Transcript valuing innovation - Camden Coalition of Healthcare Providers

innovation for people
a core value
we strive to innovate by re-strategizing and re-working solutions to meet the
needs of various departments within CCHP and patients in our community.
we understand that with innovation comes the risk of failure; however we
accept these failures as learning opportunities that continuously inform our
work.
we understand that to be successful in our work requires changing systems
from the office practice to state and national policies
where are we headed
early auto workshop
non-standard product
high cost
poor quality
early assembly line
standardized work
lower cost
higher quality
modern assembly line
team-based work
automation
delegation
standardized inputs
multiple models
varied complexity
but patient are not cars!
a core value
we strive to innovate by re-strategizing and re-working solutions to meet the
needs of various departments within CCHP and patients in our community.
we understand that with innovation comes the risk of failure; however we
accept these failures as learning opportunities that continuously inform our
work.
we understand that to be successful in our work requires changing systems
from the office practice to state and national policies
successful innovation
three things are required from all of us to be successful innovators
look
innovation begins and ends with people and requires keen and caring observation
understand
innovation is not a lightbulb moment of genius, it emerges from deep understanding,
rigorous discernment and thoughtful analysis
make
putting great ideas into action calls for a commitment to successive improvement,
frequent iteration, resourcefulness and an ability to embrace change as the norm
THE URBAN HEALTH INSTITUTE
Healthcare Delivery Innovation
August 15, 2014
Improved Outpatient Care at Lower Cost
• Large outpatient multispecialty practice dedicated to the underserved:
• 23 specialties across Medicine, Orthopedics, Surgery &
Neurosciences
• Only accepting “underserved”, defined as self-pay & Medicaid,
and Medicare from 5 Camden zip codes.
• 22 office staff FTEs, 10 grant-funded business and clinical innovation
staff, 100+ physicians, 120+ undergraduate and graduate trainees
• Group Visits: 6 disease states
• Care Management/Care Transition projects
• Data driven operational stabilization and clinical redesign
7/17/2015
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Year 2 Areas of Focus
Year 1 Top Accomplishments
• Segmented the market
• Renovated the suites
• Grew from 19 to 23 specialties
• Redesigned our clinical operations –
to make our 22 office staff flexible
across roles
• Reduced overhead cost/visit from
~$200/visit to ~$150/visit
• Grant renewed for additional 2
years
Year 2 Areas of Focus
• Meeting grant financial step-down
goals
• “The Year of Actually Fixing
Things”
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Extensive continuous
improvement for operational
processes
Clinical redesign and
protocolization
Improving the patient
experience
Predictive modeling (next
generation of SmartBooking)
Staffing stabilization and
workforce development
Care Transitions
Patient Engagement
 “Brief needs
assessment
 Facilitation
 Accompaniment
 Warm hand-off
 Responsive to needs
 “Your doctor knows you’re
beyond PCP hospital
in the hospital”
follow-up
 Rapport-building
 Patient as expert
 Motivational interviewing
Cardiothoracic Surgery
General Surgery
Trauma
Podiatry
Orthopaedics
Vascular
Urology
Complexity Involved in Building Surgical Care Management Service
A Focused Factory Approach: Group Visits
Cooper Call
Centers
ED/Hospital
Referrals
Group
Visit
Program
UHI
Physicians
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Staff
Education
Year 2: Focus on High Volume Group Visits
Diabetes
Diabetic Foot
Hand
Knee Pain
Headache
Sleep Apnea
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Clinical Redesign: Hypertension Protocol
Ongoing
Primary Care
Provider
identifies patient
as appropriate for
LPN HTN Protocol
•LPN discusses case
with PCP at each
visit
•LPN schedules
follow-up visit for
patient at completion
of visit
Continued followup with PCP and
LPN at provider’s
discretion and
case discussion
with LPN
Patient is
scheduled for LPN
visit the following
week
•LPN contacts
patients started on
new medications
•LPN contacts
patients who do not
come to follow-up
appointments
LPN Visit #2: BP
measurement and
Pocket Card
completed, video
and handout on
low-salt diet
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LPN Visit #1: BP
measurement,
video and
handout on HTN,
BP Pocket Card
completed
Custom-Designed “SmartBooking” to Optimize Physician Utilization
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Operational Improvement Metrics & Initiatives
Non-Patient Visit Needs:
Throughput:
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Outbound referrals
Inbound referrals
Prescription refills
Medical Questions
Paperwork
Arrival to Roomed and Ready
Roomed and Ready <30 minutes (%)
Median MA Time
Median Rooming Time
Scheduled vs. Actual Appt. Duration
After Visit Summary (AVS) Printed
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Operational Excellence: The Everyday 10
• Customer Service
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Champion – Julia
Suite champions – Albert & Maria
• Batching & handling of co-pays
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Champion – Evan
Suite champion – Sofia
• Chart Checklist/Provider
communication tool
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Champion – Amanda
Suite champions – Donna & Yvonne
• Referrals: Log for data collection
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Champion – Liz
Suite champions – Sylvia & Norma
• Provider Variance Log
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• Protected Health Information
Champion – Julia
Suite champions – Sofia, Karen, Stacey
• Attendance & Punctuality
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Champions – Evan & Sofia
• Teamwork: Team Huddles every session
at 9:00 & 12:55
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Champions – Evan & Liz
• Daily calls & in-basket status
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Champion – Liz
Suite champion – Aleshia
• Compliance and Inspection
Readiness
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Champion – Evan
Suite champion – Sylvia & Marisol
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Champions – Julia & Liz
Workforce Development
• Staffing instability/weakness is the biggest obstacle to success
• Additional hours are required to onboard new staff (a 6-8 week
process to fully train CPAs on both front desk and clinical
functions).
• Per diem feeder pool has dried up – candidates want full time
positions
• Designing a workforce development plan – German-style
apprenticeship supported by Cooper and in collaboration with a
local college
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a core value