Improving service delivery of the MR department of MST

Koenderink, Marcel (2010) Improving service delivery of the MR department of MST.

Abstract:Problem description This study investigates the process of conducting a Magnetic Resonance Imaging scan (MR-scan) in the radiology department of Medisch Spectrum Twente (MST). The MR scanning process is a supportive step in the total diagnosing process of the hospital. An MR scanning process which produces high quality scans within a relative short period of time is therefore beneficial for the entire hospital. The access time for conducting an MR in Enschede is very high at the moment, sometimes even higher than 40 working days. Patient diagnosis is heavily delayed as a result. The technicians experience a high work load and a high work pressure due to the fully planned schedule. However, process data is largely unknown, which makes it impossible to assess the service level performance of the MR scanning process. Objective of the research The objective of the research is to describe the MR scanning process and develop distinctive performance indicators. We gather data about the relevant performance indicators that is important for the process, steering and analysis. We analyze bottlenecks, and give interventions and propose recommendations to improve the process. Approach We analyze and map the process to get an overview of the process steps of an MR scan. We gather data from RADOS (radiology information system) to acquire an overview of the process. Furthermore we investigate the organization of the planning and control, which gives us an insight in the way how patients are scheduled and what the effects and consequences of this organization are. We perform a time registration study to acquire data on logistical performance indicators such as patient access time, patient waiting time, utilization of the process, no-shows and maintenance. Measurements/findings · Access time: has increased in 2008 from 15 working days in January to 40 working days in December. A decrease in capacity is the main cause of the increase of the access time. · Utilization of capacity: During opening hours 62% of the time is used for positioning the patient and performing the scans. 10% of the time is used to prepare a patient outside the scanner room and almost 8% is used to finish the appointment. The time to prepare a patient on the scanner table is very hard to predict and showed high variability. The other 20% of the time is used for to clean the room and to wait for the next patient. · Corrective maintenance is high on both machines: 90 hours on MR 1 and 55 hours on MR 2. Real loss of capacity due to this maintenance is higher because programs must be cancelled. · In the current situation, no actual performance data is acquired out of the process. Steering information is therefore not available for the management. Improving service delivery of the MR department of MST M. Koenderink 7 Interventions We use basis principles of logistics to propose our interventions for the improvement of the process. These principles are variability reduction, complexity reduction and waste reduction. The primary process is strongly affected by the variability of the different steps within the process. Reducing the variability is the primary goal of our interventions. Furthermore, the goal of our interventions is to reduce the complexity of the organization of the process. These complexity leads to a longer production process than necessary. Finally, a goal of our interventions is to reduce waste that exists in the current operational procedures. Based on the process analysis we found possible interventions to improve the process. We investigate the effects by discussing the interventions with the key actors of the process. We discuss the following interventions: · Update of the protocols that are in use for MR inquiries. · Insertion of intravenous lines for the insertion of contrast fluid in a preparation room outside the scanner room. · Expansion of the business time. · A dockable MR table with inserted coils. The decision has been made to expand the business time by investing in a 3rd MR scanner. The decision has an effect on the total process, therefore the effects of this decision are explained too. Conclusions & Recommendations Our analysis of the proposed interventions showed that update of the protocols in combination with acquiring more and accurate performance data appeared to be the most feasible opportunity. This must be the first step to improve the current process and serves as a basis for further improvements. This intervention makes bottlenecks visible, shows areas for improvement and makes it able to adapt the planning schedule to real-time demand. It is expected on basis of experiences of the radiologists that patient numbers can increase with 10% if this intervention is put through. The insertion of intravenous access lines in a preparation room appeared to be a good next step. The current operational procedures with 2 technicians per MR facilitates this intervention. Examples in practice (by Elkhuizen, van Sambeek, Hans, Krabbendam & Bakker, 2007) show that up to 5 minutes per contrast inquiry can be saved. With over 2.000 contrast inquiries a year the extra created capacity is enough to treat 250 patients extra a year. Expansion of the business time could be feasible but the profit (in patient type/number) depends highly on the chosen operational procedures. Two technicians per MR during the extra business time allows to perform contrast inquiries where one technician per MR allows only standard non contrast inquiries to be performed. A precondition for success of this intervention is a thorough FTE analysis of the number of MR technicians available. This should avoid that the work pressure becomes to high for the technicians. The dockable table intervention does not appear to be a feasible opportunity to improve the process. The tables are big and heavy and thus difficult to work with, while technicians expect that the service delivered to the patients would decline by the new operational procedures. However, the MammoTrak table improves the quality of mamma inquiries and makes it possible to shorten the appointment time for mamma inquiries and biopsy procedures
Item Type:Essay (Master)
Medisch Spectrum Twente
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Business Administration MSc (60644)
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