bruce siegel md mph, marcia wilson mba, khoa nguyen mph, marsha regenstein phd academy health june...
Post on 27-Mar-2015
217 Views
Preview:
TRANSCRIPT
Bruce Siegel MD MPH, Marcia Wilson MBA, Khoa
Nguyen MPH, Marsha Regenstein PhD
Academy Health
June 6, 2004
Improving the Performance of the Safety Net:
Findings of the Urgent Matters Project
Confidential information. For use by Urgent Matters and the Robert Wood Johnson Foundation only.
Program Origins: RWJF Surveys the Landscape
2000 IOM report on the safety net The safety net is “Intact but endangered” Report recommends we monitor and assess local safety nets
Drumbeat of media coverage: Overwhelmed EDs with diversion and long waits ED’s overwhelmed: 62% of hospitals report being “at” or “over
capacity” (Lewin 2002) ED’s as the “safety net for the safety net”
Take all comers, by custom and law - EMTALA
ED Volume Rising While Number of EDs Shrinks 1992-2002: Annual ED visits up 23%, Number of EDs down 15%
(CDC 2004)
Confidential information. For use by Urgent Matters and the Robert Wood Johnson Foundation only.
Confidential information. For use by Urgent Matters and the Robert Wood Johnson Foundation only.
Selection Process Applications solicited from all public/not-for-
profit level I and II trauma centers in US. 2/3, or 287 submit detailed on-line letter of intent
10 selected as grantees Criteria:
Evidence of crowding ED volume, market share Payer mix Track record in achieving and sustaining change Senior leadership commitment
Confidential information. For use by Urgent Matters and the Robert Wood Johnson Foundation only.
The 10 Hospital Learning Network
Grady Health System – Atlanta, GA Boston Medical Center – Boston, MA Henry Ford Hospital – Detroit, MI Inova Fairfax Hospital – Fairfax County, VA BryanLGH Medical Center – Lincoln, NE The Regional Medical Center at Memphis – Memphis,
TN St. Joseph’s Hospital and Medical Center – Phoenix, AZ Elmhurst Hospital Center – Queens, NY University Health System – San Antonio, TX University of California at San Diego – San Diego, CA
Confidential information. For use by Urgent Matters and the Robert Wood Johnson Foundation only.
Urgent Matters Input/Throughput/Output Model
Confidential information. For use by Urgent Matters and the Robert Wood Johnson Foundation only.
Learning Network Elements
Tool kit of best practices on patient flow Data collection methods Strategies for work flow re-design Organizational buy-in strategies Implementation strategies
Training and Reinforcement on Rapid Cycle Change Plan, Do, Study, Act
Core Metrics 17 key performance indicators (weekly and monthly
reporting)
Confidential information. For use by Urgent Matters and the Robert Wood Johnson Foundation only.
Learning Network Structure
Web-based management Tool kit, new developments and other resources Action plans and data submission Run-charts Monthly project reports “Celebrating Success” Shared data – shared outcomes
Peer Collaboration 3 group meetings 3 consultant site visits to each site, with phone consultation Monthly conference calls with topic presentation, update
from each site Listserv
Confidential information. For use by Urgent Matters and the Robert Wood Johnson Foundation only.
Confidential information. For use by Urgent Matters and the Robert Wood Johnson Foundation only.
Confidential information. For use by Urgent Matters and the Robert Wood Johnson Foundation only.
Confidential information. For use by Urgent Matters and the Robert Wood Johnson Foundation only.
Confidential information. For use by Urgent Matters and the Robert Wood Johnson Foundation only.
Confidential information. For use by Urgent Matters and the Robert Wood Johnson Foundation only.
Confidential information. For use by Urgent Matters and the Robert Wood Johnson Foundation only.
Confidential information. For use by Urgent Matters and the Robert Wood Johnson Foundation only.
Closing Thoughts: Operations
It’s The Hospital, Stupid!!
Rapid Cycle Change: Rapid Is Key Early Results More Important Than Consensus Communications are critical
Data Systems Lag But it’s doable
Executive Management Buy-In Is Key
Collaboration? Or Competition?
Productivity May Increase Dramatically
Confidential information. For use by Urgent Matters and the Robert Wood Johnson Foundation only.
Closing Thoughts: Policy
Do We Really Need All These New ED’s? Are we just building bigger reservoirs? And what are we putting in them?
Changing EMTALA Is Not the Answer
Barring the Door, or “Triaging Out”, Is Not the Answer Either
What are the Implications for Surge Capacity?
Maybe We Need to Rethink the Role of the ED as “Provider of Last Resort”
The Safety Net CAN Improve Its Performance With minimal external resources And that goes for Academic Health Centers as well
top related