Transcript LEAN Approach for Employee Engagement

Moving ACP Provider Satisfaction to
Tier 1
Objectives
 Provide a broad stroke understanding of LEAN
approach to problem solving
 How to build a “Fishbone” diagram that identifies
problems or issues with ACP Engagement
 Sharing ways to improve ACP Engagement
 Case study at NHRMC
Key Principles of LEAN
Eliminate Waste
Improve Efficiency
Improve Quality
Improve Customer Satisfaction
Save $$$
Culture Change
 Not a top down approach
 Enables staff to redesign
work when recognize its
not necessary or if they
can achieve a better
outcome
 Less meetings, more
coaching
8 Kinds of Waste
DOWNTIME
 Defects
 Over-production
 Waiting
 Not Clear
 Transporting
 Inventory
 Motion
 Excess Processing
Value Stream Mapping
Observe current state
Identify value and non-added value
activities
Observe work where its being done
Map out process
Dragon
All stroke
patients not
on same floor
Prioritization
moves patients
outside 24 hours
Volume vs
24 hour
policy
Dr. Os
Call/vacation
schedule not
reviewed by RN
Order not
in EPIC
still
Consultants
for WHA
patients
-Mond
RN discussion,
see patient, open
note (Dr. Oster)
Patient
off floor
8 am
prioritization
huddle (Dr.
Oster/Gail)
Nurse,
EPIC,
Resident
Triage
Don’t have all
overnight
information at 8 am
Interruptions
RN/MD
No
“workup”
testing
Must deal with
WHA “pager only”
call information

RN to MD
consult call is
not efficient
Document
notes in
EPIC
Noon Huddle
-Review patients
seen by Gail
-Adding to list
-Reprioritize
Afternoon Rounds
-Gail’s patients- 85%
-Resident’s patients100%
-Own patients
Patient off
floor
Order in
EPIC for
consult
Multiple phone
calls for the
same patient
MD doesn’t
call their
own consult
Unofficial
consults
RN doesn’t
have all
information
Resident Lectures
(At least 3 times a
week)
Interruptions
RN/MD
-Every
-Call st
Order not
in EPIC
Inappropriate
consults
Outpatient
only physician
volume
Document notes
in EPIC (Sign
residents & Gail
notes)
Process for building the Fishbone
 Distribute sticky notes to all participants
 Ask a specific question
 Allow all participants to write one item on each sticky
note and call time in 3 to 4 minutes
 Going around the room, each person shares one note
 Anyone else who wrote something similar shares their
note and these go together in one category – name the
category
 Go around the room until everyone’s notes are read
ACP Provider Engagement
 Invited all of the PA’s and
NP’s to attend initial
session regarding ACP
Engagement
 Asked the question:
 What would you change
that would make you feel
the best about you and
your job at the end of the
day?
Fishbone Analysis: NHPG ACP Provider Satisfaction A3
Office Flow (11)
Documentation
Issues (9)
rooming process
not standard (5)
Standardizatio
n
Different MDs
preferences
Appreciation (3)
Scheduling (6)
Add-ons
EPIC Issues (6)
Staffing (2)
Provider-Provider
Communication when
receiving patient
Miscellaneous (3)
Not
following
protocols
Coordinating
Imaging/Labs
Don’t know who to
call
Lack of response
Costs & Resources (9)
 Finding resources for
patients
 Specialty consults not
available
Follow Up with Patients (6)
 Quality vs quantity
 Time to follow up
 Time off
Prioritization (5)
 Incomplete Triage by nurse
 Triage of calls and priority patient
messages
 Communication of patient status
 Task planning
Carolinas requirements vs
NHRMC protocols
Communication
Conflicts (3)
Responses
 The relationship with my
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MD. Positive feedback
and respect.
The relationship I have
with my
patients/families
Direct link to a resource
person at CHS
Respected by my
physicians
Viewed as a provider
Describe things you would like to
see changed

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NHRMC Physician Group does not provide recognition. No
announcements to the community (this has already been fixed)
Not sure who my employer is? CHS vs. NHRMC vs Administrator
often with differing expectations
Not sure who to contact for certain problems/issues
Mixed communication/Receiving inaccurate information
Not being included in the physicians’ lounge at NHRMC
First name only on name badge. Does not acknowledge my role
Desire regular team meetings with effective next steps. Seems
nothing ever changes when we make suggestions.
Want to operate at highest scope of my credentials with
appropriate support
Recognition and thank you from the physicians
Sometimes I am an employee/sometimes I am a colleague
Response Categories
 Office Flow
 Documentation Issues
 Costs and Resources
 Scheduling
 Follow up with Patients
 EPIC Issues
 Prioritization
 Communication
 Appreciation
Communication
Created the ACP Leadership
Council
Meets monthly
8 Team Members
Representation on the Physician
Leadership Council and on MD
committees for EPIC and Quality
Governance Structure
Administrative
Council
PNLC
Quality
Subcommittee
Co-Leaders:
Amy Messier, M.D. (PNLC Member)
Dan Goodwin (PNLC Member)
PNLC
PNLC
Epic
Subcommitte
e
Co-Leaders:
Amy Messier, M.D.
Melissa Davis (PNLC Member)
Co-Leaders:
VACANT (Charlotte PNLC)
Dan Goodwin (Charlotte PNLC)
ACP
Leadership
Council
Co-Leaders:
Megan Whitley, PA (PNLC Member)
Kathy Gresham (Administrative)
Co-led Governance and Committee Structure
16
Initiatives
 LEAN Training for
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Leadership
ACP Site Visit book
streamlined
Input on Quality Matrix
Optimization of EPIC
strategies
Review of Incident to
billing
Ideas for NP and PA
week
Appreciation
 Rounding in the PA and NP Lounge
 Identifying low hanging fruit changes
 “Sweat the little stuff”
 PA and NP Week
 Congratulations Cake
 Popcorn
 Snack/Cheese Tray
 Cake Pops
 Ice Cream
Next Steps
 LEAN project to further develop the scope of the
Leadership team and to develop a communication plan
 ACP meetings within each specialty group with
Physicians to discuss process improvement
 Continue monthly leadership meetings
 Socials outside of office/hospital time
Questions
Communication
Respect
Recognition