Abstract
This paper relates to the changes needed to cut back on the patient waiting time in the triage units in a local hospital. The current system does not have metrics for use in the calculation of the efficiency of the triage units. The new system will rely on IT to measure the time it takes to serve a patient. The IT system will also assign patients to triage units based on nurse availability and ranked according to the time of arrival. The main benefit of the new system will be increased user satisfaction. Its main risk will be increased stress levels among the triage nurses.
Introduction
The medical profession faces many challenges when it comes to business process design. The main reason for this is that medical professionals join medical facilities that have established processes (Omachonu & Einspruch 2010). Also, the training that most medical professionals receive tends to impart the same approaches towards business process design in the health sector (Ulmer 2010). Medical professionals such as nurses and doctors also show more dedication to their licensing authorities such as the medical board rather than HR departments at the local health facility (Glenn 2007). This paper looks at the handling of patients in the triage unit of a local hospital, to find ways of reducing the time spent in the triage waiting bay.
Literature Review
Business process management refers to all activities an organization undertakes to improve the efficiency of operations (Sahu 2009). Business processes include both business activities and management activities. Business activities refer to the specific functions undertaken by a business unit to attract and serve customers. Management activities include HR functions, the fulfillment of regulatory obligations and corporate social responsibilities (Arson & Gray 2011). One of the main objectives of business process management is to improve the efficiency of operations. Efficiency measures include the total number of patients served per unit time, financial returns per period, the percentage reduction in cases of hospital-acquired infections, among others (Boyle 2011). Efficient operations in healthcare facilities lead to greater customer satisfaction (Sinreich & Marmor 2005). Delays in service provision, including the length of stay on a physician’s station, contribute towards overall patient satisfaction with the services of a health facility (Bauer & Nay 2008).
Triage is a critical aspect of modern healthcare. Usually, patients or their caregivers tend to overestimate the severity of medical conditions when they walk into a healthcare facility (Niles 2010). Triage helps to sort out the cases to ensure that those who need urgent attention receive it within a reasonable time. Efficient triage services determine whether a hospital can handle ambulatory patients (Niles 2010).
Methodology
The main objective of this paper is to examine the possibility of increasing the effectiveness of triage services in a local hospital. The analysis of current practices will make it possible to determine the opportunities that exist to improve the efficiency of the triage services. The analysis of current practices will include the identification of key performance indicators (KPIs) and the relevant metrics for quantifying the KPIs. This will culminate in the development of new KPIs and metrics to measure changes.
Existing Process Work Flow Description
The current role of the triage units in the local hospital is very similar to the triage functions in many hospitals in the region. After patients arrive at the hospital, a receptionist takes their details and sends the details to the triage nurses. The duty nurses call out each patient and carry out the basic measurements needed to understand the condition of the patient. Usually, this includes measurement of body weight, and body temperature, and pulse rate. These measurements are fed into the hospital’s IT system which the primary care physicians view when the patients walk in to see them.
Key Performance Indicators
The current KPIs for the triage unit are as follows. First, as long as there are patients in the waiting area, the nurses in the triage units do their best to serve them to transfer them to the waiting bays leading to the primary care physicians. No additional performance measures exist to gauge their effectiveness. Secondly, the hospital increases the number of triage stations at various times during the day in response to the arrival patterns of patients in the facility. The busiest hours for the hospital are morning hours between 10 a.m. and 12 p.m., with an influx of patients during lunch hour, and around 5 p.m. when people leave their offices.
Metrics
As the situation stands now, there are no proper metrics for measuring the performance of the triage units. The only useful deduction that can be made is that during peak hours, the hospital increases the number of triage points from three to five to cater for the large number of patients. Otherwise, no data exist regarding the efficiency of operations at each unit in regards to the number of patients served per unit time.
Innovation and Need to Improve the Work Flow Process
The two main innovations needed to improve the efficiency of the triage services are as follows. First, there is a need to change the assignment current assignment process of patients to specific triage units, to a pooled system where the queue always moves regardless of the presence of a nurse at a particular station. It is common for patients to wait for about 15 minutes before their turn at the triage unit. Usually, the nurses must leave the units periodically to take health breaks. Patients assigned to the nurse usually become impatient.
The second innovation needed to increase the efficiency of the triage unit is to develop a timing system that takes into account the time a patient arrives and the time it takes for them to access services at the triage unit. The best way to deal with this is to introduce an electronic timestamp, which indicates the time that the patient arrives at the reception, and the time the patient reaches the triage unit.
The third innovation is to set the goal of ensuring all patients pass through the triage within ten minutes, and to make it public. This will help patients to remain calm as they wait for their turn. The nurses should be required to issue apologies to patients who wait for longer than ten minutes to get attention. This will also help to deal with impatience.
Design of the New Process Work Flow with BPM Insights
The new process aims at reducing the patient waiting time at the triage units based on the seven steps of business process management is as follows. First, the overall process goal is to reduce the amount of time spent waiting to access services in the triage unit. This time starts as soon as the patient is received by the receptionists, and ends when the patient leaves the triage unit. Other related goals include setting up an electronic timestamp to track the time spent in the unit.
The specific strategy for cutting down on time spent in the triage unit is as follows. First, the data collected via the timestamp will show the periods of high triage demand characterized by longer waiting times. Secondly, the increased awareness of the nurses to this goal should result in faster service delivery. This may lead to the need for faster methods of offering triage services.
Thirdly, the nurses will help to document productivity bottlenecks at the triage. One of these bottlenecks could be the current IT system. Also, lack of information on the number of patients awaiting triage services could be driving down the efficiency of nurses. Currently, they are not aware of the number of patients in their queue.
Fourth, the IT system will need an upgrade for it to deliver real-time demand capabilities to help the nurses and the receptionists to handle triage services better. The system should handle the assignment of patients to triage services based on nurses that are logged-in at any one time. If a nurse needs to take a break and logs-out, the system should reassign the patients to the active nurses based on their arrival time.
The fifth step in the new design will be to generate weekly reports to detect trends affecting how patients arrive in the triage units, to adjust service delivery accordingly. When quantified, this information will help the hospital administrators to determine whether it needs to increase or reduce triage units in line with demand.
The triage nurses are the main process participants. Each week, they should receive a weekly report showing their current efficiency compared to previous weeks. The report should also show them how their performance compares to other nurses.
Finally, the new process should result in higher customer satisfaction because they will be certain that they will see a primary care physician within ten minutes of arriving at the reception. This satisfaction will come from increased predictability of the time it will take to access services (Armistead 1989).
New Key Performance Indicators
The New KPIs for the triage process will be a reduction in the time spent by the patients in the triage bay for an average of 15 minutes to an average of 10 minutes, or less. Secondly, faster triage should increase the number of patients that come to the hospital including ambulatory patients (Borkowski & Gordon 2005). This should result in a healthier bottom line for the hospital.
New Metrics
The new metrics needed to measure performance improvement are as follows. There is a need to know the changes in the average waiting time per patient, and the average waiting time per nurse (Brown 2009). There is also a need to know how reduced time in the triage bay affects patient inflow and the income of the hospital.
Challenges
The main challenge expected in the implementation of the new system is the development of IT capabilities to handle triage assignments and to place electronic timestamps in the triage process. The second challenge will be motivating the nurses to participate in the proposed system because it will force them to change their working habits (Zell 2003). It may lead to more stress for the nurses of not carefully implemented (Piderit 2000).
Impact of Information Technology
Information technology will form a vital part of the new process (Larkley & Maynhard 2008). The current IT system can handle the new demands, but it shall require the addition of some components. The measurement of the patient flow rate and the generation of weekly performance reports will depend on IT.
Human Aspects in the New Design
The main issue that will affect the implementation of the new design is whether the nurse will cooperate. The new system may lead to increased stress levels among triage nurses who want to keep working at their own pace (Boyle 2011). On the patients’ side, it will lead to greater satisfaction with the services.
Optimization
The optimization of this system will arise when there is sufficient data relating to the ideal patient to nurse ratio. However, weekly performance reports will also help in the optimization of triage services since nurses will know whether their performance was within the required levels (Grant 2005).
Implementation
The implementation process will take two weeks. The two main issues will be to develop the IT capabilities needed to support the system, and thereafter to train the nurses on how the new system works. Also, the hospital administrators will need to know how to integrate the results derived from the new process to calculate its overall impact of patient inflow, and on profitability.
Accomplishments and Conclusion
The main accomplishment that will arise from the new process is a reduction in patient waiting time in the hospital, by a reduction in the time spent on the triage unit.
Reference List
Armistead, CG 1989, ‘Customer Service and Operations Management in Service Businesses’, The Service Industries Journal, vol 9, no. 2, pp. 247-260.
Arson, EW & Gray, CF 2011, Project Management: The Managerial Process, McGraw Hill International, New York, NY.
Bauer, M & Nay, R 2008, ‘Factors Associated with Constructive Nursing Staff-Family Relationships in Care of Older Adults in the Institutional Setting. A Systematic Review’, International Journal of Evidence-Based Healthcare, vol 7, no. 5, pp. 23-45.
Borkowski, N & Gordon, J 2005, ‘Entrepreneurial Organizations: The Driving Force for Improving Quality in the Healthcare Industy’, Journal of Health and Human Services Administration, vol 3, no. 4, pp. 531-549.
Boyle, S 2011, ‘Health Systems in Transition’, United Kingdom (England) Health System in Review, vol 2, no. 6, pp. 1-467.
Brown, T 2009, Change by Design: How Design Thinking Transforms Organizations and Inspires Innovation, Harper Collins, New York, NY.
Glenn, R 2007, Bringing User Experience to Healthcare Improvement: The Concepts, Methods and Practices of Experience-based Design, Radcliffe Publishing, Oxon.
Grant, RM 2005, Contemporary Strategy Analysis, Wiley-Blackwell, Malden, MA.
Larkley, JE & Maynhard, VB 2008, Innovation in Technology, Nova Publishers, New York, NY.
Niles, NJ 2010, Basics of the U.S. Healthcare System, Jones & Bartlett Learning, Sadbury, MA.
Omachonu, VK & Einspruch, NG 2010, ‘Innovation in Healthcare Delivery Systems: A Conceptual Framework’, The Innovation Journal: The Public Sector Innovation Journal, vol 15, no. 1, pp. 1-20.
Piderit, SK 2000, ‘Rethinking Resistance and Recognizing Ambivalence: A Multidimensional View of Attitudes Toward an Organizational Change’, Academy of Management Review, vol 25, no. 4, pp. 783-794.
Sahu, RK 2009, Performance Management System, Excel Books, New Delhi.
Sinreich, D & Marmor, Y 2005, ‘Ways to Reduce Patient Turnaround Time and Improve Service Quality’, Journal of Health Organization and Management, vol 4, no. 2, pp. 88-105.
Ulmer, C 2010, Future Directions for the National Healthcare Quality and Disparities Reports, National Academies Press, Washington DC.
Zell, D 2003, ‘Organizational Change as a Process of Death, Dying, and Rebirth’, Journal of Applied Behavioral Science, vol 39, no. 1, pp. 73-99.