airica steed, rn, bsn, mba administrator, operations ......> 90% of all surgical patients are...

1 Operations Excellence Proprietary information

Airica Steed, RN, BSN, MBA

Administrator, Operations Excellence

Lorraine Saintus, MSPH

Manager, Operations Excellence


Session Objectives

► Share the industry-wide burning

platform to embrace transformational

change in healthcare

► Introduce our organization’s

transformation strategy and approach

► Provide best practice case study of

achieving breakthrough performance

excellence in Ambulatory Surgery

► Share leadership lessons learned


Burning Platform for Transformational Change

Did You Know?

“A full third of the $2.3

trillion in annual

healthcare spending - is

wasted on things like

medical mistakes,

hospital-acquired

infections, medication

errors, overuse of

emergency departments,

and unnecessary lab tests

and medical imaging.”

– The Boston Globe

Efficiency

Patient Safety/ Quality

Revenue/ Costs

Regulatory Compliance

Technology Adoption


► Increasing pressure to do more with less

► Reimbursement cuts and higher operational costs

► Staffing shortages with higher productivity standards

► Preventable medical errors and mistakes

► Regulatory standard challenges

► Redundant and inefficient processes

► Lack of readiness to embrace technology

► Challenges with sustaining optimal

levels of customer satisfaction

(external & internal)

Healthcare Industry Challenges…


Advocate Condell Medical Center…

► 271-bed, not-for-profit, acute-care level I trauma facility,

providing a wide range of comprehensive inpatient,

outpatient, diagnostic and ambulatory medical services.

► Embraced an organization-wide transformation in response

to these plaguing concerns that impacted patient

satisfaction, efficiency, associate engagement, physician

satisfaction, and financial viability.


Operations Excellence Transformation Strategy


Leveraging Malcolm Baldrige Framework

Operations Excellence

Transformational & Accountable

Leadership

Innovative Best Practice

Strategies

Customer Centered

Associate Driven

Mixed Methods Process

Transformation

Continuous Breakthrough

Results


Cultural and Leadership Transformation

Initiative and Innovation

Empowerment

Create a learning organization

• Equip people to identify and solve problems by teaching skills in initiative and innovation

• Increase involvement and commitment by empowering people to directly impact the organization

• Build a culture of continuous learning and improvement to accelerate high performance


Operations Excellence Transformation Roadmap

BURNING PLATFORM FOR

CHANGE

CURRENTPERFORMANCE

OPPORTUNITIESFOR

IMPROVEMENT

TARGET STATE SOLUTION

IMPROVEMENT TACTICS

OUTCOMES &BIG CHANGES!!

PERFORMANCE TRACKING

CONTINUOUS IMPROVEMENT PLAN (WWW)

LESSONS LEARNED


Transformational Change at its Best…

Advocate Condell Medical Center Case Study

Ambulatory Surgery


► The surgical services division is one of the largest revenue-

generating profit centers in the hospital. The majority of

surgical volumes consist of ambulatory procedures.

► Our patients and physicians have “choices” regarding the

selection of their ambulatory surgery services.

► An opportunity existed to transform existing practices in order

to transform service experience and enhance organizational

performance….

Ambulatory Surgery Transformation

Why is this important?



Original State Condition

► Poor patient perception of care – bottom decile patient

satisfaction

► Poor physician satisfaction and loyalty

► High patient cancellation rates prior to surgery

► Under-utilized capacity due to inefficient scheduling practices

► Inefficient use of resources (people, technology, space)

► Elongated wait times and throughput on day of surgery

► Hard and soft denials due to poor financial controls

► High surgical scheduling abandoned/lost call rate



Methodology & Approach

► Rapid Improvement Event /Kaizen/Workout

► Process Improvement Tools (Lean, DMAIC, etc.)

― Time Studies/Observation/Interviews

― Process Mapping

― Spaghetti/Communication Diagram

― Root Cause Analysis

― Data Analysis & Modeling

― Gallery Walk

― Simulations/Pilots

► Operational & Workforce Analysis Components

― Benchmarking (Internal & External)

― Redesigned Operational Infrastructure

― Redesigned Roles & Responsibilities

― Redesigned Staffing & Productivity



Outcomes & Big Changes

PREVIOUS STATE

• All initial contact made by phone call to surgery schedulers

• 50% calls to surgical scheduling went to voicemail or lost

• Cases scheduled without order or complete patient information

• Only 40% cases were financially cleared prior to day of surgery

• Underutilized capacity and block times

PRESENT STATE

• Surgeon offices utilize an electronic request

• 95% financial clearance performed prior to day of surgery

• All cases have completed order at time of booking and financial clearance within 24 hours of booking

• Optimized capacity and surgical blocks

The Surgical Request – “Booking a Case”




PREVIOUS STATE

• First phone contact with patient was < 24 hours prior to surgery

• No patient mailing or education

• 5% chart completion prior to day of surgery.

• Orders & pre-operative testing not completed until day of surgery

• No inclusion of primary physician in surgical team

• 4% patient cancellation rate

PRESENT STATE

• Patients are called 14 days prior to day of surgery

• Welcome packets & orientation

• 95% of all pre-operative chart completed 48 hours prior to surgery

• Primary physician is integral part of pre-operative navigation process

• 50% reduction in patient cancellation rate

Pre-Operative Navigation




PREVIOUS STATE

• Multiple check-in points for registration

• Lengthy registration process (20 min average)

• > 160 minute admitting throughput time

• Siloed and fragmented service delivery

• Poor perception of experience

PRESENT STATE

• Point-of-service registration with “one-stop-shop” experience

• Patient greeted and immediately escorted to admitting bay

• Expedited rapid check-in (<3 min average)

• “Patient-Centered” approach (registration, nurse, surgeon, volunteer)

• WOW Factor experience

“Day of Surgery” Patient Experience


► > 90% of all surgical patients are financially cleared for “rapid check-in”

on the day of surgery

► > 40% improvement in surgical admitting throughput

► > 50% reduction in patient cancellation rate less than 24 hours prior to

surgery

► > 50% improvement in surgical scheduling call answer rate

► 50% improvement in chart completion rate before surgery

► Improved patient health assessments pre-operatively (baseline <24

hours pre-operatively)

► Significant improvement in patient satisfaction from baseline single

digit performance

► Decreased surgery denials due to hardwired financial clearance

procedures


Breakthrough Outcomes Summary


Ambulatory Surgery Transformation Breakthrough Performance Dashboard

0

10

20

30

40

50

60

70

80

90

0

20

40

60

80

100

120

140

160

180

Pa

tie

nt

Sa

tisfa

cti

on

(d

ecile

)

Wa

it T

ime

(m

in)

Ambulatory Surgery ImprovementPatient Wait Time & Patient Satisfaction Correlation

Patient Wait Time Patient Satisfaction


1

14

Patient Health Assessment Prior to Surgery (days)

Pre-Transformation Post Transformation



4

2

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Pre-Transformation Post Transformation

Patient Cancellation Rate <24 Hours Before Surgery (%)



You have the opportunity to transform your

organization to excellence!


Transformational Leadership Lessons Learned..

Establishing a High Performance Driven Culture

Leading by Example

Empowering and Engaging Frontline Constituents

Becoming Catalysts for Continuous Change and Learning

Adopting a Non-Prescriptive Process Vehicle


Establish a High Performance Driven Culture…

► Have a relentless commitment to excellence – do not

except mediocrity as an option..

► Invest in coaching, developing, and mentoring people

► Foster open communication (up, down, and sideways)

► Encourage an environment of creativity, individual

expressiveness, and unyielding innovation

► Show compassion and enthusiasm

► CELEBRATE SUCCESS!!!


Leading By Example…..

► Take personal responsibility for performance and

results

► Empower associates to be change agents for what

needs to get done

► Follow through and “do what you say you’ll do”

► Set clear expectations - for yourself and others

► Establish ACCOUNTABILITY through

consistent performance tracking


Empower and Engage Frontline Constituents…

► Empower people who do the work to make the decisions

(get to the grassroots level)

► Engage associates in a “learn by doing” style of leadership

► Allow associates the opportunity to become decision

makers and team leaders

► Ensure a mechanism for ideas to be heard and for

associates to have a “voice”

► Associates should be inspired to think

and act like the “CEO” of the transformation

experience

► Empower associates to take pride in their work


Understand and Articulate the GE quote….

“62% of quality efforts fail from lack of attention to the

cultural and people sides of change”

– GE Healthcare

Transform into Catalysts for Continuous

Change and Learning…

►Understand the changes needed and take an active part in

the change process

►Establish a foundation and shared need for change before

improving processes

►Obtain buy-in through empowerment


Adopt a Non-Prescriptive Process Vehicle…

► Embrace a mixed methods approach to

process transformation

► Attack the broken system and not the

people

► Focus on effective problem solving and root

cause analysis

► Integrate leadership and behavioral

accountabilities with process improvement

tactics

► Use standardized continuous improvement

action plans

► Be transparent in all goals and measures


Advocate Condell’s Journey Wrap Up…

► Embracing transformational change is a journey

► Achieving breakthrough performance requires vision,

initiative, engagement, and accountable leadership

► Transformation occurs through the combination of

integrating accountable leadership, excellent behaviors,

and superior processes


Closing Thoughts….

“If you are going to achieve excellence in big

things, you develop the habit in little matters.

Excellence is not an exception, it is a

prevailing attitude.”

- Colin Powell


Questions & Answers…


Advocate Condell Medical Center – Contact Information

Airica Steed, RN, BSN, MBA

Administrator, Operations Excellence

[email protected]

Lorraine Saintus, MSPH

Manager, Operations Excellence

[email protected]

mailto:[email protected]

mailto:[email protected]

airica steed, rn, bsn, mba administrator, operations ......> 90% of all surgical patients are...

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