Radiation Oncology Current State Map for Bone and Brain ...

Jul-05 *** = 3 patient visits in Radiation Oncology

Radiation Oncology Current State Map for Bone and Brain Metasatic Patients

From Consult Request to First treatment

External Ref. Physician or

Internal MD or

Radiation Oncology MD -

Sub group in the process being reviewed

3a. Billing Rep notified, data collected

3b. Rep verify Coverage

3c. Notify RadOnc MD

if no coverage

Pt Rep P/T 120 W/T 0 FTQ 100%

1440

0

120

Pt Rep P/T 30 W/T 1680 FTQ 100%

0

1680

30

Pt Rep P/T 30 W/T 0 FTQ 80%

0

0

30

Minutes 3120 180 3300

WT PT Lead Time

5% 80%

VA FTQ

1. Request made

2. Gather info.

3. Schedule appt,

EWS,VaRis, Sched

4. Prepare Radiation Oncology

chart

5. Call Pt to confirm appt/48 hours

***6. Patient checks in

for consult

7. Add additional paperwork to Radiation Oncology

Chart

8. Pt waits in lobby

P/T W/T FTQ

24 20 10%

P/T W/T FTQ

5 5 10%

P/T W/T FTQ

5 5 95%

P/T W/T FTQ

15 5 100%

P/T W/T FTQ

2 0 70%

P/T W/T FTQ

5 0 100%

P/T W/T FTQ

5 0 98%

P/T W/T FTQ

1 0 100%

Some Standard Shapes (Other Shapes in AutoShapes & "Learning to See" Book):

Kaizen Bursts: work changes or reductions

Prescription:

Electronic Flow:

Patient Diagram:

Information Flow:

Multi-Flow:

Rework Flow:

(colored)

or

Formulaes: Phone: In Box: Worker: Data Box:

Process Time:

P/T

Wait Time:

W/T

First Time Quality: FTQ

Other Tests may be ordered

9. Gather Pt and chart

10. Vitals taken

11. Pt put in exam room

30

12. Dr. paged

13. Consult

14. Pt checks

out

30

10

15. Simulation and Start

appt. scheduled

16. Pt goes home

***17. Pt checks in

for simulation

1440

18. Chart and info prepared

P/T W/T FTQ

1 0 99%

P/T W/T FTQ

5 0 40%

P/T W/T FTQ

1 0 100%

P/T W/T FTQ

1 0 99%

P/T 45 W/T 45 FTQ 100%

P/T W/T FTQ

5 0 95%

P/T W/T FTQ

15 15 95%

P/T 0 W/T 0 FTQ 100%

P/T W/T FTQ

1 0 99%

P/T W/T FTQ

2 0 100%

P/T W/T FTQ

Other Tests may be ordered

19. Pt has seat in waiting room

20. Pt put in exam

room

21. Pt shown video, consent signed

10

Patient 1 0

100%

Nurse Aide

Nurse Aide

P/T

2

P/T

30

W/T

0

W/T

20

FTQ 100% FTQ 75%

0

0

20

1

2

30

22. Pt taken to simulator

23. Simulation performed

24. Pt given tour

25. Pt goes home

***26. Pt checks in for

treatment

27. Pt treated

10

P/T W/T FTQ

RTT 1 0

100%

P/T W/T FTQ

10

0

0

1

RTT 50 10 95%

10 50

1980

Patient P/T 5 P/T W/T 0 W/T FTQ 100% FTQ

Patient 0 0

100%

P/T W/T FTQ

0

0

1980

5

0

Patient 1 0

100%

0 1

5

P/T W/T FTQ

RTT 60 5 100%

clinic open 10 hour Days

5

5

7955 min Total Wait Time

60

288 min Time in Process

8243 min Lead Time

13.25 days 0.5days

13.74 days

7825 min W/T between process 13 days

3%

Value Added ( PT/LT)

0.16%

FTQ

Figure 1. Current state value stream map. The current state map revealed there were 27 process steps, many of which were nonstandardized. The clerical staff received a consult request many different ways: by fax, telephone, or e-mail sent from physicians. In process step 3, the patient received instructions about their initial consultation appointment; however, he were rarely informed of the appointment time and location. During process step 4, the patient's chart was prepared, and once this was completed, then the patient would finally be notified of their appointments. This delay in process was variable in how effectively this information was communicated, and thus led to many no show visits. In process step 6, the patient would arrive for his initial consultation. During process steps 9 to 16, the patient would be seen in initial consultation, sometimes consented, and was sent away with schedules for both a simulation and first treatment appointment or scheduled for other diagnostic tests. In process step 17, the patient would arrive for his second visit--simulation. At this time, the patient consented and the simulation was performed. In process step 25, the patient would go home and return a few days later for the initial radiation treatment. To complicate matters further, the billing office was not notified on a timely basis to start the process of billing authorization and approval (sub processes 3a, 3b, and 3c). The entire process to see the patient in initial consultation, simulation, and treatment was inefficient. While the total process time was only 0.5 days, due to the excess wait time in the process (13.25 days), the total lead time was 13.74 days. * The current state map required three patient visits (process steps 6, 17, and 26). CT sim, computed tomography simulation; EWS, enterprise wide scheduling system; MDC, multidisciplinary clinics; PAD, physician activity document; Rad, radiation; RadOnc, radiation oncology; Sched, home grown scheduling system; TX, treatment; UMHS, University of Michigan Health System; VaRis, commercial scheduling and charge capture system; P/T, process time; W/T, wait time; FTQ, first time quality; VA, value added.

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