1. Joseph Slaughterbeck III Program Analyst, CPHT, VA-CASE, VERC

2. Patient Transport Study AIMs & Objectives: –Shadowing –Voice of the Customer –Simulation Analysis: – Root Cause, observation, Voice of the customer Key Findings: –Observation, Implication & potential opportunity –Short term to Future term

3. Shadowing Objective 1: –Observe real interactions between patients and escorts. –See the first hand challenges patient escorts face throughout the day. – Analyze how patient escorts interact with their environment and tools.

4. Voice of the Customer Objective 2: –Gain a better understanding of current patient transporting system. –Understand challenges hospital staff currently face. –Discover possible opportunities for improvement.

5. Simulations Objective 3: Gain an understanding of the process through the patient’s eyes. Case 1: Isolation room to exam room Case 2: Multiple transfer Case 3: ER to observation room (transfer from cart to bed) Case 4: Change of plans (exam cancelled by doctor) Case 5: Bariatric wheelchair with equipment (IV, Oxygen tank) attached Case 6: Crowded hallway with a bedridden patient (slide-transfer from bed to cart) Case 7: Discharge

6. Analysis Root Cause Analysis, Prioritization Matrices, VOC, Observation Key Quotes & Observations:

7. Key Findings & Implications Key Perspectives: –Patient Perspective –System Perspective –Equipment Perspective Short Term Long Term

8. Patient Perspective Observation: Patients are left outside of testing rooms alone while waiting for the nurse to greet them, putting them in an awkward situation. Implication: Patient feels awkward waiting in non designated areas. Patient’s experience is fragmented 1.Have the patient escorts ask "Would you like me to wait with you until the nurse arrives?” 1.Provide something for the patient to do while waiting. Create more wheelchair and cart compatible waiting stations outside of testing rooms. Short Term Long Term

9. Patient Perspective Observation: Patients have a lot of questions and concerns while on their journey with Patient Escorts. Implication: The amount of information Patient Escorts can give is limited. Experience can be confusing and frightening Short Term Long Term 1.Use the time to mentally and emotionally prepare patient for the next step in their journey. 2.Have patient escorts be trained in general knowledge of destination. 3.Avoid hospital lingo while talking to the patient. Prepare a pamphlet or tablet with information on procedure and the providers the patient will meet.

10. Equipment Perspective Observation: Equipment is utilized on a by- need basis. Personal preference for particular equipment There is no way to update the location or condition of the equipment. Sign in/ out sheets around the equipment. Tracking system for the different pieces of equipment. Short Term Long Term Implication: Transactions take longer as the escort must find and assemble equipment. Equipment is utilized even when unnecessary Little Feedback about the use of particular equipment; therefore harder to account for wear and tear.

11. Implication: Excessive wasted motion and additional wear incurred upon equipment. returning to dispatch. Missed opportunity to complete a series of jobs located in proximity. Equipment Perspective Observation: Escorts are frequently returning equipment to an arbitrary location regardless of where the next job is located. Short Term Long Term Move the dispatcher to the same location as the escort waiting room. 1.Shift to a call-in based queue system. 2.Use smart phones to locate jobs in proximity. “Google maps layer” Adopt an “air traffic control” system to plot out optimal job sequencing and pathways.

12. Implication: Lack of communication between department compromise the efficiency of patient escort. System Perspective Observation: The communication of transport request between issuer and dispatcher lacks clarity at times. Transactions are not synced between the clinical departments and patient transport team during shift changes Short Term Long Term Establish unified format and time schedule for information update. One system is used throughout the whole hospital with different levels dedicated to each department. Include a transporter in a huddle, to brief them on patient situation.

13. Implication: Continuous information about current workload and upcoming jobs will enable escorts to be more adaptive to balance between efficiency and courteous service. System Perspective Observation: Escorts must either call in or physically report to dispatch; No automatic status update regarding the current workload. Short Term Long Term Utilize the functions (e.g. text message) of a cellphone to update workload status between escorts and dispatcher. Develop stand-alone electronic application for tracking and updating escorts.

14. Implications: The system is not encouraging the patient escort to improve interpersonal relationship with patient. System Perspective Observation Performance evaluation of a transporter is more quantitatively focused. Short Term Long Term Incentivize escorts to more fully engage the patient during transportation through reward system. Proactively gather patient’s vote to evaluate quality of transportation through digital application.

15. Summary/ Discussion Goals & Objectives: –Shadowing –Voice of the Customer –Simulation Analysis: – Root Cause Key Findings: –Observation and Implication Discussion

16. Acknowledgements Institute for Creative Integration (iCi) Aurora Health Care Clinical Partnerships in Healthcare Transformation, VA- Center for Applied Systems Engineering, U.S. Veterans Health Administration