Innovative Employee and Union Driven Activities to Improve ......management relationships for a...

Innovative Employee and Union Driven Activities to Improve Patient Care

Why is Healthcare Transformation

Needed?

NRI Innovation Network’s Workshop

Gothenburg, Sweden

November 3, 2015

Our History▪ Rooted in ILR legacy: improving labor/

management relationships for a sustainable economy

▪ Focus on Manufacturing: automotive, textile, high tech (1980) ▪ Programs for Employment and Workplace

Systems (PEWS) ▪ Sustaining Manufacturing jobs in the US

▪ Focus on Healthcare (1997): Healthcare Transformation Project ▪ Creating more integrated delivery systems to

improve patient care and reduce costs

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We’ve always done it this way…..

Insanity: “When you continue to do the same thing and expect a different result.”

-Albert Einstein

Key ClientsCompanies - Hathaway Shirt Co. - Saturn Corporation - Sun Ship Building and Dry Dock Company - World Bank - Xerox Corporation Key Unions - AFL-CIO –Corporate Affairs and Working for

America Institute - AFT - Auto Workers - 1199/SEIU Health Services Workers Union - UNITE

Key Clients (continued)Healthcare Work - Department of Health Services, LA - League of Voluntary Hospitals and Nursing

Homes - Maimonides Medical Center - N.J. Medical School International work - Ireland – Local Government and Health

Care Partnerships - Norwegian Work Research Institute - Poland – with Solidarity

Key Rearch Findings

• Extensive frontline engagement is critical • Effective use of sector strategies • Borrowing/Stealing from others blending tacit

knowledge with best practices • Create new roles for unions • Labor relations supports operational issues • Workforce development is needed to prepare for new

jobs • Investment in $ and resources is needed– no free lunch

But don’t get what we pay for.

HIGH COSTS & LOW QUALITY

Life Expectancy vs. Healthcare Expenditure Per capita

Income and Insurance DisparitiesWe spend almost twice as much on healthcare as other countries…

POOR ACCESS TO CARE

Mirror, Mirror: Ranking of Six Nations

AUSTRALIA CANADA GERMANYNEW

ZEALANDUNITED

KINGDOMUNITED STATES

OVERALL RANKING (2007) 3.5 5 2 3.5 1 6

Quality Care 4 6 2.5 2.5 1 5

Right Care 5 6 3 4 2 1

Safe Care 4 5 1 3 2 6

Coordinated Care 3 6 4 2 1 5

Patient-Centered Care 3 6 2 1 4 5

Access 3 5 1 2 4 6

Efficiency 4 5 3 2 1 6

Equity 2 5 4 3 1 6

Long, Healthy, and Productive Lives 1 3 2 4.5 4.5 6

Health Expenditures per Capita, 2004 $2,876* $3,165 $3,005* $2,083 $2,546 $6,102

Source: K. Davis, C. Schoen, S. C. Schoenbaum, M. M. Doty, A. L. Holmgren, J. L. Kriss, and K. K. Shea, “Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care,” The Commonwealth Fund, May 2007

Country Rankings

1-2.66

2.67-4.33

4.33-6.0

* 2003 data

How Bad is It?

• Agency for Healthcare Research- 1.5 % annual improvement over 7 years

• Ranked 64 out of 100 internationally

• Most expensive healthcare system in Western countries

• Lowest quartile in quality

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Silo-ed healthcare system drives inefficiencies, diffuses accountability

New Areas of Transformation

Sector Strategies

Improving what we do

Blended Work

Innovation Activities

Process Improvement

Tools (common strategy)

Innovation Activities

Best Sector Strategies

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Best Sector Strategies➢Auto: teams assembling cars together ➢Healthcare: integrated care/primary

care and behavioral health joint services

➢Manufacturing: modular work, just-in- time processes

➢Ship building – zone construction

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Healthcare Sector Strategy includes:

➢ Creating Patient-Centered Medical Homes (PCMH)…and now Health Homes

➢ Behavioral health and primary care coordination

➢ Integrated delivery care systems to create greater health and wellness

➢Greater coordination with community organizations

Components of an Integrated Care Delivery System

Integrated Care

Coordinated Care:

Patient centered care involving collaboration

among primary care physician, nurses, patient,

family and community

Information Technology:

Electronic Medical

Records/History, E-Prescriptions,

Interactive Patient Web

Portal

Health Coach, Nurse

Navigator: Staff use of electronic portals and

tracking tools to monitor progress

of patients, especially those

with chronic conditions

Reimbursement Reform: Restructuring of

the current system used to

compensate physicians based

on “fee for service” to one that is bundled/pre-paid, and

quality outcome linked

Tracking Outcome

Tools: Use data to

identify issues of critical care

Feedback to Physicians

and Healthcare

Team Measure clinical

or service performance by

physician/practice 17

Focus on Transformation… Not Change

Innovation Across the Lifecycle

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Seed

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Product Innovation

Process InnovationN

umbe

r of

Inn

ovat

ions

Dominant Design (Industry Standard)

Discontinuous Innovation

Discontinuous Innovation and

change

End of Life

Established

Emerging

Mature

© 2010 Sapience

Continuous Improvement

1964 Mustang 2013 Mustang2014 electric car

Innovation

Creating New Knowledge Extensive Front-line Staff Engagement

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Employee Driven InnovationTwo Approaches

➢ Study ActionTeams ➢ Quality Lab- creating

significant breakthroughs- disruptive change

Key Componens

• 6 staff freed-up from normal work to analyze and development new process and decide on new equipment with clear quality and costs

• Budget provided for innovative incubator Problem solving

• Constant contact with staff including technical staff

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4-Work System Design 6-Data collection for review

• Strategic targets and adjust • Plan of work

1-Leadership 7-Review and adjust 2-Strategy 8-Re-configurability 3-Quality Lab 5-Launch teams

• Training • Standardize processes • Network/innovation

MOBILIZE

ACT

ADAPT

Cornell’s Labor-Management Change

Process

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Aligning Sub-Systems

Input (response to a

specific problem or system)

Environment

Resources

History

Output / Performance

System Unit

Individual

Informal Organization

Work & Technology Strategy

Formal Organization

(Structure, Roles. Procedures) Culture

Engagement of People,Skills, &

Accountability

Source: Nadler and Tushman

Two CulturesExecution Culture

• You focus on improving current

processes

• You meet current customer needs

• You exploit what you know

• You impose set processes and structures

• You allow little room for error

Innovation Culture

• You think outside the box & challenge current processes

• You anticipate future customer needs

• You explore what you don’t know

• You let things emerge

• You allow freedom and flexibility

Organizing Change

Present State

What you’ve

got now.

Future State

Your vision.

Transition PlanTransition Plan

Extensive Front Line Engagement: Worker Voice

Maimonides Medical Center▪ 706 bed hospital, Brooklyn,

NY ▪ 5,600 employees ▪ A tertiary care, teaching

hospital ▪ Improving patient

experience and clinical outcomes

▪ Three unions: ▪ Committee for Interns and

Residents (CIR) ▪ New York State Nurses

Association (NYSNA) ▪ 1199/SEIU United

Healthcare Workers

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Maimonides CIR, NYSNA and 1999/SEIU Strategic Alliance

Cornell Researchers

Developers

Labor-Management Oversight Com. (LMOC)

Labor-Management Council (LMC)

Environmental Serv. DLMC

Cardiology DLMC

Measurement & Documentation

Workgroup

Improvement Tools

• Process mapping

• Problem solving

• Cause and effect analysis

• Microsystems 31

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Outcomes➢70% decrease in patient falls in cardiac and med- surg units ➢100% decrease in call bell responses time (to 1

min.) in cardiac units ➢50 % increase in patient satisfaction scores in

med-surg units ➢75 % improvement in cleanliness of patient

rooms and 50 % improvement in patient satisfaction scores

➢Call center functioning with high quality ahead of schedule

LADHSLos Angeles Department of Health Services

▪ 2nd largest public health system ▪ 4 hospitals, 2 ambulatory care

centers, 16 comprehensive health centers, 1 rehabilitation facility—750,00 patient visits

▪ 1,671 beds ▪ 18,460 staff ▪ Delivery system transformation,

improving patient experience ▪ Two unions:

▪ Committee for Interns and Residents (CIR)

▪ SEIU Local 721

Labor-Management Transformation Council

Integration activities with LA-DMH and LA-DPH

LMTC Operations Group CIT Workgroup

Quality & Safety Workgroup

Patient Experience Workgroup

LA-DHS/SEIU Partnership Process

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Outcomes➢Reduced wait time between registration

and being seen from 23 minutes to 3 minutes

➢Wait time was reduced 795 to see a primary care provider

➢Cycle time in urgent care reduced from 2 hours to 34 minutes

➢Patient satisfaction scores increased by 50% in terms of cleanliness of rooms

“No doubt that a small group of thoughtful citizens can change the world. Indeed, it’s the only thing that ever has.”

Margaret Mead

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Smart Risk Taking