This title slide features the main title "PATA Implementation Strategy: From Bottlenecks to Better Care." The subtitle emphasizes improving flow, experience, and safety at MGH’s Pre-Admission Testing Area.

PATA Implementation Strategy: From Bottlenecks to Better Care

Improving Flow, Experience, and Safety at MGH’s Pre-Admission Testing Area

Source: MGH PATA Presentation

PATA processes ~55 patients daily, directly impacting OR start times and throughput. Long, unpredictable visits frustrate patients and staff, requiring an operationally sound, realistic plan.

Why PATA Is Critical

• Processes ~55 patients per day
• Impacts OR start times and throughput
• Long, unpredictable visits frustrate patients/staff
• Requires operationally sound, realistic plan

Source: PATA Implementation Strategy: From Bottlenecks to Better Care

Core operational findings show RN utilization at ≥100% for much of the day, with the RN step as the primary bottleneck causing the longest wait times. Peak overload hits from 12-2 PM with the highest queues, and 65% of time is spent waiting—more than in care.

Core Operational Findings

• ≥100%: RN Utilization

Much of the day

• RN Step: Primary Bottleneck

Longest wait times

• 12-2 PM: Peak Overload

Highest queues

• 65%: Time Waiting

More than in care Source: 6.2 Analysis

The slide summarizes Proposals 1 and 2 from section 6.2: Proposal 1 uses 45-minute appointments to smooth arrivals and lower peak utilization but reduces throughput and extends the clinic day; Proposal 2 adds staff/rooms to fix RN queues with strong impact but faces FTE, space, and budget barriers. Proposal 3 targets process waste without new staff but requires behavior change, with a hybrid approach—anchored in process improvements—highlighted as the best and most realistic option.

Summary of Proposals from 6.2

| Proposal 1 (45-min appts): Pro: Smooths arrivals, lowers peak utilization; Con: Less throughput, extends clinic day.

Proposal 2 (More staff/rooms): Pro: Fixes RN queues, strongest impact; Con: Requires FTEs, space, budget barriers. | Proposal 3 (Process): Pro: No new FTEs, targets waste; Con: Needs behavior change.

Hybrid best: Anchored in process improvements, realistic implementation. |

The "Phased Hybrid Strategy" timeline outlines three phases over 12 months to address RN overload. Phase 0 (0-2 months) focuses on preparation and baseline metrics, Phase 1 (2-6 months) on low-cost process and scheduling improvements, and Phase 2 (6-12 months) on targeted resources and IT enhancements.

Phased Hybrid Strategy

0-2 months: Phase 0: Prep & Baseline Preparation activities and establish baseline metrics for tracking progress. 2-6 months: Phase 1: Process/Scheduling Low-cost process improvements and scheduling changes to ease RN overload. 6-12 months: Phase 2: Resources/IT Targeted resource additions and IT enhancements based on Phase 1 data.

Source: PATA Implementation Strategy: From Bottlenecks to Better Care

Phase 1 targets quick wins without hiring new full-time employees. It emphasizes smoothing appointment patterns, pre-visit data collection, streamlined documentation, and staggered lunches/breaks.

Phase 1 – Quick Wins Without New FTEs

• Smooth appointment patterns
• Pre-visit data collection
• Streamlined documentation
• Staggered lunches/breaks

Source: PATA Implementation Strategy: From Bottlenecks to Better Care

The slide "Improving Daily Flow at the Front Line" proposes a central status board for real-time visibility and brief huddles to anticipate bottlenecks. It also emphasizes reducing search time via better coordination and minimizing staff miscommunication.

Improving Daily Flow at the Front Line

• Introduce central status board for real-time visibility
• Conduct brief huddles to anticipate bottlenecks
• Reduce search time through better coordination
• Minimize miscommunication between staff members

Source: PATA Implementation Strategy: From Bottlenecks to Better Care

Phase 2 – Targeted Investments starts by reviewing Phase 1 data on utilization and wait times. It then adds +1 RN FTE or per-diem if overload persists, embeds IT templates for streamlined documentation, and implements electronic queues for workflow visibility.

Phase 2 – Targeted Investments

• Review Phase 1 data on utilization and wait times
• Add +1 RN FTE or per-diem if overload persists
• Embed IT templates for streamlined documentation
• Implement electronic queues for workflow visibility

Source: PATA Implementation Strategy: From Bottlenecks to Better Care

The slide "Securing Buy-In Across Stakeholders" outlines motivations like reduced stress for RNs, smoother OR flow for physicians, better coordination for front desk/lab, and ROI for admins. It details a negotiation approach using data-driven metrics, clinician co-design, and alignment with hospital goals like throughput, safety, and the Quadruple Aim.

Securing Buy-In Across Stakeholders

| RNs: Reduced overload and stress. Physicians: Smoother patient flow to OR. Front desk/Lab: Better coordination and less chaos. Admins: Proven ROI via efficiency gains. | Data-driven: Metrics show bottlenecks and wins. Clinician involvement: Co-design with staff input. Hospital alignment: Boosts throughput, safety, Quadruple Aim. |

Source: PATA Implementation Strategy: From Bottlenecks to Better Care

The slide "Making the Change Stick" outlines Kotter’s model for sustaining change by creating urgency with data on bottlenecks and building a guiding team of RNs, MDs, and leaders. It emphasizes targeting short-term wins like reduced waits, leveraging positive feedback for momentum, and applying the model for lasting impact.

Making the Change Stick

• Create urgency with data on bottlenecks and delays
• Build guiding team of RNs, MDs, and leaders
• Target short-term wins: reduced waits, shorter visits
• Leverage positive feedback to build momentum
• Apply Kotter’s model for lasting change

The slide "How We Will Measure Success" outlines four key performance targets. These include 50% reduced patient wait times, 95% patient satisfaction score, 85% RN utilization at peak load, and 2x ROI multiple.

How We Will Measure Success

• 50%: Reduced Wait Times

Target cut in patient waits

• 95%: Patient Satisfaction

Quality experience score

• 85%: RN Utilization

Peak workforce load

• 2x: ROI Multiple

Business case return

This conclusion slide highlights ethical, high-quality care that protects patient safety and staff well-being while maintaining throughput and aligning with the Quadruple Aim. It calls for approving Phases 0-1 today, securing leadership support, reviewing metrics in 6-12 months, and transforming PATA together.

Ethical, High-Quality Care and Clear Next Steps

• Protects patient safety and staff well-being

• Maintains throughput and aligns with Quadruple Aim
• Next Steps: Approve Phase 0-1, secure leadership support, review metrics in 6-12 months

Call-to-Action: Approve Phases 0-1 today to unlock better care!

Thank you. Let's transform PATA together.

Source: PATA Implementation Strategy: From Bottlenecks to Better Care