University of Phoenix Online
March 7, 2011
Emergency Department Bottleneck Proposal
Most hospitals experience the affects of the unexpected, ambiguity and uncertainty, and as a result, face challenges with quality. Middletown Hospital is a 200-bed general not-for-profit hospital. The hospital has a 20-bed Emergency Department (ED). It averages 100 patients per day. The CEO of the hospital has been receiving numerous complaints about long waits for care and poor service and has charged the Six Sigma team to analyze the root cause of the bottleneck (University of Phoenix, 2011 Course Syllabus). This paper analyses the root cause of Middletown Hospital’s emergency room bottleneck dilemma, and provide recommendations for improvement.
Purpose of the process improvement proposal
The purpose of this proposal is to capture a granular understanding of the problem in the Emergency Department and devise a plan to capture and maintain an efficient operation. This will be accomplished by gaining an understanding of the patient demand and determining if the source of the problem is due to insufficient capacity or if it is tied to a person, role, or any other obstacles within the department.
Process Improvement Method
Using the Six Sigma process improvement method, several steps will identify the bottleneck to improve one aspect of the current process performance. The Six Sigma process is a system of defining, measuring, analyzing, improving, and controlling (DMAIC) a process for an existing process that fall below specifications and looking for incremental improvements (Swinton, 2006). The process will clearly define the problem in the following manner: • Define the real problem and its impact on quality
• Use a root cause analysis, to accurately quantify the current reality of the problem using process mapping, • Dig deep into analyzing non value added steps in the current processes • Implement a solution that will identify early-on if the solution is defective and • Control the process by providing tools for staff to address the issues as they arise in a more timely fashion. By using these steps, the Six Sigma team will be able to make the connection of why the influx in admissions during the evening hours has such an impact on the quality of service rendered. Data Collection
Because capacity planning requires analysis of both demand and resources, data collection will establish both capacity and demand in the Emergency Department (ED), but also ancillary departments. The team will use forecasting to identify the current and future demands related to patient volume. The univariate method forecasts demand by examining the historical data in one variable like number of patients (Langabeer, 2008). Data related to patient volume could easily be collected from the registration database. This data provides a current picture of the patient volumes coming into the emergency department and how it relates to the time of day or day of the week. Staffing resources will also be assessed using scheduling data not only from the ED, but also from the ancillary departments. Displaying this data can provide the team with a comprehensive picture of the variations in staffing that may affect patient flow. Equipment inventory in the laboratory and radiology department will provide useful data with analysis of each device’s effective capacity. Knowledge of the effective capacity is a step to determine how much demand can be accommodated by the capital resources in the hospital. Bottleneck Analysis Methods
According to Langabeer (2008), a bottleneck occurs at the point where demand exceeds capacity. Capacity planning in de-bottlenecking an emergency department puts the focuses on patient flow and constraints (Rechel, Wright, Barlow, & McKee, 2010).Administration believes that a bottleneck exists because of an...