1. Clinical Process Analysis Ambulatory Operations Project: Endoscopy Center Summary April 6, 2013

2. STAFF Laurie Kaufman MSN, RN Manager Gina Aranzamendez MS, RN-BC Courtney Barnes MBA Beverly Hayes Valerie Haywood MBA, BSN, RN Duke Rohe, IE Marvetta Walker, MHA, RN Manager Endoscopy

3. Time Driven Activity Based Costing (TDABC) Harvard University Business School –Michael Porter, PhD –Robert Kaplan, PhD Institute for Cancer Care Excellence (ICCE) –Thomas Feeley, MD –Heidi Albright, Director –Head & Neck Center Pilot Office of Performance Improvement –Process Flow Charting

4. TDABC & Clinical Process Analysis

5. 2. HOW WE IMPROVE WHAT WE DO 3. HOW WE PERFORM OUR SERVICES INPUTSINPUTS Outcomes Costs = Value Vision: Making Cancer History Design and Redesign Plans to Improve Our: Performance as a System Knowledge of Variation Use of the Theory of Knowledge Application of Psychology OUTPUTSOUTPUTS 4. WHAT WE DELIVER Patients Families Staff Suppliers Equipment Supplies Partners Etc. Processes that produce: Work Force Development Financial Viability Patient Care Research 1. WHY WE DO WHAT WE DO 1.To Cure Cancer 2.To Provide Patient Care 3.To Develop Our Workforce 4.To Maintain Financial Viability MDACC’s Framework for Improving As A System Based on W. Edwards Deming’s “Profound Knowledge” Adapted From: A Framework for the Continual Improvement of Health Care. Batalden PB. Journal of Quality Improvement Vol 19 No. 10 1993

6. Clinical Process Analysis

7. The Office of Performance Improvement, © 2012 The University of Texas MD Anderson Cancer Center Process Flow Chart, Direct Labor Cost & Opportunities for Improvement CPA Methodology Participants: Clinical Lead: Designated clinical point person for the project CPA Team: Clinical Process Analysis Team, Performance Improvement Clinical Leadership: Clinical Administrative Director; Center Business Manager; SOT: Senior Operations Team Nurse Manager; Medical Director; Quality Officer Center Process Flow Charter: Maintains process flow charts for the Center after Content Experts: Frontline staff CPA Project is completed Performance Improvement Phase Weeks 4 - 14

8. The Office of Performance Improvement, © 2012 The University of Texas MD Anderson Cancer Center Background: Endoscopy Center Project Center Variation Scope Development

9. The Office of Performance Improvement, © 2012 The University of Texas MD Anderson Cancer Center

12. Process Flow Charts

13. Aligning Data to Frontline Processes & Elements of a Process Flow Chart

17. Direct Labor Cost

18. Process Flow Chart converted to Excel for Direct Labor Costing

19. Costing Salaries based on FY 2012 from ResourceOne Data based on information captured in process flow charts from 10.17.2012 – 12.12.12 Based on estimated times given by frontline staff in the Endoscopy Center Salaries in this report are average adjusted hourly rates including fringe Salaries for each Job Code Group are blended by utilizing FTEs to weight the averages: MD- Professor, Associate Professor, Assistant Professor PSC- Lead Services Coord, Patient Services Coord MLP- APN and APN supervisor Data is reported per patient

20. Costing Summary: Direct Labor Costs

21. Costing Summary: Estimated Times in Minutes

22. OFIs (Opportunities for Improvement) Waste, Delays, Inconsistencies, Rework…

23. SharePoint Site for Project Storage Provides storage for project work-ups Available for bench-marking Easy placement in Quality Project database

24. OFI Summary Total OFIs: 53 OFIs in department's control: 6 OFIs out of department's control: 14 OFIs within department's influence: 33

25. OFI Projects  6 Quick Fixes  8 PDSA  1 CS&E 1. Ready Call pagers 2. Consult processing/patient check-in 3. Optimization of Endoscopy Online Consult Health questionnaire 4. Bedside consenting 5. Nurse sedation practices 6. Guidelines for scheduling an Endoscopy procedure 7. Physician notification process for patient cancellation or reschedule

26. OFI Projects 8. iConsent 9. PYXIS medication availability 10. Anesthesia sedation & recovery charge reconciliation 11. Endoscopy safety procedure checklist 12. Room standardization