritized the improvement
opportunities based on analysis
results.
Prioritization is critical during this
time to ensure the most impactful opportunities
are addressed and to reduce
the bias individuals within the team may
have toward improving particular portions
of the process.
As a result of the prioritization process,
the team was able to identify
items that were low effort implementations,
such as adjustments to patient
education, versus those that would take
considerable resources and efforts,
such as a complete process redesign of
a particular phase of care. Additionally,
the prioritization process also identified
improvement opportunities that were
already addressed in existing improvement
efforts.
VCU Health redesigned processes
and tools to ensure we are sharing in20
OR
Manager | February 2020
Compared to other industries, healthcare has
been slow to identify who the customer really is.
formation gathered along the way at
the appropriate time in the process. For
example, information collected from the
patient during preanesthesia assessment
must be shared with presurgical
unit (PSU)/day of surgery staff. Often
processes are created within silos,
which may result in suboptimal handoff
at transition of care.
Instead, the team focused on a system
view, addressing the four levels
of the healthcare system, as defined
in The Healthcare Quality Book: Vision,
Strategy, and Tools: " Level A is the patient's
experience. Level B is the microsystem
where care is delivered by small
provider teams. Level C is the organizational
level-the macrosystem or aggregation
of microsystems and supporting
functions. Level D is the external
environment, which includes payment
mechanisms, policy, and regulatory factors. " 3
And,
as noted by the authors, the
team also focused on " [t]rue north in
the model...the experience of patients,
their loved ones, and the communities
in which they live. " By focusing on the
patient's journey along the surgical continuum,
the team developed more flexible
processes, allowing for more patient
choice and convenience.
The future state design also focused
on eliminating waste. " The Toyota Production
System (TPS) identifies seven
categories of waste: overproduction,
waiting, transporting, processing, inventory,
motion, and correction, " according
to the Institute of Healthcare Improvement.2
The team sought to address
waste identified in the current state
through the design.
The future state also incorporated
the new ERAS principles into the process,
ensuring that the standards of
care would be hardwired into the care
pathway.
Standardized pathways
The result of combining process design
with ERAS principles is creating
standardized care pathways that reduce
waste and increase value to the patient.
As mentioned in the January 2020 article,
using a standardized closing kit
and process across all surgeons has
significantly reduced surgical site infections
for colorectal procedures.
In future articles, we will review
methodologies for implementing and
sustaining these changes. ✥
Mary Fain, PMP, is program
manager, office of
clinical effectiveness, at
Virginia Commonwealth
University Health System in
Richmond.
Paula Spencer, MSHA,
PMP, CPHIMS, is director,
office of clinical effectiveness,
at Virginia Commonwealth
University Health
System in Richmond. She
is also adjunct professor, department of
health administration, at Virginia Commonwealth
University.
References
1. https://www.lean.org/WhatsLean/
2. Going Lean in Health Care. IHI Innovation
Series white paper. Cambridge,
MA: Institute for Healthcare
Improvement. 2005. www.IHI.org.
3. Ransom E R, Joshi M S, Nash D
B, et al. The Healthcare Quality
Book: Vision, Strategy, and Tools.
Chicago, IL: Health Administration
Press, 2004.
www.ormanager.com
https://www.lean.org/WhatsLean/ http://www.IHI.org http://www.ormanager.com
OR Manager - February 2020

Table of Contents for the Digital Edition of OR Manager - February 2020
