PATA - PATA Operational management case PDF

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PATA Operational management case...

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FAR EASTERN

Case: PATA (Pre-Admission Testing Area) Massachusetts General Hospital

Operations Management MBA 703 FEU-Manila

Submitted by: Reporting Group  Reacting Group BRAGAIS BELZA LIM CANTOS

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I. Case Background The Pre-Admission Testing Area (PATA) of the Massachusetts General Hospital (MGH) was an outpatient clinic with 12 exam rooms, a lab and a waiting room. Its mission is to make sure that a patient that will undergo an outpatient procedure will be properly assessed by an anesthesiologist before undergoing the procedure. For two years PATA has been struggling with inefficiencies and long wait times which has taken a toll on both patients and providers affecting the output of surgical procedures.

II. Statement of the Problem Patient waiting time can be up to 4 hours with only a 1.5 actual face time with the staff

1. Patient waiting time can be up to 4 hours with only a 1.5 actual face time with the staff 2. Capacity was only at 65% of total outpatient procedures 3. Over worked and understaffed with RNs and MDs and with dissatisfaction due to long work hours 4. Low funding due to the non-revenue nature of PATA’s operations 5. Incomplete patient workup /assessment of patient as some walked out due to long waiting. This can lead to delays in OR operations. 6. Patient complaints about the long wait times may lead to physicians referring patients elsewhere 7. Inefficient workflow system as there can be redundancy of work or entries as well as providers leaving work when there are no patients waiting to been seen.

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FAR EASTERN 8. Disorganized and manual operations and charting

III. Assumptions 1. The hospital is open to the idea of installing a software that will incorporate all data from all departments and sections including PATA’s. 2. A budget can be made available for this purpose 3. The new software can make a better and more efficient queuing system. 4. HR department has not assigned the appropriate number of staff proportionate to the workload of the PATA 5. Fund raising activities can be made to support the PATA program.

IV. Areas of Consideration

a. Human Resource and Development Staffing of the PATA involves 5 lab techs, 5 nurses and 8 anesthesiologists. There are also 2 front desk attendants (1 attendant greet patient, give out forms, locate medical chart and the other answer phones, enter data and process paperwork). There is one charge nurse who serves as director of patient flow and assignment of patients and providers.

b. Operations

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FAR EASTERN The PATA operates Mondays to Fridays 7 am to 5 pm. 4 patients assigned every half hour 7-12nn (total of 40 patients); 2 patients every half hour 12nn-130pm (8 patients); and 4 patients every half hour from 2pm to 3 pm (8 patients). Theoretically, 56 patients can be seen with this schedule.

c. Finance The PATA is non-profit and non-income generating. Staff salaries and operating expenses comes from MGH.

d. Marketing MGH is ranked as one of the top 5 hospitals in the US, attracting patients from all over for treatment. PATA can serve as a first impression of MGH to patients who have been referred from other institutions. However, is no current active marketing program for PATA because of its non -revenue nature.

e. IT / R & D Business Development etc. The PATA has not invested in adequate software to update its EMR and patient queuing system.

V. Framework (e.g. SWOT, Porter’s etc)

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FAR EASTERN Strength

Weakness

Staff has high quality of care and concern for

Limited finances due to non-revenue nature

its patients

Inefficient system leading to long wait times

A dedicated Chief of Anesthesia who

Insufficient number of MDs and RNs

welcomes ideas from stakeholders

No clear cut guidelines on which patients should undergo PATA assessment.

Opportunities

Threats

Hospital Management open to improving

Patients walking out in the middle of the

PATA.

PATA process due to long wait can lead to

The high number of complaints that can

complaints and unfavorable reviews.

prompt management to increase financial

Referring physicians outside MGH may

support to its PATA program.

refer their patients elsewhere due to PATA

Increase productivity from 65 to 100%

complaints.

VI. Alternative Courses of Action (at least 4)

Alternative course of action 1. Clear cut rules on which

Advantages Decrease the number of

Disadvantages Some surgeons do not know

patients should be assessed in

patients leading to

which patients can skip the

PATA. Healthy patients that

deceased waiting time and

PATA assessment .

need not go to PATA have their workloads

Patients that may have

workups done as outpatient

unrecognized co-morbidities

before day of procedure.

that are discovered on surgery day can lead to delays in

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2.Invest in Personnel

Physician assistants have

surgery Some patients demand that

education. Train nurses to be

lower salaries than MDs.

they be attended to by MDs

Physician Assistants. Hospitals Properly trained PAs can often have foundations or

instead to PAs

decrease the number of

funding for CME of their staff. patients that need to be 3. Increase staffing

seen by the MDs. It will decrease the patient:

Source of funding for

staff ratio

additional salaries and benefits that entail hiring additional personnel may not be approved

4. Invest in a more efficient

This will increase

by administration New software is expensive.

EMR and electronic triage

efficiency of staff.

However it can be annexed to

system. Appointments are to

MGH EMR and can be

be done electronically, with

implemented at a minimal cost.

fixed number of slots per day 5. Change layout of PATA

It remove bottle neck areas

Additional costs will be

floor plan

and allow the charge nurse

incurred by the construction.

to see all examination 6. Request additional budget

rooms. Availability of funds will

Administration can deny the

for PATA coming from the OR

allow PATA to hire

budget request.

budget as PATA’s operations

additional staff and

OR budget will be decreased.

increase OR efficiency.

logistical arrangements.

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FAR EASTERN VII. Action Plans Activity Staff education/scholarships to train existing personnel Increase budget to hire additional personnel Education of referring physicians as to which patients should be referred to PATA; Formulation of guidelines Software acquisition/upgrade of EMR to include patient appointments to PATA and an electronic queuing system at PATA Fund raising activity to generate income for PATA operations

Responsible Person/s, or Department/s, Team/s, etc HR and CME department

Finance department and HR department Anesthesia department; CME department

Timeline 1-3 years

1 year 6 months

Information Resource Management

1 year

Anesthesia Department

Annual event

VIII. Recommendation Since the institution can not give additional funding or additional personnel and space, these are our recommendation to decrease the waiting time of the patients in PATA: 1. To increase the efficiency of each personnel in PATA

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FAR EASTERN by: a. Have a clear guidelines in PATA wherein all the staff and referring MDs should comply.

b. Having a monthly meeting with the whole PATA staff. Agenda will include: how many patients they were able to serve, how long the waiting time, the time the whole process a patient took, if there were any unsatisfied patient or patient’s relative, etc.

c. A quarterly meeting or biannual meeting with the MDs. To remind everyone to hasten the examination time but with utmost care and to try to cut off talkative patients and relatives in a polite manner to decrease the time. In this way, they could see more patients. This will also remind them to see not less than 6 patients per day, to be fair to other MDs who have seen more than they saw.

d. Adding a personnel due to its cost is a problem. However, we may haggle on just adding 1 additional personnel to help increase the efficiency of the PATA. We recommend to add a floater attendant or a floater RN in the waiting room who will help the front desk attendant in locating medical charts, document the arrival time and in

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FAR EASTERN giving out the complete form when patients arrived at once. The floater attendant will also help the charge nurse in checking the master list. The floater attendant will help in checking available rooms, double checking the patients what process have done to them already. In this way, the staff will know if there are patients who is not seen yet of if the patient was seen by a staff twice.

IX. Conclusion In conclusion, there should be a partial revamp in PATA’s operational management to help increase its efficiency. The MGH should not see PATA Clinic as a non revenue clinic. PATA helps in revenue generation of the hospital. PATA is under DACCPM, and the PATA clinic does the pre-operative assessment. If the PATA clinic is efficient and can reached its 90-100% potential capacity and capability, more operations will be done in the OR and more revenue will go in. It will also minimize the numbers of pre-operative work ups done in the OR. By minimizing the numbers of pre-operative work ups done in the OR, less surgical cases will be delayed and will increase the number of surgeries done.

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