Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping

Sampalli, Tara; Desy, Michel; Dhir, Minakshi; Edwards, Lynn; Dickson, Robert; Blackmore, Gail

doi:10.15171/ijhpm.2015.76

Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping

Document Type : Original Article

Authors

Tara Sampalli ¹^{, 2}^{, 3}

Michel Desy ⁴

Minakshi Dhir ¹^{, 3}

Lynn Edwards ³

Robert Dickson ¹

Gail Blackmore ⁴

¹ Integrated Chronic Care Service, Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada

² Dalhousie University, Halifax, NS, Canada

³ Primary Health Care, Nova Scotia Health Authority, Halifax, NS, Canada

⁴ Performance Excellence, Nova Scotia Health Authority, Halifax, NS, Canada

10.15171/ijhpm.2015.76

Abstract

Background
Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely – an adaptation of Value Stream Mapping (VSM) to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding.

Methods
Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care. Patient centric views were obtained through surveys such as Patient Assessment of Chronic Illness Care (PACIC) and process engineering based questions. In addition, LEAN methodology, VSM was added to identify non-value added processes contributing to wait times.

Results
The care team successfully reduced wait times to 2 months in 2014 with no wait times for care anticipated in 2015. Increased patient engagement and satisfaction are also outcomes of this innovative initiative. In addition, successful transformations and implementation have resulted in resource efficiencies without increase in costs. Patients have shown significant improvements in functional health following Integrated Chronic Care Service (ICCS) intervention. The methodology will be applied to other chronic disease management areas in Capital Health and the province.

Conclusion
Wait times to care in the management of multimoribidities and other complex conditions can add a significant burden not only on the affected individuals but also on the healthcare system. In this study, a novel and modified LEAN methodology has been applied to embed the voice of the patient in care delivery processes and to reduce wait times to care in the management of complex chronic conditions.

Highlights

Commentary Published on this Paper

Can a Healthcare “Lean Sweep” Deliver on What Matters to Patients?; Comment on “Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping”

Abstract | PDF

Watch the Video Summary here.

Keywords

Wait Times

Multimorbidities

Lean Methodologies

Patient Experience

Subjects

Healthcare Quality

1. Tinetti ME, Fried TR, Boyd CM. Designing health care for the most common chronic condition – multimorbidity. JAMA 2012; 307: 2493-4. doi: 10.1001/jama.2012.5265
2. Canadian Institute for Health Information. All-Cause Readmission to Acute Care and Return to the Emergency Department. Ottawa, Ont., Canada; 2012. [updated 2012 June 14; cited 2014 Nov 18]. Available from: https://secure.cihi.ca/free_products/Readmission_to_acutecare_en.pdf
3. Fortin M, Bravo G, Hudon C, Vanasse A, Lapointe L. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med 2005; 3: 223-8. doi: 10.1370/afm.272
4. Glynn LG, Valderas JM, Healy P, Burke E, Newell J, Gillespie P, et al. The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. J Fam Pract 2011; 28: 516-23. doi: 10.1093/fampra/cmr013
5. Capital Health. Primary Health Care. Annual Report on multimorbidities and chronic conditions. Annual Report; 2012. [updated 2012 Oct 1; cited 2014 Nov 24]. Available from: http://www.cdha.nshealth.ca/primary-health-care/documents
6. 6. Statistics Canada. Canadian Community Health Survey, Cycle 3.1.[ Public Use Microdata File (PUMF) User Guide]; 2005 Statistics Canada, Ottawa, Ont., Canada. [updated 2006 June; cited 2014 Nov 1]. Available from: http://www23.statcan.gc.ca/imdb-bmdi/pub/document/3226_D7_T9_V3-eng.pdf
7. Statistics Canada. CANSIM Table 326-0021 – Consumer price index (CPI) - health care costs, 2005 basket, annual; 2009b Statistics Canada, Ottawa, Ont., Canada. [updated 2009; cited 2014 Nov 1]. Available from: http://www.statcan.gc.ca/pub/11-621-m/11-621-m2010084-eng.pdf
8. Statistics Canada. CANSIM Table 051-001: Estimates of population, by age group and sex for July 1, Canada, provinces and territories, annual (persons); 2012 Statistics Canada Ottawa, Ont., Canada. [updated 2014 Sept 26; cited 2014 Nov 1]. Available from: http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/demo31a-eng.htm
9. Capital Health. The Promise of Primary Health Care: The Community Master Plan Working Document. Capital Health; 2010. [updated 2012 Aug 29; cited 2014 Nov 12]. Available from: http://www.cdha.nshealth.ca/primary-health-care/community-master-plan
10. Sampalli T, Edwards L, Christian E, Dhir M, et al. A patient-centered redesign framework to support system-level process changes for multimorbidities and chronic conditions. Healthcare Q (In Review) 2014.
11. Sampalli T, Christian E, Edwards LA. A corridor’ approach to support system-level transformations for chronic conditions.Healthcare Q (In Review) 2014.
12. Trebble TM, Hansi N, Hydes T, Smith MA, Baker M. Process mapping the patient journey: an introduction. BMJ 2010; 341: c4078. doi: 10.1136/bmp.c4078
13. Trebble TM, Hydes T. Redesigning services around patients and their doctors: the continuous relevance of lean thinking transformation. Clin Med 2011; 11: 308-10.doi: 10.7861/clinmedicine.11-4-308
14. Eller AJ. Rapid assessment and disposition: applying LEAN in the emergency department. J Healthc Qual 2009; 31: 17-22. doi: 10.1111/j.1945-1474.2009.00026.x
15. Barr VJ, Robinson S, Marin-Link B, Underhill L, Dotts A, Ravensdale D, et al. The expanded chronic care model: An integration of concepts and strategies from population health promotion and the chronic care model. Hosp Q 2003; 7: 73-82.
16. Chen JC, Cox RA. Value stream management for lean office: a case study. American Journal of Industrial and Business Management 2012; 2: 17-29.
17. Bushell S, Shelest B. Discovering lean thinking at progressive healthcare. The Journal for Quality and Participation 2002; 25: 20-5.
18. Lummus RR, Vokurka J, Rodeghiero B. Improving quality through Value Stream Mapping: a case study of a physician’s clinic. Total Quality Management 2006; 17: 1063-75. doi:10.1080/14783360600748091
19. Sampalli T, Fox RA, Dickson R, Fox J. Proposed model of integrated care to improve health outcomes for individuals with multimorbidities. Patient Prefer Adherence 2012; 6: 757-64. doi: 10.2147/ppa.S35201
20. Fox RA, Joffres MR, Sampalli T, Casey J. The impact of a multidisciplinary, holistic approach to management of patients diagnosed with Multiple Chemical Sensitivity on healthcare utilization costs: An observational study. J Altern Complement Med 2007; 13: 223-30. doi: 10.1089/acm.2006.60
21. Glasgow RE, Wagner E, Schaefer J, Mahoney L, Reid R, Greene S. Development and validation of the Patient Assessment of Chronic Illness Care (PACIC). Med Care 2005; 43: 436-44.
22. Rosenbach M, Kagan S, Leventhal S. Dermatology urgent care clinic: A survey of referring physician satisfaction. J Am Acad Dermatol 2013; 69: 1067-9. doi: 10.1016/j.jaad.2013.08.018
23. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77-101.
24. Bayliss E, Edwards A, Steiner J, Main D. Processes of care desired by elderly patients with multimorbidities. Fam Pract 2008; 25: 287-93. doi: 10.1093/fampra/cmn040