One of Four Anchor One of Four Anchor

Medical CentersMedical Centers

Myrtle BeachCharleston

Florence

Columbia

WHO ARE WE?

VITAL STATISTICS

�� 4,729 employees4,729 employees

�� Largest employer in regionLargest employer in region

�� $214 million payroll$214 million payroll

�� 28,429 inpatient admissions/year28,429 inpatient admissions/year

�� 238,580 outpatient visits/year238,580 outpatient visits/year

�� 83,274 ER visits/year83,274 ER visits/year

�� Serve all regardless of ability to payServe all regardless of ability to pay

�� $180 million worth of non$180 million worth of non--reimbursed care annuallyreimbursed care annually

�� McLeod Regional Medical Center McLeod Regional Medical Center -- 453 Bed Tertiary 453 Bed Tertiary Care, Teaching HospitalCare, Teaching Hospital

�� ChildrenChildren’’s Hospitals Hospital

�� WomenWomen’’s Hospitals Hospital

�� McLeod Hospital Darlington McLeod Hospital Darlington –– 49 Bed Community 49 Bed Community HospitalHospital

�� McLeod Hospital Dillon McLeod Hospital Dillon –– 79 Bed Community Hospital79 Bed Community Hospital

�� McLeod Behavioral Health McLeod Behavioral Health –– 23 Bed Inpatient Facility23 Bed Inpatient Facility

�� McLeod Hospice House McLeod Hospice House –– 12 Bed Inpatient Facility12 Bed Inpatient Facility

FULL SERVICE MEDICAL CENTER!

�� Ambulatory Surgical Center Ambulatory Surgical Center

�� Health and Fitness CenterHealth and Fitness Center

�� McLeod Foundation McLeod Foundation -- Guest HouseGuest House

�� Family Practice Residency ProgramFamily Practice Residency Program

�� 12 Primary Care Health Centers and Physician Network12 Primary Care Health Centers and Physician Network

�� Home Health AgencyHome Health Agency

FULL SERVICE MEDICAL CENTER!

�� High Risk BirthsHigh Risk Births

�� Perinatal System OutreachPerinatal System Outreach

�� Neonatal Intensive CareNeonatal Intensive Care

�� Pediatric Intensive CarePediatric Intensive Care

�� ChildReachChildReach and and HeartReachHeartReach AmbulancesAmbulances

�� WomenWomen’’s Health Education & Resource Centers Health Education & Resource Center

EXCLUSIVE PROVIDER IN 12 COUNTY REGIONEXCLUSIVE PROVIDER IN 12 COUNTY REGION

�� Top 5% Patient Safety (2007, 2008, 2009, 2010) HealthgradesTop 5% Patient Safety (2007, 2008, 2009, 2010) Healthgrades

�� American Hospital Association American Hospital Association -- Quest Quality Award FinalistQuest Quality Award Finalist

�� Premier Quality Award for ExcellencePremier Quality Award for Excellence

�� Awarded Robert Wood Johnson Foundation grant for Pursuing Awarded Robert Wood Johnson Foundation grant for Pursuing Perfection Perfection –– One of Five Hospitals from 256 applicantsOne of Five Hospitals from 256 applicants

�� 2000 Malcolm Baldrige Governor2000 Malcolm Baldrige Governor’’s Quality Awards Quality Award

LOCAL SERVICE, NATIONAL RECOGNITIONLOCAL SERVICE, NATIONAL RECOGNITION

PROBLEM SOLVING METHODOLOGYPROBLEM SOLVING METHODOLOGY

Video

A3 - Thinking

Reason For Action

As Is State

Desired State

GAP Analysis

Solution Approach

Rapid Experiments

Completion Plan

Confirmed State

Insights

What is the Problem?

How do you know it’s a Problem?

Scope (Trigger / Done)?

Current Process?

How long does it take?

Current Outcomes?

Problem Actionable Root Cause What is left to do?

Do This Get ThisVisual Management

Linked Checking

Red/Green Yes/No

MFDI

PDCA (Plan, Do, Check, Act)What do you want the New process to deliver?

Desired Outcomes?

What did you learn?

Quality of the Service

Quality of Safety

“Just Culture” Operational Effectiveness

Physician &Executive

Leadership

Quality of Science

Building Evidence Based Care

OPERATIONAL EFFECTIVENESS (OE)

• Application of principles of Clinical Effectiveness for operational improvement.

• Identification and elimination of waste

• Based on learning from Toyota Production System and Lean manufacturing

• Plan to reduce and eliminate “non-value added” work

OPERATIONAL EFFECTIVENESS (OE)

Video

OE STEERING

COMMITTEE

VSA

RIE

RIERIE

RIE

CORE Team

VP Chair

Implementer

Spreader

STRUCTURE

1 x 1Flow

6S

StandardWork

Tight Connections

Cause & Effect

OrganizationalIntelligence!Leveling

1 way to respond

Batching Is Evil!

Ability To Detect Normal Vs. Abnormal

1 way in

Pull

VisualManagement

Box 1 – “Reason For Action”

The current system has focused more on task The current system has focused more on task completion than on care delivery for the bedside nurse.completion than on care delivery for the bedside nurse.

Business Case-- Reduce Length of Stay therefore decreasing costs and increasingReduce Length of Stay therefore decreasing costs and increasingrevenue growthrevenue growth

-- Improve Outcomes therefore decreasing costImprove Outcomes therefore decreasing cost-- Reduce Nurse TurnoverReduce Nurse Turnover

Value Case-- Improve Patient Outcomes by reducing or removing defectsImprove Patient Outcomes by reducing or removing defects

-- Improve Patient SatisfactionImprove Patient Satisfaction

“As Is” & “Desired State”

As Is Desired

Defect Free Patient Care (Heat Map Score)Defect Free Patient Care (Heat Map Score)

Box 4 - “Gap Analysis”

Box 5 - “Solution Approach”

Nurses and other clinical staff are wasting time and motion searching and gathering for supplies needed for patient care. This results in:

-Inappropriate Inventory levels- Hoarding of supplies

-Inaccurate Inventory / Missing Supplies- Rework

RIE #1 – Supplies – “Reason For Action”

- Average Lost Revenue Per Week (9th and 5th) = $1,975

- Average of 60 minutes per nurse gathering supplies in a 12 hour shift (8% of work time spend gathering supplies)

- 8,895 feet/shift/nurse hunting and gathering supplies (1.6 miles per nurse)

53,375 feet/shift/unit hunting and gathering supplies (10.1 miles per shift)

RIE #1 – Supplies – “As Is”

RIE #1 – Supplies – “Gap” & “Solution ”

Before RIE After RIE

Before RIE After RIE

Before RIE After RIE

Before RIE After RIE

RIE #1 – Motion/Time Outcomes

RIE #1 – Financial Outcomes

DESKTOP EXERCISE

Quality of the Service

Quality of Safety

Just Culture Physician and Executive

Leadership

Operational Effectiveness

Quality of Science

Building Evidence Based Care

Quality Of SafetyQuality Of Safety

Video

QUALITY OF SAFETY - FMEA

Improving the Quality of Safety through the use of Process Failure Modes Effect Analysis (PFMEA)!

FMEA

Error Proofing

Safety

Process Improvement

WHAT IS A PFMEA?

• A systematic way of identifying and preventing problems in processes before they occur.

• Other than it’s the RIGHT thing to do!

• JCAHO Requires that:Leaders of the organization ensure that an ongoing, proactive program for identifying risks to patient safety and reducing healthcare errors is defined and implemented.

WHY USE A PFMEA?

REQUIREMENTS FOR A PFMEA

• Standard Work For Job Functions• Process Flow Map• Risk Assessment

• Flow Map – Define the scope of the process and map out the steps to accomplish

• Failure Mode - Identify ways in which a process step can fail

• Risk of Failure - Each failure has a relative risk associated with it. In healthcare, the risk is determined by 3 key factors:

A. Severity - consequence of the failure should it occur.B. Occurrence - likelihood, or frequency of the failure occurring.C. Detection - likelihood of knowing or detecting that an error

has occurred

• RPN Number – (Severity x Occurrence x Detection)

• ACTION, ACTION AND MORE ACTION

CONCEPTS

LETS LOOK @ ONE

Quality of the Service

Quality of Safety

Just Culture Physician and Executive

Leadership

Operational Effectiveness

Quality of Science

Building Evidence Based Care

QUALITY OF SCIENCE QUALITY OF SCIENCE –– Clinical EffectivenessClinical Effectiveness

“The Inside – Looking In ”

–Physician Led

–Evidence Based

–Data Driven

CLINICAL EFFECTIVENESS (CE)CLINICAL EFFECTIVENESS (CE)

• Projects to date – 40 +

• MD leadership to date – 150 +

• Participation to date – 200 +

““THE INSIDE LOOKING INTHE INSIDE LOOKING IN””

• Aortic Aneurysms AMI (Heart attack)**

• Peds Asthma Colon Resections

• Chest Pain Congestive Heart Failure*

• C-Sections CVA (Stroke)

• GI Hemorrhage Gall Bladder Surgery (Lap)

• Long Stay NICU (nutrition, infection, etc)

• Pneumonia* PCI (Cardiac interventions)

• Surgical Care Improvement (Antibiotics, Beta Blockers, DVT)*

““THE INSIDE THE INSIDE -- LOOKING INLOOKING IN””

• Vascular Initiatives

• ICU Redesign (Rapid response team, ventilator associated pneumonia, central line infection reduction, hypothermia)

• Hysterectomy Alcohol Withdrawal

• Medication Safety Carotid Surgery

• Cerebral Aneurysm Palliative Care

• Hip and Knee Replacement Surgery CABG (Open Heart Surgery)

• Cardiac Valve Surgery Sepsis

• * All campuses ** Florence and Dillon

““THE INSIDE THE INSIDE -- LOOKING INLOOKING IN””

DESKTOP EXERCISE

MISSION AND VALUES

• The Mission of McLeod Health is to improve the overall health and well-being of the people living within the eastern regions of North & South Carolina by providing excellence in health care.

• Four Core Values:• The Value of Caring• The Value of the Person• The Value of Quality• The Value of Integrity

Quality of the Service

Quality of Safety

“Just Culture” Operational Effectiveness

Physician &Executive

Leadership

Quality of Science

Quality of Service = Loyal Patients

QUALITY PYRAMID

Video

Service Excellence Strategic Hierarchy

Authentic

Personal

Relationship

Tools and Skills

Service Standards

Establish System-Wide Predictability:

Provide clear, consistent

expectations across the organization.

Improve Outcomes: Provide core strategies

that departments can adopt to affect scores.

Empower Employees: Enable employees

to passionately engage 1:1 with

the customer for mutual satisfaction.

Cultural FoundationDevelop a Cultural Foundation:

Grow and develop leaders, staff, and

processes that support a

patient-centered approach.Shared Vision / Leadership / Accountability

What Creates Loyal Patients

• Loyal Patients = Patient’s that will recommend you

• Likelihood to Recommend = to excellent service received during every visit or care stay

• To assure service is consistent – service excellence standard are communicated and expected from all employees

• Service Excellence Standards are a set of 10 expectations describing what excellent service behaviors look like.

• They are tangible expressions of our McLeod Values.

• They will serve as a guide for how we treat every customer, every minute of every day.

THE VALUE OF CARING

• “A spirit of willing and compassionate service to others.”

• PROFESSIONALISM – We are fully present for our customers, displaying a positive image that shows respect for ourselves, for McLeod Health, and for the customer.

• ENVIRONMENTAL CLEANLINESS – We are relentlessly committed to a neat, clean and safe environment.

THE VALUE OF THE PERSON

• “A commitment to the well-being of the whole person.”

• COURTESY – We treat people with the respect we want our loved ones to receive.

• RESPONSIVENESS/CUSTOMER WAITING – We minimize waits as much as possible.

• PRIVACY, RESPECT AND DIGNITY – We purposefully protect our patient’s privacy and dignity at all times.

THE VALUE OF QUALITY

• “A dedication to superior healthcare quality.”

• PROVIDING INFORMATION/COMMUNICATION – We listen first, and communicate clearly and simply, second.

• DIRECTIONS/WAY-FINDING – We make sure people get where they need to go.

• TELEPHONE COMMUNICATION – We meet the needs of our callers quickly and accurately.

THE VALUE OF INTEGRITY

• “An ethical responsibility for upholding standards for honesty and truth.”

• PERSONAL OWNERSHIP – As owners of McLeod Health, each of us will do whatever it takes to ensure an excellent patient experience.

• SERVICE RECOVERY – When things don’t go perfectly, we quickly do what we can to make things right.

THE TEN SERVICE STANDARDS

• PROFESSIONALISM• ENVIRONMENTAL CLEANLINESS• COURTESY• RESPONSIVENESS/CUSTOMER WAITING• PRIVACY, RESPECT AND DIGNITY• PROVIDING INFORMATION AND COMMUNICATION• DIRECTION AND WAY FINDING• TELEPHONE COMMUNICATION• PERSONAL OWNERSHIP• SERVICE RECOVERY

• What does Excellent Customer ServiceLook Like?