Bridging Care Support and Care Delivery with Engineered Logistics and Technology

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Abstract Geisinger Clinic's Supply Chain Services has developed 'Project HELP' (Healthcare Enabled Logistics Program) that is based on successful manufacturing and engineering workflow processes and proposes a lean redesign of supply delivery, support service operations, and the clinical workflow on inpatient units. Project HELP's goal is to remove clinicians from support services activities, and, reinvest this time in patient care activities. Support services are being defined as non-clinical departments in the hospital that support the delivery of care (e.g., pharmacy, lab, and linen services). Our preliminary research has estimated that approximately 16.8% of nurses' time (6.72 hours per 40-hour week per inpatient nurse) is wasted in logistics activities that they should not have to engage in, an amount that is common in the industry. This led to the project hypothesis that by improving the care delivery support system, we can remove nurses from support service activities, thereby allowing redirection of the clinician to patient care activities and enabling improved quality of care. This study represents a way to improve the value of health care - i.e., reduce waste or unnecessary costs while improving quality. Project HELP will engineer a proactive support service system to replace the current, healthcare industry-standard, reactive system, thereby eliminating wasted logistics trips and non-value added support service activities. The new processes will increase support service efficiencies and consolidate the numerous independent and silo-operated departments. In addition, we plan to design workflows which provide frontline logistics support to the clinical staff. The frontline support will be coordinated by a new team member who will be the bridge between the clinical staff and all support services. This person will be tasked with coordinating most, if not all, of the support service activities for a given work area (e.g. 1 or 2 nursing units). To support these efforts, we will also develop a care support information system that captures the nurses' knowledge of support activities required to prepare for and perform care. The information system developed will guide the workflow for the logistics staff by providing the required information to proactively prepare all resources (i.e., equipment and supplies) for defined clinical procedures. This system will include information such as number of consumable supplies needed for common procedures (e.g., dressing change) performed on a nursing unit. We propose to perform a three-year project to engineer efficient and effective care delivery support processes and to reduce or eliminate nursing involvement with routine logistics activities through the use of discrete event simulation modeling and by applying established manufacturing and engineering practices (Aim 1), as well as develop an information system to support the new processes (Aim 2). The project will also include a pilot implementation on two nursing units (one general medical/surgical unit and one progressive care unit) and the evaluation of implementation on several key performance indicators (Aim 3).