Engaging and Developing Leadership in Organizational Transformation

Rush University Medical Center

Patricia Nedved AVP, Professional Nursing Practice

Anthony Perry, MD CMO, Rush University Medical Group & AVP, Clinical Affairs

Susan Crown Vice-Chair, Board of Trustees

Lauren Goebel Vice President, Transformation & Organizational Development

Engaging and Developing

Leadership in Organizational Transformation

Susan Crown

Lauren L. Goebel

Anthony J. Perry, MD

Patricia Nedved, MSN, CENP

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Presentation Focus

• Transformation program created an engaged organization and developed leadership opportunities at all levels of our organization, including board, staff and clinicians

• Project guiding principles promoted continuity for teams and phases of work, from visioning to decision making

• Success of the Tower planning, training and implementation has led to successful organizational outcomes

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Rush University Medical Center (RUMC) has been a part of the Chicago landscape for more than 170 years. RUMC’s main campus includes:

679 staffed bed academic medical center serving adults and children

Health sciences university with over 2,200 students and $130 million in annual research expenditures

Mixed medical staff model including Rush University Medical Group with 438 employed physicians

653 medical residents

Single governance structure

$ 1.6 annual budget

About Rush University Medical Center

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The mission of Rush University Medical Center is to provide the very best care for our patients. Our education and research endeavors, community service programs and relationships

with other hospitals are dedicated to enhancing excellence in patient care for the diverse communities of the Chicago area – now and in the future.

What Distinguishes Rush?

Mission

Patient Care

Research

Education

Community Service

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Recognized for Quality

Focused Team Created Outside of Normal Organizational Structure

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• 2002: Board of Trustees 14-Point Strategic Plan – “Focus on Ashland/Harrison Campus”

• 2005: Office of Transformation Created

– Vice-President, Campus Transformation – Multi-Disciplinary Rush Team: MD, RN,

Administration – Program Management and Architects – Oversight by Facilities Committee of the Board of

Trustees

Today’s Campus

8 Courtesy of Perkins+Will

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The Tower

Acute Care Floors Floors 12, 13 and 14 (192 beds)

Critical Care Floors Floors 10 and 11 (112 beds)

Labor and Delivery and Neonatal Critical Care

Floor 8 (10 LDR rooms, 3 ORs, 72 NICU suites)

Interventional Platform Floors 4, 5 and 7 (42 procedure suites, 88 prep/recovery rooms,

24 extended stay beds)

Non-Invasive Imaging Floor 3 (CT, general radiology, ultrasound,

cardio, fluoroscopy, MRI, nuclear medicine)

Mechanical Floor 9 (heating and

cooling, electrical and ventilation)

Ground Floor McCormick Center for Advanced

Emergency Response (60 emergency department bays)

800,000 Sq. Ft. $675 Million

Transformation Milestones

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2009 Orthopedic building

opens

2009 Epic

implemented

2010 Major inpatient

Electronic Medical Record milestones

complete

2010 Automated Guided

Vehicles (AGVs)

2011 Outpatient Cancer

Center opens

2012 The Tower opens

& ambulatory rollout of Electronic

Medical Record complete

Over $ 1 Billion of total investment in campus and technology

OOT: Created Vision and Made Decisions

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Transformation Steering

Committee

Facilities Committee

Board of Trustees

Executive Leadership

Council

Office of Transformation

(OOT)

Board Oversight

Management Oversight

Facilities Oversight Committee

Design Phase User Groups, Task Forces, Operational Planning, Move-In, and Issue Resolution Committees

Guiding Principles Framed Decision Making

• Optimize the patient and family experience

• Conscientiously consider safety of patients and staff

• Organize services around delivery of care

• Utilize technology on behalf of patients and staff

• Ensure integration of research and education

• Design a comfortable environment to support Rush core values

• Anticipate change through adaptable/flexible best practices

• Embrace the community through design

• Incorporate sustainable (“Green”) design where applicable

• Standardize when possible

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Office of Transformation Teams Co-Located

Engine-ers Shared

Conference

Construction &

Program

Management

Architects

Capital Projects

Office of Transformation

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“everyone wears the same t-shirt”

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Mock-up

Mock-up

Actual

Mock-Ups: Clinical Feedback & Participation

15 Courtesy of Rush Photo Group

Mock-up

Mock-Ups: Clinical Feedback & Participation

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Courtesy of Rush Photo Group

The Butterfly: Multiple Stories, One Consistent Theme

Rush’s version Contractor’s version

Engineer’s version Planner’s version Designer’s version

17 Courtesy of Perkins+Will

Building and Clinical Technology in the Tower

• Highly complex topics – many different systems – required focused OOT resources

• Created various organizational engagement opportunities

• Clinical Communication Example

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Vision User Requirements

Implementation Plan

PHASE 0PILOTS

PHASE 1JAN 2012

PHASE 2OCT 2012

PHASE 3BEYOND

APPLICATION BASED ASSIGNMENTS APPLICATION BASED ASSIGNMENTS UNIFIED ASSIGNMENT INTELLIGENT ASSIGNMENT

REQ

UIR

EMEN

TS

1. Nurse Call (Source Caller ID & Voice)• Nurse Assignment /Routing

– Within Application– Role Based

• Escalation– Default Fixed Assignment

• Acknowledgement– Call Answer / In Room Cancel

• End User Device– Integration to Wireless VoIP Phone– Plus RB Pager Support

• Basic System Functionality– ADT from EPIC– Locator Badge– Wireless Bed Alarm

• Care Call Alert - Caller ID– Out of Bed Alerts– Pull-cord Alerts– Etc.

• Phone Call Alert - Voice– Remote answer of Pt calls, station calls

• Dial out to any intercom station or console• Use telephone throughout facility• No texting capabilities within NC• Reporting within Application

2. Voice to Voice• Using Wireless VoIP Phone• VoIP Phone to On Campus Phone

– Complete Campus Directory• VoIP Phone to VoIP Phone

– Dedicated to VoIP Phone Directory• With Speed Dial Keys - Freq #’s• Hands-free Voice Capable

1 and 2 - East Tower Wide

3. Pneumatic Tube Alert (Fixed)• Nurse Assignment / Routing

– Within Application– Pager Role Based

• Escalation– Tube Returned to Sender

• Acknowledgement– None

• End User Device– Integration to Pager– No VoIP Support

• Basic System Functionality– Transaction Type/PCU/Role/Pager

Consistent Assignment– Secure Trans Alert to Unit/Role Based

assigned Pager• Reporting within Application

4. Pt Monitoring Alerts (via NC)• Nurse Assignment / Routing

– Within NC Application– Role Based

• Escalation– Within NC

• Acknowledgement– Within NC

• End User Device– Witihin NC - VoIP Phone and NC Pager

• Reporting within Application

1, 2, 3 and 4

5. Nurse CallPneumatic TubePatient Monitoring

• Nurse Assignment / Routing– Single Point of Entry – Enhanced Role Based– Enhanced Routing

• Escalation– Criteria Based – Flexible

• Acknowledgement– Button versus Voice

• End User Device– Integration to Single Device

• Consolidated Reporting• Outbound Text Messaging

6. Pt Care Device Alerts (via NC)

7. Enhanced Role Based DeviceAssignment / Routing

– Pharmacists– Transporters– EVS

1 – 7

• Intelligent Assignment / Routing• Unified Presence• Enhanced & Expanded Workflow

Support• Enhanced User Interface• Text Messaging• Integrate RFID location to achieve

optimized Alert Routing• Inside / Outside Communications &

Routing• Application Convergence on Single

Device – Data, Voice, Graphics

RISK

LOWInstalled other sites, Piloted RushLow Operational Training

MEDIUM – LOWInstalled other sites, some custom workSignificant Add-on Training

MEDIUM – HIGHSome installed other sitesSignificant TrainingVery dynamic Solutions Market

HIGHSome components in Beta SitesDevelopment still underway

SOL

RB 5, CISCO NETW, CISCO PHONES, BLUE TOOTH Pneumatic Tube SystemPt Monitoring

1. Communication Routing Engine (“middleware”)

1. Communication Engine Extensions2. Smart Phone/Pad/Tablet

COST

S

IN BUDGETSome additional Implementation IS FTE’sPlus Ownership Costs – Support IS FTE’s

IN BUDGET – NC & Pt MonitoringPlus Ownership Costs – Support ClinEng FTE’s

$1M for Install includes:•Software Licenses•Hardware•Services

Plus Ownership Costs – Support IS FTE’s

$1M for Install Includes:•Software Licenses•Hardware•Services

Plus Ownership Costs – Support IS FTE’s

Operational Transition: Employee & Leadership Participation

• Over 980 nurses trained • Over 450 interventional

and imaging staff • Over 600 support and

other clinical staff • Over 300 ambassadors

trained to give tours and get staff acclimated to space

• Adult learning techniques used throughout

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Training Engaged Staff in Operational and Technology Changes

• Three-part training for Rush nurses and staff working in the Tower

– 1 hour – Tower tour – 1 hour – Communication

system training – 2.5 hours – Self guided stations

and scavenger hunt; included proctored stops with hands on return demonstration

• Each trained staff member will become a Citizen of the Tower

• Began 10 weeks prior to move-in • Utilized 13th floor Tower

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Additional Resources Developed by Interdisciplinary Teams

• Transformation stories

• Orientation videos

• Staff meeting resources

• Manager talking points

• Maps and posters

• Contact information

• Links to external sites

• Manuals and pocket guides

• New intranet subpage

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Operational Transition: Move-In Planning and Testing

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The Move: Utilizing Hospital Incident Command Structure

23 Courtesy of Rush Photo Group

Results: Increased Volumes

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2,100

2,200

2,300

2,400

2,500

2,600

2,700

2,800

January February March April May June July August September October November

Admissions 2011

Admissions 2012

-

1,000

2,000

3,000

4,000

5,000

6,000

January February March April May June July August September October November

ED visits 2011

ED visits 2012

Admissions

Emergency Department Visits

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Results: Patient Satisfaction Scores Improved

71.5%

72.7%

74.6%

78.4%

80.4%

70%

72%

74%

76%

78%

80%

82%

FY11 Total Average FY12 July-Dec Average FY12 Jan-June Average FY13 July-Dec Average FY13 Jan-June Average

Rush University Medical CenterOverall Rating of Hospital (HCAHPS)

Inpatient Satisfaction Score (HCAHPS)

Move to Tower

% o

f 9 o

r 10

Results: HCAHPS Comparisons for Units that Moved

* Discharges as of 10/7/13 26

65

91

59

76

50

79

19

84

56

67

83

92

0

10

20

30

40

50

60

70

80

90

100

Before Move (2011) After Move (2012- 2013 YTD)

HCA

HPS

Per

cent

ile

Overall Hospital

Nurse Communication

Cleanliness

Quietness

Communication about Medication

Discharge Information

Results: Intensive Care Units Increased Time Spent Inside Patient Room

Inside Patient Room

Medications

Supplies Equipment Document

ation Traveling Other

Before 39% 3% 1% 0% 20% 8% 29% After 57% 3% 1% 0% 10% 9% 20%

0%

10%

20%

30%

40%

50%

60%

Data Courtesy of: Melinda Noonan DNP,RN, NEA-BC, Kathleen Delaney PhD,PMH-NP, Nelson Holmberg MS , Theresa Osunero BS , Sigma Theta Tau 27

What We Learned

• Office of Transformation structure offered ideas and decision making not typically achievable through regular organizational structure

• Guiding principles clarified vision and framed all decision making across various oversight bodies

• Team wore same t-shirt throughout project • Involvement, empowerment and innovation early

and often across all disciplines • Each phase offered engagement and sense of

increased ownership • Hand-off to operational leadership, essential to

success

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Thank you

Questions?

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