25-09-2012, 10:48 AM
Analysis of the Improved Trends Of Inpatient Discharge Process imparted by AHIRC
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OVER VIEW OF AHIRC
Asian Heart Institute situated at Bandra Kurla Complex, in the heart of Mumbai is the dream of leading cardiac specialists- Dr. Ramakanta Panda, Dr. Sudhir Vaishnav & Dr. Tilak Suvarna. The hospital started in 2002, has today completed 8 glorious years in world class cardiac care. Internationally Accredited with ISO 9001:2000, JCI & NIAHO, Asian Heart today is India’s highest accredited hospital.
It has been designed as per International Standards with stress on safety and patient comfort. All Patient areas have been designed to minimize the risk of infection. AHI was not started as a business but rather a dream to plug the gap in the existing healthcare scenario in India.
It offers the full range of cardiology services, from prevention to early disease detection to complex interventions. AHI cardiologists, amongst the best in the country, have been routinely performing complex angioplasties and closure of congenital heart defects and other high risk cases.
Leading the cardiac surgery team is Dr. Ramakanta Panda, specially chosen to perform redo bypass surgery on Hon’ble Prime Minister of India, Dr. Manmohan Singh in 2009 & bypass surgery on Hon’ble CM of Assam, Shri Tarun Gogoi in 2010. With a team of some of the best cardiac experts, AHI does the maximum number of cardiac surgeries in Mumbai. Almost all of bypass surgeries here are done on a “beating heart’ which provides the safest & best long term success for the patients. 95% of bypass surgeries are performed using arterial grafts, which results in best long term success. A quarter of AHI patients are from high risk group. The team has pioneered new techniques in India which aid in quicker patient recovery.
AHI is known for its Preventive Cardiology and Cardiac Rehabilitation department which is one of its kinds across the country. The prevention program is for individuals who are at risk for heart disease. The cardiac rehabilitation program is for those who have had a cardiac procedure. The aim of the program is to return the person to their normal life as quickly and as safely as possible, and to reduce their future risk of heart problems
ABSTRACT
Strategies for improving the patient discharge process have a beneficial effect on many hospital activities. The main objective of this research was to analyze the improvement trends in the discharge process at Asian Heart Institute and Research Centre, Bombay. This study contributed to knowledge present in the current literature which describes discharge process and went further to investigate if an manufacturing methodologies like Lean Six Sigma can be helpful for process improvement through identification of goals and barriers in the discharge process. This study also looked at timely discharges also influences patient satisfaction with the discharge process from hospital to home and if the concept of early identification of barriers help in better control of process adding to quality of care. The study describes the application of five phases of Lean Six Sigma Define, Measure, Analyze, Improve and Control to identify waste and defects in the process and streamline the Discharge process by eliminating waste and reducing gaps. This study took the form of a case study in which data is collected by questionnaire, observation and process mapping. Microsoft Excel and Operations Research (O.R.) methods were used to analyze data. The findings suggested that the average time for patients to complete the discharge process was 3.3 hours.
INTRODUCTION
The Inpatient Discharge process of Asian Heart Institute and Research Centre in
Bombay, 130 bedded State of Art Cardiac Care Centre is confronted with long wait times and delays adding peak workloads to concerned departments. Although most patients are generally satisfied with their service experience, they may not be uniformly satisfied with all aspects of the care they receive. Research on discharge process shows that waiting time are patients‟ main dissatisfaction with hospital services (Huang, 1994) (1). According to doctors and personnel, overtime and peak workloads are potential threats for the quality of care and the quality of labour, because they increase stress and time pressure (1). Methodologies already proved to be successful in solving related problems from manufacturing companies can be applied in healthcare sector to resolve these problems. Lean Six Sigma is one such successful methodology that can help a healthcare entity provide less wait times and variation for patients, an increased accuracy with prescriptions, and safer emergency departments (2). This detailed study focuses on Lean Six Sigma Methodology as a means to improve these problems for the Inpatient Discharge Process in AHIRC.
Context Description
Rising national health care expenditures and privatization developments put Public and economic pressure on hospitals to improve utilization of resources (OECD, 2005; TPG, 2004). Additionally, waiting times in hospitals are of high importance for patients, politicians, and hospital managers (3). Discharge is a process which is linked with the exit of patient from the service provider. It is often patient’s last encounter with the hospital. Hospitals are complex settings where a breakdown in communication between care providers possesses serious ramifications for patients who require coordinated discharge care. They have a responsibility to ensure that patients are discharged from their care in a safe and efficient manner (4). These delays add to waiting times in the discharge process 3 which is proportional to patient dissatisfaction as well as large loss of time and resources (1).Discharge is a complex activity requiring a wide range of clinical and organizational skills to address needs of patient, family and health care system and to promote the optimum functioning of patients, families and support systems. Delay factors may be internal (waiting for discharge summaries; waiting for declaration of chronicity; transfer between nursing units; lack of documentation of discharge plan); external (lack/delay of access to rehabilitation, convalescence, palliative care, home care resources, long term care facility); and psychosocial (waiting for family adjustment to illness, waiting for patient function to improve, unrealistic expectations of patient/family, social isolation of patient, inadequate support at home, lack of concrete medical aids, transportation for treatments, financial, family burden prevents discharge home) (5). The Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) requires hospitals to implement projects to their patient discharge processes. Yet the rules are ambiguous about how to implement improvements. Several authors have studied the application of individual quality methods for data driven systems improvement in healthcare. These methods have included Failure mode and effect analysis (FEMA) and Root Cause Analysis (Robinson et al. 2006) (6).
OBJECTIVES
The purpose of the discharge improvement project is to determine the effectiveness of Lean Six Sigma methodologies in identifying the waste and defects in the existing process. Also to develop improved discharge processes with inclusion of early provision of discharge goals, identification of barriers and problem-solving of the barriers by removing variations to impact patient and organization perception of the discharge process. This study examines whether or not non value added waste and defects in the discharge process impacted the incidence of lengthening the process and adding to patient dissatisfaction. By using Lean Six Sigma Methodology, this study hopes to shed new light on the development of measurable outcomes for successful discharge to decrease cost and improve quality of care for patients.
LITERATURE REVIEW
The objective of this literature review is to analyze the Lean Six Sigma Methodology used in previous studies, and to evaluate its applicability to the AHIRC In patient Discharge Process. Additionally, if we work the other way around: we verify whether certain Lean Six Sigma tools and techniques we use for process improvement and control, are described in the literature. Barbara et al. (2003) have emphasized the importance of viewing the processes entirely to find out the existing defects in the processes which add up a lot of waste making process stagnant. Examining the entire operation from the “crow’s nest” will allow you to find the problems in the system. Oftentimes, the problems have become so imbedded in the process that they aren’t even realized as waste (1). Optimized organizations use a standardized toolset for Performance Improvement by identifying these defects and removing the waste which contributes to these gaps. Standardized tools optimize the effectiveness of change, boost efficiency in performing tasks, and can save time and money. Using a standardized methodology forces the utilization of the most effective tools for staff members who may not be familiar with business process reengineering (2). Lean Six Sigma continues to be of interest in the corporate world because of its capability to invade this “crow’s nest” (1).
LEAN SIX SIGMA OVERVIEW
Sandra L. Furterer (2009) defines Lean Six Sigma as an approach focused on
improving quality, reducing variation, and defects, while improving profitability
in an organization. It is the combination of two improvement programs: Six Sigma and Lean Enterprise. The former is a quality management philosophy and methodology that focuses on reducing variation; measuring defects (per million output/opportunities); and improving the quality of products, processes, and services. The concept of Six Sigma was developed in the early 1980s at Motorola Corporation. Six Sigma was popularized in the late 1990s by the General Electric Corporation and their former CEO, Jack Welch. Lean Enterprise is a methodology that focuses on reducing cycle time and waste in processes. Lean Enterprise originated from the Toyota Motor Corporation as the Toyota production system (TPS), and increased in popularity after the 1973 energy crisis (3). Barbara et al (2003) coated “Lean eliminates „waste‟ and establishes a standard. Six Sigma and its tools are used to resolve any negative deviations from that standard. So with the complement of Lean and Six Sigma, the proverbial bar is perpetually raised.”