Mary Ann Yezadzhyan Jonathan BarcoDenise NagaokaParul Tyagi

“While ensuring the financial stability and quality care

of Tulare Regional Medical Center (TRMC) today,

we must also do the work needed

to be a sustainable hospital, prepared to meet

our region’s future medical needs.”

Shawn Bolouki, CEO

Source: Tulare Regional Medical Center Annual Report 2011

Situation Analysis

Excess Bed Capacity Undesirable Payer Mix Affordable Care Act (ACA) & Reform Aging Medical Staff Need:

Physician recruitment and alignment Primary Care & Chronic Disease Management

Medical Tower Expansion – 2013

Strategic Recommendations

Monitor & Sustain Financial Position Improve Quality & Operational Effectiveness Increase Utilization & Enhance Services Workforce Development & Physician

Alignment

Monitor & Sustain Financial Position

Optimal Efficiency Nurse Productivity per Patient Day

Source: www.oshpd.ca.gov

Reduction of Waste

Solution: Stockless Systems delivered Just in Time Limit variety of commonly used supplies Estimated Savings - $5 million

Direct Expenses Total % of Total Expenses

Supplies & Inventory $10,671,605 14.65%

Salaries & Wages $27,763,080 38.11%

Employee Benefits $8,932,601 12.26%

Source: www.oshpd.ca.gov

Market Share Breakdown

Source: MDS Consulting – TRMC Case Study Analysis

Improve Quality and Operational Issue

Patient Satisfaction

Source: www.hospitalcompare.hhs.gov

National California KDMC TRMC

Nurses always communicated well 76% 71% 75% 68%

Doctors always communicated well 80% 76% 76% 76%

Patients always received help as soon as they wanted

64% 58% 59% 50%

Pain always well controlled 70% 66% 66% 55%

Staff always explained 61% 57% 55% 55%

Room always clean 72% 69% 67% 54%

Always quiet at night 58% 48% 50% 37%

Staff gave patients information about what to do during recovery at home

82% 80% 80% 71%

Patients who rated 9 or 10 68% 65% 67% 50%

Patients that would recommend hospital

70% 68% 69% 50%

Culture of Safety

Institute for Healthcare Improvement Framework: Conduct Patient Safety Leadership WalkRounds Create a Reporting System Designate a Patient Safety Officer Reenact Real Adverse Events From the Hospital Involve Patients in Safety Initiatives Relay Safety Reports at Shift Changes Appoint a Safety Champion for Every Unit Simulate Possible Adverse Events Conduct Safety Briefings Create an Adverse Event Response Team

Source: www.ihi.org

Best Practices

Spread standardization of best practices across hospitals and health clinics Hospital Mortality Outcome Measures

Death Rate for Heart Attack PatientsDeath Rate for Heart Failure PatientsDeath Rate for Pneumonia Patients

Hospital Readmission Rates Outcome of Care MeasuresRate of Readmission for Heart Attack PatientsRate of Readmission for Heart Failure PatientsRate of Readmission for Pneumonia Patients

Source: www.ihi.org

Medical Home Model

76% of Medicare spending is on patients with chronic diseases

21% increase in adults 65+ between 2011 - 2016

Great Outcomes

Practice Organization 

Quality Measures

PatientExperience

Heath Information Technology

Sources: www.aafp.org and MDS Consulting – TRMC Case Study Analysis

Increase UtilizationAnd

Enhance Services

Increase Utilization and Enhance Services

Workforce Development New medical staff to enhance

their service portfolio Broader range of procedures

within specialty More competitive within

market share

Medical School affiliation

Strengthen Hospital Physician Alignment

Physician Alignment

Competitive advantage Transparency Supports quality, cost and purpose Starts with upper management and

Physician Champions

Physician Hospital Alignment

Conclusion

Conclusion

Future of health care is uncertainRecommendations will place TRMC at a competitive

advantageSustainabilityAccountabilityGrowth

Questions?