In this task you will assume the role of a process owner tasked with improving shoulder replacement surgical processes at a medical center.
Competencies
3232.3.2 : Applies Quality Management Strategies
The learner applies quality management principles and strategies for continuous improvement in an organization.
Introduction
Improving, optimizing, and stabilizing business processes is critical in today’s business environment, which requires data-driven decision-making competencies.
In this task, you will assume the role of a process owner tasked with improving shoulder replacement surgical processes at a medical center. You will use a Six Sigma approach to improve patient care, reduce waiting time, and reduce costs. Using the case study provided, you will apply principles of the DMAIC model to create a value stream map.
Scenario
Use the information in the attached “Case Study: Shoulder Replacement at Fielder Medical Center” supporting document to complete your submission.
Create a Value Stream Map
- Create a multimedia presentation (e.g., PowerPoint, Keynote) (suggested length 10–15 slides)for key stakeholders in which you apply the DMAIC model to create a value stream map by doing the following:
Define and Measure Phase
- Using the attached case study, apply the Define and Measure phases of the DMAIC model by doing the following:
- Develop the project charter by doing the following:
- Explain the project scope and problem.
- Identify the time frame, boundaries, and stakeholders.
- Identify threecritical characteristics for customer satisfaction.
- Identify oneof each: output, input, and process variable.
- Qualitatively describe threedefects in the current system.
- Describe quantitative measurements of eachof the three defects from part A1d.
- Evaluate the process capability for eachof the three defects from part A1d.
Analyze Phase
- Using the attached case study, apply the Analyze phase of the DMAIC model by doing the following:
- Describe the root causes for eachof the three defects from part A1d by using a cause-effect table.
- Assign a value analysis process to eachof the root causes from part A2a based on a determination of whether they are value added (VA) or non-value added (NVA).
- Justify your answer to part A2b.
Improve Phase
- Using the attached case study, apply the Improve phase of the DMAIC model by doing the following:
- Explain oneproposed solution to eachof the defects from part A1d, for a total of three solutions.
- Describe how onesolution from part A3a will be implemented by doing the following:
- Describe the expected outcome of the proposed solution.
- Describe onetask to be performed.
iii. Describe the documentation process for the proposed solution by referencing the current baseline.
Control Phase
- Using the case study, apply the Control phase of the DMAIC model by doing the following:
- Create a control plan by doing the following:
- Describe what stakeholders will monitor in the implementation of the proposed solution from part A3a.
- Explain the purpose of a statistical process control (SPC) chart within the control process.
- Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.
- Demonstrate professional communication in the content and presentation of your submission.
Reference List
Bartelstein, M. K., Forsberg, J. A., Lavery, J. A., Yakoub, M. A., Akhnoukh, S., Boland, P. J., Fabbri, N., & Healey, J. H. (2022). Quantitative preoperative patient assessments are related to survival and procedure outcome for Osseous metastases. Journal of Bone Oncology, 34, 100433. https://doi.org/10.1016/j.jbo.2022.100433
Dunn, J. C., Lanzi, J., Kusnezov, N., Bader, J., Waterman, B. R., & Belmont, P. J. (2015). Predictors of length of stay after elective total shoulder arthroplasty in the United States. Journal of Shoulder and Elbow Surgery, 24(5), 754–759. https://doi.org/10.1016/j.jse.2014.11.042
Healthcare Information Systems: Opportunities and challenges. (n.d.). Retrieved April 26, 2023, from https://commons.nmu.edu/facwork_bookchapters/14/
Jazayeri, R. (2023, February 12). Optimizing Total Shoulder Replacement Surgery Recovery: XR™ blog. Xcelerated Recovery™. Retrieved April 25, 2023, from https://xrscience.org/blogs/education/optimizing-total-shoulder-replacement-surgery-recovery
Kassin, M. T., Owen, R. M., Perez, S. D., Leeds, I., Cox, J. C., Schnier, K., Sadiraj, V., & Sweeney, J. F. (2012). Risk factors for 30-day hospital readmission among general surgery patients. Journal of the American College of Surgeons, 215(3), 322–330. https://doi.org/10.1016/j.jamcollsurg.2012.05.024
Ngafeeson, Madison, “Healthcare Information Systems: Opportunities and Challenges” (2014). Book Sections/Chapters. Paper 14. http://commons.nmu.edu/facwork_bookchapters/14
Panahi Tosanloo, M., Adham, D., Ahmadi, B., Rahimi Foroshani, A., & Pourreza, A. (2019, October 24). Causes of conflict between clinical and administrative staff in Hospitals. Journal of education and health promotion. Retrieved April 26, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6852373/
Case Study: Shoulder Replacement at Fielder Medical Center
Shoulder replacement surgery is one of the most common surgeries in the United States, where an estimated 70,000 shoulder replacement procedures are performed annually. An average cost of $25,000 per surgery represents an aggregate cost of $1.75 billion per year (Jazayeri & Singh). This single procedure is a considerable expense to insurance companies and patients.
Administrators at Fielder Medical Center decided to improve the center’s shoulder replacement surgical process using a Six Sigma approach to improve patient care, reduce waiting time, and reduce costs. Currently, shoulder surgical patients have a negative view of the center’s process and quality of care. A project team was assembled that included medical center staff from different areas, including administrative, medical, and nursing staff. The team believed there was utility in involving staff with varying degrees of knowledge of the existing process, as a diverse team could provide insider perspectives and practical external ideas.
The team participated in brainstorming sessions to develop a high-level process map to identify value and reduce waste. After analyzing the scope of work, the team decided that the shoulder surgery itself involved too many uncontrollable variables. Therefore, the team agreed that the goal was not to change how surgeons performed the procedure but to eliminate the waste associated with shoulder surgeries to improve patient care.
The team recognized that Fielder Medical Center has been dealing with the issue of patient overflow. Many patients scheduled for shoulder surgery are left in hallways for three or more hours waiting to see a nurse or get a bed. The 1,000-bed center has one central receiving area that patients must pass through before being assigned a unit and bed. It is common for patients to become upset if asked to queue for even a short time. Complex administrative procedures, data collecting, and communication missteps among staff involved in the process compound patients’ waiting time.
According to the National Association of Healthcare Access Management, centralized intake benefits include streamlined workflows, increased control, and measurability. However, the disadvantages include lack of flexibility and potential return on investment (ROI) loss. Conversely, decentralized intake offers more heightened awareness of the intake process, less congestion, and improved patient interaction. Most hospitals in the United States use a centralized intake process in the sense that different stations use the same technology for scheduling, billing, and other administrative functions; however, these stations are decentralized, with each unit having its own reception area.
The project team also found that staff consistently complain about the medical center’s out-of-date healthcare tracking system, which often freezes and requires computer rebooting. This system allows multiple users to review, input, and export data. Often, the system needs to be rebooted five times each day. In addition, the current system is not as user-friendly as other hospitals’ modern systems, and training new employees to use the outdated system is challenging. Care staff are concerned about how much time a patient must spend and the number of office staff a patient must see before nurses are permitted to prepare the patient for surgery.
The National Institutes of Health recommends that healthcare providers use technology that offers interoperability and safeguards to protect patient data. The market is saturated in software options, but Epic is widely used among larger hospitals, including Johns Hopkins Hospital, Cedars-Sinai, and the Mayo Clinic. In addition, this system offers reliability, round-the-clock support, and real-time backup, so it works in the event of a system or power failure.
A 2019 study published by the National Library of Medicine (Tosanloo et al, 2019) concluded that poor data collection and communication between clinical and administrative staff result in lower quality of service. Specifically, researchers identified bureaucracy and prolongation of processes, insufficient understanding of working conditions and imposing opinions of nonclinical staff in decision-making processes, and ambiguity in hospital policies as factors contributing to complex administrative procedures. This quantitative study used a descriptive-analytical approach that supported the research conclusion.
Another technological hurdle is the negative assumptions patients have concerning health information systems (HIS). A Northern Michigan University study (Ngafeeson, 2014) explored how assumptions regarding HIS affect patient care. The study suggested a correlation between effective HIS and positive patient experience. Put simply, HIS technology affects the organization’s structures and work routines in significant ways, and therefore, promoting an effective HIS is today’s standard for hospital administrators.
Patients also undergo a surgery risk assessment after being admitted to the medical center. This assessment involves a complete examination, including diagnostic and laboratory testing, that often takes two to three days to complete. According to a 2022 study (Bartelstein et al), quantitative preoperative patient-reported assessments may be a valuable tool for surgeons when planning the most appropriate procedure for each patient.
The discharge process, in which a hospital confirms that the patient no longer needs inpatient care and can go home, can also be an area of concern. The Agency for Healthcare Research and Quality asserts that healthcare providers without a standardized discharge process risk a disconnect between staff and patients. The data (Kassin, et al 2012) show that this disconnect has resulted in a 70% rehospitalization rate within 30 days of discharge and a cost of $17.4 billion in a single year. In addition, hospitals with a less robust planning strategy provided no guidance for surgeons performing extensive procedures with long rehabilitation periods.
The team also investigated the patient’s length of stay (LOS) for shoulder surgery. Team members decided to collect historical data from 18 months of admissions to the orthopedic surgical department. This department focuses on injuries and diseases of the body’s muscular and skeletal system. The data represented 80 patients who had shoulder replacement surgery during this period. They found that the data were normally distributed, with an average LOS of six days.
Therefore, the team set a goal to reduce the hospital LOS to less than two and a half days, on average, for the shoulder replacement procedure. The team noted that according to the National Institutes of Health (Denn et al, 2015), the median inpatient stay for shoulder replacement surgery was between two and four days.
The team concluded that poor or incorrect surgical planning is present in several aspects of the preparation process before an injured person is cleared for surgery and identified several solutions to reduce waste. Team members executed a pre-hospitalization service, which allows the patient to go through all the risk assessment steps without hospitalization. With this new approach, the surgery itself is the first in-hospital process the patients would experience. Moving pre- and post-surgical activities out of the hospital might shorten the LOS; thus, patients spend less time at the medical center.
Procedures for reserving operating rooms and other critical spaces needed for shoulder surgery should be optimized. Fielder Medical Center also has a state-of-the-art electronic bed tracking and information system (BTIS), which, if used effectively, can alert nurses and doctors as to the status of beds in the hospitals. Post-surgery should follow a standard discharge procedure.
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