Help to improve efficiency and production in the gastroenterology unit.
Because of organizational and staff changes, the gastroenterology unit of a medium-sized hospital was in dire straits: a negative report from the Health Care Inspectorate and financial loss.
Therefore, our challenge from the board of directors was as follows: ‘Develop and implement improvements in planning, staff rotas, capacity management, and collaboration to achieve a significant increase in efficiency and productivity in the endoscopy unit to get production back on budget.’
The endoscopy unit is not an island unto itself; it’s part of the entire patient journey in a hospital. This is why we started to describe this patient journey: tracking the process from polyclinic via the endoscopy unit to admission to the clinic. This provided a number of findings. There was no production-based direction, no clarity on capacity or staff deployment, and no coordination among the different units.
Medical specialists did not feel particularly responsible for the primary process, and there was an us/them culture brewing between doctors and nurses, and between endoscopy and other units. Enthusiasm and communications were down, absence due to sickness was up, and the quality of care and production was under pressure.
The unit, management, and board all had a tall order: increase productivity in the endoscopy unit by 15 per cent for the long term. Such a sustained increase in productivity takes more than a boost in efficiency. Above all, it calls for a culture of enthusiasm with pleasure, team spirit, and real togetherness among units. For each professional, this translates into their intrinsic motivation for quantitative and qualitative excellence.
The insights gained from the patient journey were real eye-openers for all staff. And that stimulated their creativity. Finding the enthusiasm to work more efficiently and flexibly – and to boost teamwork with internal suppliers – became second nature. It was this enthusiasm which enabled us to optimize the endoscopy process. Specifically, this also means that the pre-endoscopy visits have been improved by using a specially developed electronic survey. This is now discussed by gastroenterology nurses with patients to improve communications in both directions. The planning was also tightened up, and some employees have become skilled for multiple jobs, such as at the polyclinic and in the endoscopy unit. We also lengthened the polyclinic planning horizon in combination with these improvements to achieve a reduction in the number of changes and telephone cancellations.
In addition, the nurses took over part of the tasks of the specialists as a consequence of this project. The time freed up as a result was used by the medical specialists on new patients (read: more endoscopy patients) and to do more for the clinic (faster discharge procedures).
Finally, we updated the nursing and medical procedures to tackle the growth in production. These cover areas such as time slots, release data, communications, and registration.
We introduced a new staff rota programme, based on the principles of integral capacity management. This is a proactive way of generating staff rotas, matching available capacity to current demand. Part of this new procedure is a weekly planning and performance meeting in each unit where a specialist and unit head assess the prior week’s performance and make any necessary adjustments. For example, if the waiting list for patients is too long, they can decide at the meeting to schedule extra polyclinic days or pre-endoscopy days instead of endoscopy days.
Medical specialists and unit heads can now take direct responsibility for planning and production. This was made possible by first improving the required management information (production data, waiting lists, and available capacity) so that they could manage programme utilization. We also identified the common elements of the patient journey. Next, we worked with the specialists and unit heads to develop new, simpler dashboards so they could keep better track of their performance.
In addition, we set up a Staff Rota and Planning Performance Committee where all heads and medical specialists from the performance meetings come together to improve performance throughout the gastroenterology unit via a planning and staff rota tool. This formal structure enables participants to experience joint quantitative and qualitative responsibility for the primary process and to respond effectively to changes in production or capacity based on shared aims and principles. This ensures overall balance between production, waiting list, and capacity.
In assessing performance, overall responsibility and decision-making for the gastroenterology patient journey is taken by the centre manager and gastroenterologist/medical manager. Together, they use a specific dashboard (qualitative and quantitative data) to ensure capacity, production, and communications with a view to optimal coordination between medical and managerial topics at tactical level.
We achieved the hard objective: production rose by 20 per cent in the first three months of our activities. This is down to the new way of planning and management. Turnaround time, for instance, dropped from 22 minutes to 6 minutes and 20 seconds. And gross endoscopy times declined because of better work coordination among staff. This helped to reduce the waiting time for patients and boost productivity.
In addition, the atmosphere and culture have been further professionalized: respect for the interests of the patient, teamwork, and the correction of non-professional conduct have become commonplace. As a result, patient hospitality and accessibility to the hospital and the specialists have improved. That, in turn, has reduced waiting and admission times.
