While medical expertise, bedside manner and efficiencies of care might top the list of things that patients say are important, another process touches guests in a healthcare facility extensively: patient transport. From the time patients enter the facility through all the procedures and examinations they undergo to final discharge, the patients or their specimens are in regular movement across the facility. Small inefficiencies or issues in transport can add up to big problems for individual patients or for the facility in total.
Just how extensive is patient transport?
A first step in improving patient transport is understanding where it occurs. Looking at patient flow with a value stream analysis is extremely effective in seeing all the places where transport takes place and what kinds of bottlenecks or wait times are created.
Consider these and other transport paths as you construct a transport value stream map:
- Patient intake
- Patient transport to examination areas (e.g. imaging, cardio lab)
- Patient transport to and from hospital room to procedural areas (e.g. operating room, therapy, recovery, ICU, morgue)
- Equipment transport (e.g. portable imaging equipment)
- Specimen delivery (including appropriate hazardous material considerations)
- Room replacement materials (e.g. soiled/clean mattresses)
- Escorted visitors
The value stream will include not only the process steps, but also the number of people involved. Many facilities find that when designated transport personnel are not available, nurses and other clinical staff step in to make moves happen. While this may be expedient for a given patient, it is likely to be harmful in the long term as it removes these staff members from their specialized duties, possibly creating other bottlenecks or potentially leading to errors in health care.
Impact of patient transport on patient satisfaction
Transport may not come to the top of the list of stated patient dissatisfiers, but if you probe, patients might express concerns such as these:
- I was in the hallway outside the x-ray area a long time and it was freezing.
- Could there be any more bumps in the hallway?
- I’ve got bruises on my back. I think they just shoved me onto the gurney when they took me for an x-ray when I was unconscious.
- I think the guy pushing me got lost. We went down the same hallway three times.
- Why did I have to wait for an hour for a wheelchair to take me out of the hospital when I was discharged? Either let me walk or have the guy there when I’m ready to go.
As with other parts of the patient workflow, it’s important to complete an assessment to gather patient input rather than simply make assumptions about these or other issues. When you have gathered and organized data from observations and patient surveys, be sure to complete root cause analyses of any problems identified. For example, is a transport delay due to slow personnel or does it stem from backup at another department in the facility? Because transport problems are likely to show up as bottlenecks, they often indicate underlying issues in operating processes that need to be fixed.
Using the information gathered from analyses of observations and survey input, you will create a plan of attack to achieve operational excellence in transport within the framework of overall patient care. This plan is likely to include:
- Standard work – Apply the best-known method with the best-known tools and the best possible timing. For example, the best path for patient transport to the imaging area might not be the shortest path, but instead the one with the fewest doors, corners and traffic, making it easier and more comfortable to deliver the patient on a large transport bed.
- Load levelling – Look at the bottlenecks in the value stream. If delays arise consistently in one area, consider adjusting that process step or staffing for that step to make the flow smoother. For example, if patients are waiting a long time for transport at discharge, trigger the call for transport at a specific point earlier in the process.
- Walking the flow – The improvement team can walk each step of the process to understand exactly what the patient, specimen, or equipment goes through during transport. This simple practice can often reveal problem areas when people are given the time and encouragement to look for issues.
- Mistake-proofing – Consider errors that have occurred and could occur. Engage staff to brainstorm procedural or other solutions to prevent these problems.
- Training – This will include operational training in using transport equipment, communications training and understanding of service level requirements, and customer care training.
Is transport really that important in the grand scheme of patient care?
Remember that psychologists recommend focusing on the peak and end of customer experiences to favourably influence overall satisfaction. Patient transport is generally the last step of the patient’s on-site experience with the hospital, thus it becomes the “end” experience. This can be positive as the patient begins his or her path to recovery or it can leave a bad last impression, often a lasting impression.
Be sure the transport process at discharge is efficient. A patient who is ready to leave wants to leave NOW. Make sure transport staff are well trained, not just on routings through the hospital, but also on “bedside” manner. It may be just as important to train entry-level staff pushing wheelchairs on how to interact pleasantly with patients as it is to train physicians and nurses.
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