Philips consultants helped the cardiology department at the Reinier de Graaf Hospital, Delft, Netherlands with this challenge: How can throughput be improved so that the department no longer has to freeze admissions to the Chest Pain Center (CPC)?
Results include:
* During office hours ** From January to September 2018. Several factors contributed to this reduction, including the initiatives described in this article. It is not possible to determine the percentage that each initiative contributed.
I am not such a fan of consultants. It’s an investment and doesn’t always produce results. But this team had great communication skills and helped us make the right choices. This is the first time I really have the impression that an improvement project will bring lasting results.”
Jolanda Versteegen, Interim Business Manager, Cardiology
Reinier de Graaf Hospital
Jolanda Versteegen is Manager of the Mother and Child Care Unit and has also been Interim Manager of the cardiology department since September 2018. “Just like many other hospitals, our cardiology department is facing a growing demand for care. We need to meet this demand within our existing budget and we have had to freeze admissions to the CPC more often. Management offered us the opportunity to use the consultancy hours from the hospital’s long-term strategic contract with Philips to tackle this issue.
Our approach
“The Philips consultants started in November 2018,” Jolanda recalls. “During the first few weeks, they observed the department’s processes and interviewed all our staff in depth about any bottlenecks and issues they experience. Every two weeks, they gave us feedback, and we used this to jointly formulate our research question.” Matthijs Bax is a Cardiologist and spends half of his time as Medical Manager of the cardiology department at Reinier de Graaf Hospital. He and Jolanda form the cardiology management team. “The Philips consultants took a very practical approach. They sat down with our staff and asked them, ‘What would be easiest to implement and what would have the biggest impact?’ Earlier discharge One idea we investigated was earlier discharge from the cardiology ward. It might be possible to achieve by restructuring the process for the ward rounds. “This idea was worked out using a real co-creation approach,” explains Versteegen, “in short sessions with big boards and sticky notes.” Bax says, “Everyone got involved—nursing staff, ward physicians, cardiologists, assistants—and had a chance to give their input, which was very valuable.” Using simulation models and calculations, the consultants presented a clear picture of the impact that changing the discharge process would have on the department.
Results
The changes were implemented. “Everything went very smoothly thanks to the Philips consultants, who supervised the whole process from within the department,” attests Versteegen. “We now have the first results: On average, patients go home an hour earlier. That may not sound like much, but it makes a big difference whether patients are discharged at half past three or ten to three. Half past three is when we change over from the day shift to the evening shift. Staffing levels are lower during the evening shift, so it’s far better for our throughput if we can discharge patients during the day shift.” Creating an emergency outpatient clinic Once staff saw how well this improvement worked in the clinic, it was time to address a major concern in the cardiology outpatient clinic. Just like many other outpatient clinics, Reinier de Graaf is dealing with longer waiting times. The solution was an emergency outpatient clinic for patients who need to be seen within a period of two days to two weeks. Via phone, general practitioners decide together with the cardiologists who needs to go to the emergency outpatient clinic. “Setting up the emergency outpatient clinic wasn’t a simple process,” Bax recalls, “but the help we received from the Philips consultants was fantastic. They were quickly able to provide us very sound advice based on actual data in clear and simple terms. This took a huge weight off our shoulders,” confirms Versteegen. The emergency outpatient clinic is up and running and working splendidly. Patients, schedulers and physicians are all extremely satisfied. This has also helped decrease the number of CPC freezes, because urgent patients who previously could only be seen in the CPC can now go to the emergency outpatient clinic instead.
Results from case studies are not predictive of results in other cases. Results in other cases may vary.
For almost eight centuries, the Reinier de Graaf Hospital has been providing outstanding care for the residents of the city of Delft and its surrounding area in the Netherlands. Of the hospital’s 2600 employees, 200 are medical specialists and 800 are nursing staff. The hospital has 481 beds. Together with the HagaZiekenhuis and the LangeLand Ziekenhuis, Reinier de Graaf is part of the Reinier Haga Groep.
