1 Clinical redesign strategies for multi- site implementation and quality improvement initiatives at a large academic healthcare system Luming Li, MD; Melissa Davis, MD, MBA; Brittany Branson, MD; Scott Sussman, MD; Stephanie Amport, MBA; Ian Schwartz, MD Yale New Haven Health, Yale School of Medicine
Yale New Haven Health At-a-Glance − Five Hospitals − Primary teaching hospital of Yale − Yale New Haven Hospital School of Medicine − Bridgeport Hospital − 8,113 medical staff members − Greenwich Hospital − 790 trainees − Lawrence + Memorial Hospital − System physician foundation: − Westerly Hospital Northeast Medical Group − 2,563 Licensed Beds − 990 providers − 25,800 Employees − $4.6 Billion in Revenues − * Recently acquired Milford Hospital Bridgeport Hospital Greenwich Hospital Lawrence + Memorial Hospital Westerly Hospital Yale New Haven Hospital Northeast Medical Group 3
Yale New Haven Health FY18 At-a-Glance $4.6B revenue* 182,655 inpatient cases* 2.4M outpatient encounters 25,800 employees 8,113 medical staff 271 sites *Does not include Yale School of Medicine **Inpatient cases and observations 4
Clinical Redesign: Achievements To Date As Clinical Redesign has matured, it has adopted a wider scope and has addressed some of the most complex clinical issues across the health system. FY 2015-2019 YTD Projects by Outcomes of two key signature projects: Delivery Network Impact Care (YNHH): A series of initiatives aimed at BH, 32 enhancing patient throughput and efficiency while lightening YNHH, 98 the burden on the Emergency Department and Hospitalist GH, 11 Service • Opened 18 beds additional observation status beds NEMG, 1 195 LMH, 5 • Converted a Hospitalist unit to Heart and Vascular Total • Increased weekend Care Coordination resources • Implemented a Hospitalist Service staffing model • Saved 458 inpatient days by discharging to CT Hospice System, 48 • Saved 210 patient days through Gaylord collaboration • 47K consults processed through connect center Outcomes of Traditional Clinical Redesign Initiatives Integrated Care Models (System/Ambulatory): Geriatric Trauma (BH) Process to improve patient-centric value through standardized Reduced average LOS by 7% for geriatric trauma patients • care, consistent experience and improved coordination and Operating Room Efficiency (GH) collaboration of YNHHS, YM and community partner clinicians • Improved first case on-time starts by 25% Standardization of Operating Room Checklist (LMH) • Impacted 4,618 patients since March 2019 go-live • Surgical checklist and time-out procedure standardized • Standardized protocols, pathways, and evaluation tools Procalcitonin Testing Optimization (System) • Wave 1 initiatives focused on breast abnormality screening, colonoscopy referrals for screening, abnormal prostrate • Reduced overall usage of procalcitonin testing by 18% screening, and evaluating asthma control and treatment Hackathon T3 (YNHH) • Optimized Epic tools to provide patient facing transparency 11/22/19 5
Clinical Redesign Success Formula Clinical Redesign helps rethink how we deliver care, realign our resources to enhance patient care, and redesign processes crucial to the successful, reliable, and sustainable delivery of that care. Clinical Redesign drives value-focused improvement in care delivery across YNHHS. The initiative has a broad Ø scope, and over the past three years has enhanced patient care across many key areas. Ø We have developed and calibrated a methodology to drive rapid-cycle projects to completion. 𝑊𝑏𝑚𝑣𝑓 = 𝑟𝑣𝑏𝑚𝑗𝑢𝑧 + 𝑡𝑏𝑔𝑓𝑢𝑧 + 𝑞𝑏𝑢𝑗𝑓𝑜𝑢 𝑓𝑦𝑞𝑓𝑠𝑗𝑓𝑜𝑑𝑓 𝑑𝑝𝑡𝑢/𝑞𝑠𝑗𝑑𝑓 𝑔𝑝𝑠 𝑞𝑏𝑧𝑓𝑠𝑡 & 𝑞𝑏𝑢𝑗𝑓𝑜𝑢𝑡 Idea Senior Rigorous Analytics / Clinician-Led 90-Day Generation & Leadership Project EPIC Collaborative Timeline Case Selection Support Management Optimization Teams Adapted from: Porter, M. E. & Teisberg, E. O. Redefining Health Care: Creating Value-based Competition on Results . (Harvard Business Press, 2006).
Clinical Redesign Team Members Physician Partners Project Managers Olukemi Brittany Melissa Patrick Lynda Hillary Crystal Kelsey Akande, MD Branson, MD Davis, MD Kenney, MD Cook, RN D’Atri Clemons Cole, PA Jennifer Kent Daniel Caitlin Anesta Luming Darcy Stephen James John Johnson, APRN Owusu, PharmD Heacock, PA Sculley Williams, RN Li, MD Harris, DO Possick, MD Pallett, MD Roberts, MD Scott Sussman, MD Maribeth Cabie, PharmD Ian Schwartz, MD Senior Medical Director, Clinical Operations Director, Clinical Redesign VP Operations 11/22/19 7
Ten Elements of Success 1) Dedicated, motivated, and engaged leadership from respected clinicians 2) Full clinical team engagement 3) Administrative support from senior-level hospital leaders 4) Risks to project success identified early and mitigated throughout the case lifecycle 5) Defined scope with clear end-points and deliverables 6) Evidence-based and/or patient/family centered case goals 7) Clinically relevant data regularly delivered to units and providers 8) Competition accelerates achievement of goals 9) Physician pain points specifically addressed 10) Clear education and communication to create visibility of project goals Adapted from: Borgstrom, M. P., Deshpande, O. M. & Balcezak, T. J. Pursuit of Value Drives Strategy to Improve Operations and Outcomes. Front. Health Serv. Manage. 34 , 3–13 (2017)
Project Phases Li, L., Davis, M., Branson, B., Amport, S., Sussman, S., Schwartz, I. “Implementation of a Clinical Redesign Intervention Leading to Improved Quality and Reduced Costs an Academic Healthcare System.” JAMA Network Open. In Preparation. 2019.
Project Selection Project Timeline S p o n s o r C l i n i c a l L e a d T e a m Project days 90 Planning D i e n t t e e r r m v e i n n t e i o n ( s ) M e t r i c s f o s r u c c e s s I T c o m p o n e n t s P E a n t g i a e g n e t m e n t Pilot Launch 3 0 d a y 6 0 d a y 9 0 d a y S u s t a i n a b i l i t y P l a n Sustainability phase
Project Management Based Approach
Defined Team Roles Role Title Responsibility • CRD Project Manager Organizes and leads the project team • Executes the project against/in alignment with the project plan • Reports to and consults with project oversight leader/Clinical Lead on progress • Consults with medical oversight leader/CRD Physician Partner on clinical topics/issues • Drives the project to completion • CRD Project Oversight Consults, guides and mentors project leaders to ensure their success • Assures adequate resources for project execution (data analytics, dedicated time by Leader important roles) • Provides data analysis expertise and support • Supports the project leaders when they need to bubble up issues • CRD Physician Partner Acts as a clinical resource to the project manager • Ensures project definition and planned interventions are clinically sound • Acts as a liaison between the project team and overall clinical community • Coordinates clinical interventions as needed • Helps to select appropriate core team members and expressing your desire for their Project Sponsor commitment to the effort. • Intervenes if team member participation falters. • Approves the charter which details the project objective, scope and metrics. • Meets with the project leader to receive an update at least twice in the 90-day project cycle. • Keeps current with the team’s progress by reviewing meeting minutes and/or attending a team meeting on occasion. • Selects a Sustainability Lead • Praises the team’s accomplishments
Defined Team Roles (Continued) Role Title Responsibility Local Clinical Leader • Plans for team meetings with project manager • An active member of team meetings • Assists project manager with holding team members accountable for attendance and deliverables • Acts as a clinical resource for project manger • Coordinates the development and deployment of clinical interventions and acts as the change management champion as it relates to the project • Works with project manager to meet project plan deliverables (charter, dashboard validation, sustainability lead, summaries) • Communicates with project sponsor as appropriate • Project Team Members Attends meetings and actively participates in project work as a subject matter expert • Completes project deliverables within the allotted timeframe • Participates in the development and deployment of clinical interventions • Sustainability Lead Serve as champion to ensure that the team’s interventions are followed • Monitor the process performance via the associated dashboard at a minimum of once a week • Intervene when the current performance trend is negative • Celebrate with the team when the current performance is consistently positive • Communicate the performance status to sponsor
Dashboards and Trackers: 11/22/19 14
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