how to transform your orthopedic program into a destination center
DESCRIPTION
How do you excite all levels of the organization and motivate them to move towards one true north? The key is creating focus, energy and alignment. - Learn how to listen and connect with the voice of your customers (VoC), the voice of your business (VoB) and the voice of your employees (VoE) - Break down department silos and create a thriving team culture eager to drive innovation and improvement - Delight your patients and watch 'word of mouth' marketing become a major driver of sales for your program Stephanie Allison is the founder of Right Brain Left Brain. Stephanie is a Biochemical Engineer from Auburn University. She has more than 20 years of experience in scientific industries, from nuclear and chemical to medical device and healthcare. Early in her career she was exposed to Lean Six Sigma, changing and improving her engineering approach to become much more about people and process interactions. Steph has saved millions of dollars utilizing her Master Black Belt certification in Lean Six Sigma while simultaneously creating positive culture environments.TRANSCRIPT
Right Brain Le- Brain VISION
Improving the lives of pa#ents and
employees wherever we go!
Why Choose Right Brain Le; Brain? • 100% Vendor Neutral – Our goals are your goals! • Proven Track Record – OpImized mulIple TJR Programs improving paIent
outcomes and driving excepIonal business results • Strategy Development Experts – Our unique blend of Process Engineers and
Specialized Clinicians work with your team to translate your Vision and Mission Statement into a TacIcal ExecuIon Plan in one event gaining buy-‐in and accountability by the whole team.
• Process Improvement Experts – Each program is customized for your facility, your staff and your paIents by uIlizing state-‐of-‐the-‐art process improvement techniques and technologies.
• Culture Warriors – Our rapid improvement workshop approach breaks down silos and creates focus, energy and excitement, while enabling swi; and effecIve goal achievement
• Knowledge Sharing – Our moXo is to share our knowledge in all aspects of our partnership to create confident team members that will be able to sustain gains and charter new improvements with confidence.
How Do You Become An Orthopaedic
DesInaIon Center?
VoC Voice of the Customer
VoE Voice of the Employee
VoB Voice of the Business
Highest Quality Excep=onal Service
Best Value
VoC Voice of the Customer
translates to “The PaIent Experience”
Quality: The New Hospital Shoppers
• PaIents are more technology savvy than ever before – if not the paIent themselves, then most certainly their care giver. – InformaIon about your facility is easily available and paIents are accessing it.
• HealthGrades • CMS Website: Hospital Compare – HCAHPS, SKIPs and Safety
• Physician stats are public • Joint Commission and other CerIficaIons
PAT and Pre-‐OP
Pt EducaIon/Experience • ScripIng • guidebooks
Pre-‐Admission TesIng Protocols
• H&P • Medical and
Cardiac
Pre-‐Op CommunicaIon Protocol
Hair Removal
Opera=ng Room
Scheduling /Block UIlizaIon
Technical Manuals for StandardizaIon
Anesthesia Process
Back Table Set Up
Skin Prep Protocol
PosiIoning
Draping
Staff Trng OR Choreography
Wound Closure Protocol
Turnover
Wellness Joint Clinic
Physician Order Set Protocol
• VTE • InfecIons
Physical Therapy Protocol
Blood Management Guidelines
JC Annual Training for Staff
Pt Rounding Protocols • UIlizing
communicaIon board
• HCAHPS
Anesthesia Protocol
Post OP Pain Management Protocol
Inventory
Discharge
Discharge Planning
Pt Outcomes; ComplicaIon Management
• Falls
Post Discharge Pt Call Protocol
Quality: Evidenced Based PracIces & Protocols
RBLB brings the research and benchmarking to
you. We do not pracIce
medicine, but we make it all available to you!
AddiIonally, RBLB will
help you align everything to enable cerIficaIons and
maximum reimbursements.
RBLB has protocols that enable TJR patients to: Ambulate 2 hours post op Pain never exceeds level 4 PONV minimized or eliminated Falls minimized or eliminated Infec=ons minimized LOS 2.0 days
Risk of Re-‐admissions minimized!!!!
Quality: Same Day Procedures
• If you are ready and interested in moving your facility to the forefront of Total Joint Replacement pracIces: – We have same day protocols and pathways! – RBLB can help you get there!
• 31% of knee replacements are performed on adults 45-‐55 years of age.
• OutpaIent knee replacements cost the payer 41% less than inpaIent procedures.
Highest Quality Excep=onal Service
Best Value
VoC Voice of the Customer
translates to “The PaIent Experience”
Full Implemented
Absent
DissaIsfied
Extremely SaIsfied
Delighters Things they didn’t know they wanted or never expected. They set you apart from the crowd!
SaIsfiers – Typical expectaIons.
Assumed, must be there or you are not even considered!
Basics
KANO Analysis
Service: What Do PaIents Expect Today?
Service: Delighters, SaIsfiers & Basics
11
• Basics • Quality of Care – JC CerIficaIon, CompeIIve
HealthGrades, Excellent Safety records
• SaIsfiers • PaIent EducaIon • Clear and consistent expectaIons • Happy and friendly staff
• Delighters: • Total Joint Wellness Center • Real Ime tablet/smartphone communicaIon
throughout conInuum of care, • Group Therapy & Group Dinners • Veterans Reunions • AmeniIes – gi;s, shirts, mugs, etc
Service: PaIent Experience Extends Across the EnIre Service Line
• Pre-‐Admission TesIng (PAT) – What is this experience like? Is it easy? Does the paIent have a guide or point of contact and are they easily available?
• Pre-‐OP – Is everyone asked to arrive at 0530, regardless of surgery Ime? Is it quiet, organized? Do they know exactly what to expect? Are they asked all the same quesIons over and over again?
You only get 1 chance to make a first impression!
Highest Quality Excep=onal Service
Best Value
VoC Voice of the Customer
translates to “The PaIent Experience”
Value: PaIent ExpectaIons?
• Cost EffecIve – Is your pricing compeIIve? – Is your hospital known for never ending bills that conInue to trickle in…..
– Are wait Imes so excessive, paIents will pay higher prices elsewhere to avoid your experience?
– Can you accommodate the huge growth projecIons in TJR in the next few years, or are your paIents already experiencing excessive surgery lead Imes?
Value: Pricing Must Be CompeIIve
• How do you provide the highest quality and also the best pricing?
How Do You Become An Orthopaedic
DesInaIon Center?
VoC Voice of the Customer
VoE Voice of the Employee
VoB Voice of the Business
Voice of the Employee (VoE) Culture
Work Place Environment Professional Development
VOE: What Do Employees Desire?
• Culture – Respect for each other, no maXer the posiIon – A voice that is heard and encouraged – Clear goals and the tools to achieve them
• Work Place Environment – Organized, safe and conInuously improving – Efficient and standardized processes with clear and up-‐to-‐date procedures and protocols
– Access to and training for advanced technologies • Professional Development Opportuni=es
– Furthering educaIon assistance – CerIficaIons available
Culture: Starts with the Structure
Pa=ent Centric Highest Quality
Excep=onal Service Best Value
Clinic & Surgery
Scheduling
PAT & EducaIon
Pre-‐Op & PaIent Prep
Cut to Capsule Close
Turn Over & PACU
Total Joint Wellness Center
Discharge to Home
PaIent Referrals/MarkeIng
Clinic
PAT
Discharge
Floor Post OP
Peri-‐OP
Pre-‐OP
Home (20%)
Rehab or SNF (70%)
Other (10%)
Hospital Centric – Department Goals and Focus
PaIent Centric – Same goals for everyone across the Service Line
Transforma=on
VoE: Consistent Goals Across the Service Line
• Break down the silos by providing a working venue for team building – Kaizen Events are “rapid improvement events” and are one of the most effecIve Lean Six Sigma (LSS) tools available!
• They enable buy-‐in and ownership by uIlizing a cross-‐funcIonal team across the enIre service line.
• They provide an on-‐the-‐job learning environment for LSS tools. • They shorten project compleIon Imes by more than 60% • RBLB experts will develop kaizen facilitators on your team to ensure independence and enable sustained results!
VoE: Hands On Training of Tools and Techniques
• Develop Customized Mktg Strategy
• Cost effecIve AmeniIes
• PaIent Access and Edu
• OpImize Discharge Process
• Increase Discharge DisposiIon to Home
• CommunicaIon Boards
• Metric Boards • Inventory
Control • PaIent & Staff
Flow
• Reduce Turn-‐over Time
• Reduce DownIme B/W Procedures
• Reduce Case CancellaIons & Late Starts
• Reduce PaIent Prep Ime
• OR Staff Training • Tech Manuals
and Visual Aides for StandardizaIon and Training
• Reduce Wait Times
• Increase Hosp/Clinic/PaIent CommunicaIon & CoordinaIon
• Reduce Pat. Wait Time
• Improve Scheduling Process
RBLB PracIIoners partner with your team to share their
extensive LSS knowledge via hands on opImizaIon tools
and techniques.
OpImized processes are then ready for
advanced technology communicaIon and tracking systems like
Wellbe!
Clinic & Surgery
Scheduling
PAT & EducaIon
Pre-‐Op & PaIent Prep
Cut to Capsule Close
Turn Over &
PACU
Total Joint Wellness Center
Discharge to Home
PaIent Referrals/MarkeIng
Pa=ent Centric Highest Quality
Excep=onal Service Best Value
VoE: Work Smarter, Not Harder
• Breakthroughs in medicine and technology are changing rapidly these days, so a different way to perform must be embraced.
• RBLB brings years of experience creaIng and teaching how to use simple and concise work instrucIons and visual aides on the job. We will create them with your team as we idenIfy the needs!
• SynchronizaIon of staff during OR paIent prep and turnover greatly reduces Wheels-‐In to Wheels-‐In Time as well as improves uIlizaIon of staff.
VoE: Program TransformaIon
• A typical transformaIon of an Orthopaedic Program for an average size hospital takes approximately 2.5 to 3 years when driven internally
• Partnering with RBLB can shrink that Ime to approximately 8-‐10 months
– Now that you have aligned the VoC and the VoE, we must determine where to take this endeavor.
– How do we know when we have won?
How Do You Become An Orthopaedic
DesInaIon Center?
VoC Voice of the Customer
VoE Voice of the Employee
VoB Voice of the Business
Voice of the Business -‐ Profitability
25
VoB: 5 Year Financial Pro Forma
RBLB performs a thorough assessment of your facility to determine your baselines and potenIal for improvement
goals.
We work closely with your finance team so every number is verified and transparent.
We treat your Orthopaedic Service Line as a Business,
creaIng it’s own P&L report.
VoB: Cost ReducIon or Revenue GeneraIon
Mul=ple scenarios analyzed to assess risk and determine total poten=al
Most hospitals assume if they can increase their market share, they will
be fine.
Unfortunately, that is not the case most of the Ime.
RBLB worked with a reIred CFO of an HCA system to develop a mulIple
scenario analysis.
To date, the results have always been similar, in that, revenue generaIon
alone cannot keep up with the pace of inflaIon.
Process Op=miza=on is the key!
VoB: Analyze System Data and Verify with ObservaIon Data
Dr. C Future
Dr. C
Dr. B Future
Dr. B
Dr. A Future
Dr. A
Benchmark
20
31
20
35
20
39
20
69 99
102 132
89
119
45
15
15
15
15
10 5
10 5
10
7
10
10 31
10 32
10 31
10
PP S Close TO Down
Benchmark: WI to WI = 90 mins Dr. A: Current: WI to WI = 196 mins
Future: WI to WI = 141 mins Dr. B: Current: WI to WI = 204 mins
Future: WI to WI = 152 mins Dr. C: Current: WI to WI = 166 mins
Future: WI to WI = 119 mins
Approximately 28% ReducIon for “Wheels In to Wheels In”
Time
Current data from 142 total Hip & Knee Procedures from 10/1/11 to 3/29/12
PP = Pa=ent Prep Time: Begins when paIent enters O.R. and ends with skin incision S = Surgery Time: Begins with skin incision and ends when surgeon breaks scrub TO = Turnover Time: Begins when wound is closed and ends when turnover team leaves room Down = OR Down Time: Begins when turnover crew is complete and ends when next paIent enters O.R.
28
VoB: OR Flipping – Are Your Surgeons & Staff Ready?
• StandardizaIon and synchronizaIon minimizes Surgeon involvement in Pat. Prep, Close and Turn Over.
• OpImal Surgeon Ime for flipping is cut to capsule close of approximately 45 minutes or less.
Each block represents cut to capsule close
OR 1
OR 2
Pat 1 Pat 3 Pat 5
Pat 2 Pat 4 Pat 6
OpImized Surgeon’s Time
• RBLB process engineers analyze your layout and your equipment using 3D state of the art simulaIon so;ware.
• We work with your team to determine streamline opportuniIes to reduce paIent exposure and improve paIent flow.
• The analysis determines: – If you should dedicate OR’s? – How to schedule block Ime? – How to level load the schedule? – How to manage busy days and slow
days?
VoB: Streamline PaIent Flow Across the EnIre Service Line
VoB: Can Your Current Unit Handle Increased Volumes Thru the OR?
31
0 2 4 6
10/1/201
10/15/20
10/29/20
11/12/20
11/26/20
12/10/20
12/24/20
1/7/2012
1/21/201
2/4/2012
2/18/201
3/3/2012
3/17/201
3/31/201
# Surgeries C
ompleted
Date
Total Hip & Knee Procedures Done by Date
0
5
10
12/28/20
1/28/201
2/28/201
3/31/201
4/30/201
5/31/201
6/30/201
7/31/201
8/31/201
9/30/201
10/31/20
11/30/20
12/31/20
Num
ber o
f Pa=
ents
Date
Beds Occupied by Date
Increase capacity with no capital investment!
Avg. LOS Cases per Wk OR Scheduling Max Beds Needed
Current = 4 6 Current 9
Current = 4 6 Level Loaded 6
Current = 4 9 Level Loaded 9
Decreased to 3* 9 Level Loaded 6
VoB: Tier 1 Metric ReporIng
32
Monthly ExecuIve Level Dashboards
Physician Level Dashboards
VoB: Tier 2 & 3 Metrics
Daily Floor Level Metric Boards
Weekly Management Level Metric Boards
VoB: Revenue GeneraIon
Electronic (Website, blogs, social media) Trade Show Design Direct Mail & Sales PromoIons PublicaIons Print – Brochure, business card, poster, etc. IdenIty Design – logo, staIonary, newsleXers, etc. BulleIn Boards Radio We will even help you select a theme for your Physical Therapy program and Wellness Joint Center and then brand all of your materials with your customized theme. Pa#ents will always remember their experience at a facility that makes healing and recupera#on fun!
MarkeIng & Branding
VoB: Billboard MarkeIng
35
VoB: Print & Brochure
36
VoB: Web Design
Many hospital markeIng teams are extremely busy and cannot devote Ime to one specific program: We work with your MarkeIng team to incorporate a page in your exisIng site or to build a new site.
TransformaIon: Become DesInaIon Center
Transform your Orthopedic Program into a DesInaIon Center.
Understand and Address: VoC Voice of the
Customer
VoE Voice of the Employee
VoB Voice of the Business
Comprehensive Assessment for Baseline
39
TJR Service Line Assessment Clinic Assessment 1. Market Assessment 2. Best PracIce Clinical Protocol and Pathway
EvaluaIon 3. Joint Replacement – Internal Data
Assessment 4. OperaIng Room Efficiency: System Data &
ObservaIon 5. Efficiency of PAT, Pre-‐OP, Post-‐OP and
Discharge Processes 6. Total Joint Wellness Center Gap Analysis 7. Future State PaIent Centered Strategy 8. 5 YR Financial Pro-‐Forma 9. Joint Commission Disease Specific
CerIficaIon Gap Analysis 10. Medicare Alignment Analysis 11. MarkeIng & Branding Assessment
1. PaIent Flow Analysis 2. PaIent Sat Survey Scores 3. Office OrganizaIon & CommunicaIon
Systems 4. Scheduling PracIces 5. Financials 6. Inventory Handling 7. Surgeon and Staff UIlizaIon
Thank You for Your Time.
Please feel free to contact us if you have any quesIons:
Stephanie Allison President & CEO Right Brain Le; Brain steph.allison@rb-‐lb.com 904-‐302-‐2939.