innovating healthcare delivery - 2020 courses · innovating healthcare delivery october 2018...

Innovating Healthcare Delivery

October 2018

Meeting Patients Where They Are

Ralph Gonzales, MD, MSPH Chief Innovation Officer, UCSF Health and Associate Dean, UCSF

Jessica Chao, PharmD, MBA Director, UCSF Clinical Innovation Center

Team

11/15/18 2

Jessica Chao, PharmD, MBA Director PharmD (UW), Residency+MBA (Hopkins), Mobile/Product designer, startup founder

Jan Yeager, Mdes (hired 9-2016) Service Designer Service Designer at Mayo Clinic, 15+ years in industry strategic design experience

Anke Hebig Prophet , MS (hired 10-2017) Project Manager, Inside Out Accelerator Informatics MS from University of Washington, on the Board of Women HIV Clinic at UCSF

Ralph Gonzales, MD, MSPH Chief Innovation Officer Systems thinker and innovator

Aimee William, MPH (hired 7-2018) Project Manager MPH from UCLA, Lead Health Educator at SF State

Yoon-Ji (Zii) Kim (hired 9-2017) Service Designer Graduate from CMU

Christy Boscardin, PhD Implementation Scientist Associate Professor, SOM

What We Do

3

CIC Research and Training

Opportunities

Improve Service and Performance

MISSION

VISION

VALUES

PILLARS & PRIORITIES

MANAGEMENT SYSTEM

Redefining Possible

Best Care at Lower Cost; Best Place to Work

Research, Monetize, and Disseminate Products

Dentistry

Nursing

Medicine

Pharmacy

N

We develop pla0orms to create a diverse and open environment to think differently

4

Platforms

People Partnerships Service Designers

Industrial Engineers

Data Analysts

Business Developers

Project Managers

UCSF Health

UCSF SOM, SOP, SON, SOD

Academia (i.e. Berkeley)

Industry

Accelerators / Startups

Inside Out Accelerator

UCSF Health Initiatives (e.g., Caring Wisely)

Global Innovation Ecosystem

…..and use a service design approach to solving problems

5

INNOVATIONS 1. Device 2. Algorithm 3. Service 4. Digital applications

Solve the right problem Solve the problem right

DEVELOP DELIVER DISCOVER DEFINE 1 2 3 4 Crowd sourced

Ideas

6

Platforms



Data Analysts

Business Developers

Project Managers

UCSF Health



Industry



UCSF Health Initiatives


7

Delirium Reduction Campaign

Essential Elements

8

Burning Platform: 15-20% patients w/ Delirium é Falls, Ulcers, CAUTI é Pt/Family/Staff Concern é LOS

Local Champions & Experts •  Stephanie Rogers, MD

•  SME/Champion • Vanja Douglas, MD

• Researcher/Champion

•  Funded as Value Improvement through CPI; $100,000

•  Estimated savings: $1.6M

11/15/18

Connecting People and System

9

Multi-disciplinary Delirium Pathway implementation for all non-ICU units across UCSF Health

FRONTLINE Nurses / Physicians / Pharmacists / PT/OT / PCAs / Volunteers / Families

INTERNAL SERVICES Report writing / Apex

LEADERSHIP Departmental / Executives

UNITS 8L / 6L / 14M / 14L / 15L

INTERNAL INNOVATORS Delirium leads / AC3 Apex / Data science

EXTERNAL INNOVATORS Berkeley IEOR Jacobs Institute

CIC Core Delirium analytics Visual advancement Activities coordination Workflow optimization

11/15/18

SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 30 31 32

2016 2017 2018

Compliance Ck in*

PILOT 2 Medicine 15L, 14L, 14M MB A5, A6 – Feb 6th

Compliance Ck in*

PILOT 3 Cardiology 10CVT

Compliance Ck in*

PILOT 5 Hematology/Oncology 11L, 12S, 12L

Compliance Ck in*

PILOT 4 General Surgery, Ortho Neurospine 13L, 6S, 7L, 7E, 8S

Compliance Ck in*

PILOT 6 Transplant 9L

Compliance Ck in*

2019

PILOT 1 Neurology/Neuro Surgery 8L, 6L Central Resource Group

2018 2019

Mission Bay Spillover effect

Design & launch with CIC

Implementation & spread with STIM & Value Improvement

Validate outcomes & hardwire

Strategic Improvement Spins Off Innovation

11

”DELIRIUM TOOLKIT” Data & educational visualization of delirium reduction progress, healthy competition, and recognition

AMBIENT SIMULATION Berkeley Jacobs Institute LUMOS - smart ambient & light controller with ability for families to send videos and images into patient room

AMBIENT SIMULATION Berkeley Jacobs Institute ReOrient - Noise / Motion / Light sensor mounted above patient bed to detect sleep interruptions, patient movement, and potentially detect delirium

Solution-product fit discovery cycle

DATA SCIENCE ICHS Machine-learning algorithm to perform delirium screening & diagnosis automatically

11/15/18

Example

12 11/15/18

Outcomes:

Delirious Pts LOS CMI Readmissions

Baseline FY17 11.0 2.4 16.8%

FY18 YTD (April) 10.3 2.6 13.1%

Budgeted Actual

$456,193 $1,797,443

YTD Savings:

Edit via "Header & Footer" 14

Examples | UCSF Health Strategic Improvement

Psych

My back hurts!

UCSF PCP

Radiology

Osher

Pain Clinic Ortho

PT

Neuro manipulations

pilates injections

medications

acupuncture surgery exercise

massage

imaging

yoga mindfulness

CBT

EMG

neuromodulation

ice

heat

ultrasound

cupping

UCSF PCP

My back still hurts!

EXISTING PATIENT EXPERIENCE

Integrated Spine Service

UCSF PCP

INTEGRATED SPINE SERVICE

UCSF PCP

My back hurts!

My back is better- I can cope

1 2 3 4

Understanding multiple perspectives



Lowen Cattolico Calvin Coats Steve Baxter Kurt van der Schalie Chris Holland

PT PT Supervisor (MB) Scheduling Supervisor Physical Therapist PT Supervisor (Mt Zion) Director, Rehab Services

Mario DePinto Diane Ozawa

Pain Management

Specialist(Mt Zion) Practice supervisor

Nat Gleason Dan Null Don Ng Brent Kobashi

DGIM

Ambulatory Director Medical Director Medical Director Medical Director

Debbie Gee OI Director of OI Admin

UCSF Stakeholders

1 2 3 4

Patients

•  2 Chronic •  2 Acute

1 2 3 4

Finding patterns in data & identifying needs



1 2 3 4

Generating service principles to address needs



1.  Shift attitudes and beliefs about treatment effectiveness

2.  Provide seamless, coordinated care

3.  Providers are empathetic, trusted and accessible

4.  Treat the whole patient

5.  Set clear expectations

1 2 3 4



Framing the solution

§  Change focus from “treating pain” to “treat functional ability, deficits in strength/ movement”

§  Help patients work through pain from a mental standpoint/develop a different mental model

§  Provide education on underlying psycho/neuro principles

A platform of services and expertise

A different way of seeing pain

A patient-centered interaction model SERVICE PRINCIPLES | Seamless coordinated care | Set clear expectations Empathetic, trusted accessible providers

SERVICE PRINCIPLES | Shift attitudes and beliefs about treatment effectiveness | Set clear expectations

•  An integrated continuum of care •  PT Spine Specialists applying cognitive behavioral principles •  Embedded MD specialists in pain management •  A conduit to other modalities •  A breadth of vetted, quality educational resources within easy reach

•  Employ shared decision making

•  Open communication across clinicians

•  Clear strategy for reviewing and communicating patient progress across the team (including PCP)

SERVICE PRINCIPLES | Seamless, coordinated care | Treat the whole patient

1 2 3 4

Developing a prototype



REFERRAL PHASE

Integrated Spine Service Blueprint ISS | SCHEDULE AND FIRST VISIT ISS | FOLLOW UP

PT clinic PCP clinic PT clinic MD clinic

AND/OR

ISS referral ISS referral

Option 1- PT only Option 2- PT+MD

Call PCP

PCP evaluation

Surgeon

Patient or PCP prefer surgeon evaluation?

PCP Admin

Patient or PCP prefer PCP management?

PCP FU

Features & options •  Education •  Shared decision-

making •  PT •  Medications •  Behavioral Health •  Complementary Rx •  Imaging •  Injections •  Surgery

Other clinic

AND/OR

PT FU

PT Admin

PT

PT Admin

MD FU

MD Admin

MD Admin

Other FU

Admin

Other

Admin

MD

Coordination of care through formal and informal communication re treatment plan

Extension of ISS experience across different service sites

ED Red Flags?

Make appt

PT Admin

Schedule ISS MD spine specialist

Identify location (MB or MZ)

Schedule ISS PT spine specialist

Check-out

PT Admin

Schedule follow up PT visits

Evaluation

PT eval Assess SB/

PROMIS, consider MD referral

Determine treatment plan

Educational materials

OR

15 minute overlap w/patient

Separate notes/billing

Multi-disciplinary treatment plan

Combined PT/MD eval

PT Admin

Give StartBack and PROMIS

questionnaires

Collect 2 co-pays

Check-in

ISS informational brochure

Submit referral information for authorization

PT Co-pay

MD Co-pay

PROMIS10 STarTBaCK MyChart Phone call

Review AVS with patient

Patient Ed workbook AVS

Send referral to PT work queue

1 2 3 4

Developing a prototype



Website www.iss.ucsf.edu

Patient education

1 2 3 4

Implementing



Referrals generated from DGIM 1.  Mission Bay ISS Clinic Launch: December 2017 2.  Mount Zion ISS Clinic Launch: February 2018 Upcoming Women’s Health Clinic China Basin Clinic Executive Health Clinic



ISS: Process Measures

15

3632

6760

12

21 2227

0

10

20

30

40

50

60

70

80

Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18

Total Referral (by referral date) Total ISS Visits (by visit date) Total ISS Visits Target

Significant psychological factors in 78% of patients, severe in 30%

PT-MD

PT-Only

Null

Referral Mix

Total Referrals

Total ISS Visits (MD-PT and PT-Only)

ISS Referral and New Patient Visits

Psychological assessment

Physical and mental health improved in all patients with available data Functional outcomes

Target



ISS: Process Measures | Patient Satisfaction

Patient interviews N=10 § “They are watching over me and even care about my emotional

situation”

§ “Clinicians are very good at explaining things to me—what I was told made sense and I feel I’m getting a more permanent diagnosis of my problem”

§ ”I can already feel that my back is getting stronger—I had surgery and the post-op exercises didn’t help as much as the ones that I’m doing now”

§ 10 of 10 patients would refer other patients to this service

24

Platforms



Data Analysts

Business Developers

Project Managers

UCSF Health



Industry


Inside Out Accelerator UCSF Health Initiatives



25

Run by

As part of the Clinical Innovation Center (CIC), the Inside Out Accelerator program supports frontline providers and staff in redesigning health care delivery to improve practice, patient experience, and health outcomes through sponsorships with foundations, companies, and venture capital.

2 | Being Present 2.0: Web-based Mindfulness Meditation to Reduce Distress Associated with Metastatic Cancer "

27

Problem | Meditation programs not designed around cancer patients and caregivers’ daily lives and medical needs Innovation | Introducing low-cost, disease-state-specific mindfulness programs directly from the clinical environment compared to conventional means

•  Unconventional Features •  Live online community sessions •  Program content with variation to support spectrums of

patient and caregiver

28 2 | Being Present 2.0

2 | Being Present 2.0: Web-based Mindfulness Meditation to Reduce Distress Associated with Metastatic Cancer "

29

Prelim Results | •  High engagement at 90% •  Preliminary results showed distress, fatigue, anxiety reduction

(similar to published results BP 1.0) Next Steps | •  Complete enrollment & publish results; design follow up study in an

expanded patient population; expanding to other sites

2 | Being Present 2.0

3 | Using Health Information Mobile Technology to Improve the Patient Navigation Experience for Cancer Clinical Trials ""

30

Problem | Clinical research is not distributed fairly among all sector of society Innovation | Patient trial matching tool translates complex clinical trial navigation into plain language and consideration for treatment burden

Design Principles •  Design for flexibility & accessibility •  Be transparent and honest •  Having a “trustworthy” voice is

better than a “legitimate” one •  Facilitate a “safe space”

31

Discover & Define

3 | Navigating Cancer Clinical Trials

Develop

18 3 | Navigating Cancer Clinical Trials

3 | Using Health Information Mobile Technology to Improve the Patient Navigation Experience for Cancer Clinical Trials ""

33

Next Steps | •  Implement in-clinic pilot study •  Expand to other sites and diseases

3 | Navigating Cancer Clinical Trials

innovating healthcare delivery - 2020 courses · innovating healthcare delivery october 2018...

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