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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