Transcript Revolutionary change in healthcare delivery

Revolutionary change in
healthcare delivery
ThedaCare
A healthcare system in
Northeast Wisconsin
Agenda
- Who is ThedaCare
-What have they accomplished
-Examples of Revolutionary Change
-How did they get there
-Other ways to get there?
Who is ThedaCare
Seven Hospitals
Plus
ThedaCare Physicians
ThedaCare Behavioral Health
ThedaCare at Home
6,800 employees
What have they accomplished
Hospitals and Healthcare Networks
Most Wired since 2002
The first year of the award
One of the original
Medicare Pioneer ACO’s
(Accountable Care Organizations)
Best overall cost and quality
performance in the country
Medicare ACO Ranking
2013
Beta-site for EPIC
2003
TIS (ThedaCare Improvement
System)
Example of Revolutionary Change
2007
First Collaborative Care Unit
Opened at
Appleton Medical Center
Birth of Collaborative Care
• Launched the ThedaCare Improvement System in 2003 (use of Lean concepts
and tools as our foundation for improvement initiatives).
• Around 2004 a growing number of leaders, physicians, nurses, pharmacists, and
others began voicing the obvious “our current state of inpatient care was
broken”
 Care was fragmented, inconsistent and not coordinated
 Resulting in dissatisfaction, confusion, errors
 Needed to do something that was game-changing
 Absolute – high integration of our patients/families
Background
• This transformational initiative was supported by leadership but
designed by those doing the work
• Consisted of 18 months of off-line work by a dedicated
interdisciplinary team to build the model of care one process at a
time
• Opened our 1st Collaborative Care unit on Feb. 19, 2007 at AMC
• Entire model and partial components spread to all Med/Surg Units
• Selected components spread to specialty units
Copyright © 2014 ThedaCare. All Rights Reserved.
Essential to the Work
“Voice of the Customer”
“I want to feel that you are all working
together. If I don’t feel this, I’m not sure you
know what you are doing!”
Copyright © 2014 ThedaCare. All Rights Reserved.
Collaborative Care Vision
We will create a customer-driven
interdisciplinary model of care that reliably
delivers exceptional patient outcomes and
makes ThedaCare hospitals the inpatient
destination of choice for patients and healthcare
professionals.
Copyright © 2014 ThedaCare. All Rights Reserved.
Paradigm Shifts
• A culture and supporting physical environment that promotes
cost-effective, reliable patient experiences and outcomes, to
meet quality and patient safety goals.
• Roles designed to integrate disciplines into a team that together
care for a patient
– Physician as the medical expert for the team
– Nurse as coordinator of care progression
– Pharmacist as clinical expert at the bedside
– Case Manager real time UR and transitional planning
– Patient as “Captain of the Ship”
• Professional care team together standardizing clinical practice
and collaborative processes, that bring accountability for quality
improvement to the bedside.
Copyright © 2014 ThedaCare. All Rights Reserved.
Strategic Change Processes
PAST vs. CURRENT
KEY ATTRIBUTE
TRADITIONAL MODEL
COLLABORATIVE MODEL
Patient Experience
Disjointed. May be confusing, even
contradictory.
Single plan of care developed with
patient - is visible, continuously updated
with patient driven schedule and goals.
Clinical Quality
Admirable, but not 100% reliable.
Manage errors. Nursing maintaining
thru heroics
Reliable, standard work, using
evidence-based quality and real time
problem solving to prevent errors.
Physician Role
Hierarchical.
Partner in care team. Exposes thinking
to professionals team.
Nursing Role
Task oriented. Too much time spent
running for supplies and equipment.
Care manager. Expanded and
empowered role in decision making and
patient care progression. Bedside
management of quality measures
Pharmacist Role
Back end.
Bedside presence. More involved in
patient contact/education. Teacher to
patient and team.
Environment
Semi-private, dated.
Private. Designed for patient/ staff
safety, and to support collaborative
processes.
Copyright © 2014 ThedaCare. All Rights Reserved.
Key Elements of Redesign
• Admission Team
• Tollgates (patented)
• Daily Bedside Care Conferences (Full or Modified)
• Electronic Medical Record (EMR) supporting one plan of care and links to
Milliman Guidelines (EBP)
• Visual Patient Control Management for seeing care progression
• Clarity of all roles to function at their highest scope of practice
• Create a physical environment that promotes safety and key
increase the quality and efficiency of care at the bedside
Copyright © 2014 ThedaCare. All Rights Reserved.
processes that
Admission Team
• Done jointly by MD, RN,CM and Pharmacist
• Admission Med Rec by the Pharmacist/extender
• HPI, ROS and Physical exam by MD and Nurse
• Risk assessments completed by the nurse and affirmed by the team
• Problem list and Plan of Care determined
• Interventions begun very timely
• Anticipated discharge date discussed
Copyright © 2014 ThedaCare. All Rights Reserved.
Tollgates
• Staff use “tollgates” – purposeful timeouts –
to analyze the patient’s status and remove
obstacles in care delivery. Tollgates, a lean
concept, are the equivalent of pulling off the
road to check the map, an investment in
thinking time to stay on track with the plan.
• Are we progressing? If not, why?
Patient Control Board
26
Electronic Medical Record and
Milliman Guidelines
• Link is embedded within our EMR product which supports the care
plan and education plan for the patient
• Part of standard discussion upon admission and at the daily
Bedside Care Conference
• Documentation occurs against the guideline by members of the
care team
Copyright © 2014 ThedaCare. All Rights Reserved.
Physical Environment
28
Patient Server
• Staff can easily access supplies inside the patient’s room.
• Supply restocking occurs from outside the patient’s room, to avoid disturbing
the patient.
• Dramatically reduces the hours per day spent both searching for supplies and
restocking the server.
Copyright © 2014 ThedaCare
Patient Server
• Allows pharmacy staff to deliver medications directly into a locked
compartment, from outside the room without disturbing the patient.
• The nurse unlocks, opens and accesses those medications from within
the patient’s room.
• Kanban system to trigger replenishment of supplies
Copyright © 2014 ThedaCare
30
Patient Information Greaseboard
• Visual communication board in each hallway
identifying rounding status, ancillary collisions,
nursing assignments, discharge, new orders/results
and overdue medications
Copyright © 2014ThedaCare
31
Other Unit Visuals
• Flag system to identify patient fall risk, completion of
vitals, hazardous medications and discharges
• Equipment locator boards when in use
Copyright © 2014ThedaCare
32
How’s it different for the Care Team?
•
•
•
•
•
•
Respectfully challenge and be challenged
Teams critically think together producing better care
Continuity of teams
Less individual heroics
One plan of care
Use highest scope of practice/expertise
Collaborative Care Year End 2012
AMC Medical/AMC Cardiovascular/TC Medical Combined
Pre CC
Quality Bundles
Pneumonia
CHF
Customer Loyalty
“Recommend the Hospital"
HCAHPS Results
End 2012
% Improvement
•
•
63.3%
88.5%
92.6%
93%
46%
5%
•
78.2%
80.1%
2.4%
•
3.38 days
3.22 days
•
$4062
$3645
•
$10774
•
3.61
Length of Stay
5%
Cost per Case (all in 2012 $)
Medical
Surgical
Vitality Survey
10%
$9107
15%
RN/LPN/CNA
4.11
(End 2011)
14%
YouTube Videos
• Admission
• http://youtu.be/hIi72V2p1lM
• Bedside Care Conference
• http://youtu.be/EK0htEqOLs0
How did they get there
Merger of two competitor
hospitals in 1989
• In 1990 New CEO Hired CEO
• CEO’s first hire Sr. VP of HR and Organizational
Development
• First assignment, develop a 5 yr. Cultural
Transition Plan
360 Feedback
• Executives
• Managers
• Supervisors
LSI Composites
Research Profiles
42
Models for Professional Practice Day 3
43
Models for Professional Practice Day 3
44
Models for Professional Practice Day 3
45
Models for Professional Practice Day 3
46
Models for Professional Practice Day 3
Branding Campaign
• Employer of Choice
• Hire only top 20%, based on competencies
and cultural fit (aligned values)
Learning Maps
• Huge investment in people
• Respect for people
Dottie Kraus
ThedaCare 2006 Branding
Campaign
49
David Seeley
ThedaCare 2006 Branding
Campaign
50
Jennifer Raj
ThedaCare 2006 Branding
Campaign
51
Kathy Lawson
ThedaCare 2006 Branding
Campaign
52
Mary Schmude
ThedaCare 2006 Branding
Campaign
53
Kathy Williams
ThedaCare 2006 Branding
Campaign
54
Principals are the stated methods
we use to achieve
values
Shingo Principles
• Respect every individual
• Lead with humility.
• Seek perfection.
Shingo Principals Cont.
• Ensure Quality at the source.
• Employee scientific thinking.
• Focus on process.
Shingo Principals Cont.
• Think systemically.
• Create constancy of purpose.
• Achieve transparency through visual
management.
Serving the Customer
•
• Business
Engagement
Quality
2001 arrives
• ThedaCare’s world is pretty good
• Quality better than average
• Service reputation better than average
• Cost lower than average
What’s wrong with this picture?
The Customer
• You still charge too much
• You still make mistakes
• I still don’t feel like you #1 priority
Pull
We need to do something different
• Incremental Improvement will not get us
where we need to go
• Needs to be a complete paradigm shift in how
we think about improvement
• We need bigger improvements, faster
The search starts
• Six Sigma, GE style
No
• IHI, Institure for Health Improvement
• Lean, GM style in 2001
• And many more
No
No
In comes Ariens Corp.
• Snow Blowers and Lawn Mowers
• Site Visits
Started Slow
• Engaged a consults - Simplier
• A lot of learning
• 5S type work
First Two Value Streams
• Accounts Receivable sponsored by the CFO
• Unlike many organizations never had to worry
about Finance support
• Accounts Receivable was in the Corporate
Office
Hit the Wall
• 4 to 5 RIE every week
• Managers burning out
• Still fire fighting and working on improvement
A3
• Why did we hit the wall?
• Input from all levels of management and and
consultants
• Finally
Very Lean
• Very flat
• Not respecting managers
• Spent $1.8 million dollars to add supervisor in
the hospitals
• Created management to staff ratio 5-1
People development system
• Management finally had enough time to ask
Why, why, why, why, why
That’s ThedaCare’s Story
Other ways to get there?