[Federal Register: November 21, 2008 (Volume 73, Number 226)]
[Notices]               
[Page 70648-70649]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr21no08-60]                         

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality

 
Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Agency for Healthcare Research and Quality, HHS.

ACTION: Notice.

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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.

DATES: Comments on this notice must be received by (insert date 60 days 
after date of publication).

ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, 
Reports Clearance Officer, AHRQ, by email at 
doris.lefkowitz@ahrq.hhs.gov.
    Copies of the proposed collection plans, data collection 
instruments, and specific details on the estimated burden can be 
obtained from the AHRQ Reports Clearance Officer.

FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports 
Clearance Officer, (301) 427-1477, or by email at 
doris.lefkowitz@ahrq.hhs.gov..

SUPPLEMENTARY 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 process-redesign methodology adopted 
from Toyota Production Systems. The goal of Lean/TPS is to empower 
front-line 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), 78-91). 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 non-linear 
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 non-linear 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 in-person), 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 in-person interviews to be conducted across the four 
locations is 100; the total number of telephone interviews is 36. The 
in-person interviews will be conducted through a multi-day 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 in-person 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 1--Estimated Annualized Burden Hours
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                                                                            Number of
                                                               Number of    responses    Hours per      Total
                       Data collection                        respondents      per        response      burden
                                                                            respondent                  hours
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In-person 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
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                                   Exhibit 2--Estimated Annualized Cost Burden
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                                                                              Total       Average
                       Data collection                         Number of      burden    hourly wage   Total cost
                                                              respondents     hours        rate *       burden
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In-person 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
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* 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 above-cited 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. E8-27521 Filed 11-20-08; 8:45 am]

BILLING CODE 4160-90-M