Innovative Employee and Union Driven Activities to Improve Patient Care
Why is Healthcare Transformation
Needed?
NRI Innovation Network’s Workshop
Gothenburg, Sweden
November 3, 2015
Our History▪ Rooted in ILR legacy: improving labor/
management relationships for a sustainable economy
▪ Focus on Manufacturing: automotive, textile, high tech (1980) ▪ Programs for Employment and Workplace
Systems (PEWS) ▪ Sustaining Manufacturing jobs in the US
▪ Focus on Healthcare (1997): Healthcare Transformation Project ▪ Creating more integrated delivery systems to
improve patient care and reduce costs
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We’ve always done it this way…..
Insanity: “When you continue to do the same thing and expect a different result.”
-Albert Einstein
Key ClientsCompanies - Hathaway Shirt Co. - Saturn Corporation - Sun Ship Building and Dry Dock Company - World Bank - Xerox Corporation Key Unions - AFL-CIO –Corporate Affairs and Working for
America Institute - AFT - Auto Workers - 1199/SEIU Health Services Workers Union - UNITE
Key Clients (continued)Healthcare Work - Department of Health Services, LA - League of Voluntary Hospitals and Nursing
Homes - Maimonides Medical Center - N.J. Medical School International work - Ireland – Local Government and Health
Care Partnerships - Norwegian Work Research Institute - Poland – with Solidarity
Key Rearch Findings
• Extensive frontline engagement is critical • Effective use of sector strategies • Borrowing/Stealing from others blending tacit
knowledge with best practices • Create new roles for unions • Labor relations supports operational issues • Workforce development is needed to prepare for new
jobs • Investment in $ and resources is needed– no free lunch
But don’t get what we pay for.
HIGH COSTS & LOW QUALITY
Life Expectancy vs. Healthcare Expenditure Per capita
Income and Insurance DisparitiesWe spend almost twice as much on healthcare as other countries…
POOR ACCESS TO CARE
Mirror, Mirror: Ranking of Six Nations
AUSTRALIA CANADA GERMANYNEW
ZEALANDUNITED
KINGDOMUNITED STATES
OVERALL RANKING (2007) 3.5 5 2 3.5 1 6
Quality Care 4 6 2.5 2.5 1 5
Right Care 5 6 3 4 2 1
Safe Care 4 5 1 3 2 6
Coordinated Care 3 6 4 2 1 5
Patient-Centered Care 3 6 2 1 4 5
Access 3 5 1 2 4 6
Efficiency 4 5 3 2 1 6
Equity 2 5 4 3 1 6
Long, Healthy, and Productive Lives 1 3 2 4.5 4.5 6
Health Expenditures per Capita, 2004 $2,876* $3,165 $3,005* $2,083 $2,546 $6,102
Source: K. Davis, C. Schoen, S. C. Schoenbaum, M. M. Doty, A. L. Holmgren, J. L. Kriss, and K. K. Shea, “Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care,” The Commonwealth Fund, May 2007
Country Rankings
1-2.66
2.67-4.33
4.33-6.0
* 2003 data
How Bad is It?
• Agency for Healthcare Research- 1.5 % annual improvement over 7 years
• Ranked 64 out of 100 internationally
• Most expensive healthcare system in Western countries
• Lowest quartile in quality
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Silo-ed healthcare system drives inefficiencies, diffuses accountability
New Areas of Transformation
Sector Strategies
Improving what we do
Blended Work
Innovation Activities
Process Improvement
Tools (common strategy)
Innovation Activities
Best Sector Strategies
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Best Sector Strategies➢Auto: teams assembling cars together ➢Healthcare: integrated care/primary
care and behavioral health joint services
➢Manufacturing: modular work, just-in- time processes
➢Ship building – zone construction
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Healthcare Sector Strategy includes:
➢ Creating Patient-Centered Medical Homes (PCMH)…and now Health Homes
➢ Behavioral health and primary care coordination
➢ Integrated delivery care systems to create greater health and wellness
➢Greater coordination with community organizations
Components of an Integrated Care Delivery System
Integrated Care
Coordinated Care:
Patient centered care involving collaboration
among primary care physician, nurses, patient,
family and community
Information Technology:
Electronic Medical
Records/History, E-Prescriptions,
Interactive Patient Web
Portal
Health Coach, Nurse
Navigator: Staff use of electronic portals and
tracking tools to monitor progress
of patients, especially those
with chronic conditions
Reimbursement Reform: Restructuring of
the current system used to
compensate physicians based
on “fee for service” to one that is bundled/pre-paid, and
quality outcome linked
Tracking Outcome
Tools: Use data to
identify issues of critical care
Feedback to Physicians
and Healthcare
Team Measure clinical
or service performance by
physician/practice 17
Focus on Transformation… Not Change
Innovation Across the Lifecycle
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Seed
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Product Innovation
Process InnovationN
umbe
r of
Inn
ovat
ions
Dominant Design (Industry Standard)
Discontinuous Innovation
Discontinuous Innovation and
change
End of Life
Established
Emerging
Mature
© 2010 Sapience
Continuous Improvement
1964 Mustang 2013 Mustang2014 electric car
Innovation
Creating New Knowledge Extensive Front-line Staff Engagement
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Employee Driven InnovationTwo Approaches
➢ Study ActionTeams ➢ Quality Lab- creating
significant breakthroughs- disruptive change
Key Componens
• 6 staff freed-up from normal work to analyze and development new process and decide on new equipment with clear quality and costs
• Budget provided for innovative incubator Problem solving
• Constant contact with staff including technical staff
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4-Work System Design 6-Data collection for review
• Strategic targets and adjust • Plan of work
1-Leadership 7-Review and adjust 2-Strategy 8-Re-configurability 3-Quality Lab 5-Launch teams
• Training • Standardize processes • Network/innovation
MOBILIZE
ACT
ADAPT
Cornell’s Labor-Management Change
Process
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Aligning Sub-Systems
Input (response to a
specific problem or system)
Environment
Resources
History
Output / Performance
System Unit
Individual
Informal Organization
Work & Technology Strategy
Formal Organization
(Structure, Roles. Procedures) Culture
Engagement of People,Skills, &
Accountability
Source: Nadler and Tushman
Two CulturesExecution Culture
• You focus on improving current
processes
• You meet current customer needs
• You exploit what you know
• You impose set processes and structures
• You allow little room for error
Innovation Culture
• You think outside the box & challenge current processes
• You anticipate future customer needs
• You explore what you don’t know
• You let things emerge
• You allow freedom and flexibility
Organizing Change
Present State
What you’ve
got now.
Future State
Your vision.
Transition PlanTransition Plan
Extensive Front Line Engagement: Worker Voice
Maimonides Medical Center▪ 706 bed hospital, Brooklyn,
NY ▪ 5,600 employees ▪ A tertiary care, teaching
hospital ▪ Improving patient
experience and clinical outcomes
▪ Three unions: ▪ Committee for Interns and
Residents (CIR) ▪ New York State Nurses
Association (NYSNA) ▪ 1199/SEIU United
Healthcare Workers
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Maimonides CIR, NYSNA and 1999/SEIU Strategic Alliance
Cornell Researchers
Developers
Labor-Management Oversight Com. (LMOC)
Labor-Management Council (LMC)
Environmental Serv. DLMC
Cardiology DLMC
Measurement & Documentation
Workgroup
Improvement Tools
• Process mapping
• Problem solving
• Cause and effect analysis
• Microsystems 31
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Outcomes➢70% decrease in patient falls in cardiac and med- surg units ➢100% decrease in call bell responses time (to 1
min.) in cardiac units ➢50 % increase in patient satisfaction scores in
med-surg units ➢75 % improvement in cleanliness of patient
rooms and 50 % improvement in patient satisfaction scores
➢Call center functioning with high quality ahead of schedule
LADHSLos Angeles Department of Health Services
▪ 2nd largest public health system ▪ 4 hospitals, 2 ambulatory care
centers, 16 comprehensive health centers, 1 rehabilitation facility—750,00 patient visits
▪ 1,671 beds ▪ 18,460 staff ▪ Delivery system transformation,
improving patient experience ▪ Two unions:
▪ Committee for Interns and Residents (CIR)
▪ SEIU Local 721
Labor-Management Transformation Council
Integration activities with LA-DMH and LA-DPH
LMTC Operations Group CIT Workgroup
Quality & Safety Workgroup
Patient Experience Workgroup
LA-DHS/SEIU Partnership Process
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Outcomes➢Reduced wait time between registration
and being seen from 23 minutes to 3 minutes
➢Wait time was reduced 795 to see a primary care provider
➢Cycle time in urgent care reduced from 2 hours to 34 minutes
➢Patient satisfaction scores increased by 50% in terms of cleanliness of rooms
“No doubt that a small group of thoughtful citizens can change the world. Indeed, it’s the only thing that ever has.”
Margaret Mead
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Smart Risk Taking