Embed Size (px)
Citation preview
ThedaCare Improvement System
John Toussaint, MD
Six Sigma in Healthcare
is a comprehensive, community-owned health care system focused on caring, customer satisfaction, and value. Our mission is to improve the health of our communities.
Appleton Medical Center
a 160-bed acute care medical center
Theda Clark Medical Center
a 260-bed acute care medical center
ThedaCare Physiciansemploying over 100
physicians
New London Family Medical Center
a 40-bed acute care medical center
Gold Cross Ambulance Service
jointly owned with Affinity Health
Systems
ThedaCare Physicians Shawano Family
Medicinea multi-site physician practice jointly owned with Shawano Medical
Center
Fox Valley Nephrology Partners and Dialysis
Care
nephrology services provided jointly with
Affinity Medical Group
Fox Cities Community Clinic
a free clinic jointly owned with St.
Elizabeth Hospital
ThedaCare Behavioral Health
a comprehensive provider of inpatient and outpatient mental health/substance
abuse services
ThedaCare At Home
Home health, hospice, DME, respiratory
therapy, infusion, and pharmacy services
The Heritage/
Peabody Manor
a continuing care campus for older adults
3
Some examples of our experience so far….
Saved $154,000 in the Cath Lab supply procurement processes.
In 2004, we reduced A/R from 56 to 44 days equating to about $12M in cash flow.
Redeployed staff in several areas amounting to the equivalent of approximately 33+ FTEs.
*data as of 1/21/05
4
Some examples of our experience so far…
Improved TCP phone triage times by 35%, reducing hold time from 89 to 58 seconds.
Reduced TCP phone triage abandonment rates by 48% from 11.6% to 6.0%.
Radically reduced the Hospital admission clinical documentation cycle time (50%).
AMC Med/Surg decreased medication distribution time from 15 min/med pass to 8 min/med pass impacting 4.1 FTEs of staff time.
*data as of 1/21/05
All Divisions
DEC 2004 YTD# of Value Streams 3 16# of Events-First Pass 10 68# of Events-Second Pass 1 2# of Events-Third Pass 0 0# of Projects 9 48
QUALITYSignificant Quality Improvements 2 21Significant Service Improvements 12 60
EMPLOYEE ENGAGEMENTTotal Empl Engagement 85 859New Empl Engagement 58 606
FINANCIALFTE Reduction 2.9 33.55Labor/Benefit Savings 219,177$ 1,485,857$ AR (3.5% of cash flow) 5,000$ 365,350$ Capital Avoidance -$ -$ Revenue 1,000$ 1,000$ Supplies 8,215$ 356,965$
Other Savings + 45,000$ 1,130,140$ Total Savings 278,392$ 3,339,312$
ThedaCare Monthly Tracking Summary
Number of Wisconsin Collaborative Measures Meeting the 95th Percentile Performance
5 Principles of Lean Thinking
VALUE - what customers are willing to pay for
VALUE STREAM - the steps that deliver value
FLOW - organizing the Value Stream to be continuous
PULL – triggering flow from customer needs
PERFECTION - continuous improvement forever (culture)
(from Lean Thinking, Womack and Jones, 1996)
Why Do We Need The ThedaCare Improvement System?
•To eliminate waste
•To make processes flow more smoothly
•To eliminate non-value added work 8 Wastes
Unused Talent
Waiting Time
Inventory
Transportation
Defects
Motion
Over Production
Processing Waste
The 7-Week Cycle of an R.I. Event 3 weeks before – Value Stream review, Event
Selection, Select Team Leader/Co-Leader and team members estimated financial, quality and staff impact
1-2 weeks before – RI Checklist, preparation .. Cell Communication, aim statement, measures
day 1 - current conditions day 2 – create the future day 3 - run the new process day 4 - standard work day 5 - presentation
1st week after - Capture the savings 2nd week after – Update Standard
Work 3rd week after – CFO validation
•Step 1 “Identify” waste
•Step 2 “Eliminate” waste
Value Stream Map Visual map of all steps in a process including
material, information and services regarding a product or family of products.
Adult BeforeAdult BeforePt. calls to schedule appt.
Scheduler schedules appt.
Front desk confirms appt.Pre Visit
MA sets up room
MA walks pt. to exam room
MA walks to waiting room w/pink slip
MA calls patient
MA picks up Pink Slip
Pink sheet prints. “Arrived” in computer schedule
Send patient to assigned waiting room
MA obtains pt weight
MA obtains pt height
MA logs onto computer
MA collects additional relevant vitals
Visit
MA records vitals, enters allergies, HM, meds, smoking status, pharmacy & Med/Surg Hx
MA secures screen, leaves room, flips flag, pink slip by door
Pt. disrobes
Provider flips flags, grabs pink slip & enters room
Provider greets pt, logs onto computer
Provider reviews info
Provider discusses med use & allergies
Medical info. changed, Problem List updated
Provider pulls MA into room
Provider performs exam
Labs and injections ordered
Discuss HM issues to schedule & anticipatory guidance
Refills meds/ gives samples.
Provider queues AVS, provider leaves room, AVS prints & is given to pt.
Pt. dresses
Does pt. need a triage nurse? No
YesPt. talks to triage nurse
Does pt. need a scheduler? No
YesPt. talks to scheduler, appts. scheduled
Does pt. need lab/x-ray?
No
Yes
Pt. checks out at Front Desk
Pt. exits clinic See next slide
Adult Before (continued)Adult Before (continued)X-ray is performed
X-ray film is processed and checked
Pt. taken to x-ray room, disrobes if needed
X-ray pre-work is done
Reception takes AVS, calls x-ray, pt. directed to waiting room
Pt. checks in at Lower Level, AVS given to receptionist
Patient dresses
Is Lab needed?
No
Yes
X-ray staff delivers film & AVS to lab
Lab staff picks up film, AVS, orders & labels
Patient walked to drawing room
Lab staff: IDs pt, checks orders, organizes equip, draws blood
Labs processed and resulted
Patient visit is finished
Post Visit
Lab/X-ray results to provider
Provider reviews message in in-basket
Result note sent to triage pool with instructions
Nurse gets result notes, tries to contact patient
Reviews results & instructions with patient
Nurse gets hold of patient
No
Yes
Leave message for pt. to return call. Re-call pt.
Contact ended, no changes made
Coordinate additional pt. care
Are results abnormal?
Yes
No
Adult AfterAdult AfterPt called to confirm appts. and info gathered: HM, open orders, pharmacy, meds, allergies and Chief complaint taken
Pre VisitLab drawn 2-3 days before Dr. visit
Lab results labeled “pre-visit labs;” sent to Dr.
Patient calls to schedule visit
Scheduler schedules appt. & puts in best time to call pt.
MA walks pt. to exam room
MA walks to waiting room w/pink slip
MA calls patient
One of 3 MAs takes Pink Slip
Pink sheet prints. “Arrived” in computer schedule
Send patient to assigned waiting room
MA sets up room
Provider & MA huddle
MA logs onto computer
MA takes appropriate vitals & records, if pre-call not done, completes that info also
MA secures screen, leaves room, flips flag, pink slip by door
Pt. disrobes
Provider flips flags, grabs pink slip & enters room
Provider greets pt, logs onto computer
Provider does Pertinent Review of Systems
Provider performs exam
Provider pulls asst. as necessary
Provider accepts pended orders
Provider reviews results with pt., discusses need for any further testing/appts.
Provider queues AVS, provider leaves room, AVS prints & is given to pt.
Pt. dresses
Does pt. need a scheduler? No
YesPt. talks to scheduler, appts. scheduled
Pt. checks out at Front Desk
Pt. exits clinic
Visit
Adult Bar ChartAdult Bar Chart
ADULT BEFORE/AFTER
0
10
20
30
40
50
60
70
RESOURCE
MIN
UT
ES Documentation
InbasketVisitPre-Visit
TAKT TIME
Day 3 Run the new process
• Make changes in process steps
• Equipment
• Room design
• Measure performance
• Perfect immediately
• Communicate to other staff not involved
Day 4 Standard Work
Standard work…creating a process for what’s needed, when needed, in quantity needed, consistently every time by everyone.
Why use it? Work must be standardized before it can be measured and improved
Standard work systems …• Achieve least amount of variation in the work
process.• Have written and posted standard work process
charts.• Create the flow of human work within an operation.• Can be measured and defects identified and improved
Spaghetti ChartWell Child
Communication Circle-Pre Phone Event
Specialist /
Central Scheduling
PSR
Patient
Switchboard
Advice – Blue
Results=Green Refill=Red Appt=Orange
ReferralsReferrals = = YellowYellow
Triage Pool
PCP
Triage
Communication Circle-Post Phone Event
Specialist / Central Scheduling
PSR
Patient
Switchboard
Triage Phone Queue
PCP
Triage
Advice – Blue
Results=Green Refill=Red
Appt=Orange
ReferralsReferrals = = YellowYellow
Day 5Present results
1. Present results.2. Support the work area and implement
the changes.3. Continue to work the “To Do” list.4. Celebrate the success of your team.5. Communicate, Communicate,
Communicate!
