Introduction Most hospitals experience the affects of the unexpected, ambiguity and uncertainty, and as a result, face challenges with quality. Middletown Hospital is a 200-bed general not-for-profit hospital. The hospital has a 20-bed Emergency Department (ED). It averages 100 patients per day. The CEO of the hospital has been receiving numerous complaints about long waits for care and poor service and has charged the Six Sigma team to analyze the root cause of the bottleneck (University of Phoenix, 2011 Course Syllabus).

This paper analyses the root cause of Middletown Hospital’s emergency room bottleneck dilemma, and provide recommendations for improvement. Purpose of the process improvement proposal The purpose of this proposal is to capture a granular understanding of the problem in the Emergency Department and devise a plan to capture and maintain an efficient operation.

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This will be accomplished by gaining an understanding of the patient demand and determining if the source of the problem is due to insufficient capacity or if it is tied to a person, role, or any other obstacles within the department.

Process Improvement Method Using the Six Sigma process improvement method, several steps will identify the bottleneck to improve one aspect of the current process performance. The Six Sigma process is a system of defining, measuring, analyzing, improving, and controlling (DMAIC) a process for an existing process that fall below specifications and looking for incremental improvements (Swinton, 2006). The process will clearly define the problem in the following manner: • Define the real problem and its impact on quality.

• Use a root cause analysis, to accurately quantify the current reality of the problem using process mapping, • Dig deep into analyzing non value added steps in the current processes • Implement a solution that will identify early-on if the solution is defective and • Control the process by providing tools for staff to address the issues as they arise in a more timely fashion. By using these steps, the Six Sigma team will be able to make the connection of why the influx in admissions during the evening hours has such an impact on the quality of service rendered.

Data Collection Because capacity planning requires analysis of both demand and resources, data collection will establish both capacity and demand in the Emergency Department (ED), but also ancillary departments. The team will use forecasting to identify the current and future demands related to patient volume. The univariate method forecasts demand by examining the historical data in one variable like number of patients (Langabeer, 2008). Data related to patient volume could easily be collected from the registration database.

This data provides a current picture of the patient volumes coming into the emergency department and how it relates to the time of day or day of the week. Staffing resources will also be assessed using scheduling data not only from the ED, but also from the ancillary departments. Displaying this data can provide the team with a comprehensive picture of the variations in staffing that may affect patient flow. Equipment inventory in the laboratory and radiology department will provide useful data with analysis of each device’s effective capacity.

Knowledge of the effective capacity is a step to determine how much demand can be accommodated by the capital resources in the hospital. Bottleneck Analysis Methods According to Langabeer (2008), a bottleneck occurs at the point where demand exceeds capacity. Capacity planning in de-bottlenecking an emergency department puts the focuses on patient flow and constraints (Rechel, Wright, Barlow, & McKee, 2010). Administration believes that a bottleneck exists because of an increase in patient complaints and documented volume peaks during the evening.

However, a bottleneck can occur at any point in the patient flow process from registration, treatment, or at discharge (Langabeer, 2008). Using time-motion studies will give the team a complete assessment of the patient flow from registration to dismissal from the emergency room. Time-motion studies will involve a step-by-step measurement of the length of time the patient spends in each phase of the process. Examining the cycle times over several days can identify the time bottlenecks are occurring in the patient flow process and at what stage.

The goal of capacity planning is to ensure that patients move along the shortest and least costly path by avoiding as many delays as possible (Rechel, Wright, Barlow, & McKee, 2010). Using capacity planning will systematically guide the team through analysis of the demand and availability of resources. Scheduling and controlling techniques With the six sigma authority in place, the first recommendation is to change the scheduling pattern of the shifts. By doing so they can put more doctors and nurses on the shift that falls from 6:00 to 9:00 p. m. where the overloading of patients comes into the emergency room.

When this is done, it will have adequate assistance to help with the high volume of patients coming into the emergency room during the 6:00 to 9:00 p. m. hours. If more doctors and nurses are on that shift, more patients will be seen and taken care of at a faster time and the turnaround rate will be more than suffice.

The second recommendation is to expand the emergency room, so it can hold more beds to accommodate the demands in the community. Therefore with the expansion of the emergency room, there will be more room and the availability to hold more beds for the patients who come in to be seen through the ER.

The expansion of the emergency room can be an asset to Middletown Hospital because they can accommodate more patients at any given time and more room and more beds can mean, more money, coming into Middletown Hospital.

Make recommendations on staffing or alternative sources of care. Six Sigma has come up with a couple of recommendations on staffing or alternative sources of care for Middletown Hospital ED. If an influx of 70 patients is seen from 6:00 to 9:00pm out of 100 patients the hospital averages a day, staffing appropriately at those peak times is a must.

Middletown Hospital must schedule their full time employees (FTE’s) as well as their part time (PRN) help during these peak hours for the emergency department. This starts with staffing check-in specialist to physicians to account for the high patient volumes during these peak hours.

Ideally, Middletown Hospital needs to increase the efficiency of their patient flow and their turnover rate. Reducing their FTE’s and PRN personnel during regular hours will justify management increasing staff for the 6:00 to 9:00pm hours. Management will need to collect and monitor data that shows possible improvements to outcomes and satisfaction rates.

If these rates are not reduced and patient volumes are still overwhelming for the hospital and staff, management may need to work out a plan with other area emergency departments. Another recommendation if finances allow is with the expansion of the ED as mentioned above in another section. Conclusion References Langabeer, J. R. (2008). Health Care Operations Management:

A Quantitative Approach to Business and Logistics. Sudbury, MA: Jones and Bartlett Publishers, Inc. Rechel, B. , Wright, S. , Barlow, J. , and McKee, M. (2010). Hospital Capacity Planning: from Measuring Stocks to Modeling Flows.

Bulletin of the World Health Organization, 88(8), 632-636. Retrieved from http://search. proquest. com. ezproxy. apollolibrary. com/docview/744483685? accountid=35812 HSC Alerts, Retrieved on March 5, 2011, from http://www. hschange. com/CONTENT/651/ Swinton, Lindsay, (2006).

Process Improvement Made Easy: The Six Sigma Process Improvement Method Explained. Retrieved March 5, 2011, from http://www. mftrou. com/six-sigma-process-improvement. html. Langabeer, J. R. (2008). Health Care Operations Management: A Quantitative Approach to Business and Logistics. Sudbury, MA: Jones and Bartlett Publishers, Inc.