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Creating a Culture of Excellence in the Hospital Environment Jared Quinton, MHSM, ASQ CSSBB Lean Six Sigma, Patient Care Services, UC Davis Medical Center

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Page 1: Creating A Culture Of Excellence In The Hospital Environment

Creating a Culture of Excellence in the Hospital Environment

Jared Quinton, MHSM, ASQ CSSBBLean Six Sigma, Patient Care Services, UC Davis Medical Center

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Serving 6 million residents in 33 counties encompassing 65,000 square milesMajor educational, research and patient-care facilities spread across more than 140 acres

Licensed beds 645Admissions 33,169 ER Visits 54,938 Clinic Visits 915,452

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What is @

A systematic methodology utilizing effective data analysis tools and techniques driven by DMAIC [deh-may-ihk]

design processes with very high reliability, seeking to improve quality, delivery, and cost

Measure

Analyze

Improve

Control

Define

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What is @

lean six sigma

lean six

sigma

*

* requiressystemsthinking

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audit perceptions

shift perspective

eliminate silos

systems thinking

What is @

steps to achieving systems thinking…

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What is @

DMAIC

lean six sigma

audit perceptions

shift perspective

eliminate silos

process culture

systems thinking

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DMAIC

“A structured team-oriented application of the scientific method”

“Organized common sense, using data to drive decisions”

M

AI

C

D

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Lean vs. Six Sigma

Process Flow

Driven by Observation

Identify & Eliminate Waste

Process re-design

Process Variation

Driven by Data

Identify & Eliminate Variation

Design Controls

Continuous Improvement

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LSS Roles

CEO Project Champion

Project Sponsor

Project Leader Black Belt

Green Belts

Team Members

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Creating a Culture of Excellence in the Hospital Environment:

Clinical Case Management at UCDMC

Case Study10

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Case Management

i. Why target Case Management?Non-optimal coordination of case management

Discharge Planning vs. Utilization ReviewCompeting priorities and points of viewPhysician/Nurse dissatisfaction with case management processGeographic barriersTechnology gapsTurnoverEver changing organizational structure

ii. Expected Outcomes:Reduction in length of stay outliers (patients w/ LOS >20)Increased physician and nurse satisfaction with case management processReduction in turnover

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CCM Redesign

i. Building a team:Key members from Case Management

Discharge PlanningUtilization ReviewUnit ManagersOther

Demonstrate support of senior leadershipAcknowledge the past and commit to redesign

Tangible responsibility of the team

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CCM Redesign

ii. Introducing Lean & DMAIC:Establishing a project charter

ScopeObjectives

Just-In-Time Education & TrainingLean philosophy and tools related to project

GembaObserve everything related to case management process

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CCM Redesign

iii. Defining Case Management at UCDMC

A collaborative practice model that requires timely communication to facilitate a continuum of patient care though effective resource coordination and includes the professions of nursing and social work.

Support and monitor the delivery of quality, cost effective patient care.

Assure appropriate continuity of care through the coordination of internal and external health care resources.

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CCM Redesign

iv. Understanding the Current StateValue Stream MapA3

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CCM Redesign

v. Developing the Future StateCreate flow and pull value through the value stream

Create standard work and remove non-value-added activityAll patients and team members receive the same case management

Maintain user-friendlinessEnsure case management is available to the patient and health care team when it’s needed in a safe and efficient manner

Unobstructed throughputContinually monitor and eliminate constraints to flow

UCDMC reality…

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Discharge Planning

Utilization Review

Clinical Case Management

CCM Redesign

vi. Defining a new role:

“Clinical Case Manager”

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Page 23: Creating A Culture Of Excellence In The Hospital Environment

CCM Redesign

vii. CCM Goals:

All UCDMC patient shall be reviewed by case management within 24-48 hours of admissionFacilitate patient access to the appropriate level of care and required resourcesPromote patient/family participation and right to self determination balanced with the appropriate utilization of resourcesFacilitate reimbursement for the services rendered at the appropriate level of careEducate staff regarding effective case management, patient care, and planning that promote the missionCase management staff will be trained in all aspects of utilization review and discharge planningIdentify procedures, tools and technologies that facilitate effective case management communication

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Page 24: Creating A Culture Of Excellence In The Hospital Environment

CCM Redesign

viii. CCM Teams:Organize CCMs by specialty instead of geographyUtilize EHR to help identify appropriate CCM4-5 CCMs per team

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Team Unit1 Gen. Medicine, Family Practice, MICU

2 Orthopaedics, Trauma, Burn/Plastics

3 Urology, ENT, Neurology, Hem./Onc. BMT, Surg./Onc

4 Pediatrics, OB/GYN, PICU, NICU

5 CT Surgery, Thoracic, GI Surgery, Vascular, Transplant

6 ED

Page 25: Creating A Culture Of Excellence In The Hospital Environment

CCM Redesign

ix. KaizenPolicies & Procedures / Guidelines

Establish standards of care that encompass the goals and mission of case managementDevelop procedures required for effective discharge planning and utilization review

Training & EducationDevelop a plan to cross train staff on all functions of utilization review and discharge planningIdentify formal and informal education resources to ensure a standardization of training for staff

Team ConfigurationImplementation

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CCM Redesign

x. Implementing CCMRevise case management policies & procedures

Solidify support from leadership and decision makers

Train/educate all clinical case managersCCM is now responsible for both discharge planning and URInterQual training (establish four in-house trainers)

Educate physicians/nurses of new CCM roleUtilize EHR (EPIC) to assign CCM to the treatment team

CCM now follows treatment team vs. geographic location

Spread awareness of change throughout the institutionPresentations at various staff, management, leadership meetings

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Page 27: Creating A Culture Of Excellence In The Hospital Environment

CCM Outcomesi. Reduction in LOS outliers

8% reduction in the number of patients with LOS >206% reduction in the number of patients with LOS between 21-4918% reduction in the number of patients with LOS between 50-997% reduction in the number of patients with LOS ≥100

ii. Increased Physician/Nurse Satisfaction with case management process

Treatment team has live view of assigned CCM via EHRObtain and sustain high compliance for treatment team assignments

iii. Decreased CCM Turnover

iv. Increased CCM Job SatisfactionNo regretsTeam model benefits collaboration amongst CCM (workload/outliers/coverage)

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Lessons Learned

i. Identify, understand and address resistance as early as possible

ii. Review mission…integrity in every situation!Create a tangible “why?”

iii. Maximize the engagement of front-line staffEmpower front-line staff with Lean principles

Educate and rely upon the expertsLeadership/Management support is crucial

Reassure the group of the importance of the Lean process to the organizationContinued resource support = remove barriers

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SepsisHealthcare-acquired Infections (HAIs)

Ventilator-associated Pneumonia (VAP)Central Line-associated Bloodstream Infections (CLABSI)Catheter-associated Urinary Tract Infections (CAUTI)

Environmental ServicesData continuityPolicy (Healthcare Reform/DSRIP)

LSS Focus Areas29

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Reference Material for Case Study

A Lean Guide to Transforming HealthcareThomas G. Zidel, Quality Press, 2006

The Certified Six Sigma Green HandbookASQ, Quality Press, 2009


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