Federal Register: November 21, 2008 (Volume 73, Number 226)
DOCID: fr21no08-60 FR Doc E8-27521
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
NOTICE: NOTICES
DOCID: fr21no08-60
DOCUMENT ACTION: Notice.
SUBJECT CATEGORY:
Agency Information Collection Activities: Proposed Collection; Comment Request
DATES: Comments on this notice must be received by (insert date 60 days after date of publication).
DOCUMENT SUMMARY:
This notice announces the intention of the Agency for Healthcare Research and Quality (AHRQ) to request that the Office of Management and Budget (OMB) approve the proposed information collection project: ``Reducing Waste and Inefficiency through Process Redesign: Lean/Toyota Production System (TPS) Implementation.'' In accordance with the Paperwork Reduction Act of 1995, 44 U.S.C. 3506(c)(2)(A), AHRQ invites the public to comment on this proposed information collection.
SUMMARY:
Agency Information Collection Activities; Proposals, Submissions, and Approvals,
SUPPLEMENTAL INFORMATION
Proposed Project
``Reducing Waste and Inefficiency through Process Redesign: Lean/
Toyota Production System (TPS) Implementation'' AHRQ, through its
contractor, American Institutes for Research (AIR), proposes to
investigate the contribution of Lean/TPS to reducing waste in health
care delivery systems. Lean is a processredesign methodology adopted
from Toyota Production Systems. The goal of Lean/TPS is to empower
frontline staff to apply continuous quality improvement methods to
reduce waste and enhance value in workflows and operations (Spear, S.
Fixing healthcare from the inside, today. Harvard Business Rev., 2005
83(9), 7891). AHRQ is interested in assessing and disseminating
promising techniques and methodologies for redesigning health care
processes to reduce waste and enhance efficiency. Using a purposive
sample of health care organizations and projects, AHRQ will describe
and assess the ways in which Lean/TPS has been implemented and the
related challenges and solutions experienced. The sample will vary in
community and market characteristics, type of service (e.g., inpatient/
outpatient), and delivery system characteristics (e.g., relationship
between physicians and hospitals, ownership). AHRQ plans to disseminate
the lessons learned from this project on the implementation of Lean/TPS
to health care delivery systems. This project is being conducted
pursuant to AHRQ's statutory authority to conduct and support research
on health care and on systems for the delivery of such care, including
activities with respect to: The quality, effectiveness, efficiency,
appropriateness and value of health care services; quality measurement
and improvement; and health care costs, productivity, organization, and market forces. 42 U.S.C. 299a(a)(1), (2), and (6).
Method of Collection
At least four research locations (i.e., hospitals or other health settings) will be selected to create eight case study reports. Four of the studies will employ a retrospective analytics perspective, while four will employ a prospective analytics perspective. At each location, implementation of Lean/TPS in two departments will be studied: One department with an essentially linear process (clinical laboratory, radiology, or ED) and one department with an essentially nonlinear process (cardiology, GI, or med/surg unit). A linear department is one in which the process is essentially uniform and predictable for most or all services delivered. A nonlinear department is one in which the process is much less uniform and predictable. If there is more than one Lean/TPS project in the selected department, we will purposively select a project that appears to have the most information for others about the processes and outcomes of Lean/TPS implementation.
Qualitative data will be collected directly from the four locations selected for this study. The collection will be accomplished using interviews telephone and inperson), collection of documentation, and digital diaries for the four prospective studies. The ``digital diary'' is a data collection method using a diary entry guide and a digital recorder to describe key aspects of the implementation process. The total number of inperson interviews to be conducted across the four locations is 100; the total number of telephone interviews is 36. The inperson interviews will be conducted through a multiday visit to each site. The number of digital diary submissions will depend on the number and duration of the Lean/TPS project within in each department. Estimated Annual Respondent Burden
Exhibit I shows the estimated annualized burden hours. A total of
25 inperson interviews will be conducted with the administrative and
clinical personnel from each of the four participating health care
facilities. The estimated time per response is 1.0 hour for a total of
100 burden hours. Additionally, a total of 9 telephone interviews will
be conducted with each facility. The estimated time per response is 30
minutes, for a total of 18 burden hours. The digital diaries will be
completed once a month for eight months by two personnel from each
facility, and will require about 30 minutes each per month for a total
of 32 hours. Finally, administrative staff from each site will be asked
to provide training materials, reports on Lean/TPS implementation, and/
or any other documentation or existing data from previous or current
Lean/TPS projects implemented. We anticipate this task will simply
consist of forwarding emails and or photocopying and sending documents
to the project team one time throughout the course of the project and
will take about four hours per facility or 16 hours total. The total
estimated burden is 166 hours. Exhibit 2 shows the estimated annualized
cost burden for the respondents' time to provide the requested data. The hourly rate of
[[Page 70649]]
$35.07 is an average of the administrative personnel hourly wage of
$14.53 and the clinical personnel hourly wage of $62.52 for physicians
and $28.15 for registered nurses. The total cost burden is about $5,492.
Exhibit 1Estimated Annualized Burden Hours
Number of
Number of responses Hours per Total
Data collection respondents per response burden
respondent hours
Inperson interviews........................................ 4 25 1.0 100
Telephone interviews........................................ 4 9 30/60 18
Digital Diaries............................................. 4 16 30/60 32
Collection of documentation................................. 4 1 4 16
Total................................................... 16 ........... ........... 166 Exhibit 2Estimated Annualized Cost Burden Total Average Data collection Number of burden hourly wage Total cost respondents hours rate * burden Inperson interviews........................................ 4 100 $35.07 $3,507 Telephone interviews........................................ 4 18 35.07 631 Digital Diaries............................................. 4 32 35.07 1,122 Collection of documentation................................. 4 16 14.53 232
Total................................................... 16 ........... ........... 5,492 * Based upon the average hourly wages of administrative support personnel, physicians, and registered nurses, National Compensation Survey; Occupational Wages in the United States 2005, U.S. Department of Labor, Bureau of Labor Statistics.
Estimated Annual Costs to the Federal Government
The total cost to the Federal Government for this project is $415,000, with an average annual cost of $207,500. This figure includes the cost of data collection, data analysis, reporting, and government oversight of the contract.
Request for Comments
In accordance with the abovecited Paperwork Reduction Act legislation, comments on AHRQ's information collection are requested with regard to any of the following: (a) Whether the proposed collection of information is necessary for the proper performance of AHRQ's health care research and health care information dissemination functions, including whether the information will have practical utility; (b) the accuracy of AHRQ's estimate of burden (including hours and costs) of the proposed collection(s) of information; (c) ways to enhance the quality, utility, and clarity of the information to be collected; and (d) ways to minimize the burden of the collection of information upon the respondents, including the use of automated collection techniques or other forms of information technology.
Comments submitted in response to this notice will be summarized
and included in the Agency's subsequent request for OMB approval of the
proposed information collection. All comments will become a matter of public record.
Dated: November 6, 2008.
Carolyn M. Clancy,
Director.
[FR Doc. E827521 Filed 112008; 8:45 am]
BILLING CODE 416090M
FOR FURTHER INFORMATION CONTACT
Doris Lefkowitz, AHRQ Reports Clearance Officer, (301) 4271477, or by email at
doris.lefkowitz@ahrq.hhs.gov..