Penn Medicine Center for Health Care Innovation

Oncology Design Sprint


Design thinking for Oncology bed-flow.

Opportunity

UPHS leadership asked the Center for Health Care Innovation to examine Oncology bed-flow, as patient length of stay (LOS) and time of discharge were increasing. We held a 5-week design sprint: a design-thinking approach to discover the barriers to efficient bed-flow, and the qualities required for innovative solutions.

For our initial meeting, we interviewed oncology staff and mapped the described delays as they occur along the patient journey. Leadership then requested we focus on scheduling for elective chemotherapy patients: constant bed capacity forced these patients to be rescheduled, adversely affecting dose regularity and intensity. Our goal became “Time to Chemo:” How might we eliminate the delays between elective chemo scheduling and the time when the patient receives treatment?


Intervention

In conducting contextual inquiry with diverse oncology staff, we discovered the root causes of scheduled delays. These causes originated across the system of oncology, regardless of setting (inpatient and outpatient) or type of admission (scheduled, urgent, and emergent).

We crowd-sourced staff ideas and solutions that addressed these causes. We then asked two main questions. First: Does each solution save a bed (ideal: decreases or eliminates LOS), or just improve the speed of a part of the journey? Second, we asked: What are the qualities of these ideas and solutions—what underlying need is solved? Our goal became to reduce unnecessary bed demand and to consolidate the largest number of qualities into the fewest number of solutions. Rather than implementing multiple solutions with lesser impact across oncology, we intended to ideate robust solutions to address oncology-wide needs.


Impact

We presented two solutions that have the potential to both address the majority of causes of delays. These ideas were initiated by leaders within oncology, and can be supported with prototyping and experiments to become powerful solutions.

The first solution, an oncology admissions process, could perform three main functions: to load balance patient scheduling based on clinical priority, to reduce in-bed delays by preparing patients before hospitalization, and to reduce overall scheduled bed demand by scheduling all potential mixed-outpatient treatments as such. We outlined experiments to test this solution, including a scheduling system to be co-created by the 19 physicians who schedule patients for inpatient treatment.

The second solution, an outpatient clinic, could also offer several functions: to evaluate patients, offer uncomplicated patients an ideal and accurate level of outpatient care, and allow for earlier hospital discharge. The solution would reduce urgent and emergent admissions to the hospital and ED, and decrease LOS. We supplied a vapor test as an experiment to gauge real demand, surveying all clinicians who currently need to admit patients due to the absence of this clinic.

Both solutions could increase patient satisfaction and increase hospital bed throughput.

What's Next? Our work with oncology and leadership is ongoing. The Center for Innovation will continue to aid in experimentation and prototyping to test and refine these solutions.

Collaborators:

Rebecca Hirsh
MD Director, Inpatient Oncology Services

Mauri Sullivan
MSN, RN Clinical Director, Medical Nursing

Regina Cunningham
PhD, RN, AOCN, Chief Administrative Officer, Cancer Service Line

Matthew Goldstein
MS, Associate Director of Operations, Abramson Cancer Center

Lisa Bellini
MD, Vice Chair, Education and Inpatient Services

PJ Brennan
MD, Chief Medical Officer and Sr. Vice President for UPHS

Derek Mazique
Medical Student, Innovation Center Scholar

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