April 7, 2006
Volume 17, No. 7
Download a PDF of this issue
Judy Herstine took a blank sheet of paper and demonstrated how to draw a “spaghetti diagram.”
Carefully, the administrator for Women’s Cancer Services outlined the step-by-step process taken by staff to complete the registration process for a screening mammogram and prepare the patient for the procedure at a Magee Womancare Center site.
In a few minutes, the paper did resemble a drawing of a plate of pasta. Ms. Herstine drew a series of lines to show how the staff member walked to and from the registration area, a file area where necessary forms were stored, the dressing room, and finally another room housing mammography equipment.
“The completion of the spaghetti diagram demonstrated that there were inefficiencies in workflow processes,” says Ms. Herstine. “We knew that if we could eliminate these inefficiencies in our processes, we could ultimately impact the time patients spend waiting for this important screening.”
Driving toward quality improvements
Diagrams such as the one drawn by Ms. Herstine are process improvement tools in the Toyota Production System (TPS). The Japanese vehicle maker developed TPS to streamline operations, eliminate inefficiencies, and ensure quality in all aspects of production.
“Although the system was developed to produce cars, components of TPS can be used in health care to optimize the levels of service we provide to our patients,” says Ms. Herstine.
Magee used elements of TPS to reduce wait times for screening mammography, a service offered at six Womancare Centers. The quality improvement initiative defined wait time as the amount of time between the patient’s arrival in the office and the procedure.
Approximately 52,000 patients a year undergo screening mammography at Magee’s Womancare Centers. Appointment time expectation is 40 minutes (20 minutes before the procedure and 20 minutes for the exam).
The Womancare Center–South Hills in Bethel Park, one of Magee’s busiest sites for screening mammography, was chosen as the pilot location for the initiative.
After the responsibilities of schedulers, receptionists, registration personnel, technologists, and other staff were identified, Dianne Wibner, coordinator, Breast Imaging Services, visited the site to observe workflow processes and completed the spaghetti diagrams.
“We learned a great deal from these observations,” says Ms. Herstine. “Workflow processes can be disrupted if receptionists have to go to another part of the office to find a form. En route, the receptionist may be interrupted by co-workers with other questions or requests, which extends the wait time for the patient the receptionist is trying to serve.”
Reducing wait times with practical changes
Common-sense approaches, such as placing forms and supplies within easy access to receptionists and staff, can improve wait times. Other reductions to wait time have been made through the introduction of technology coupled with the reassignment of work tasks.
“Previously, patients filled out paperwork asking them questions about their history of using hormonal therapy, family history of cancer, and past experiences with breast procedures,” says Ms. Herstine.
As part of the wait time initiative, technologists began using computers placed in examination rooms. The UPMC eRecord application Imagecast was then used by the technologist to ask the patient questions about her medical history and log those answers directly into the electronic health record system. Before the installation of Imagecast, the baseline average for wait time for a screening mammogram was 21 minutes. After installation, the average wait time for all six sites improved to 15 minutes.
Ms. Herstine noted that the wait time initiative now will focus on such issues as how staff schedules impact wait times and encouraging patients to preregister for their screening mammograms.