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LEAN Approach for Employee Engagement
Moving ACP Provider Satisfaction to Tier 1
ObjectivesProvide a broad stroke understanding of
LEAN approach to problem solvingHow to build a “Fishbone” diagram that
identifies problems or issues with ACP Engagement
Sharing ways to improve ACP EngagementCase study at NHRMC
Key Principles of LEANEliminate WasteImprove EfficiencyImprove QualityImprove Customer Satisfaction
Save $$$
Culture ChangeNot a top down
approachEnables staff to
redesign work when recognize its not necessary or if they can achieve a better outcome
Less meetings, more coaching
8 Kinds of WasteD O W N T I M E
DefectsOver-productionWaitingNot ClearTransportingInventoryMotionExcess Processing
Value Stream MappingObserve current stateIdentify value and non-added value activities
Observe work where its being done
Map out process
-Monday-Friday 6:30 am- 7:00 pm
-Every 5th weekend on call-Call starts at 5 pm & ends
at 8 am
Document notes in
EPIC
Resident Lectures (At least 3 times a
week)
Afternoon Rounds-Gail’s patients- 85%-Resident’s patients-
100%-Own patients
Noon Huddle-Review patients
seen by Gail-Adding to list-Reprioritize
Document notes in EPIC (Sign
residents & Gail notes)
Order in EPIC for consult
Nurse, EPIC,
Resident Triage
RN discussion, see patient, open note (Dr. Oster)
8 am prioritization huddle (Dr. Oster/Gail)
MD doesn’t call their
own consult
Outpatient only physician
volume
RN doesn’t have all
information
Inappropriate consults
Order not in EPIC
Unofficial consults
Multiple phone calls for the
same patient
Interruptions RN/MD
Patient off floor
Patient off floor
Consultants for WHA patients
Call/vacation schedule not
reviewed by RNOrder not in EPIC
still
Volume vs 24 hour policy
All stroke patients not
on same floorDragon
Prioritization moves patients
outside 24 hours
RN to MD consult call is not efficient
No “workup” testing
Must deal with WHA “pager only”
call information
Don’t have all overnight
information at 8 am
Interruptions RN/MD
Dr. Oster/Gail Workflow01.23.14
Process for building the FishboneDistribute sticky notes to all participantsAsk a specific questionAllow 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 EngagementInvited 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
Appreciation (3)
Costs & Resources (9) Finding resources for
patients Specialty consults not
available
Prioritization (5) Incomplete Triage by nurse Triage of calls and priority patient
messages Communication of patient status Task planning
Communication Conflicts (3)
EPIC Issues (6)
Office Flow (11)
Scheduling (6)
Provider-Provider Communication when receiving patient
Not following protocols
Add-ons
Don’t know who to call
Carolinas requirements vs NHRMC protocols
Lack of response
Follow Up with Patients (6) Quality vs quantity Time to follow up Time off
rooming process not standard (5)
Staffing (2)
Standardization Different MDs preferences
Documentation Issues (9)
Coordinating Imaging/Labs
Miscellaneous (3)
ResponsesThe relationship with
my 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
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 CategoriesOffice FlowDocumentation
IssuesCosts and ResourcesSchedulingFollow up with
PatientsEPIC IssuesPrioritizationCommunicationAppreciation
CommunicationCreated the ACP Leadership Council
Meets monthly8 Team MembersRepresentation on the Physician Leadership Council and on MD committees for EPIC and Quality
16
Governance StructurePNLC
Administrative Council
PNLCQuality
Subcommittee
PNLCEpic
Subcommittee
Co-led Governance and Committee Structure
Co-Leaders:VACANT (Charlotte PNLC)Dan Goodwin (Charlotte PNLC)
Co-Leaders:Amy Messier, M.D. (PNLC Member)Dan Goodwin (PNLC Member)
Co-Leaders:Amy Messier, M.D.Melissa Davis (PNLC Member)
ACPLeadership
Council
Co-Leaders:Megan Whitley, PA (PNLC Member)Kathy Gresham (Administrative)
InitiativesLEAN Training for
LeadershipACP Site Visit book
streamlinedInput on Quality MatrixOptimization of EPIC
strategiesReview of Incident to
billingIdeas for NP and PA
week
AppreciationRounding in the PA and NP LoungeIdentifying low hanging fruit
changes“Sweat the little stuff”PA and NP Week
Congratulations CakePopcornSnack/Cheese TrayCake PopsIce Cream
Next StepsLEAN 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
QuestionsCommunication
RespectRecognition
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