Cancer center improvement through practice-based clinical leadership team infrastructure.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 180-180
Author(s):  
Mary Coniglio ◽  
Regina Cunningham ◽  
Dawna Gillespie
Keyword(s):  
Patient Satisfaction ◽  
Performance Improvement ◽  
Performance Metrics ◽  
Leadership Team ◽  
Cancer Center ◽  
Team Approach ◽  
Patient Throughput ◽  
Clinical Leadership ◽  
Number Of Patients ◽  
Lean Tools

180 Background: A practice based clinical leadership team (PBCL) was created in the outpatient cancer center to identify, evaluate, and implement initiatives to improve safety, quality, and patient satisfaction. A quality leader facilitates the team which includes nursing, physician leaders, as well as subject matter experts from throughout the cancer service line. Methods: Key focus areas include data review/analysis, facilitating performance improvement teams to enhance patient satisfaction and patient safety; and to reduce variations in care. PBCL members participate in Performance Improvement in Action (PIIA) program that includes just-in-time process improvement training while completing projects in a 90-day period. The PIIA approach embeds quality/lean tools in the organization. The training provides structure, common terminology, and stresses the use of data to make decisions, relying on the voice of the customer and clear articulation of the problem statement before jumping to solutions. The methodology incorporates six sigma/lean tools and plan-do-check-act. Results: The PBCL structure has resulted in several specific improvement projects. The patient throughput project team implemented recommendations that increased the percentage of patients who arrived and completed lab tests before their scheduled appointment time by 36%. In addition, a simulation model was created which quantified a 28 minute reduction in total time in the department by increasing the number of patients seen independently by advanced practice providers and removing the room assignment constraint by assigning providers to a “pod of rooms” rather than a specified room(s). An infusion fast track program was implemented for selected medications to expedite patient throughput resulted in an 18 minute (52%) reduction of time in the department. Conclusions: Incorporating clinical leadership in a structured framework for quality improvement increases the buy-in to change while maintaining an objective, data driven approach. The team approach and use of performance metrics provides the opportunity to expedite pilot project testing while raising awareness of key metrics to inform of additional opportunities.

Kaizen quality initiative to improve patient satisfaction and throughput in an academic cancer center.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 78-78
Author(s):  
David Dougherty ◽  
Patti Murray ◽  
Julie Ann Berkhof ◽  
Lynn Levandowski ◽  
Alok A. Khorana
Keyword(s):  
Quality Improvement ◽  
Patient Satisfaction ◽  
Induction Period ◽  
Continuous Process ◽  
Operational Efficiency ◽  
Cancer Center ◽  
Patient Throughput ◽  
Throughput Time ◽  
Patient Satisfaction Score ◽  
Improve Patient

78 Background: Lean management principles have long been employed in manufacturing to improve operational efficiency but have only recently been adopted into healthcare settings. To address prolonged wait times and inadequate performance on patient satisfaction surveys, our cancer center utilized a Kaizen event as part of a quality improvement initiative. Methods: We utilized methods of Kaizen philosophy to evaluate all processes related to the patient experience in the outpatient facilities of the James P. Wilmot Cancer Center of the University of Rochester. The Kaizen initiative was conducted by a multidisciplinary group and consisted of an intensive 5-day induction period to identify problems within the system of care followed by regular quality improvement meetings. The group developed immediate solutions to some problems and identified priorities for the longer term. Changes in patient throughput times (time from clinic check-in to check-out) and patient satisfaction (utilizing Press-Ganey surveys) were tracked before and after initiating Kaizen and this report evaluates results over the first 12-month period. Results: Our Kaizen initiative involved a group of 17 faculty and staff who assembled during the induction period and met bi-monthly over the 12-month period from May 2011 to June 2012. Prior to the Kaizen intervention, mean throughput time for a 30-minute clinic visit was 80.34 minutes (n = 259; median 76; range 18 to 261) and mean overall patient satisfaction score for the quarter preceding the Kaizen was 89.3 (43rd percentile AHA Region 2). Over the 12 months following the Kaizen, mean throughput time reduced to 57.85 minutes (n = 249; median 53; range 11 to 205) and patient satisfaction scores improved to 91.9 (p<0.05; 63rdpercentile). Conclusions: Utilizing continuous process evaluation and Kaizen methodology, we reduced patient throughput times by 28% and improved patient satisfaction percentile rank by 20%. Ongoing efforts focus on utilizing continuous quality improvement to improve patient and family-centered cancer care. Kaizen is an effective, resource-neutral method for improving operational efficiency and patient-centered outcomes in an academic oncology practice.

Improvements in communication and engagement of advance care planning in adults with metastatic cancer through a targeted team approach.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 14-14
Author(s):  
Sabrina Q. Mikan ◽  
Lalan S. Wilfong ◽  
Margaret Rhoads ◽  
Mary Ann Cagle ◽  
Cynthia B. Taniguchi
Keyword(s):  
Advance Care Planning ◽  
Patient Engagement ◽  
Metastatic Cancer ◽  
Fold Increase ◽  
Leadership Team ◽  
Cancer Center ◽  
Team Approach ◽  
Care Planning ◽  
Improvement Project ◽  
Advance Care

14 Background: Advance care planning (ACP) continues to be a vital part of comprehensive, person-centered cancer care. A large community oncology practice performed a targeted approach to improve patient engagement of ACP. A process improvement project with three goals was set: increasing ACP referrals, ACP counseling visits and completed Values Assessment (VA) instrument. A leadership team consisting of practice director, physician, nurse manager, and nurse practitioner was developed with ownership of roles and responsibilities. Methods: The ACP leadership team outlined workflows to be tested, followed by evaluating outcomes of each goal over 107 days. Barriers and challenges were identified; ACP education was taught to staff. NP and RNs introduced ACP to patients during ChemoTeaching. Eligible patients were identified weekly by infusion RNs on C1D1, and patients were given the VA. Desk RNs would speak with patients on C1D2 to review symptoms and VA responses. RNs would offer ACP visits to patients. Referrals were made for patients to have one-on-one counseling with NP. Staff was educated about EMR documentation by RN manager. Weekly team phone meetings were held to discuss project status. Results: During the first 53 days of the project, 20 patients were identified at C1D1, 5 VA were completed and 15 ACP visits occurred. After evaluation, weekly communication with clinical staff increased to daily huddles. Daily communication allowed for RNs to identify C1D1 patients and communicate to the full team. During the second 54 days, 94 patients were identified at C1D1, 46 VA were completed, and 27 ACP visits occurred. A 5-fold increase occurred in patient identification; a 9-fold increase in VA completion occurred, and approximately 2-fold increase occurred in ACP counseling. Conclusions: By developing a focused and concerted process on ACP, the cancer center was able to show that patient engagement in the ACP process markedly improved. A navigation process for identifying patients who would benefit from ACP counseling was vital in increasing in the counseling visits. Continual quality improvement by refining processes in the ACP program will benefit patients.

Clinical process analysis: Embedding performance improvement skills for measurable and sustainable change.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 67-67
Author(s):  
Beverly A Hayes ◽  
Courtney Barnes ◽  
Gina Aranzamendez ◽  
Laurie Kaufman ◽  
Valerie Haywood ◽  
...  
Keyword(s):  
Performance Improvement ◽  
Process Analysis ◽  
Cancer Center ◽  
Labor Costs ◽  
Patient Centeredness ◽  
Process Flow ◽  
Clinical Leadership ◽  
Clinical Process ◽  
State Process ◽  
Md Anderson

67 Background: The Clinical Process Analysis methodology, based on Time Driven Activity Based Costing (Kaplan), aligns data reporting with frontline processes to drive improvement in clinical quality and financial performance. After the completion of 6 ambulatory centers (with 6 in progress), the program evolved to include a Performance Improvement (PI) Phase. The goal: embed PI skills in all clinical operations; provide resources for PI project initiation, facilitation, and sustainability; and continue collaboration with MD Anderson Cancer Center process owners through measurable improvement in safety, timeliness, effectiveness, efficiency, equity and patient-centeredness. (IOM 2001). Methods: The center and the CPA Team utilize institutional dashboards and multiple data resources to establish the project scope. The scope is converted to a Blueprint which outlines a timeline of the project, a list of required resources, and center-specific data. The CPA Team interviews frontline staff, clinical leadership and financial teams to create a current state process flow chart. Opportunities for Improvement (OFI), operational and clinical variations, cycle times and other management reporting metrics are included on the charts, as well as patient experience audio, as gathered by an MD Anderson marketing team. OFIs are evaluated, categorized, and prioritized by clinical leadership, and the CPA Team works with the center’s designated PI team to develop and implement Quick Fixes, PDSA and more extensive projects. Results: In 6 completed ambulatory centers in FY13: 176 Opportunities for Improvement, $936,463 Savings. Summary reports provide direct labor costs and estimated times, per resource type, for center activities. Per MDs, managers, staff and financial experts, other uses for process flow charts include: tracking patient flow; resource utilization; customer satisfaction; patient education; and on-boarding staff. Conclusions: In FY14, the CPA Program will focus on patient access in 15 centers, gathering data to identify trends and common themes to implement Best Practices across the institution.

Rehabilitation of the Atrophic Posterior Maxilla With Pterygoid Implants: A Review

2012 ◽  
Vol 38 (S1) ◽  
pp. 461-466 ◽  
Author(s):  
Eugenia Candel ◽  
David Peñarrocha ◽  
Maria Peñarrocha
Keyword(s):  
Patient Satisfaction ◽  
Bone Loss ◽  
Weighted Average ◽  
Success Rates ◽  
Number Of Patients ◽  
Posterior Maxilla ◽  
Clinical Series ◽  
Fixed Prosthesis ◽  
Success Of Treatment

The purpose of this article is to review the literature published and to assess the success of treatment of patients with atrophic posterior maxilla with pterygoid implants. Studies from 1992 to 2009 on patients with atrophic posterior maxilla rehabilitated with pterygoid implants were reviewed. Those reporting clinical series of at least 5 patients with atrophic posterior maxilla (Class IV and V of Cawood and Howell), rehabilitated with pterygoid implants and fixed prosthesis, and with 12 months minimum follow-up were included. In each study the following were assessed: number of patients, number of implants, surgical technique, prosthetic rehabilitation, success rate, bone loss, complications and patient satisfaction. Thirteen articles were included, reporting a total of 1053 pterygoid implants in 676 patients. The weighted average success of pterygoid implants was 90.7%; bone loss evaluated radiographically ranged between 0 and 4.5 mm. No additional complications compared with conventional implants were found, and patient satisfaction level with the prosthesis was high. Pterygoid implants have high success rates, similar bone loss levels to those of conventional implants, minimal complications and good acceptance by patients, being therefore an alternative to treat patients with atrophic posterior maxilla. Two anatomical locations in which implants are placed in the retromolar area can be distinguished: the pterygoid process and the pterygomaxillary region. Implant lengths and angulations vary between these two techniques.

Experience of an Interdisciplinary Pediatric Pain Service

PEDIATRICS ◽  
1991 ◽  
Vol 88 (6) ◽  
pp. 1226-1232
Author(s):  
Barbara S. Shapiro ◽  
David E. Cohen ◽  
Kenneth W. Covelman ◽  
Carol J. Howe ◽  
Sam M. Scott
Keyword(s):  
Sickle Cell Disease ◽  
Patient Care ◽  
Sickle Cell ◽  
Health Care Professionals ◽  
Tertiary Care ◽  
Direct Patient Care ◽  
Team Approach ◽  
Cell Disease ◽  
Number Of Patients ◽  
Physician Time

This article is a report of our experience with an interdisciplinary pain service in a large tertiary care pediatric hospital. During the first 2 years of operation, we received 869 consultations and referrals from more than 19 hospital divisions. Postoperative pain was the most frequent reason for consultation (56% of patients). Patients with pain related to cancer and sickle cell disease comprised 25% of the consultations. The remaining patients had a wide variety of primary diagnoses and causes of pain. We calculated the time spent by pain service physicians in direct patient care. The majority (63%) of physician time was spent with a small number of patients (17%). Most of these patients had pain that was unrelated to surgery, cancer, or sickle cell disease, and many posed dilemmas in diagnosis and treatment. Physician time was correlated directly to the use of psychologic and physical therapies for the pain, involving multiple team members. This experience supports the demand for an interdisciplinary pain service in a tertiary care children's hospital. A significant amount of physician time is necessary to provide patient care and to maintain a team approach, however, and pediatricians and other health care professionals who aim to implement such services should be cognizant of the time required.

Selection methods of lean management tools: a review

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ali Jaber Naeemah ◽  
Kuan Yew Wong
Keyword(s):  
Decision Making ◽  
Performance Metrics ◽  
Work Conditions ◽  
Lean Management ◽  
Selection Methods ◽  
Tool Selection ◽  
Content Type ◽  
Customer Complaints ◽  
Lean Tools ◽  
Selection Of

PurposeThe purpose of this paper is (1) to review, analyze and assess the existing literature on lean tools selection studies published from 2005 to 2021; (2) to identify the limitations faced by previous studies; and (3) to suggest future works that are necessary to facilitate the selection of lean tools.Design/methodology/approachA systematic approach was used in order to identify, collect and select the articles. Several keywords related to the selection of lean tools were used to collect articles from different Scopus indexed journals. Next, the study systematically reviewed and analyzed the selected papers to identify the lean tools' selection method and discussed its features and limitations.FindingsAn analysis of the results showed that previous studies have adopted two types of methods for selecting lean tools. First, there are various traditional methods being used. Second, multi-criteria decision-making (MCDM) methods were commonly used in previous studies, such as the multi-objective decision-making method (MODM), single multi-attribute decision-making (MADM) methods and hybrid (MCDM). Moreover, the study revealed that the lean tools' selection methods in previous studies were based on evaluating the relationship between either lean tools and performance metrics or lean tools and waste, or both.Research limitations/implicationsIn terms of its theoretical value, the study is considered as an extension of the previous researches performed on this topic by determining and analyzing the features of the most selection methods of lean tools. Unlike previous review papers, this review had considered discussing and analyzing the characteristics and limitations of these methods. Section 2.2 of this paper reviewed some of the categories of MCDM methods as well as some of the traditional methods used in the selected previous studies. Section 2.1 of this paper explained the concept of lean management and its application benefits. Further, only three sectors were covered by the previous studies in this review paper. This study also provided recommendations for future research. Therefore, it provided researchers with a good conception of how to conduct the studies on lean tools selection. Besides, knowing the methods used in previous studies can help researchers develop new methods to select the best set of lean tools. That is, this study provided and advanced the existing knowledge base for researchers concerning lean tools selection, especially there is limited availability of review papers on this topic. Moreover, the study showed researchers the importance of the relationship between lean tools and indicators or/and performance indicators to determine the appropriate set of lean tools so that the results of future studies will be more realistic and acceptable.Practical implicationsPractically, manufacturers face a significant challenge when selecting proper lean tools. This study may enhance managers, manufacturers and company's knowledge to identify most of the methods used to choose the best set of lean tools and what are the advantages, disadvantages and limitations of these methods as well as the latest studies that have been adopted in this topic. That means this study can direct companies to prioritize the application of lean tools depending on either the manufacturing performance metrics or/and manufacturing wastes so that they avoid incorrect application of lean tools, which will add more non-value added activities to operations. Therefore companies can decrease the time and cost losses and enhancing the quality and efficiency of the performance. Correctly implementing the best set of lean tools in companies will lead in general to correctly applying lean management in corporations. Therefore, these lean tools can boost the economic aspect of companies and society through reducing waste, improving performance indicators, preserving time and cost, achieving quality, efficiency, competitiveness, boosting employee income and improving the gross domestic product. The correct lean tool selection reduces customer complaints and employee stress and improves work conditions, health, safety and labor wellbeing. Besides, the correct lean tools selection improves materials usage, energy usage, water usage and decreases liquid wastes, solid wastes and air emissions. As a result, the right selection of lean tools will have positive effects on both the environment and society. The study may also encourage manufacturers and researchers to adopt studies on lean tools selection in small- and medium-sized companies because the study referred to the importance and participation of these kinds of companies in a large proportion of the economy of developing countries. Further, the study may encourage some countries that have not previously adopted this type of study, academically and industrially to conduct lean tools selection studies.Social implicationsAs mentioned previously, the correct lean tool selection reduces customer complaints and employee stress and improves work conditions, health, safety and labor wellbeing. The proper lean tools selection improves materials usage, energy usage, water usage and decreases liquid wastes, solid wastes and air emissions. As a result, the right choice of lean tools will positively affect both the environment and society.Originality/valueThe study expanded the efforts of previous studies concerning lean management features. It provided an accurate review of most lean tools selection studies published from 2005 to 2021 and was not limited to the manufacturing sector. It further identified and briefly described the selection methods concerning lean tools adopted in each paper.

scholarly journals HUBUNGAN METODE PELAKSANAAN EPEEP (EXPLAIN, PAIN, ELIMINATION, ENVIRONMENT AND PLAN OF RETURN) DENGAN KEPUASAN PASIEN DIRUANG RAWAT INAP PANDORIA RUMAH

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Yulianti Wulandari ◽  
Siska Afri Nofita
Keyword(s):  
Patient Satisfaction ◽  
Daily Activity ◽  
Client Satisfaction ◽  
Sampling Technique ◽  
Satisfaction Survey ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Implementation Method

In health service, nurses are at the forefront of providing health care, if the nurses don’t provide the care and not accompanied by EPEEP implementation (Explain, Pain, Elimination, Environment and Plan Of Return) it will have an impact on decreasing client satisfaction. From the results of the preliminary survey the nurses have not done EPEEP implementation method (Explain, Pain, Elimination, Environment and Plan Of Return) properly. And the achievement of patient satisfaction in the pandoria room of Awal Bros Batam Hospital from the results of satisfaction survey in September 2018, very satisfied category was 46%, satisfied category was 54% and less satisfied category was 2%. Therefore , it is necessary to implement EPEEP (Explain, Pain, Elimination, Environment and Plan Of Return) in providing services to clients. This study aimed to determine the Relation between EPEEP Implementation Methods (Explain, Pain, Elimination, Environment and Plan Of Return) With Patient Satisfaction at Pandoria Inpatient Awa Bros Batam in 2019. This type of research was descriptive correlation with cross sectional approach, 129 respondents selected using purposive sampling technique. Data were obtained by observation sheets on nurses about EPEEP implementation (Explain, Pain, Elimination, Environment and Plan Of Return) and provide satisfaction questionnaires to clients. The study was conducted in February until March 2019 in the Pandoria room. Analysis of the data used Chi square. There was a relationship between EPEEP implementation method (Explain, Pain, Elimination, Environment and Plan Of Return) with patient satisfaction and with nurses inpatient at Pandoria Awal Bros Batam Hospital, and the p-value was 0.00 (p <0.05). It can be concluded that the implementation of EPEEP (Explain, Pain, Elimination, Environment and Plan Of Return) can affect client satisfaction. Suggestions for future researchers can conduct research related to how long the nurse responds if there are patients who call or press the bell (Patient Calls) and for the Home Pain as an input to perform research related to nurse daily activity, because Pandoria Room compared to other inpatient rooms was the room with the highest number of patients and the highest mobile patients.

scholarly journals Data Aggregation and Its Impact on Performance Enhancement

2019 ◽  
Vol 9 (2S) ◽  
pp. 316-319
Keyword(s):  
Performance Improvement ◽  
Data Aggregation ◽  
Performance Metrics ◽  
Performance Enhancement ◽  
Data Availability ◽  
Quality Data ◽  
Data Organization ◽  
Data Handling ◽  
Aggregation Techniques ◽  
Important Position

Wireless sensor network incorporates an innovative aspect called as data handling technologies for big data organization. In today’s research the data aggregation occupies an important position and its emerging rapidly. Data aggregation incudes, process of accumulating the data at node, then either store or transfer further to reach out the destination. This survey depicts about the previous work on data aggregation in WSN and also its impact on the different services. There are number of data aggregation techniques available for reducing the data, processing the data and storing the data. Some of them are discussed here as a review. The data aggregation performed using certain techniques can also be aimed in having energy efficiency, time efficient, security could be in the form of confidentiality, unimpaired, authenticate, freshness, quality, data availability, access control, nonrepudiation, secrecy, secrecy. These are the relevant performance metrics to maintain the better Qos in WSNs applications. The goal of this paper is to display an overview of existing techniques for performance improvement in homogenous/ heterogenous networks.

scholarly journals Comparison of 3 Approaches to Percutaneous Epidural Adhesiolysis and Neuroplasty in Post Lumbar Surgery Syndrome

2018 ◽  
Vol 1 (21;1) ◽  
pp. E501-E508
Author(s):  
Haitham Hamdy Salem
Keyword(s):  
Patient Satisfaction ◽  
Pain Relief ◽  
Group Analysis ◽  
Pain Severity ◽  
University Hospital ◽  
Pain Clinic ◽  
Complication Rates ◽  
Lumbar Surgery ◽  
Time Intervals ◽  
Number Of Patients

Background: Percutaneous epidural adhesiolysis and neuroplasty (PEAN) has been proven to be safe and effective in treating different spine pathologies, in particular post lumbar surgery syndrome (PLSS). Objectives: The purpose of this study was to compare the efficacy and complication rates of the 3 different PEAN anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) used to treat PLSS. Study Design: This study used a case control, blind study. Setting: The research took place at the pain clinic and interventional pain practice room at Asyut University Hospital, Assiut, Egypt. Methods: Sixty consecutive PLSS patients were recruited and randomized into 3 groups (caudal, S1 foraminal, and L5-S1 transforaminal) before receiving adhesiolysis and neuroplasty. All patients underwent nerve conduction studies and magnetic resonance imaging (MRI). Pain severity levels were assessed and measured using the Oswestry Disability Questionnaire (OSW) and the Visual Analog Scale (VAS). Patient satisfaction was evaluated using a Likert scale. The first assessment was performed prior to the procedure to determine the patients’ baseline levels of pain severity. Followup assessments were performed 1-, 3-, and 6-months after the procedure. Results: Results of the group pairwise analysis indicated that, relative to baseline, there were significant decreases in pain relief scores (VAS and OWS) and functional assessment expressed by patients’ satisfaction across all time intervals and in all 3 groups (P < 0.01). Conversely, a between group analysis revealed that VAS, OWS, and patient satisfaction scores were comparable across the 3 groups at all time intervals (P > 0.05). There were no differences in rates of complications between the 3 different groups. Limitations: Our study was limited by the low number of patients and the short duration (6 months) of follow-up. Conclusion: The 3 anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) result in the same outcome with regard to pain relief and complication rate. Key words: Post lumber surgery syndrome, post laminectomy back pain, percutaneous adhesiolysis, Racz catheter, percutaneous neuroplasty

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