QI Assignment 1: Complete a Value Stream Map
Read Chapter 3 in Delisle carefully “Principle 2: Map the Value Stream”. I note specific pages from these readings in the instructions below to assist you with each section of this assignment.
In this assignment complete the following steps:
Identify a healthcare process. See the example in :”Chapter 3 Principle 2: Map the Value Stream” (see attachment in Week 3). The process can include a patient, such as the example of a patient visit for a PCP exam. Or, it may include a process that does not involve a patient, such as a process for completing lab work. Ideally, you will select a process that you can observe in your current place of employment. If you are not employed, think of a past job you had and an example of a process in that setting.
If you have no experience working in healthcare, then you can use the fictional case study “Case Study with data for Assignment 1: Value Stream Map for Dr. Lynn’s clinic” below. This case study is based on the example of a patient who makes a visit for a PCP exam and then is referred to a Behavioral Health Consultant (BHC) for a “warm handoff” (meaning the physician walks the patient to the BHC in a clinic exam room, introduces patient to the BHC, and leaves the patient with the BHC for an evaluation).
Case Study with data for Assignment 1: Value Stream Map for Dr. Lynn’s clinic
Instructions: Read this case study carefully. All of the data needed to complete the value-stream map formulas are included in the case study. Your job is to create a value stream map of the current state based on this case study.
We met Dr. Lynn last weekJ. She works in a busy urban primary care clinic staffed by an administrative assistant, a scheduler, four PCP’s, two nurses, a physician assistant (PA), a medical assistant (MA) and a nutritionist. Dr. Lynn has decided to create a value stream map for process of a patient visit to the PCP, including a warm handoff to the BHC (Dr. Lynn).
Dr. Lynn consulted with all of the staff and identified a basic process map of each step from the time a typical patient first walks in the clinic door until the time the patient walks out of the clinic. Dr. Lynn completed a walk of the process from start to finish to complete the value stream map. All of the times below are based on averages provided by the staff. The times for each process step includes the estimated initial First Pass Yield (PPY) percentage in parenthesis. Dr. Lynn determined the FPY for each process step based on feedback from the team member who is most expert on that step (e.g., administrative assistant for check in, PCP for PCP interview, etc.).
All patients complete the My Own Health Report (MOHR) as part of their annual physical exam. If one is not on record the administrative assistant will instruct the patient to complete it in the waiting room after check-in using an office tablet. The physician reviews the MOHR during the patient annual physical exam, but usually not during other visits. Dr. Lynn reviews the MOHR for each new patient. Dr. Lynn will also have the patient complete the full PHQ-9 and GAD-7 if the PHQ-4 that is part of the MOHR is positive. She does this in the session with the patient using a tablet for automatic scoring and feedback. Dr. Lynn may use other rating scales or patient education, self-monitoring or other forms based on the presenting problem and treatment approach. The clinic has an Electronic Health Record (EHR) system and all staff enter notes and data for all encounters.
From the time the patient enters the office and approaches the nurses station it is one minute. The check-in with the receptionist takes 4 minutes (FPY: 97%). The patient then waits in the waiting room for 14 minutes. Then the patient is called in to compete vitals with the PA, that takes 5 minutes (FPY: 95%). The patient returns to the waiting room and waits an average of 12 minutes. Then the patient is called into the examination room for the nurse interview. The nurse interview takes 4 minutes (FPY: 90%). Then the patient waits in the examination room for an average of 17 minutes until the PCP arrives for the PCP examination. The PCP examination takes 12 minutes (FPY: 90%). The PCP then walked the patient to Dr. Lynn’s examination room and introduced the patient to Dr. Lynn. This takes 2 minutes. Dr. Lynn then completes the BHC interview that takes an average of 20 minutes (FPY: 85%). Upon completion of the BHC interview the patient returns to the nursing station to check out. Then the patient leaves the office. The clinic is relatively small, so the average time to walk from waiting room to any exam room is one minute.
Dr. Lynn made several observations during her consultation with the staff and during the process walk. First, Dr. Lynn identified the following high-level process steps: