Curing MRI: a study on MRI workflow to increase productivity after changing to a new location with new state of the art MRI equipment

Kooij, J.S. (2010) Curing MRI: a study on MRI workflow to increase productivity after changing to a new location with new state of the art MRI equipment.

Abstract:Introduction As a result of the changes in the entire health care system, hospitals are working towards becoming more efficient as well as more effective. This focus provides opportunities for the health care industry. At the end of 2009, Siemens Healthcare and the Jeroen Bosch hospital (JBZ) came to an agreement for a partnership for the delivery and maintenance of medical imaging systems for the JBZ. The planned changes of the JBZ towards a new hospital building and the use of new medical imaging systems provide the opportunity to redesign the workflow. This research focuses on the MRI service. Problem description In April 2011, the MRI service of the JBZ should be treating its first patients on the new location with the new MRI systems. The planned changes have influence on the workflow, throughput, quality of diagnosis, job satisfaction, and demand for the MRI service. These influences cause uncertainty for all MRI stakeholders. In addition to the uncertainty resulting from the planned changes, the MRI service has an access time of four weeks, yearly production targets have not been met and the MRI service acts as a bottleneck in the entire care process. The goal of this research is to analyze the change of medical imaging systems and the change to a new location of the JBZ in order to improve the MRI service. The analysis should result in recommendations for both the JBZ and Siemens. Approach This research uses an Operations Management approach to analyze the current situation, find alternative solutions and redesign the MRI workflow of the JBZ. Since the JBZ has to be operational on the new location with the MRI systems within nine months, change management literature is used to improve adoption. The current situation is analyzed using quantitative and qualitative data and results in the identification of areas for improvement (1). These areas for improvement are the main subjects in a benchmark between four Dutch, non-academic hospitals. The benchmark is used to interpret the results from the analysis of the current situation and identify best-practice. In addition to the benchmark, we have used manufacturing improvement theories as Lean and Theory of Constraints to create a list of possible improvement interventions (2). To redesign the workflow for the new situation, we have combined both (1) and (2). We have organized presentations, involved and informed MRI actors to improve adoption of workflow interventions. Results The MRI service in the current situation has an average lead time of four weeks, while the average value adding time is 45 minutes. The JBZ offers the MRI service on two locations using three MRI systems with different user interfaces. In 2009, 13202 MRI examinations have been performed. Due to a lack of data, actual scanning times are unknown. The current organization of the MRI service results in heavy administrative workload and delay occurs when different actors have to be involved. Only 79% of the total capacity is used and 19% of capacity is planned for inpatients. Planning inpatient blocks is known in literature as carve out and has negative effects on the access times. There are no clear operational goals to guide decision making and the cooperation between radiographers and radiologists is inhibited because of large boundaries between these two professional groups. The benchmark showed many factors influencing performance and that performance is a trade-off between three objectives; productivity, quality of care, and quality of labor. Data shows that JBZ performs on an average level, but questions can be asked about the comparability of the four hospitals in the benchmark. The best performing hospital in the benchmark uses a digital request form, does not screen request forms before scheduling, prepares the patient outside the MRI room, and uses G2 speech recognition with self correction. The benchmark also showed the option to allocate capacity towards departments to lower administrative workload and interruptions and set a maximum on department’s MRI requests. The application of the lean concept resulted in the identification of different sources of waste, options to increase flow and increase customer focus using a due date for every MRI request. These improvements have been used to create a Curing MRI MSc graduation thesis JS Kooij 5 Future State Value Stream Map. The application of the ToC concept provides options to eliminate the MRI service as the bottleneck in the entire care process. On the new location the request form should directly result in an appointment for the patient. Patient preparation should be done outside the MRI room. During the examination, radiographers should be able to make all the decisions concerning additional sequences. The result of the MRI examination should be processed into a report on the same day. Planning should result in the availability of patients in the waiting room at all times and inpatient blocks should be eliminated. After all actors have adopted the new workflow and MRI systems in their routines, less staff could be used due to a shared control room. New MRI systems improve performance on productivity, quality of care, and quality of labor. The creation of a common goal, team culture and cooperative attitude should have high priority. The use of due dates and multi disciplinary teams are useful solutions. Conclusions The MRI service will be improved on the new location since the concentration of all the facilities on one location eliminates some of the current restrictions and also the state of the art technology of the new MRI systems improves productivity as well as quality. However, our analysis showed important inefficiencies in the MRI organization which provides opportunities to improve the performance of the MRI service even more. The success of the change towards the new location and the implementation of the advised improvements will be greatly influenced by the involvement, insight and acceptance from stakeholders. The creation of a common goal, team culture and cooperative attitude should have high priority. Recommendations JBZ Management We recommend changing the workflow as given in the future state value stream map. New information systems (EMR, RIS) should have priority to enable complete digital workflow and establishing a team culture to improve adoption. Planning should be focused on flexibility of using a central waiting room to adapt on variability. Data collection should be improved to continuously monitor performance. Performance data should be made transparent to all actors in radiology to enable continuous improvements by radiology actors. Our last recommendation is to communicate problems, wishes and ideas with Siemens to attain joint value creation. Recommendations for Siemens Healthcare This research has provided insight in how customers manage their services. An important conclusion we can derive from this project is that when using workflow improvement (opportunities) as a key selling point, additional advice on how to design their service can be a valuable addition. The benchmark has showed that many radiology managers have interest in improving their service. Business partners should be able to advise customers on how to improve their workflow to fully benefit from the capabilities of the medical imaging systems. Another recommendation is to develop a preparation process for both radiographers and radiologists to inform, educate and prepare them for future use.
Item Type:Essay (Master)
Siemens Nederland N.V
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Industrial Engineering and Management MSc (60029)
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