Arnold Palmer Hospital Labor and Delivery Workflow Analysis

Introduction: APH as a High-Performance Healthcare Provider

Arnold Palmer Hospital (APH), located in Orlando, Florida, is considered one of the most efficient and patient-centric healthcare providers in the United States, as evidenced by its customer satisfaction scores and the volume of patients it serves annually. APH has been ranked fifth in patient satisfaction out of 5,000 hospitals and sees an average of 1.5 million children and women each year. It is the fourth-busiest labor and delivery hospital in the U.S. and operates the largest neonatal intensive care unit (NICU) in the entire Southeastern United States. APH has also implemented one of the most thorough and well-respected continuous improvement processes in the U.S. healthcare system. With a goal of 100% patient satisfaction, APH has built an entire quality management and improvement organization that is now a critical part of its institutional culture.

Of the many processes that APH relies on to operate daily, one of the more challenging is the Labor and Delivery check-in. This process is made more difficult by the continually changing status of the patient and her imminent delivery. Healthcare processes need to be contextually relevant and have time and value durations comparable to patient needs in order to contribute to patient satisfaction (Ahsan, Shah, & Kingston, 2010). The APH labor and delivery check-in process is highly complex, with ample room for patient dissatisfaction given the intricate nature of its eight distinct decision points. With so much complexity, there is significant potential for confusion and frustration on the part of patients.

This paper proceeds in four parts. First, the initial analysis of the Labor and Delivery check-in workflow is presented. Second, the additional complications introduced by a Caesarean-section birth are discussed. Third, a proposed electronic pre-registration system is outlined, accompanied by a streamlined workflow flowchart. Finally, recommendations for re-engineering the emergency room process workflows are offered. For process re-engineering to be successful, there must 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 the best practices of business process re-engineering (Bertolini et al., 2011).

Analysis of the Labor and Delivery Process

The existing Labor and Delivery process has significant room for improvement, as shown in Figure 1: Existing Workflow of the APH Labor & Delivery Process. There is substantial potential for improvement in the areas of the check-in process, Labor and Delivery Triage, and the NICU. Workflows in each of these areas are very complex, time- and condition-dependent, and lack a quantifiable level of measurement to determine which steps need to be taken to assist a child's progress over time. Labor and Delivery Triage and the NICU could easily become bottlenecks if not managed against a series of performance-related goals. The entire Labor and Delivery process resists straightforward performance measurement due to its inherent complexity.

To ensure long-term customer satisfaction, it would be advisable to break the registration process, Labor and Delivery Triage area, and NICU into smaller sub-processes. Ideally, a separate, more streamlined workflow should be created for newborns experiencing significant medical problems who cycle between the NICU and Mother-Baby Care areas. This segment of the workflow currently presents 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 the ICU, NICU, and Mother-Baby Care require greater coordination. Because a C-section involves surgery, additional process areas must be incorporated: pre-operation preparation, the operation itself with all its logistical requirements, and post-operation recovery procedures. A C-section workflow would require an entirely new series of processes branching off from the Labor and Delivery Triage origination point. There would also need to be greater focus on post-operation procedures in the NICU to stabilize both the baby and mother. These additional steps introduce several layers of complexity into the workflows shown in the lower-left corner of the existing process workflow in Figure 1.

Integrating C-section procedures would also require an entirely new set of recovery and discharge process steps for newborns and mothers. Additionally, since C-sections are covered under some but not all healthcare insurance programs, it is critically important to address insurance verification at the very beginning of the process, during check-in and registration. If a patient and physician anticipate the possibility of a C-section, that contingency must be planned for at the outset of the check-in process. With this greater level of complexity comes the need for stronger quality management to ensure that customer expectations are consistently met and exceeded (Whiteman, 2004). C-sections also carry a mortality risk, which requires the process workflows to include thorough support for patient contingencies and life support. Best practices in managing healthcare processes associated with mortality risk require high levels of auditability and compliance with government reporting standards (Bertolini et al., 2011).

Conclusion

Arnold Palmer Hospital's labor and delivery workflows present significant opportunities for improvement through targeted process re-engineering. The existing check-in process, with its eight decision points and manual dependencies, creates unnecessary variation and risk for patient dissatisfaction. The introduction of electronic pre-registration, a mandatory orientation session, and a scheduled admittance date can substantially reduce this variation. C-section workflows require additional layers of coordination and compliance planning, while the emergency room triage process would benefit from knowledge management tools and clearer patient routing protocols. By applying best practices in healthcare business process re-engineering, APH can continue to strengthen its position as a national leader in patient satisfaction and operational excellence.

References

Ahsan, K., Shah, H., & Kingston, P. (2010). Location context for knowledge management in healthcare. International Journal of Healthcare Technology & Management, 11(1), 3.

Bertolini, M., Bevilacqua, M., Ciarapica, F. E., & Giacchetta, G. (2011). Business process re-engineering in healthcare management: A case study. Business Process Management Journal, 17(1), 42–66.

Hellstrom, A., Lifvergren, S., & Quist, J. (2010). Process management in healthcare: Investigating why it's easier said than done. Journal of Manufacturing Technology Management, 21(4), 499–511.

Whiteman, A. S. (2004). Applying quality management in healthcare: A process for improvement. Hospital Topics, 82(1), 37.