Rapid process improvement workshop eliminates delays and improves quality
Physicians and transcriptionists with the forms they developed during the rapid process improvement workshop. Pictured (L to R): Dr. Radevski, Dr. Vlatchanova, Cheryl Zacharias, Jill Speir-Potter, Nat Schick-Myhr, Kim Gilbert and Dr. Fakhir
In a one-week rapid improvement event, held from March 3-7, a team of physicians and transcriptionists at the Cypress Regional Hospital in Swift Current came together and found ways to significantly reduce wait times and improve service delivery overall for the benefit of both patients and staff. The event was supported by 3sHealth, which is working on a plan for improving transcription services across the province.
The team’s review of the current state indicated it was taking a long time to complete transcription work due to missing information from providers, unclear dictations and a lack of standard templates. This led to a lot of confusion, stress, a great deal of rework and, most importantly, long turnaround times, which negatively affected the quality of patient care.
Physicians and transcriptionists build new standard templates and forms together. Pictured (L to R): Dr. Vlatchanova, Susan Beverly, Dr. Radevski, Dr. Fakhir. Nat Schick-Myhr is in the foreground and John Black & Associates consultant Susan Neidig looks on in the background.
Participants created standard templates for physicians to follow when they dictate. This improvement means transcriptionists will no longer have to track down important information after the fact (like work type, most responsible diagnosis, admission and discharge dates, pre-op and/or post-op diagnoses, and more).
“I think this will be a very positive impact on our transcription department and staff by having standard work processes that will deliver prompt information to the doctor and patient,” said Jill Speir-Potter, a medical transcriptionist in the Cypress Health Region.
“There is a lot of value in reducing wasted time and wasted work, helping us to do our jobs as transcriptionists quicker and with much less stress.”
Office Admin Assistant Cheryl Zacharias, who works in Health Information, added, “The impact [of this] is less stress. Charts will be completed faster, eliminating tracking the charts for weeks and months. It will eliminate duplicate work which will save us a great deal of time. Because of this Lean event I can now concentrate on my job and hopefully not have to handle a chart numerous times to get it completed.”
Physicians also were provided with a standard set of data elements for each type of dictation they do to ensure the right information is captured on a consistent basis.
“Because of this event, I can now reduce waste and non value-added work, thereby improving the quality of my work and the services I provide,”
said Dr. Shamsuddin Fakhir, a pediatrician and event participant.
New dictation spaces
Participants also created three new dictation spaces to allow doctors to dictate immediately after care in a quiet, private space. By dictating immediately after care, their patients’ charts will no longer get held up in a pile of charts waiting for a check of missing information. The existing dictation space was reorganized and made more appealing for physicians to use.
Approach to reduce current backlog
Physicians and transcriptionists also came up with a plan to start doing transcriptions the day they are requested instead of putting them into a queue. They also came up with an approach to work through the current backlog of charts until the backlog is eliminated entirely.
“I can now dictate discharge summaries at the point of care without delay,” said family physician and event participant Dr. Zdravka Vlatchanova. “When discharged patients come in for follow-up appointments in one week’s time, my discharge summaries will now be available.”
Dr. Vlatchanova added that,
“The Lean process and tools added focus and efficiency.”
Her colleague Dr. Ivo Radevski, who works as a senior medical officer, shared a similar perspective.
“The event allowed me to master the practical application of the Lean tools that I will use in my daily work,” said Dr. Radevski. “They added structure and the necessary scientific rigour necessary to effect and sustain change. Because of this Lean event, I can now confidently lead and participate in improvement work.”
Liz Gordon, who participated in the event as a patient representative said, “This event will bring a positive impact on continuity of care and safety for patients.”
Gains improve accuracy and timeliness
Before the session got underway, in some cases it was taking as long as 159 days for hospital discharge summaries to get dictated, transcribed and included in a patient’s chart. For OR reports, the wait time/turnaround time was as long as 50 days.
But by the end of the event, participants had significantly reduced wait times/turnaround times for transcription work. The turnaround time for discharge summaries, for example, was reduced from 159 days to 13, while the turnaround time for OR reports went from 50 days down to seven.
As if these reductions weren’t remarkable enough, Executive Director of Quality and Privacy and event sponsor Beth Adashynski added, “I can now see the possibility of same day turnaround.”
The improvements that came out of this event will be observed and documented by team members over the next three months to determine how well they are working and if further improvements are needed all in the spirit of continuous improvement that is the provincial Lean journey.