09-Jun-2018

When the scope defined by this client was only as ‘Deliver Business Value’

A fast-developing specialist hospital that I consulted recently was receiving far too many complaints such as patients needing to wait for long hours to visit the doctor, doctors unable to keep up with appointments due large number of walk in patients, shortage of parking space, shortage of seats in waiting areas, long queues at all counters – registration, to see doctor, tests, pharmacy and even at payment counter and the doctors complain of long wait to get operation theatre, specialist equipment for tests to mention a few. Best reputed super specialist doctors of this hospital spent a significant amount of their time listening to the grievances concerning hospital services. Despite employing some of the best doctors, hospital did not enjoy a good reputation. The board proposed adding capacity by leasing additional buildings and equipment. However, the dynamic CEO convinced the board for professional intervention to fine tune processes and upgrade use of technology to resolve the issues. This client with a vision to be best in the breed and increase patients, doctors and staff’s satisfaction defined our scope as (at high level) 1. Reduce average total time spent for first time walk-in patients from 4.30 hours to 2 hours ( from walk-in to walk out) 2. Set up an effective appointment management system 3. Ensure smooth flow of patients from entry to exit, that includes parking, registering, appointment, specialist checkup (if any), Pharmacy, payment and follow up 4. Ensure systems support compliances (HL7, ICD, CPT, NABH) 5. Ensure optimal utilization of resources, including operation theatres, specialist equipment and other facilities Client left the decision of selection of technology to and definition of next level of scope on us. Our intervention started with building a ‘value case’. As in most organizations, the value perceptions were different for different stakeholders within the organization. The doctors were more concerned with correct diagnosis, availability of equipment/tests on a short notice and easy access to information whereas the CEO was focussed on the bigger picture of improving experience of patients, doctors and staff and optimal use of resources. Our goal was to provide value to the organization using a value realization framework that we commonly use as shown in fig 1. Fig 1 – Value Realization Cycle A value case considers both financial and non-financial parameters making it easier to get stakeholders’ consensus on the value and provides a more persuasive and defendable justification for the program. A value case is unique in its multi-stakeholder and multi-value approach whereas the business case is an important financial level understanding. The value enablers, levers, measurement process, time span, expectations on quantities as well as intangible benefits and dependencies, measurement process, ownership are specified in the benefits/’value management plan, which is one of the key deliverables of a value case. (details of value case and approach can be accessed from my book ‘https://www.amazon.com/Transform-Thrive-step-step-organizational/dp/1973187639. The value was tracked throughout the program. Value tracking ensures that while addressing scope, cost and schedule requirements, the planned value delivery takes precedence and is not missed out. We were measured on the value delivered. We achieved more than 90% of envisaged value, after 2 months of going live. The fine tuning is still on. 1. More than 60% of the walk-in patients are leaving within 2 h. However, average time still is close to 2.30 h. 2. Online appointment, registration through kiosks and assisted registration thru hand held devices have significantly reduced the waiting period. 3. Hospital timings (except for emergencies) are changed to 8 AM to 8 PM from 9AM to 5 PM. The change in timing, faster turnaround, appointments spread over to the morning and evening hours (less preferred by walk in patients) and availability of other equipment and resources for longer hours have solved the issues of longer queues, parking, seating capacity without any intervention. 4. Pharmacy has increased revenue recognition. The utilization of OTs and other test equipment is increased by 18 to 20% 5. A few resources were redeployed, for example corporate relations dept. was found with surplus resources, a few of them got redeployed in ‘assisted registration’ which is a new function. 6. The earlier plan to lease additional buildings is held in abeyance. We did face some conflicts while implementing Patient Management System, where doctors (at times) resisted to our suggestions. Such resistances are often experienced while implementing change. As professional project management consultants at Project Management CoE, we deal with such situations on regular basis and are well equipped to effectively handle them. Being a partnership company, this client was not open to discuss financial details and measurements. However, the financial gains were obvious with increase in spending on corporate social responsibility, increase in spending on R&D projects, hiring of additional doctors etc. We are now setting up HR service centre.