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