As a successful interventional cardiologist and systemwide associate medical director for the Heart and Vascular Service Line at Detroit’s Henry Ford Health, Akshay Khandelwal (PEMBA, ’22) still wanted to improve his skill set and position himself for further leadership growth. This desire to grow academically and professionally led him to the Haslam College of Business at the University of Tennessee, Knoxville. When looking for healthcare-related academic programs, Khandelwal wanted to find a streamlined, graduate-level program designed specifically for physicians that would allow him to work full-time. Haslam’s one-year Physician Executive MBA (PEMBA) program provided a well-timed opportunity.
Increasing Lab Efficiency
Henry Ford Hospital, like many healthcare facilities, faced challenges in the wake of COVID-19. Among those challenges was a low patient procedure throughput rate in Khandelwal’s service line’s catheter lab, which meant overtime was routinely required, causing poor staff morale and retention. Additionally, low throughput in the lab meant the hospital could only apply complexity expertise to a limited number of external transfers into the facility.
Khandelwal had these challenges in mind when he began the PEMBA program, and he thought the hospital might need to build more labs and employ additional personnel to facilitate more procedures without putting further stress on the current staff. When exploring options for his PEMBA Organizational Action Project (OAP) — a required project for all PEMBA students in which they addresses a significant concern for their organization — Khandelwal thought back to the problems at Henry Ford and decided to focus his OAP on the catheter lab’s woes.
“The thought was, how do we make more efficient use of our labs so we can we get more procedures done in a day, cut down on overtime and improve retention?” Khandelwal says.
Identifying Issues, Finding Solutions
As part of his OAP, Khandelwal led a change management team to define the lab’s process, invite stakeholder input and propose and implement a new throughput process that focused on procedure start times and turnover times. The team found that lack of clarity on cultural norms, including expected staff start times, contributed to the lab’s problems.
The lab instituted new processes with defined roles for pre-procedural preparation and post-procedure management as a result of their analysis. Overall, these procedures led to better outcomes in the lab — start times improved by about 30 minutes and turnover times improved by about 10 minutes. These improvements theoretically allow all the catheterization labs to finish on time or perform at least one additional procedure in each procedural lab. To continue improvements, the plan is to scale this approach to include other procedures in the hospital’s labs and other catheter labs in its system for increased efficiency, improved culture, opportunities for growth, higher patient satisfaction and improved margins.
“It was about alignment,” Khandelwal says. “There was a lot of dead time that wasn’t being utilized. Some of that had to do with cultural expectations within our practice about starting times, some of it was scheduling meetings and a variety of things. We decided to move certain meetings off, and we put in some hard stops or more firm language about expectations regarding what time physicians arrive in the lab.”
The Frog in the Well
According to Keith Leitner, a lecturer with Haslam, PEMBA teaches students to look at process throughput from the perspective of the value that it creates and attempt to maximize that value. Maximizing the value of a process throughput is achieved, in part, by identifying all the work done outside of the value creation and reducing or eliminating as much of this non-value activity as possible.
“Akshay did an amazing job of pulling back and objectively looking at all the work necessary to prep for and change over between cases,” Leitner said. “He facilitated many solid improvements that reduced and improved those activities.”
“The way that I looked at the problem was very different than how I would have looked at it in the beginning,” Khandelwal says. “Before, I would have easily gone to build more labs, hire more people, but [my perspective] was different enough for me to say we don’t need to do that. There was an opportunity to make an impact by improving processes and by making what I now thought were simple, common-sense changes to workflow.”
“It’s like the frog in the well versus the frog in the ocean parable. You don’t know what you don’t know until you can step out and see a bigger picture. Then, suddenly, you have a new perspective on how to approach the problem.”
“A Better Experience”
Khandelwal continually applies his PEMBA skills and knowledge in other areas of his work. He currently uses his newly acquired skills to work with supply chain personnel on a new state-of-the-art tower Henry Ford is building to house higher-end services, including cardiovascular. That’s just one example.
“I can say the same thing about looking at clinic flow, looking at any kind of process where we talk about throughput in the hospital and figuring out where the bottlenecks are,” he says. “I think it’s going to lead to a better experience, not just for the nurses and the techs and the physicians, but most importantly, for the patients and their families.”
Khandelwal will now put his skills to use improving patient and staff experiences in a new role — he just accepted the position of system chair for Cardiology at Allegheny Health System.
Kate Atchley, executive director of Haslam’s graduate and executive education healthcare division, says Khandelwal’s journey is typical of many PEMBA students.
“Students begin the program with a passion to develop their skills, and they are able to apply their learning immediately to their organizations,” she said. “They leave with greater ability and strategic awareness, which accelerates their impact on the practice of healthcare.”
About the Haslam College of Business Graduate and Executive Education Programs
Haslam offers an extensive portfolio of graduate and executive education programs that prepare students to reach their full potential and advance their careers. At the master’s level, these programs include the Haslam Full-Time MBA, Online MBA, Professional MBA, Executive MBA (Global Supply Chain, Healthcare Leadership, Strategic Leadership), Aerospace & Defense MBA, Physician Executive MBA, Master of Accountancy, MS Management and Human Resources, MS Marketing, MS Business Analytics, MS Supply Chain Management Tri‑Continent and MS Supply Chain Management Online.
Haslam’s graduate programs address real-world challenges through an interdisciplinary approach that develops both analytical and leadership skills. Faculty are industry thought leaders, seasoned practitioners and accomplished researchers who work tirelessly to create dynamic, relevant and impactful learning experiences.
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Scott McNutt, business writer/publicist, [email protected]
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