Arnold Palmer Hospital Labor and Delivery Workflow Analysis
The Arnold Palmer Hospital (AHC) located in Orlando, Florida is considered one of the most efficient and patient-centric healthcare providers in the U.S. due to the customer satisfaction scores the facility receives and amount of patients the hospital sees on an annual basis. The AHC has been ranked fifth in patient satisfaction out of 5,000 hospitals and sees on average 1.5 million children and women annually. It is the fourth-busiest labor and delivery hospital in the U.S. And the largest neonatal intensive care unit in the entire Southeastern U.S. AHC has also put into place one of the most thorough and well-respected continuous improvement processes in the U.S. healthcare system. With the goal of 100% patient satisfaction, AHC has created an entire quality management and improvement organization which is now a critical part of its culture.
Of the myriad of processes that AHC relies on to operate daily, one of the more problematic is the Labor & Delivery Check-In. This process is made more challenging by the continually changing status of the patient and her imminent delivery of a baby. Healthcare processes need to be contextually relevant and have comparable time and value durations as patients in order to contribute to patient satisfaction (Ahsan, Shah, Kingston, 2010). The AHC labor and delivery check-in process is one that is very complex with ample room for patient dissatisfaction given the highly intricate nature of eight different decision points. With so much complexity there is the potential for confusion in the Labor and Delivery check-in process and frustration on the part of patients. Clearly this process needs significant improvement as the initial analysis of the workflow is shown in the first part of this analysis. Following the initial analysis of the Labor and Delivery check-in workflow, the complication of dealing with a Caesarean-section birth is discussed. Third, if mothers were electronically checked in vs. The manual process today, the workflows would change significantly. A second flowchart has been created to show the streamlined workflow as a result of the AHC choosing this alternative. For process re-engineering to be successful there needs to be a prioritization of customer-based goals first, followed by the selective use of technologies (Bertolini, Bevilacqua, Ciarapica, Giacchetta, 2011). The use of more automated means to check maternity patients in follows this best practices of business process reengineering (Bertolini, Bevilacqua, Ciarapica, Giacchetta, 2011).
Analysis of the Labor & Delivery Process
The existing Labor and Delivery Process have significant room for improvement. It's shown in Figure 1, Existing Workflow of the APH Labor & Delivery Process. As has been mentioned earlier in this analysis, there is significant potential for improvement in the areas of the check-in process, use of Labor & Delivery Triage, and the use of the NCU. Workflows in each of these areas are very complex, time- and condition-dependent, and also lack a quantifiable level of measurement to determine just what steps need to be taken to assist a children's progress over time. Labor and Triage and the NCU could easily become bottlenecks if not managed to a series of performance-related goals. The entire process of Labor & Delivery defies the ability to define performance metrics due to its complexity. To ensure customer satisfaction over the long-term, it would be advisable to break the registration process, Labor and Delivery Triage Area, and NCU into smaller subprocesses. Ideally a separate, more streamlined workflow needs to be created for children who are experiencing significant problems, cycling between the NCU and Mother-Baby Care areas. This area of the workflow today has significant potential for improvement and greater simplification.
Figure 1: Existing Workflow of the APH Labor & Delivery Process
Caesarean-Section Birth Workflow
When a patient and physician choose a Caesarean-section (C-Section) birth, the process workflows in the areas of ICU, NCU and Mother-Baby Care require greater coordination. As a C-Section birth requires surgery, there are the added process areas of pre-operation preparation, the operation itself and all the logistics required, and the post-operation recovery procedures. AC-section workflow would require an entirely new series of processes branching off of the Labor and Delivery Triage origination point. There would also need to be more focus on post-operation procedures in the NCU as well, stabilizing both the baby and mother. All of these would bring several layers of complexity into the workflows shown in the lower left corner of the existing process…