Hagstrom, J. Nathan, MD, MHCM

Hahn, Toni A

Herr, Courtney E

Steidinger, Josephine P

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksResearch Scholars Poster PresentationChildren's Cancer Center as a ClinicalMicrosystem: Patient FlowToni A. HahnToni.Hahn@lvhn.orgJosephine P. SteidingerJosephine.Steidinger@lvhn.orgCourtney E. HerrCourtney.Herr@lvhn.orgJ. Nathan Hagstrom MD, MHCMLehigh Valley Health Network, j_nathan.hagstrom@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/research-scholars-postersThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtHahn, T. A., Steidinger, J. P., Herr, C. E., Hagstrom, J. N. (2019, August). Children's Cancer Center as a Clinical Microsystem: PatientFlow. Poster Presented at: LVHN Research Scholar Program Poster Session, Lehigh Valley Health Network, Allentown, PA.Lehigh Valley Health Network, Allentown, Pennsylvania• Established the Children’s Cancer Center (CCC) as a clinical microsystem, or a group of professionals who work together on a regular basis to provide healthcare services to a specific population of patients¹, that functions as a part of the larger LVHN macrosystem.• Patient flow is an important process within a clinical microsystem that can have a large impact of a patient’s level of satisfaction with their visit.• Previous data from May 2019 demonstrated long wait times to see providers within the Children’s Cancer Center.²Purpose: to assess possible areas of quality improvement in the CCC and improve patient flow as measured by cycle times and family perception.References:¹ Likosky, Donald S. (2014). Clinical Microsystems: A Critical Framework for Crossing the Quality Chasm. Journal of Extracorporeal Technology, 46, 33-37.² Reed, Kirstin (2019). Children’s Cancer and Multipurpose Infusion Center Process Improvement Report (Rep.).³ Adair, J. G. (1984). The Hawthorne effect: A reconsideration of the methodological artifact. Journal of Applied Psychology, 69(2), 334-345.• All patient wait times recorded post-intervention were <30 minutes, however, variability between visit processes and physician work flows may have contributed to some of the discernible differences from previous studies. • Recently hired physician may have acted as a positive deviance due to different approaches to huddle and patient flow. • Hawthorne effect, defined as the concept that people perform better when they know they are being watched or are part of a study, may have also had significant impact on results of this study.³• High variability in patient arrival times can cause delays and affect wait times.Pre-Intervention• Created a time study to determine wait times between each step in apatient’s visit. They were placed in folders and given to each patient to carry throughout their visit. We collected data from 156 patients with ages ranging 0-25 and with varying diagnoses as well as different types of visits.• Collected data regarding huddle efficiency through a post-assessment survey that was provided at the end of each daily huddle to all staff in attendance. Scores were analyzed using a 1-5 numerical scale corresponding to possible responses.• Patient surveys were created and distributed to assess satisfaction with various aspects of their visits.• Generated staff surveys to evaluate colleague engagement, high-reliability, and process inefficiencies.• Staff interviews were conducted with each member of the CCC staff to validate conclusions drawn from surveys. Interventions• Established goal of <30 minute patient wait time.• Implemented patient visibility boards to provide an alternate way for staff to communicate and update each other regarding progression of patient visits.• Introduced a huddle bundle consisting of:- New location for daily morning huddles to provide more privacy and allow patients to enter CCC immediately upon arrival- Set start time to promote consistency and punctuality- Huddle checklist to provide more uniform structure to daily huddles- Standardization of key elements to reduce day-to-day variabilityPost-Intervention• Repeated both the time studies and huddle surveys to compare to pre-intervention data.Overall, the Children’s Cancer Center is a fairly efficient microsystem and provides personal and quality care to patients and their families. Patient flow and daily huddles were identified as areas with potential for improvement. Interventions were put in place to test for change in these categories and have shown early improvement post-implementation. IntroductionMethodsResultsDiscussionConclusionChildren’s Cancer Center as a Clinical Microsystem: Patient FlowToni Anne Hahn, Josephine P. Steidinger, Courtney E. Herr, J. Nathan Hagstrom M.D, MHCMRecommendationsIn addition to continuing current countermeasures, it is recommended that staff download Tiger Connect to provide an alternative way for members to communicate about patients in a timely and secure fashion. Improvedcommunication between providers should help to further improve patient flow, overall efficiency, and decrease wait times. -200 -150 -100 -50 0 50 100 150 200MinutesCheck-in Time vs Scheduled Appointment Time15243664957277971280 10 20 30 40 50 60TransfusionReturn VisitChemo Inf*ProcedureSick VisitMed InfNew PatientPatient Wait Times by Visit TypePost-Intervention Pre-Intervention0510152025303540MinutesDaily Physician Wait TimesDaily Average Total AverageFigure 3: graph showing post-intervention and pre-intervention wait times, grouped by visit typeFigure 4: control graph showing daily physician wait times compared to total 3 week averageFigure 1: CCC Time Study Sheet Figure 2: CCC Huddle Survey Figure 5: bell curve showing amount of time patients arrive early or late to scheduled appointments in the CCCFigure 6: data collected from patient surveys show low scores regarding wait times

Children\u27s Cancer Center as a Clinical Microsystem: Patient Flow

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Children\u27s Cancer Center as a Clinical Microsystem: Patient Flow

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