Module 1: Process Management and Productivity

Trident University International

JASMIN HARRIS-JOHNSON

OPM500 Operations Management for Managers

Module 1 Case

Dr. Loretta Jenkins

August 25, 2019

Module 1: Process Management and Productivity

“Case: Massachusetts General Hospital’s Pre-admission Testing Area (PATA)”

For this module, the discussions will concentrate on analyzing the Pre-Admission Testing

Area (PATA) process flow in Massachusetts General Hospital’s outpatient clinic. This process is

keen to outpatients who should be subject to pre-operative evaluations prior to proceeding with

the scheduled surgery. There had been several reported incidents of lags and vulnerabilities in

the system of Massachusetts General Hospital that immediately require certain developments in

order to improve the clinic’s service rating. According to McCarty, Levi and Gallien (2012), the

significance of enhancing PATA actually lies on the delineation of the substantial downstream

influence of the clinic towards the MGH operating rooms, as well s to the whole pre-operative

care system. Evaluations for this case will be employing significant information drawn from

internal resources and feedback from the clients.”

“PATA Process flow from the Patient's Perspective”

To be able to determine the kind of experience that customers had when they went

through the PATA system of the clinic, interviews were conducted. From the information, it was

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found that several customers had long waiting experience, to the extent that they were actually

longer than the consultation they had with the specialists. Such bad experienced influenced the

representation of the patients on the quality and efficiency of the services rendered by

Massachusetts General Hospital’s outpatient clinic. Meanwhile, the above-presented illustration

indicates the flow summary of the Pre-Admission Testing Area, as determined by the patients’

experiences.

Capacity and Service Rate in the Clinic”

The patient’s response to the interview mentioned that the amount of time they waited to

be accommodated is more than half of the time they spent for consultation with the nurse and the

physician. Aside from this, the patient also stressed that they had to wait for a couple of hours in

the waiting room prior to having someone assist them. Likewise, the patients mentioned that the

interviews performed on them, to be able to obtain their information are repetitive and redundant.

For instance, they were asked a certain question upon arriving at the clinic, only to encounter that

same question on the interview before consulting with the physician. On the other hand, it would

be possible to assess the service rate and the capacity rate of the clinic through resource analysis.

With that, it would be essential to carry out analysis on various critical resources of the clinic and

contrast those with the actual outpatient clients that are seeking for check-up and consultation in

the clinic.

The floorplan of the clinic indicates that the waiting room has 26 chairs, several EKG

beds, some computer stations, a nurse station and 12 examination rooms. McCarty, Levi, and

Gallien (2012) stated that the standard duration of appointment lasts for about two-and-a half

hours, while outpatients in PATA spends over four hours before being accommodated. The

information also includes the fact that the patient service rate of Massachusetts General Hospital

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outpatient PATA clinic is only at 65% since there are restrained financial and facility resources

inhibiting the expansion of the capacity of the clinic. The limited capacity, as per McCarty, Levi,

and Gallien (2012), implied that the hospital is prioritizing the intricate and fatal cases of

outpatients seeking for medical attention.

The typical daily patient schedule of the PATA clinic reaches 55 visitations. McCarty,

Levi, and Gallien (2012) discussed that the nursing director at PATA clinic delegates five nurses,

five laboratory technicians and eight anesthesiologists every day. Meanwhile, to assess the

utilization rate of the clinic and other circumstances therein, it would be ideal to employ a multi-

server queuing calculator.”

1. As per the report, an average of 8 patients are arriving at the PATA clinic every hour.

With 5 laboratory technicians on the clinic, every server is experiencing a 26.5%

utilization rate. This means that patients had to wait for 10 minutes before they will

be attended by the lab technicians. Having said that for every hour, 8 patients are

coming in and that for every hour, 6 patients are accommodated simultaneously, a

patient arrives every 7.5 minutes. The probability of having all servers busy is 1.3%,

while the probability of having at least one server idle is 98.7%.

2. Meanwhile, with the same arrival and service rate, but having 8 anesthesiologist as

servers, it turns out that the average service time of the servers is 10.02 minutes,

leading to a 16.7% utilization rate for every server.

By manipulating two different servers with different utilization rates, it may be noticed

that there should actually be no impediment on the services in the clinic, since servers may be

able to attend all patients arriving every hour. By conducting more evaluations with regards to

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the flow of processes in the clinic, it is likely to uncover more redundancies and ineffectiveness

of the activities therein, similar to what the patients have been claiming.

Task Force Diagnoses

Having mentioned some of the reported issues in the clinic, the OR Director and

DACCPM Executive Director stressed that is is highly essential to acknowledge and

immediately resolve the vulnerabilities in the systems in order to improve the quality of services

offered by the PATA clinic to the patients. McCarty, Levi, and Gallien (2012) stated that there

had been initial recommendations for the expansion of the clinic which failed to materialize due

to limited financial resources. To make up with this failure, the management established the

PATA Task Force which will be held responsible for the management of the issues in the clinic.

The PATA Task Force led the discovery of three main issues in the clinic including: (1)

inadequate time for scheduled appointments, (2) insufficient number of rooms, and (3) limited

number of attending physicians. All these issues have been causing the long waiting time

claimed by the patients. Nevertheless, from all those, it was the inadequacy in terms of room that

is most influential. Data of the PATA clinic indicates that the MGH Surgical Services only has

12 examination rooms and 16 specialists. This rate indicates that the number of examination

room is not proportional to the number of physicians in the pre-operative clinic. Additionally,

McCarty, Levi, and Gallien (2012) discussed that the nursing director at PATA clinic delegates

five nurses, five laboratory technicians and eight anesthesiologists every day. It was also

discussed by McCarty, Levi, and Gallien (2012) that other than the insufficient examination

rooms, the clinic should also improve in terms of the number of nurses and physicians or

otherwise limit the volume of patients.

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“Variability in PATA Process Flow and Necessary Control(s)”

Case reports mentioned that pre-operative patients are even spending a lot of time waiting

for them to talk to a nurse. A sample of the patient check list was also included in the report. This

document is composed of 6-page writing that should be filled out by all patients upon arriving at

the clinic. After accomplishing the check list, patients are then interviewed by the servers with

redundant questions that they already provided in the check list. Such process inflicts

redundancy, thereby wasting significant amount of time that could have diminished the waiting

time spent by patients. McCarty, Levi, and Gallien (2012) likewise mentioned that several other

elements have been leading to the irregularity of the nurses and the anesthesiologists on other

stages of the appointment. Moreover, the clinic has issues when it comes to organizing and

managing documents, answering phone queries and in transferring records from the frontline

down to the laboratory and the specialists.

1. The report mentioned that procuring and assessing the patient;s medical history takes

20 minutes prior to proceeding onto the subsequent step. McCarty, Levi, and Gallien

(2012) discussed that during those times, the patient had to merely wait until all

assessments and verification are accomplished.

2. The nurses are also conducting a patient chart assessment which they accomplish in

an average of 10 minutes. Other than this, they also carry out a post-exam

documentation which usually takes an average of 17 minutes. McCarty, Levi, and

Gallien (2012) further mentioned that patients are even subject to medical history and

physical exam interview protocol which consumes more time.

3. Meanwhile, after the assessments by the nurses, McCarty, Levi, and Gallien (2012)

claimed that the laboratory technicians will then acquire blood samples and other

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necessary samples from the patient which takes roughly 6 minutes on average for

every patient. After this, patients are instructed to wait some more for the following

steps to be done.

4. From doing assessments on the process, it turns out that nurses and medical doctors

spend a total of 21 minutes and 29 minutes attending to every patient respectively,

accumulating all necessary activities during the pre-exam, exam and post-chart

documentation processes.

Recommendations

This documentation intended to analyze the vulnerabilities of Massachusetts General

Hospital’s Pre-Admission Testing Area (PATA) clinic. From the evaluations conducted, it was

determined that the rate of service and capacity are not actually subject to impediments.

Nevertheless, the quality of service offered by the pre-operative clinic is influenced by other

resource issues. Meanwhile, data reports that were acquired by PATA Task Force indicated that

there is insufficiency on the examination rooms in the clinic, redundancy on the patient service

process and lengthiness of the waiting time spent by patients in the clinic. From there, two

suggestions were drawn for the clinic in order for them to diminish the waiting time of the

patients and enhance its internal processes. First, it was suggested to address the redundancy of

the interviews so as to lessen the patient waiting time. Since they are already conducting the

Patient Intake Form, specialists may already acquire information from this and skip the verbal

interview. Secondly, the clinic should be able to establish a credible and effective network

computer database that will lessen the time spent in recovering the documented data, history and

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information of patients which are important for laboratory technicians and anesthesiologists to

carry out the necessary procedures.

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Reference

McCarty, K., Levi, R. & Gallien, J. (2012, January 3). Massachusetts General Hospital's Pre-

admission Testing Area (PATA). MIT Sloan School of Management. Case: 11–116.

Retrieved from https://mitsloan.mit.edu/LearningEdge/operations-

management/PATA/Pages/default.aspx