1. EXECUTIVE SUMMARY
Quinte MRI is BCMC service provider for MRI since February. Quite has been chosen to replace the existing service provider as BCMC wanted to increase the number of days available for MRI from two. BCMC were aware of Quinte impressive capabilities, such as 24 hrs per day and 7 days/week, and Haider’s integrity and personal attentiveness. MRI clinic operations in May and now is June and there are some issues. There is a backlog for the machine, the technician is working lots of works overtime, the doctors are getting their results late so they began to refer patients to competitors MRI. The identified root cause for all of these issues is that the process is not fed properly that’s why the capacity is low. By feeding the process we mean in this case the scheduling of the patients. The alternative proposed is to change the way the schedule of the patients is done now and some changes in the process. We might expect some resistance from the doctors as they will have to make sure that they don’t refer for MRI patients which do not fit. Also a scan an hour will be booked. After monitoring and control in two months will be decided if a part time technologist will be hired.
2. ISSUE IDENTIFICATION
Walk-ins patients. The expected lead time for referred patients is 48hrs but some patients called walk-ins requested scan that day. It is a significant number of walk-ins patients per year, 600, as the number of referred patients per year is 1600. If we consider these numbers: 250 operating days per year and 600 walk-ins, this means average 2.4 walk-ins per day. Patients not fit for MRI. If a technologist determined that the patient does not fit to MRI the patient is sent home and the machine is idle. This means an average 1.2 patients/day, it is a lot. Non-metal clothing. The patient is requested to wear non metal clothing to the scan to be performed. If not the patient has to change in hospital gown. 25% of the patients are in this category, this is a lot. Loss of patients referrals
As the waiting list for MRI scans is 14 days old the doctors refers patients for MRI to competition clinics Complains from hospital administrators about: MR machine low productivity, the strain resulting from MR technologist’s heavy overtime schedule, loss of patient referrals Late transcriptions report Doctors expected to receive transcriptions reports within two days of their request which didn’t happen so they started to refer the patients to some other MRI BCMC was dissatisfied because of the loss of referrals by Quinte MRI MR technologist and machine low productivity The machine was scheduled for one scan per hour but was not meeting this rate. MR technologist not willing to work too much overtime as he does now.
Process and capacity issues. There is a issue with the existing process which causes an issue for the capacity. These create the backlog which then create a bullwhip effect.
3. ENVIRONMENT AND ROOT CAUSE ANALYSIS
Strengths: is a growing business; it maintained a variety of exclusive or partnership business arrangements; its equipment and components were from many leading; manufacturers; impressive capabilities; Haider’s integrity and personal attentiveness; availability for 24hrs/day, 7days/week; the machine was new, only six weeks old Weaknesses: 1 one machine available with the capacity of two patients/hr; for 25 of the scans the scanning is 45min so less than two scans/hr; the hospital would pay the radilologist and schedule the clinic; only one technician which works too much overtime and he is willing to work less in the future Opportunities: MRI had become increasingly popular with the medical profession; the number of procedures grows a lot every ear; the number of scans grows a lot as well; the number of hospitals and non-hospitals scanning sites had risen as well a lot; BCMC has been located in a very good location with doctors, hospital beds, over 20 specialties,; there is room for competition; the forecast anticipates that MRI scans will grow with 15% yearly
Threads: MRI equipment represents a significant investment; the facility requires space and the equipment requires shielding from magnetic fields; there is a shortage of good MR technologists, especially in rural areas, not easy to find a person willing to work part time Root cause – looking at the issues and considering the environment, the identified root cause is that the process is not fed properly that’s why the capacity is low. By feeding the process we mean in this case the scheduling of the patients.
4. ALTERNATIVES AND OR OPTIONS
There is proposed the following alternative.
Alternative. In this alternative there are proposed some changes in the existing system as: the scheduling system to be computerized as this will eliminate the misreading caused by different hand writings; for eight hour shift to have scheduled eight patients as this will allow room for the technologist to send on time to the radiologist the scans faster so the radiologist will not complain and he will also send faster the results to the doctors. Scheduling only eight patients a day might lead to some extra time which can be used for walk-in patients as well; the doctor should never refer for MRI scanning a patient which is not physical able. In this way we will eliminate the idle times of the machine. When the doctor assistant contact for appointment they have to have this in writing-the patient is able for MRI; the patient has to come with 30 min before the appointment to fill out the forms and change in hospital gown. In this way we will eliminate the delay when the technologist finds out that the patient is not prepared and he has to wait till he changes his clothes. In two months if there are not the expected changes, we will try to hire a part time technologist and pay overtime to the existing one until we find one.
With part time shift we will cover 12 hours a day. In this way we will increase the number of scans in the future. The challenges that we will have with this alternative might be: convincing the BCMC to implement the computerized scheduled and follow our schedule suggestions or let our receptionist to do the schedule; the resistance from doctors as they will not have to refer the patients which are not fit for MRI; eight patients/day means 2000/year without overtime or walk-ins which is less than we do today 1600 refered+600walkins. We might not be able to scan average 10/day and this means less than we do now but still these will be happy patients, not waiting, not wrong schedule, radiologists and doctors happy; we still might need a part time person for the future so we will be able to grow and have vacation coverage.
The alternative above it is recommended to be implemented. This will involve changes in scheduling system and also in the scanning process.
What Who When
Doctors to refer fit patients only BCMC operation manager Immediate for long term New scheduling system Quinte MRI Operation Manager In two weeks Patients to arrive 30min early Quinte MRI Operation Manager Immediate Sending the patients to change room to put gown on and waiting there for the technolog. Receptionist immediate
7. MONITOR AND CONTROL
The Quinte MRI operation manager will analyze weekly the number of scans (referral scans and walk-in scans), the number of the patients which are sent home without scan and the reason, the number of wrong recordings in the schedule (scan A and B instead of A and D), how much idle time, how often the scans are sent to the technologists. At every two weeks a cross-functional team with the following members will analyze the weekly numbers that Quinte OPS manager has, the radiologist number of scans received, how often the doctors get their results and the number of days in backlog. Cross-functional team members: Quinte MRI ops manager, BCMC ops manager, BCMC information technology, David and Kevin buss development coordinators. Meeting after two months and deciding whether or not to hire a part time MRI technologist.