Value stream mapping of acute orthopaedic physiotherapists to optimise clinical efficiency.

Abstract

Introduction: The number of orthopaedic surgeries occurring at Epworth is increasing annually and it is a priority to maximise time spent with patients. Thus, it is important to evaluate the service efficiency. The current caseload expectation for acute orthopaedic physiotherapists is 14 patients a day (one patient per half hour). Considerable variability was noted in the ability of staff to achieve this target. To identify factors contributing to these differences, value stream mapping (VSM) was employed. To date, no formal mapping has been completed to evaluate how physiotherapists spend their time.

Methods: Four acute orthopaedic physiotherapists of varying experience were observed by a volunteer for a day in March 2017 to measure the time spent in direct patient contact, indirect patient contact and non-patient contact tasks. This time was collected via the use of a stopwatch and entered into a spreadsheet.

Results: Initial mapping demonstrated fifty percent of staff were meeting current caseload expectations. Factors that contributed to staff members not meeting expectations were higher non-patient to patient contact times for junior staff and considerable non-patient contact time for staff covering day surgery. Following this, treatment quality and time expectations guidelines were developed. In addition, a daily planner tool and a time management skills training package were implemented. Remapping of two new junior staff who had completed the training package demonstrated that both were able to meet caseload expectations with a higher patient contact ratio.

Conclusion: VSM is an effective way to identify inefficiencies in physiotherapy service delivery. The introduction of a time management training package was seen to be effective at maximising patient therapy time.