How I Identified Causes of Operational Bottlenecking and Improved Patient Post-Op Success
Improving Patient Flow for Shoulder Replacement Procedures
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THE PROBLEM
Fielder Medical Center was facing significant inefficiencies in its shoulder replacement process. Patients regularly waited over three hours for intake—often in hallways—and the discharge process lacked structure, leading to an increased rate of rehospitalizations. These issues negatively affected both patient satisfaction and care outcomes. The scope of this project focused exclusively on the controllable operational processes within the medical center: intake, pre-surgery preparation, surgery coordination, and post-operative discharge.
MY ROLE AND STRATEGY
Using the Six Sigma DMAIC framework (Define, Measure, Analyze, Improve, Control), I led an operational assessment to identify root causes of process delays and inconsistencies. The work excluded uncontrollable variables such as surgeon performance or patient compliance after discharge, and instead emphasized systemic, repeatable changes within the facility’s operations.
DEFINE AND MEASURE
The analysis identified three primary pain points: an outdated intake management system, excessive wait times, and a discharge process that lacked clarity and contributed to patient readmissions. Using patient data, process mapping, and standard deviation analysis, we set a time-bound goal to reduce intake wait time from over three hours to under one hour—aligned with national standards.
ANALYZE
Process mapping revealed severe bottlenecks in centralized intake, including limited staffing and poor digital workflows. Additionally, inconsistencies in discharge planning made it difficult to ensure patients left with clear recovery instructions, increasing the likelihood of complications and return visits. This phase helped isolate which variables were within control of the facility and clarified the actions necessary to make meaningful change.
IMPROVE
The central solution was to implement decentralized intake stations supported by additional staffing and IT integration. This structural change allowed for parallel intake processes, which significantly reduced bottlenecks. Standardized forms and tracking metrics were also introduced to ensure consistency across each phase of the patient journey. For discharge, we introduced a protocol-driven handoff system that clarified recovery instructions and ensured patients left the facility better informed.
CONTROL
To sustain the improvements, I implemented Statistical Process Control (SPC) charts to monitor wait time variation and flag deviations from performance standards. Regular stakeholder reviews were established—bringing together administrative staff, nurses, and IT—to track the effectiveness of changes and to realign goals based on evolving data. The SPC approach ensures that improvements are data-driven and that processes remain within control limits over time.
THE OUTCOME
The decentralized intake model is expected to reduce patient wait times by more than 66%, improving comfort, safety, and satisfaction. Enhanced discharge protocols aim to decrease rehospitalization rates while promoting recovery compliance. Ultimately, the changes position Fielder Medical Center to deliver more consistent, efficient, and patient-centered care.