Get instant access to this case solution for only $15

Massachusetts General Hospitals Pre Admission Testing Area PATA

Solution Id Length Case Author Case Publisher
2296 3568 Words (9 Pages) Kelsey McCarty, Jeremie Gallien, Retsef Levi MIT Sloan School of Management : 11-116
This solution includes: A Word File A Word File

One of the quality problems at PATA was that different registered nurses operated differently when it came to reviewing forms. While some would quickly go through them focusing on the relevant details, others took considerable amount of time, indicating lack of standardization of practices and different care quality provided to the customers. Also, the healthier patients were often asked to get their workups completed at PATA on the same day or the OR but because of PATA’s restrained capacity many patients were asked to get their workups at OR only which had a significant impact on the quality as the surgeries would be delayed and the doctors would either have to work overtime or cancel off the surgeries in line which would affect the patients emotionally as they would have made up their minds for the surgery for that day and hence would suffer from emotional stress and dissatisfaction.

Following questions are answered in this case study solution:

1. What is the activity ratio of the value stream under consideration at PATA? 

2. (a) The improvement team identified a number of issues and grouped them into categories.

Select the three categories that you believe are the top contributors to the variability experienced within the process under consideration at PATA. Explain why you have selected each of the categories, by referring specifically to one (or more) of the exhibits.

(b) For each category that you have selected above, provide a detailed recommendation to address the issue.

3. The recommendations you have provided in Question (2)b will result in organisational change. Provide three measures that you would put in place to better manage the change process. Base your answer on an appropriate framework or model (ie. all three measures must relate to a single framework/model) 

4. Health services encompasses the management and delivery of quality and safe health care services, and the quality of their service is of prime importance. However, as indicated in the excerpt from the case study, quality related challenges existed.

5. This ‘empowerment’ to improve their daily work performance is about making staff accountable for their own performance, putting them in a state of self-control. Provide three recommendations of how you would go about achieving this within UVAHS. Relate each recommendation to a different type of knowledge or resource which people must be provided with in order to be in a state of self-control. 

6. At PATA, change was managed by reforming payment policies, adding goals that allowed team members to rally behind a shared vision and initially focusing the improvement activities of coalition teams.

Case Study Questions Answers

1. What is the activity ratio of the value stream under consideration at PATA?  

The equation for calculating activity ratio is as follows: Activity Ratio = Total Process Time/Total Lead Time * 100

Talking about the different steps at PATA through which the patients would flow, the following have been outlined:

  • Patient Scheduling

  • Check In

  • Vitals and EKG

  • Change Nurse escorting Patient to Registered Nurse

  • Completion of nursing assessment form for all patients by registered nurses

  • Anesthesiologists

  • Blood Work

  • Check Out

The lead time and process time for these activities can be shown in the following table:

Activity

Lead Time

Process Time

Patient Scheduling

 

-

Check-In

17 minutes

2 minutes

Vitals & EKG

45 minutes

10 minutes

Review Medical Info

-

5 minutes

Nursing Assessment Form

103 minutes

38 minutes

Anesthesiologists Assessment

67 minutes

37 minutes

Blood Work

21 minutes

6 minutes

Checkout

-

1 minute

Total

252 minutes

99 minutes

Hence, the activity ratio is coming out to be 99/252 = 39.28%.

To determine the process time, actual time has been taken that has been mentioned in the case study. However, to determine the lead time, one of the patient’s experience that has been described in the case has been taken as a benchmark. The activity ratio is quite low which indicates that the idle time is quite high. From a different perspective, it can also be inferred that the time slots set for each patient are quite short, resulting in delays for the patients who are coming later as more time is spent on seeing the previous patient.

The value of the variables used in the equation are as follows:

Lead Time: 252 minutes

Process Time: 99 minutes

This is consistent with the experience of the patient who clearly stated that on an average it took patient 4 hours for the entire visit out of which only 1.5 hours included face time with any of the nurse or physician, which reflects a closer number of  37.5%.

2. a) The improvement team identified a number of issues and grouped them into categories.

Select the three categories that you believe are the top contributors to the variability experienced within the process under consideration at PATA. Explain why you have selected each of the categories, by referring specifically to one (or more) of the exhibits.
b) For each category that you have selected above, provide a detailed recommendation to address the issue.

The improvement team identified a number of issues as they grouped their recommendations into the following categories:

  • Improve triaging

  • Switching from paper to electronic records

  • Provision of online education regarding patient expectation of surgery

Referring to the dissatisfied patient’s letter only, he clearly mentioned tat one of the patient that he met had the same condition as his mother but he did not have to go through the PATA appointment which reflects the inefficiency of the center. Improving triaging would be a good move as in this way all the patients with similar medical conditions would be treated equally, the efficiency of the operations in the center will improve and it would be easier to move the patient flow across different assessment stages before they would check out. Improving triaging is essential as it would allow to prioritize patients on the basis of their medical needs. Hence, the patients who would require urgent care would not have to go through the long, tedious process and which would help in improving their satisfaction rate. It would be recommended that the number of doctors need to be increased so that they are able to cater to a large number of patients. From Appendix 5, the average time spent by different doctors per patient is more than 30 minutes which is higher than the time slot allotted for each patient. Hence, increasing the service time would result in less wait time and reduce the number of patients that can be catered for in a day but help in improving the service quality.

Secondly, the paperwork is quite extensive which takes It longer for the nurses to fill, review and then chart the results. This is a huge bottleneck. Therefore, it is quite essential to switch from paper records to electronic ones to manage the patient data as can be seen that PATA Patient Intake Form is quite lengthy, the patients can be given an option to fill the form online, which would save time. Same goes for Nursing Assessment form as shown in Appendix 2, which is very lengthy and even takes a lot of time to fill, again acting as a bottleneck, given the number of change nurses and registered nurses is less. It is proposed that having a resource who would be there to online collect the consumer data and fill it, would help in saving time as the patients would not have to wait for their turn. Instead, they can fill the form as per their understanding and when it will go to the registered nurse for review, she/he will be in a position to quickly review it and send it to the next step where the medical doctor would be reviewing it. This would save the patients a considerable amount of time.

Thirdly, the anesthesia consent form and surgical consent form as can be seen in Appendix 3 and Appendix 4 are also long. The nurses take sufficient time reviewing it and filling it. Also, responding to patients queries takes a longer amount of time. These forms can also be made online so that the patients are well aware in advance about what they would be expecting from the surgery. For any questions that they may have they may enter in the online portal and the representative may inform them. This way when the patients would actually visit the facility, they would be quite clear and would have few questions to ask. The time taken by the nurses to accommodate these patients would reduce which would in turn positively reflect in the reduced waiting times and higher patient satisfaction in terms of the quality service provided by PATA. With the technological trends on rise, going online seems to be the most feasible and effective option as it would help in streamlining the data, reduce the paperwork and make it easier to track the health records of the patients and accordingly engage in patient triaging to achieve the best possible results. 

3. The recommendations you have provided in Question 2)b will result in organisational change. Provide three measures that you would put in place to better manage the change process. Base your answer on an appropriate framework or model (ie. all three measures must relate to a single framework/model) 

To bring about the organizational change aimed at improving the process efficiency, certain measures will be put in place to better manage the change process that would be aligned with the Lewin’s change model. Firstly, all the staff will be required to undertake a reflective activity in which they will have to share their experiences and challenges they face in managing the patient flow and dealing with them. Once that is down, they will be asked to provide feedback and recommendations as to how the process can be improved. This way they will feel that they are a part of the change process and would be willing to accept new ways of working to bring about process efficiency. The staff will be motivated to change which will help in unfreeze the current practices and ways of working.

Get instant access to this case solution for only $15

Get Instant Access to This Case Solution for Only $15

Standard Price

$25

Save $10 on your purchase

-$10

Amount to Pay

$15

Different Requirements? Order a Custom Solution

Calculate the Price

Approximately ~ 1 page(s)

Total Price

$0

whatsapp chat icon

Hi there !

We are here to help. Chat with us on WhatsApp for any queries.

close icon