Medical Home Model Group Health Cooperative Puyallup ... · PDF fileMedical Home Model . Group Health Cooperative Puyallup Medical Center . PERFORMANCE UNDER THE MICROSC0PE

Medical Home Model Group Health Cooperative Puyallup Medical Center

PERFORMANCE

UNDER THE MICROSC0PE

• ICFD process – client, architect, contractor, 200+ patients, staff, providers

• First certified LEED Gold for Healthcare • Lean PDCA = PLAN. DO. CHECK. ACT +

ADJUST. • One year later ….

GHC | CollinsWoerman | GLY

HELP YOUR CLIENTS ACHIEVE

higher performance OUTCOMES

Overarching Hypothesis: concurrent design of business + clinical process and building creates Integrated Care: • Better outcomes • Better patient service • Lower cost Scientific Method: • Measure results by tracking metrics from

concept through operations


ICFD OBJECTIVES

changeDELIVERY

• Hypothesis 1: By establishing a new model of medical center design, we increase flexibility + speed to bring new services at lower cost.

• Hypothesis 2: By redesigning + standardizing ambulatory business processes around patient flow, we reduce waste + create integrated care experience with better outcomes in cost, quality and delivery.

• Hypothesis 3: By redesigning Supply Chain Management processes, we reduce cost associated with inventory, transportation + managing materials, including reduced reliance on centrally managed services

• Hypothesis 4: By using a patient focused approach toward operational change, we

challenge + overcome cultural barriers + create a fulfilling work environment.

FOUR HYPOTHESIS


• Develop repeatable process for new facility design that eliminates waste, maximizes flow + minimizes capital costs

• Design plan to apply “Greenfield” applications to “Brownfield” areas, including medical sub-specialties

• Define + deploy a management system that maximizes stability + continuous improvement

• Create flexible work spaces that are modular, multi-functional + predictive of current + future membership needs


CLIENT EXPECTATIONS

expectations+MEASURABLES

• Full immersion ICFD design + preplanning

• Flexibility of design + process • Testing: Mockups + design evolution • Collaboration: colocation in shared

BIM model • Lean process + construction • LEED for Healthcare • Systematic results tracking


TEAM EXPECTATIONS

uniqueSTRATEGIES

Prototype Design Process • Lean • IPD • LEED • Ascending array of services:

– Tier 1 – Tier 2 – Tier 3

• Predictability


THE “P” IN PDCA – PLAN

planPDCA



planPDCA

Medical Home Model • Commitment to team-based medical

home model of care delivery

Imbedded in Group Health culture: • Continuous process improvement • Lean design approach



planPDCA



planPDCA

Warehouse Tested • Adaptable • Modular solution • Real-time testing • Engagement of physicians, staff,

patients, support services

• Standard Work Processes • Architectural Design • Brand Identity • LEED for healthcare initiatives



planPDCA



planPDCA

IPD Agreement • Three-party agreement • Risk + reward incentives • High-level of integration • Co-location strategies • Common, jointly developed BIM model

Modularity • Key to future adaptability • Began with the care room


PLAN - THE “P” IN PDCA

planPDCA

Care Rooms • Assembled into “care pod” • Support 5 care teams • Serve 8-10,000 patients


planPDCA GHC | CollinsWoerman | GLY

On Stage / Off Stage • Preferred circulation paradigm • Second module



planPDCA

Care Pod Module • Module defined building layout • Puyallup: tier 2 facility –

30,000 patients



planPDCA

Care Room module was used as PT and Optometry space



planPDCA

Modularity Examples: • Pharmacy • Physical Therapy • Optometry • Imaging • Conference + staff support



planPDCA

Stewardship • LEED Gold for Healthcare • Consistent with brand Reclamation • Reclaimed wood from site • Indoor features + accents • Outdoor benches Respite • Extensive green roof



planPDCA



planPDCA

Energy Savings • LEED criteria to score points • True goal – long-term energy

efficiency • Measurement for IPD incentives



planPDCA

IPD Metric • Achieve LEED Gold within 12

months of substantial completion • Result: First LEED Gold-HC

for Healthcare in the world

Lean Construction + Delivery • Multiple efficiencies • Increased collaboration with client,

architect + D/B subcontractors • Budget + schedule savings • Prefabrication = improved

congestion + work flow • High quality • Safe work environment


DO - THE “D” IN PDCA

doPDCA

Adaptability + Flexibility • MEP

– All systems are isolated per pod – Future renovations easier, with

less impact on operations • Structure

– Long-span structure developed to match up with pod layout



doPDCA



doPDCA

Collaborative Strategies • Colocation with CW, including onsite

weekly during construction = field packages generated from shared model

• Updates made in shared Revit model • Information highly resolved • Set stage: prefabrication + efficient

delivery • Revit model = as built



doPDCA

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• From plan to reality – we built it three times – Mockup – Model – Build out

• Helps clients visualize spaces • Aligns expectations • Improves documents • Reduces RFIs + COs

Efficient Strategies • Pull Planning – design + permitting

process • Pull Planning construction scheduling

in phases • Creation of work zones • Drove schedule for ICFD process • Client gets clear picture of process

and decisions



doPDCA

Efficient Strategies • Extensive prefabrication • Based on shared Revit model with

design team + D/B subcontractors • Warehouse space on site • JIT deliveries + equipment/

tools on wheels • Safer, faster, more productive



doPDCA


checkPDCA

After Construction What were results? • Check: for cost + time savings • Check: for quality • Check: for lessons learned • Check: for process improvements

through lean, IPD

CHECK - THE “C” IN PDCA

Quality Goals + Results • Metric: Reduce RFIs, punch list

items and change orders by 90% • Result: 4 tenant improvement RFIs • Result: 11 core/shell RFIs • Result: 0 punch list items – 2 weeks

after substantial completion • Result: 0 change orders

ALL GOALS ACHIEVED



checkPDCA

• Metric: 0 allowable post-project* work orders

• Result: 1 minor work order after 90 days

• Solution: old-fashioned alert bell added to counter

• GHC recommends not allowing changes within 90 days of move-in



Schedule Goals + Results • Result: 12 working days saved from

aggressive schedule • Prototype for future buildings



checkPDCA

Construction Efficiencies Reduced Cost to Build • Returned savings to owner: $300,000

($5.66 per SF)



checkPDCA

Building Success – Strong Results • Improved schedule • Cost savings • High quality Game Changer – Lessons Going Forward • Incorporate Integrated Design, Pull

Planning, prefabrication • Impact on projects + internal operations

Check: Results in Operations



checkPDCA

ICFD OBJECTIVES - CLINIC OF THE FUTURE • Better outcomes • Better patient service • Lower cost

CHECKING OPERATIONAL EFFICIENCY • Methodology

– Planning the checking process – Data collection + analysis – Want to know cost + benefits of modular design, etc.

• 1 year later –What works/where to adjust – Operations – Technology: equipment + process – Furniture – Building



checkPDCA

Hypothesis 1: By establishing a new model of medical center design, we will increase the flexibility and speed at which the organization can bring new services to the marketplace at lower cost. High level: • PLP start - May 2011. End Dec 2012

(includes 5 weeks operational testing) • Hypothesis remains untested (no 2nd building)


checkPDCA

THE “C” IN PDCA – CHECK HYPOTHESIS 1

Metric: Reduced Cost to Build, 5% below Redmond • Did not meet revised goal due to

planned improvements – Sustainability, LEED Gold – Flex/adaptable building design – Operational capabilities – Flagship branding

• Good news. We know exactly why.



checkPDCA

IPD Metric: Reduce facility utility + energy costs 15% • Compared to model baseline of similar building

of 1,513,619 kWh • Result: Yearly energy consumption of

982,247 kWh • Result: 35% energy savings from baseline. • Goal Achieved



checkPDCA

Metric: Reduce waiting space by 50% • Result: 52% reduction due to self-

rooming & patient/staff tracking. Goal achieved.

Metric: Reduce storage space by 50% • Result: Impacted by Rx regulation

changes + ICFD requirements. • If these are omitted, would have

achieved goal.



checkPDCA

Hypothesis 2: By redesigning + standardizing ambulatory business processes around patient flow, we can reduce waste + create integrated care experience with better outcomes in cost, quality and delivery.



checkPDCA

Reduced Cost of Care Metric: All in: Beat peer group* average annual PMPM trends by 1.5% in total cost

– Result: 2-year metric. On track after 6 months, data trending down

– PMPM target met in first year (Target: $531.19. Actual: $529)

– PLP outperforming peer group by very slim margin



checkPDCA

Productivity - Increased Encounters • Multiple strategies implemented

– Waldo flow management – Patient self rooming – Clinical staff proximate to exam room

• Primary Care Metric: Increase 25% total encounters, per direct care FTE (per day), by Year 2 (2014)

• Pharmacy Metric: Hold current encounter (prescription) to current FTE efficiencies. • Result: Inconclusive, trending more positively • On track for 2-year target data



checkPDCA

Productivity – Reduced Clinic Cycle Time • Clinic-wide Metric: Reduction in Patient Cycle Time by 35% • Several planned strategies not implemented. Target assumed

all services coming to patient • Results: Clinic Visit Cycle Time

– OLY 71 min – Old PLP 74 min – Target 50 min – New PLP 71.8 min


checkPDCA


Hypothesis 3: By redesigning our Supply Chain Management processes (pharmacy, materials, lab,) we will be able reduce cost associated with inventory, transportation, and managing materials including a reduction in our reliance on centrally managed services.



checkPDCA

Materials Flow Reduce Supply on Hand • Metric: Maintain no more than 5 days of exam

room + cart inventory on hand • Result: Standardized inventory, room & cart Reduce Rx on hand • Metric: Reduce from 39 days, target @ 20 days • Result: Goal Met


checkPDCA


Materials Flow Maintain appropriate volumes of equipment • Metric. None • Result: Kan Ban system = “never out” status

– Universal Room drove need for more stock in room

– Kan Ban reduced cycle time to stock room by 66% (reduced labor costs)

– Kan Ban reduced excess supplies + stockpiling

– Cost of care room inventory higher due to universal use of exam rooms


checkPDCA


Hypothesis 4: By using a patient focused approach toward operational change, we will not only improve the patient experience, but will explicitly challenge and overcome cultural barriers and create a fulfilling work environment for our employees. .



checkPDCA

Operational + Cultural Change • Metric: Improve patient, provider + staff satisfaction stats by 5%

over 2011 base • Result: 90-day survey: high patient + mixed staff satisfaction

– Increased collaboration – More quiet + privacy than anticipated – No impact to HIPAA regulations – New survey underway

• GH Research Institute did a baseline in old Puyallup; authorized follow-up research of new site


checkPDCA


2014 Plan • Data collection from 2013; continues in 2014 • Feb 2014 - Complete assessment/Validate cycle time data • Feb-Mar 2014 - Complete PDCA identified work • March 2014 – Prototype/physical environment standards

adjustment decisions, then deploy • April 2014 - Engage Lean in redesign of key concepts that need

further development • Dec 2014 – Decisions on operations performance improvement to

achieve metrics and deploy into future Medical Home model • TBD – Complete Research Institutes work


ACT + ADJUST - THE “A” IN PDCA

act+adjustPDCA

Moving Forward – Key Learns • Can’t expect full design results from

partial operational design • Amount of change can approach

saturation and hinder progress • Cultural change requires ongoing

champions



act+adjustPDCA

High Level Success - Achieved original guiding principles • Easy, visual, intuitive work environment • 6 months data: we are on track • Trends indicate progress continues • Original principles achieved:

– Patients come first – Collaboration + mutual support – Lean operations – Design flexibility a big win



act+adjustPDCA

Next Generation of Medical Home Model – 2.0, 3.0 and Beyond Continual process: • Cost benchmarks • Future prototypes + standards • Future services • Patient/staff experience • Analyze + modify; apply to next designed

facility, tune-up, repeat …



act+adjustPDCA

Q + A Thanks for your attendance and participation

Documents

Medical Home Model Group Health Cooperative Puyallup ... · PDF fileMedical Home Model . Group Health Cooperative Puyallup Medical Center . PERFORMANCE UNDER THE MICROSC0PE