Radiology lab speeds throughput with Six Sigma
Changes include shift in personnel positioning
The radiology lab at Newton-Wellesley Hospital in the Boston area has nearly cut the wait time for patients in half through the implementation of a Six Sigma process improvement initiative. What's more, the program has also saved the department more than $700,000 with increased efficiency.
"When I started here in February 2004, the department had a number of challenges," recalls Brian McIntosh, RTR, operations manager for diagnostic and interventional radiology. "There was not enough staff, nor were there effective processes in place to get patients through in a timely manner. There were long delays; a number of times during the course of each day, there could be between 15-20 patients waiting for X-rays."
Much of the department traffic is walk-in and unpredictable, he explains. "It was a nightmare every day," he continues, noting that even after patients were registered, they would sometimes wait 30 to 60 minutes. "There was a full waiting room, disgruntled patients, and then volume got even bigger when a nearby hospital closed," he observes.
After the initiative was completed, the median "cycle" was down to about 23 minutes.
Hospital brings in G.E.
It was the decision of the hospital leadership team to bring in Six Sigma consultants from General Electric, says McIntosh, adding that they were used by several of the departments in the facility.
"They performed internal leader training for individuals who became Green Belts, and some eventually became Black Belts," he says.
"The training took about five or six months," adds Laurie Davis of operations management, who was a Black Belt and project manager for the radiology initiative. She adds that the program was implemented simultaneous to the training.
"We were on the throughput project as a team and we were able to consult with our G.E. mentors on what to do and how," she explains.
There were three Green Belts on the team in all, says Davis. McIntosh was the "approver of decisions," and there was also an executive sponsor. "The Green Belt team met with the staff on a regular basis — every week or so at first for two to three hours, taking the time to explain each step we were going through," he says. "We all learned at the same time, and as the Green Belts learned, they pulled data, analyzed it, explained it to the staff, and we made our decisions off of that data. While the Green Belts facilitated the discussions, we had collective agreement as to the best solutions."
It was this heavy involvement of staff that engendered buy-in, says Davis, who notes they were brought into the project "from the get-go. They were fully part of the project team; they identified what the barriers were, as well as potential solutions to help us improve wait times," she notes.
In general, she says, the staff became "heavily invested" in the process. "We had early adopters and some who were resistant, but as we went through the process we tried to move those who were resistant to be more supportive," she notes.
Key changes made
A number of changes were made through the Six Sigma initiative, including some "simple" layout changes made at the outset. "We added computer work stations and fax machines — just little things to help with the efficiency of the actual work flow," says Davis. "Then, we turned our attention to day-to-day operations."
That's where processes were changed, says McIntosh. "The way patients used to flow, they would be registered, then a registration person would get them changed, and we also had a 'radiology coordinator' who was kind of running the show," he recalls. "She did a good job, but she was about 20 and did not have a professional license; the staff did not feel comfortable reporting to her."
The flow pattern was changed, he continues, to remove parts of the process that took extra time. "For example, when patients checked in and the order was put in, the tech might meet with them only to discover there was something wrong with the order," says McIntosh. "It could take 10-15 minutes just to reconcile the orders, so we eliminated that possibility by having the coordinator be the facilitator of throughput. Now, this person gets the patient changed, so the registration person never leaves their desk anymore. There is a printed requisition, as well as a written order; they are compared, and if there are any contradictions we take the time while the patient is changing to fix the order."
The goal, he explains, was to have a technologist pick up a correct order to begin with, and then bring the changed patient into the X-ray room.
"Theoretically, we now have techs only do exams," adds Davis. "We reduced the amount of time they spent doing things that were not tech-related."
"They were doing a lot of ancillary things before helping with throughput, which really didn't help," McIntosh explains.
The other process change involved the lead person in the department. "She was on the floor before, but she was not located in an area that allowed her to oversee operations — she was in the back and out of sight," McIntosh explains. "She would have the authority to direct work flow and hold people accountable, but that led to issues. We put her up front to oversee the flow, and be more proactive rather than re-active."
In measuring their results (the time it took from registration to getting into a room, and the time from registration to a completed exam), McIntosh learned another valuable lesson. "At first we looked at averages, but we learned median figures were more accurate," he says. "Some exams, for example, take five hours; we can't help that, but they skew the averages."
Satisfaction up, dollars down
McIntosh says both patient and employee satisfaction have risen. "Patient satisfaction numbers [they use Press Ganey] have gone up dramatically," he says. "The surveys include comments, and a number of people say they love the improved processes, that things are more efficient now."
When he shares these comments with the staff, he notes, "they have a great effect," adding that employee satisfaction numbers are improved as well.
On the financial side, "we have been able to realize and exceed our volume targets by reducing wait times," says Davis. "We had also had planned on building another diagnostic imaging room in another building, but when we went through the data, we determined we were not even at 50% capacity, so we halted those plans. This came to a cost avoidance of upwards of $500,000."
[For more information, contact:
Brian McIntosh, RTR, Operations Manager for Diagnostic and Interventional Radiology, Newton-Wellesley Hospital. Phone: (617) 243-6000.]
The radiology lab at Newton-Wellesley Hospital in the Boston area has nearly cut the wait time for patients in half through the implementation of a Six Sigma process improvement initiative. What's more, the program has also saved the department more than $700,000 with increased efficiency.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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