Tips for freeing up bottlenecks in surgery
By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
Dallas
Bottlenecks are those little clumps of garbage that clog the system. They halt, slow down, or generally upset productivity. They baffle us because frequently they are difficult to identify.
How do you spot a bottleneck? First, look at your benchmarks. Is your length per case growing? Is the turnover time creeping up? Is your patient stay in the recovery area longer? Are you suddenly getting more physician complaints? Do they complain about not being able to post cases? Is volume dropping off for one particular specialty or surgeon? All of these are signs of a bottleneck. Have you changed a new procedure or switched to some new system recently? That is usually the first place to look.
Because there are so many types of bottlenecks, it is impossible to list all the potential ones. I will share with you one of the most recent and interesting ones, and you can see why the process of observation is so important.
A rural hospital same-day surgery center started receiving patient complaints about excessive waiting times for patients going into surgery. The director checked out the complaints and wrote it off to the implementation of their recently installed computerized patient registration system. "Growing pains" was the expression he used.
The medical information systems department was asked to check out the software and hardware. They found it to be in good working order and attributed the delay to "User unfamiliarity with the system — it will improve." It didn’t, and this eventually led to physician complaints about delayed cases.
The delays were now backing up into the evenings and forcing overtime. We observed by following the patient process. We got there at 6 a.m., when the first patients started arriving, and just sat and observed. There were two patient "intake" areas for registration. One employee was processing the patients quickly, but the other one was slow. After the patients had been to her window, they would return to their seat and would stay there for almost 30-40 minutes while the others went right in to surgery.
All patients for surgery were registered via the two women. It didn’t make any sense why one system would be so slow doing the identical job. I found that both terminals were on the same server and there was nothing wrong with them.
The next morning I watched again. Same thing. Between patients, I went to the slower window and asked the employee if I could watch her register patients. The staff member asked the patient the questions on the computer screen, but instead of inputting the information into the computer, she wrote it on a piece of paper! I was perplexed when, after she had written down half a page of information, she told the patient to take a seat and someone would come and get her in a little while. Then she carefully stacked the paper with the patient information on top of other similar pieces of paper. Before she called the next patient, I asked her why she was doing it that way. She leaned over and whispered that she "didn’t know how to type" and since the new system was put in four months prior, she had been writing all the information on paper. Then, when it slowed down, she’d go back and "hunt and peck" the information into the computer. "It takes me quite some time," she confided.
She was afraid that if she told her supervisor she couldn’t type, she would lose her job before she could retire. Obvious? Not really. The only way this problem was caught was to actually observe the process. It can be time-consuming, but eventually you will find it. Think "out of the box" and never assume anything. Happy hunting!
(Editor’s note: Earnhart and Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management.
Earnhart can be reached at 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: [email protected]. Web site: www.earnhart.com.)
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