Healthcare
Transformation Services

Collaborating to transformclinical and business performance
Philips Healthcare Transformation Services – Clinical Optimization Services

Clinicaloptimization
services
Healthcare leaders continually strive to improve clinical andfinancial performance by focusing on clinical outcomes,
streamlining clinical processes to increase efficiency, andenhancing patient satisfaction. Philips provides patientfocused healthcare transformation services and solutions
across the health continuum. We work collaboratively
with our client partners to operationalize value-driven
care through strategic assessment and interventions
focused on clinical and business processes. We also offer
strategic design consulting, workforce optimization
services, education and change management
programs, and technology solutions for a broader
potential to impact quality and cost.

Key advantages

Our clinical optimization services assess• Streamline clinical processes to increase

current performance and identify

efficiency and reduce costs

opportunities to streamline processes• Enhance the quality of clinical care delivery

and reduce unnecessary variations infocused on improving value to the patientcare to increase quality, reduce costs andand organization

help organizations achieve their clinical,• Data analytics and modeling tools enable

operational and financial goals. Withfact-based recommendations for change

data analytics as a foundation, change• Experience Flow Mapping identifies insights

recommendations are fact-based andand improvement opportunities with themeasurable. Our team works with eachmost potential impact

client team to agree to specific strategies• A collaborative approach garners strong support

and activities to achieve sustainable results.

of change initiatives for long-term results

A collaborative
approach
We take a collaborative approach to enable meaningful
clinical and business transformation as we recognize thebenefits of shared goals. Our consultants work closely withclients as a cohesive project team to agree on project goals,
scope, deliverables, timelines, and measurements of success.

This collaboration supports more meaningful andsustainable improvements for our clients. Stakeholder
input is gathered from clinical and non-clinical staff aswell as patients and families, when available, to provide
a holistic and complete understanding of the uniqueneeds of each client’s situation.

Phased project planning
Our consultants propose a detailed project plan as appropriate for each client’s
situation and needs.

Perform comprehensive data collection and analysis
Conduct stakeholder interviews, observation, and workshops
Gain holistic insights through our Experience Flow Mapping methodology
Leverage data modeling and simulation tools
Deliver recommendations for change initiatives
Develop project roadmap and implementation plan of prioritized initiatives
Guide combined client-Philips project teamSupport implementation and program management

Based on
data analytics
Philips is a leader in providing performance improvement
consulting services for hospitals and healthcare systems
around the world. We believe healthcare transformation should
be based on data and data should support each phase of
the consulting engagement and drive our recommendations.
The creation of data-driven insights begins with datacollection and analysis as a first essential step.

Assess

DesignImplementation

MonitorRetrospective and current
state analysis
Use client resource
utilization data, peerbenchmarking, andlibrary of best practices
to identify root causes
and opportunities for
improvement and growth.

Prospective solution
modeling
Leverage scenario
planning and predictive
analytics to forecast
the cost of proposed
improvements and impact
on future performance.

Assist implementationand change management
Use real-time metrics tosupport or manage thetransition to enhanced,
data-based processes
and provide change
management expertise.

Continued resultsmonitoringand support
On an ongoing basis,
measure performanceto sustain improvements
provide relevant updates
and recommendations tostakeholders.

We leverage a variety of data sources, researchexpertise, benchmarking, best practices, andtools to drive granular performance insights.
Data sources include public data, client systemdata, a wealth of aggregate Philips install baseinformation, third-party data, and more.
Our team analyzes retrospective data tocreate and deliver data platforms andanalytic approaches to help turn data into
insights and actions.
The goal is to provide quantitative evidence to:• Recognize gaps in workflow, capacity, anddesired versus actual outcomes• Identify and quantify improvement
opportunities• Analyze trends to forecast patient demand,
staffing and technology needs, supplies,
and more• Simulate the impact of change
recommendations to create scenario options• Embed data into client operations• Leverage visualization of results to support
informed decision making
We work closely with other Philips teams
including research and clinical technology
businesses to leverage internal capabilities inadvanced analytics, equipment, and clinicalapplications to deliver applications of big data.

The above outputs are examples of the types of data we collect,analyze, and create visualizations to help clients leverage data andanalytic tools for data-based strategy and drive decision-making.

Stakeholder
input
We put the patient at the center of care in everything we do.
So that we interpret the data and operational analysis
through the lens of the patient experience, we conduct a
series of one-on-one and group interviews, workshops, andother facilitated exercises. Key stakeholders include patientsand family members when access is granted aswell as physicians and clinical and management staff.
Adjacent departments, referring physicians,

The consultants map-out all of the dataand other clinicians are also important

points and insights gained from thestakeholders. Additional stakeholders suchdata analysis, stakeholder interviews,

as administrative staff, patient liaisons, andand workflow observations to create acare coordinators may be considered. This

comprehensive Experience Flow Map forbroader view enables an approach to change

the client. We believe this approach is a best

across the health continuum.

practice to document the patient journey
and align it with the clinical workflows,

The team looks to define quality for each client

technology utilized, and sources of data

engagement, gain a strong understanding of

to visually summarize the most impactful

the challenges and current clinical processes,

opportunities for improvement.

and map the detailed patient journeys.
Existing initiatives are also reviewed to lookfor dependencies, consistencies, and otheropportunities for building on prior successes.
Experience Flow Mapping
Our unique approach of Experience Flow
Mapping is a structured methodology toprovide an insights-based view of thepatient journey and clinical processes and tographically demonstrate areas of concern andopportunities for improvement. This process
may uncover challenges not initially identified
during the stakeholder input phase.

Cath Lab Experience Flow
Cath Lab department

Heart Institute

Processes, way of working & teams

Physicians drive patient volume
To attract more business it is crucial for the cath lab to engage with

Very ill patients and complex cases are brought to the clients cathlab, because this hospital is capable of properly treating theircondition. They can perform the most complex procedures needed
to treat the most acute patients.

to work. Physicians cannot be successful just by themselves – theyneed an infrastructure that supports them, such as: on-time casestart, the appropriate number and mix of staff, a solid plan for
emergencies, etc. There are a lot of improvement opportunities forthe client to turn it into a place where physicians do want to come andbring their cases.

“ We are now more able than ever before to do complex EP
procedures.” - management“The attitude is like ‘we have 4-5 cases to take care of today’, we are not ina rush... What they don’t understand is that non-employed physicians are ina rush!” - non-employed physician“Our staff and physicians are very good at what they do, when they getto it, but I do not think there is enough staff...” - management“At the end of the day they make it happen” - management“The outside guys should feel important as well. Functionally they go inthere [Cath Lab] but it is not inviting.”- Physician
privacy for conversations is lacking.” - Physician+

5-10 min in Heart Institute waiting area

average

Arrival & Waiting

120 min +/- std dev of 78min

ambulatory
patients

cardiologist
consult

appointment is scheduled& receive info packet

receive call from H.I.

fasting

travel to
hospitalenter lobby &navigate to admitting

wait

check-inpatient escorted toprep room H.I.

wait in H.I.
waiting room

nurse checks
patient data,
CHOPEL

undress forprocedure“They should praise the nurses more: it is unreal. They know how
to deal with criticality.” - patient“All the staff is very warm and inviting. They make you feelsecure.” - patient“The Cath Lab can feel chaotic and disorganized to staff andpatients.” - management“I felt instantly comfortable because of the great staff.” - family“In the heat of the moment, physicians might not always treat

averageTransport

nurse answers questions
and provides info

complete missing
tests CHOPEL

physician might come to

waitTransport inwheelchair or stretcher

42 min +/- std dev of 42 minfromTreatment

inpatientsand pediatrics

emergency
patients

enter Cath Lab
environment

patient

wait

1-6hr when in Heart Institute, at least 1 night when hospitalized

5-15 minHolding

Transport

10 minRecoveryprocedure iswrapped uppatients ‘go to sleep’ andundergo procedure

patient is woken up fromsedation - general anesthesia

recover fromprocedure - sedation

Some patients skip the holding area, while others areheld here longer for observation

till

Transport instretcher - elevator

enter H.I

tion and eat sandwich-

receive info about
recovery/discharge process andanticipated release time

lay on back while attached tomonitoring equipment & wait

getdressedreview discharge paperwork+ receive educational materials

sign papers

travel home: pick up by
friend/family, or pick up by taxi

try to adjust to lifestyle changes
and follow new regimes

be

d wa
is it
ava
ilab

le

Transport from Cath lab to 5North, PACU, CCI or for PEDs to pediatric hospitalEPdrive patient to hospital & park car

Familysupport patient in admission process

get a visitor’s pass

wait in H.I. waiting room

wait together with patientjoin patient to prep room H.I.

sometimes family joins patient to Cath Lab(pediatrics, non-English speaking, or anxious patients)

chat, watch tv, play a game, etc.

put patient at ease, support
in the communication

patient“ Why do I have to wait
for so long ?! When will I
be treated?” patient“We heart transplantpatients are like family! ”“ The people at admitting
were not nice to my father.
No wonder people don’t likecoming here...” family

patient

Do they know I’ve arrived?
What should I do?patient“It puts a lot of pressure
on staff if the patient’s
chart is not ready”
nurse“ It is hard to interview
a patient in an open
bay. I hate it! ”“I want to see myphysician before I go infor the treatment”“Are they are going tooperate on me here inthis wheelchair?!”patient“It would be better for patientsto stay in the HI and relax there,
instead of bringing them up here
anesthesia
and thetreatment room notbeing ready yet... ” Nurse

patient

nurse

patient“I check the name on themonitor [in the lab] tomake sure it’s mine”patient“ The labs are not ideal environments
to have family members in.
These surroundings scare them off... ”“I am worried because it is taking
so long. I have no idea what’s happening to my father [patient].” family

Patients just want toleave right away...

“I’m starving... I’m happy to
get a sandwich now”

receive info about discharge and aftercare when at home

“ Patients are still kind of
sedated when they enterour department (5N) andmay feel groggy ”

physician“family takes a lot of effort. Also privacy for conversations is lacking”

drive patient homecare for patient“ I want to see my family
member [patient]”“Teaching is one of our maintasks during patient recovery”“I am grateful for the phenomenalcare I received from the nurses
and physicians. They gave me a
new lease on life!”
patient

nurse

familyphysician

nurse

staff

“Ask any patient about the worst part of hisor her procedure, and the most common

patient

nurse

patient“We do not take enoughcare of our families...”care for patientphysician informs family member about patient outcome“ I feel relieved the procedure is over. It was actuallya piece of cake! ”

patient“ Often emergency patientsand family are freaking out! It
is important to show them wewill take care of them; that wedo this everyday. ”ED physician

Nurse

wait

“I count ceiling tiles to pass the time. I don’t liketo watch the monitor, needles, or see blood...
that makes me feel uneasy.”technician“Invasive cardiac catheterization procedures
involve a level of intimacy that most patientsare unaware of until it is time to begin”

enter Heart Institute and ask nurses about status of patient

wait

Remain in waiting area, walk around in hospital, do some work, go to the cafe, go home, sleep in car, etc...)“ The longer the patient
has to wait, the moreanxious he gets...Nurse”

can take 20 minutes” Nurse
patient

patient“My wife is even more nervous than I am...”“There is a huge issue with theelevator since preparation andwait

go to see patientfamily is asked to waitoutside the department

part ways with patient“ I always have anxiety
getting the biopsy done,
although I’ve done it before“I might have to re-think the day 25 times.” - charge nurse- staff“It’s like the nurses in the Cath Lab are on rollerscates! They movearound constantly.” - patient

Preparation is key

Preparation before the moment of procedure is key for both patient &family experience and operational effectiveness.

The client’s cardiology division has been attracting quite some negative
publicity over the past years, and the Cath Lab department is still
suffering the after-effects.
Furthermore, the client is not located in an urban environment andtherefore has never been a real community hospital.

Teams are disconnected
The physical separation between the activities at the H.I. and theteams and creates a lack of trust. These gaps in communication (andwith other departments) leads to dissatisfaction among staff. Also, in
the Cath Lab department internally there is some dishearting amongstaff (and with physicians), stemming from organizational decisions.

“Cardiac procedures? Never heard of it...”“ We have phenominal care here, but the reputations, that’s what
we are struggling with” - management

Insights“We are not operating at the same level as we used to do.” - staff

The department’s reputation has
to be managed

Cath Lab experience to educate patients and allay fears. Fear of
the unknown, worries about results and unfamiliar medical environments can heighten pre-visit anxiety.
Ideally, tests and medical information should be completed prior to thevisit, but in practice missing labs and outdated info are one of themain struggles the Heart Insitute staff is coping with. Delays in thisstep have a ripple effect on all other next steps in the process.

“On the phone I always say ‘I’m sorry to call/disturb you, ....’ But weshouldn’t be sorry for checking where the patients is” - nurse“It feels like it is ‘us against them’, and that is not right.” - H.I.<>CCL“We are one happy disfunctional family ;)” - CCLstaff

The department’s physical environment does

Physical limitations and constraints

Procedures and interventions in the cardiac catheterizationlaboratory (CCL) and electrophysiology laboratory (EPL)
can be very complex and involve acutely ill patients. Cardiac

patients may arrive at the hospital in a weakened condition, withlimited physical mobility or stamina. This may include trouble
breathing, muscle weakness, dizziness, etc., due to a poorly
functioning heart.

Uninviting start for (ambulatory) patient journey
assumptions of the care the hospital offers.
The admitting process and waiting space is not perceived as
inviting, but considered institutional and outdated. The waiting
room is located across the hallway from the heart institutewithout someone to welcome them and put them at ease.
Patients and family are anxious, look for reassurance andwant to feel they are in good hands: Qualities the hospital upon
arrival lacks to provide.

Waiting in comfort

Patients spend much of their time waiting in the prep/recovery areas of the Heart
Institute, where family members often join them. A reassuring presence is important (nurse,family, environment, etc.). Patient who are in a weakened condition can lay in a bed and rest, but
outpatients who feel well spend time talking with family, watching tv, reading, internet, playing agame, etc. An emphasis on comfort next to clinical function seems appropriate here.

Patients (and families) don’t know what to expect

Patients do not know where they are in the process. Lack of SOPs and scheduling issues
result in patients not knowing how long they still have to wait, and when they will be going forprocedure. This uncertainty can lead to frustration, which patient then take out on the staff.

Transplant outpatients are like family...

Heart transplant is a challenging life event. Bonds are created with others who have ‘been
there’. Transplant patient have to come back for a procedure often, which makes biopsy day likea reunion. They enjoy socializing during preparation: share stories, trivia, and advice. Elders
provide inspiration to new patients.

...but new outpatients need privacy

New ambulatory patients are more sensitive and self-conscious when coming for a procedure.
The H.I. has the space to offer new patients the privacy they need to be with their families. A
single room is perceived more as their own room, and feels more intimate.

“ When I entered this department, it was like I stepped back in time.” managament, staff, patients & family“A hospital should project wellness and prevention, not doom-and-gloom.”- family“The clinical staff deserves to feel they are doing something important;the environment does not give them that feeling.” - clerk

From a patient perspective, the Heart Institute and Cath Lab are partof the same experience journey, but in this case not a smooth one.
The lack of coordination creates unpredictability of what is next, andthe many repetitions in the process can lead to frustrations andincreasing anxiety as well (again have to wait, again they are asking
the same questions, etc..).
Also, family feels completely disconnected from the process once thepatient leaves for treatment.
Why can’t anybody tell me when it’s my turn? - Patient“ The schedule is not realistic. We should start at 7am,
but usually procedures don’t start before 8.30am...

Patients are transferred to
the Cath Lab department
on a stretcher or in awheelchair by the transporter. Unless seriously ill,they are still very awareof what is happening toand around them. Although it is tried to avoid
the public route, they‘meet with’ other snoopers like cleaning staff, painters etc. in the staff/patientelevators. This exposure,their immobility and themouthpiece they have towear all make them feelextra vulnurable in thisharsh transition stage: “Itis going to start...”nurse

Secretary / charge nurse

AdmittingCalls patient andsends info packet
to patient

Requests forpatient adds-on“urgent”

Checks-in patientat admitting(insurance, paperwork, etc.)

Escorts patient towaiting room H.I.
Hands-over info to
H.I. nurse

Starts CHOPEL
process

Calls patient after
4pm day before
precise appt time

Transporter

Nurse
Copy of schedule
for next day isfaxed in afternoon.

(scheduler - H.I. - CCL)

Escort patientfrom H.I. waiting
room to prep room

IF CHOPEL not
ready: Get labs andmissing tests; Get
consent“ We have no clear understanding of when the patient can come up andwhen they are called down.” - Nurse

Prepare patient forprocedure (e.g., IV,shave) and provide
info & small talkPhone calls between
H.I. and CCL about
patient / room / staff/ physician readinessTransfer patient inelevator to CCL

When a patient enters a treatment room, the staff andphysicians take care of him/her, and informs him/her about
what is about to happen. But when down to business,
physicians have to focus on executing the (sometimes very
complex) procedure. If patients are too chatty, they will
receive some more medication to calm them down.

Going to sleep..

Family feels disconnected

Many of the procedures done in the catheterizationlaboratory are performed using varying levels of sedation,from light sleep to general anesthesia. Pediatric patients,
EP and OR patient get anesthetized and are in a deep sleep
during the procedure. All Cath patients get sedation andgenerally feel comfortable, drowsy, but can be aroused andconversant enough to tell about pain or other problems.
While some of the sedated patients like to explore thishigh-tech environment during their procedure, it makesothers feel very nervous. They look for distractions.

Family members often accompany the patient to the hospitaland are by their side during prep and recovery, but when thepatient is moved to the Cath Lab department their paths
seperate. Besides a physical seperation, family members alsofeel emotionally disconnected from the patient and department at this point. While they are waiting, they have noidea what is happening to their loved one, how long it willtake and how/when they will hear about it. They are locked
out from the process and nobody takes care of themduring this period, while families also bring needs of theirown, including privacy, peace of mind, comfort and social
support. The only way for family members to get info is toenter the HI and approach one of nurses for an update; quite
a treshold for people who already feel nervous. The phone
extension in waiting area is not reassuring.

Mix of patients

Ambulatory patients (incl. heart transplants), transfers
and inpatients all congregrate in the holding area of theCath Lab (pre- and post treatment). Only pediatrics andemergency patients bypass the H.I, but still there is agreat mix of patients with different acuity levels,
mindsets and needs in one area. Cath Lab nurses aretrained to take care of the most critically ill patients.

nurse

Secretary / charge nurse
Determine which room
to put in patient. Movepatient to holding area
until room available

nurse

Nurse
Take care ofpatient in holdingarea

Charge nurse
patient is readySearching for family

Feeling groggy

After treatment some patients skip theholding area and are transported to anotherdepartment directly. Other, more
vulnerable patients, might be held longer inthe recovery area in the Cath Lab
department for close monitoring.
When waking up, patients may still feelgroggy from anesthesia.

After a procedure the physician is the person to inform family about thequiet space to speak with them in private. Face-to-face interaction is preferedover a phone conversation for multiple reasons, but requires - in the current
situation - a lot of time and effort.

Recovery is often progressive

The type of procedure and the patient’s health condition greatly impacts the lengthof a patient’s recovery. Recovery is often progressive - patients improve over time
and will be able to handle more stimuli and distractions over time.
During recovery, some patients feel great and are hungry. They are relieved theprocedure is over. Some other patients don’t feel so well after the procedure andalthough the anxiety of actual procedure may subside, they may face additional
tests/procedures which upsets them.

Post-procedure physical limitations

Patients often experience physical discomfort post-procedure. While someprocedures allow for immediate ambulation, most patients must lie on their backfor several hours and hooked up to monitors. For some, this can be the “worst
part” of the experience. Nurses teach patients the do’s and don’ts of recovering.

” Nothing is fast enough “” I would like to have ‘a periscope
downstairs’ to be more situationally aware.”management

nurse

Scheduler
Receives orderfrom Clinic /Physician; adds to
OUTLOOK

Most patients are separated from family and theirpersonal belongings just before transport to the CathLab department. Patients’ assumption is that they are on
their way to a procedure room, and are surprised whenentering the holding area; another intermediate station.
They might feel a loss of control over their bodies andsurroundings. Patients have to wait here for an, are being left to themselveswith no privacy and no positive distractions. In theholding area, anxiety builds up over time.

“ The elevator is amajor bottleneck. I
wish we could haveprep and treatment“ A lot of patients come inwithout pre-admission testing ”

Patients don’t always get the message
with the precise appointment time, or are
unable to go in the newly assigned time.

management

Focus is on procedure

Increasing anxiety

Transition

Disconnection also affects patient & family journey

Process

assumptions of the care the hospital offers. People judge from what
they see. Overall the spaces that make part of Cath Lab journey
are not perceived as inviting, but considered institutional andoutdated.

“ This is the only lab where I scrub by myself ”
Housekeeping
Treatment room iscleaned

Nurse

Technician

Prepare case /scrub.
Transport patient
to treatment room.

PhysicianAnesthesiologist

charge nurse

non-employed physician

VendorPhysician performs procedure with support of staff.
Depending on case or procedure, fellow, anesthesiologist
and/ or vender joins as well.

“ Every day we need anesthesia, but
we have to call them by 1 PM the day
before for a patient that may havebeen on the schedule for two weeks”

Team consists of 2 RNs and 1 Tech
The RNs do circulate, sedation, monitoring, patient care.The tech helps
with XR, hemodynamics, transferring of images from Volcano and IVUS.

Team consists of only RNs (2-3) depending on case or Peds.
Use Anesthesia for extended cases and Peds cases; otherwise,
RN in EP does sedation (mild – moderate).

Nurse

charge nurse

Close observationand monitoring ofpatient postprocedure

Determine which department
to transfer patient to. Keeppatient in holding area until a
bed is available

Transporter“RNs are transporting
patients the majority of thetimes. Valuable time is lostwhen constantly having to
wait on the elevators.”

Transfer patient (inelevator) to H.I., 5N,
Post Cath or Pacu

nurse

Education

Discharge can be a vulnerable, uncertain
time where new information and instructions
are presented. Patients may still feel a bit groggy
and may not remember all the details.Family
acts as the “eyes and ears” of the patient,then serve as caretakers once home, helping
their loved ones remember to takemedications, follow new regimens, etc.
Educating and supporting the family in tandem
to the patient is critical to satisfaction andsuccessful outcomes.
To prevent disappointment, patients should
be aware of the recovery / discharge planin advance so they know what to expect.
Family members remark that the waiting area
misses a key opportunity to educate family
about the hospital or the conditions their
loved-ones may be experiencing, and the aftercare. It would make them feel more
comfortable if they were more informed.

nurse

Nurse
Patient monitoringand observation

Nurse
Takes care ofpatient’s basic
needs: food, drinks,
bathroom, etc.

Checks in withpatient every 30min
and makes surehe/she is comfortable

Physician might come to prep area to see
patient & family - introduction.

Educates patientand family on therecovery /discharge process

Review discharge
papers withpatient and family

Physician calls or comes over to family in
waiting to inform them about the results

Stakeholder experiences“ Patient quote ”

Environmental context
atmospherespace,
layouteye-catcher

lightacoustics

climate“ Family quote ”“ Staff quote ”

Environmental
Analysiswhen she again has to wait in holding area)

LegendFor new ambulatory patientsthe department or within it.
The family waiting room islocated outside the H.I.
entrance, which causes some
confusion.

Welcome ! (?)

The pick-a-number mentalityof the waiting room does notof the hospital staff. It treatspatients and family as a kind of‘latch-key kid.’

Uncomfortable space

The waiting area is one of the
few areas with more spacethan is required. Chairs areplaced in one big circle withno privacy for people who are
already feeling tensed and outof their normal comfort zone.
Conversations of others canbe easily overheard. The only
distractions available are one
small television, and a DIY
phone booth.

Lack of information

The room should say, “whatthe hospital is about, explain
the care that is provided, andcommunicate what is about tohappen”(family). Only some
generic brochures can befound in the corner of theroom. Patients’ and families’
questions are left unanswered.

Individual vs. shared

Cleanliness(Heart transplant) patients are When patients are on transdifferent layouts of preparaleery of public areas, noticing port through the hallways oftion areas to serve different
potential hazards to their
the H.I., they often will look atpatient populations with their suppressed immune systems.
the ceiling. Staff and patientsown needs:Transfer patients
It is important that theappreciate the calming referneed a calm environment
department radiates cleanlience to the outdoors, created
where nurses can observeness. The HI smells very clean,them, ambulatory patients like and also patients checking for used in the H.I.
to have privacy, and heart
anything. Only the dated
transplants enjoy the social
surroundings / deferred maininteractions with others.
picture.
.

Personal belongings

When patients are transported to the Cath Lab, theyleave all their personal belonings (clothing, bags, etc.)
behind in the H.I. room. From
now on it is clear he/she has
to totally surrender. After thepatient has left, the nurse puts
the stuff in a locker, to makethe room available for a next
patient.

Elevators are bottleneck
Preparation and procedure

which causes bottle necks intransfer and procedure startup: Elevators become an extra
hurdle and challenge duringtransfers, causing extra delays
to the process.

Multi-use holding area

‘It’s a meat locker’

The Holding area is: aEveryone except physicianspassageway to storage; thenotice the cool temperaturescharge nurse and clerk’s
in the Cath Lab. Reasons vary:
headquarters; a greeting area better for equipment, forfor physcians and patients, adoctors’ focus, or due to leadclinical area, and occasionally a aprons. In the holding area
place for family to calm or
patients receive extra blankets,provide interpretation forbut also here visual or tactile
loved ones. A lot of activity
cues that convey warmth arefor a space where patients are lacking.
on hold to prepare for /recover from a procedure.

Patients notice labs

Distractions

Music... and whether equipment
During the procedure,
Many of the physcians likeappears current or outdated. patients who are still awake
playing music while“The number of monitors
are staring at the ceiling. Some performing procedures. Sometells me how high-tech the lab like to watch e.g. the x-ray
will ask patients what kind ofis... a high-tech lab is perceived monitor; others want to avoid music they like.
as more comforting andit. “I would like any potential
reassuring. Items like books
for total distraction... The
and boxes in labs send a “not staff’s banter, the lead apron
very sanitary” message todesigns, I even count thepatients.
ceiling tiles.”Each lab is different

Control rooms have an inter- There are pros and cons withcom for voice communicaeach lab, whether old or new.
tions with the lab, either via
Lighting, audio, control room,
loudspeaker or headphones.
anesthesia location, imaging
Due to outdated equipment
equipment, inventory, spaceor interference with music in
the lab, these communications every lab. Staff and physicians
pride themselves on being
must frequently repeat them- adaptable to the tools available. However, various cognitive transformations are
required to perform procedures in this context: a potential (and needless) risk.

Poor sightlines

Conrol room techs like having
a view of the patient’s face
“You can tell a lot from apatient’s facial expressions are they in pain?” Depending
to have good sightlines foreveryone. It also hampers the
charge nurse who tries toquickly assess a situation todetermine time to completionfor queueing of next patient.

Varying light settings

Some physcians prefer toperform procedures in dimly
lit rooms, making the monitors and task lighting (atprocedure site) more visible.
However, the room is fully lit
when unpacking disposables
and devices. These changes inlight settings in the lab cancreate glare inside the control
room.

EP + Cath = *%$#

Lab #3, although it isconsidered to have the best
lighting, is not ideal to EP or
Cath procedures. Thisswiss-army-knife approachcauses the room to be
sub-optimal for cathprocedures due to EP‘cockpit’ being in the way,
which - as a consequence might get damaged as well. It
creates as chaotic appearance.

Pre- & post procedure mix Busy area
Seeing post-procedure
patients (still sedated) can be
disconcerting to preprocedure patients. On theother hand, it can be reassuring as well to see someone
coming back who is relieved
and doing great.

The recovery area is locatednear the nurse station where
the charge nurse and receptionist are located. It is a highactivity area with a lot of noiseand potential for interruption.
Patients who are kept in thisarea the longest are the ones
who need the most observation (and the most rest..)Deferred maintenanceDuring the transport to andfrom the Cath Lab patients (ifawake) have a lot of time tolook around. They especially
notice the ceiling and walls,
and see elevators and equipment that are old and notworking anymore. The faded
artwork in the corridor also
reinforces “sickness.”

Memory gaps

A procedure at the Cath Lab department
can be an anxious experience, but thereality is often not as bad as theapprehensions. In retrospect many patientsare very thankful for the treatment
they received. It has given people a newlease on life.
What is by staff considered as the best partof their care (the actual treatment and earlyrecovery) is something patients won’t
completely remember afterwards
because of the sedation. An aspect thatpatients and family members do remember
from the procedure day are the long delays
and waiting times.

“We don’t have a clear understanding of when
the patient can go up or will come down.”“Are they going to operate on me here in this wheelchair?!” - Patient (confusedExperience creation model

Travel - after

Discharge

CATH

get preparedfor procedureenter procedure room

till lab/staff/physician is readyHeart Institute0 - 60 min

30 min to 240 min and longer average 96 min +/- std dev of 60 min

Holding

OR

Disorganization leads to unpredictability andAt the CathLab, good standards are delivered in spite of a lack ofstandardization. This can be observed on different levels: scheduling is
unnecessarily complex involving multiple people and process steps,
numbering of the labs is not logical, mix and skillset of staff is not
optimal, storage inconveniences, inventory and supply management,
documentation and reporting are not standardized, multiple patient
hand-offs and coordination phone calls.

5-15 minPreparationtransferpatients

Experiences

Staff and physicians do a good job relating to the patient. Theirfriendly and caring attitude make up for a lot of the other issues
the department is struggling with. Patients and families appreciate
the staff’s professionalism and dedication:

Family & Patient Journey

Important qualities of the CathLab

The Cath Lab is staffed by highly trained
physicians, RNs and techs, who provide
phenomenal care

Patients’ and families’ perception of the staff &physicians is excellent

20-30 min at admitting

Before - Travel

General Observations

Controlling temperature

The single rooms of the H.I.
have a thermostat in theroom that can be controlled.
Furthermore, the patient can
get warm blankets if theyneed them. Patients really lovethat.

Maps are usually the size of a meeting room wall, providing a bird’s eye view with attention to detail and oftendelivering insights which may have otherwise been overlooked. They help to identify and prioritize issue areas
so that change initiatives are focused properly. It is also used to demonstrate future state possibilities basedon the recommended changes.

Blocking sounds

Staff indicates that the single
rooms of the H.I. are the bestrooms for recovery, because
when closing the door all thenoises and conversations thatcome from the hallway areblocked. When patients
recover from a procedure,
quiet and private space.

Bright lighting

The lights in the H.I. are allvery bright. This is good forthe nurse who needs the lightto do her job and to feel freshand alert, but for patients inrecovery it would be ideal ifthey could dim the lights intheir room. When people
want to rest, a darker environment is more soothing.

Educational materials

After a procedure it is important to educate patients (andfamily). At discharge they arehanded a bunch of loose
papers with educational info
regarding their new medications. Nurses indicate that apacket/folder or educational
web portal would be nice tohave.

Documentation /reporting
Discharge patient

Nurse gives
patient follow-up
call next day

Recommendations
and results
Philips provides strategic guidance, working
closely and collaboratively with client teams.
Our clinical optimization recommendations
have helped clients achieve performance
results including:• Improved clinical processes• Enhanced transition between care environments• Increased patient capacity• Improved system utilization• Enhanced patient and staff satisfaction• Reduced costs as well as resource, labor,
and supply requirements
Healthcare Transformation Services
Targeted capabilities empower healthcare transformation
Clinical andBusiness
Performance
Improvement

Population
HealthStrategic
DesignEducation

ManagedServices

Information
Integration

Improve thequality andefficiency of
your clinicaland businessprocesses while
reducing costs.

Align people,
processes andtechnologies
to support andoperationalize
predictable,
sustainable
delivery of
quality andcost-effective
care.

Support yourefforts inproviding an
exceptionalcare delivery
environment
and patientand clinician
experience.

Provide clinicaleducation,
professional
development,
and producttraining plus
associatedlearning
platforms.

Deliversustainable
and affordable
access tohealthcaretechnologies
and support
services via
innovative
businesscollaborations.

Leverage thepower of yourinformation
with information
integration
services including
custom softwaredevelopment,
systemintegration,
and analytics.

Many clients have achieved
strong, sustainable results.
Learn more about how wehave helped others.
Philips helped a US regionalreferral medical center identify

Healthcarechange initiatives to increase

Transformation Services

Improving clinical process
performance and the overallpatient experience
Philips Healthcare Transformation Services collaborating for operational
improvements at a regional medical center

Who/where
A large regional referral center serving over 3 million
patients annually. USA.
Challenge
The client was looking to improve the qualityof operations in their Cardiac Catheterization /Electrophysiology Labs.

Additional
consulting services

Solution
The consulting team analyzed the current state of theclient’s operational processes, then created experience
flow maps to summarize the analysis, which led to change
recommendations and a project implementation plan.
Results
The client is implementing many of the recommended
change initiatives. They expect results to include anincrease in overall patient capacity, earlier first-casestarts, and an increase in utilization of their Cath andEP labs.

A large regional referral medical center –one that has been delivering exemplary
patient care for decades – was looking
to make operational improvements intheir Cath and EP Labs. They turned
to Philips as an innovative and trusted
partner – that could help them enhancetheir operations and implement changes
in support of their long-term strategy. A
Philips-client project team was formed
with a focus on patient care, operational
improvement, and financial returns.

patient capacity, earlier firstcase starts, and utilization of
the Cath and EP Labs.

Philips Healthcare Transformation
Services offers additional programs

Lakeland Regional Medicalsuch as:Center implemented severalof our recommendations to• Workforce optimization services

modify their ED ultrasound room,• Stand-alone data analytics

improve patient satisfaction, and• Program implementation

win EmCare’s 2014 Genesis Cup• On-site project management

Award for ED Innovations.

Learn more
Through collaborative and patient-

Our consulting team enabled afocused engagements, Philips
Healthcare Transformation Services

nonprofit US teaching pediatricHealthcare

hospital identify several

Transformation Services

can help you unlock insights andopportunities to solve your mostcomplex challenges of care delivery.
We can help you achieve meaningful
and sustainable improvements in clinicalexcellence, operational efficiency, care

performance improvement
Streamlining the workflow
processes for a high-volume
MRI department
Philips Healthcare Transformation Services enabling
performance improvement at a large academic children’s hospital

Who/where
A premiere pediatric teaching hospital that provides
care to over 100,000 children annually. USA.
Challenge
Increase system utilization and patient throughput inthe MRI department by streamlining the processes fromscheduling through to examination.
Solution
The Philips Healthcare Transformation Services teamled a collaborative consulting engagement which
included in-depth data collection and analysis, onsite
observations, and staff interviews, followed by root cause
analysis and prioritized change recommendations.
Results
The consulting team identified several performance
improvement opportunities that should result inincreased MRI room capacity and patient throughput
as well as improved staff and patient satisfaction without
requiring additional operational cost.

A large, nonprofit teaching pediatrichospital that has been named among
the top in the US for clinical excellence
wanted to enhance its MRI processes.
They were caring for pediatric patients
efficiently and effectively in a competitivemarket. Patient volume had been risingsteadily and was expected to continue
to rise in the future. They had room tosupport this growth, but were looking
to further improve workflow, systemutilization, and patient throughput.

opportunities to increase MRI
room capacity and patient
throughput.

delivery, and financial performance
to improve value to your patients.
For more information, please visit

Please visit www.philips.com/clinical_improvement to readwww.philips.com/healthcareconsulting.

about these engagements and download these case studies.

Please visit www.philips.com/healthcareconsulting© 2015 Koninklijke Philips N.V. All rights reserved. Specifications are subject to change
without notice. Trademarks are the property of Koninklijke Philips N.V. (Royal Philips)
or their respective owners.

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