From Conception to Birth: Engaging Physicians and Families as Partners Children’s Hospital Association Annual Conference 2013
AGENDA • Introduction • Engaging Physicians and Families • Fostering Collaboration • Continuous Engagement • Results • Q & A Page 1
INTRODUCTION Page 2
Texas Children’s Hospital: Who We Are Page 3
Vision 2010: Excellence to Eminence Page 4
Pavilion for Women Page 5
Houston Market Page 6
Risks Page 7
We Had No Choice St. Luke’s notified Texas Children’s of intent to get out of OB services. Texas Children’s and St. Luke’s enter a management agreement for obstetrics service line 1950s 1980 – 1990s 2006 Today Texas Children’s and Texas Children’s and The partnership Pavilion for Women provides SLEH sign a contract St. Luke’s separate in provides community comprehensive care with 1987. Texas Children’s to construct adjoining with unique centers of excellence in buildings and operate resources and specialties including: continued to grow and • Maternal Fetal Medicine under joint immediate access has become one of the • Infertility administration . This to high-risk largest freestanding • Fetal Intervention & Surgery arrangement continues children’s hospitals obstetrics experts • Fetal Cardiology for 35 years. and >40 pediatric in the nation. • Reproductive Genetics subspecialties in • Perinatal Nutrition one location . • Neonatology • Reproductive Mental Health • Gynecology Page 8
Our Initial Vision Improve neonatal outcomes by taking care of women prior to and during their pregnancy Page 9
Executing the Vision Page 10
Changing the Model of Care Page 11
ENGAGING PHYSICIANS & FAMILIES Page 12
Transformation Required The Red Zone • Culture Changes Future • New Market Entry Business Model Today’s • Partnership Formation Business Model • Competitive Response • Operational Challenges • A New Facility Page 13
Patient Experience Management Source: Gelb/APQC/Beryl Institute Benchmarking Study Page 14
Physician Experience Management Source: Gelb Benchmarking Study Page 15
Customer Enchantment Page 16
Recognize Needs Functional Emotional Page 17
Engagement Process Page 18
Experience Map Awareness Need Scheduling Treatment Transition • Front Desk Staff • Faculty/Medical • Faculty/Medical • Faculty/Medical Staff • Physician • Support Staff • Faculty/Medical Staff Staff Liaisons Staff • Support Staff • Support Staff • Faculty/Staff Primary Experience Stewards Key Touchpoints Page 19
From Data… 1. Video / Audio Recordings Communications Physical Environment 2. Interview Transcripts Page 20
…to Insights 4. Day in the Life Touchpoint Assessment 3. Detailed Findings Page 21
Segmenting Patients Handle with Care OB - Driven Support Seekers In Control Page 22
Physician Partners Feel existing OB Want OB leadership, nursing team highly not pediatrics skilled and capable Concerned about lack Convenience and of adult care focus at access in the Texas Texas Children’s Medical Center can be challenging Page 23
Change in Perspective Page 24
Selling the Vision Page 25
FOSTERING COLLABORATION Page 26
It’s not the building… Page 27
Guiding Principles Create a significant architectural landmark Fit into existing TCH campus Provide flexibility for change over time Respond to physician and staff needs Support cutting edge patient care and services Provide the ultimate customer experience Page 28
Inclusion Page 29
Transparency Page 30
Why is Input Critical? Page 31
Physician Experience Management Page 32
Family Experience Management Page 33
Program Components • LDRs (Not LDRPs) • Emergency C-Section ORs (On same floor as LDRs) • Scheduled C-Section & GYN / Fetal Intervention ORs (On dedicated floor) • Assessment / Triage Center • Women’s Specialty Unit • Mother Baby Unit • NICU (Level 2 & 3) • Family Fertility Center with IVF Lab • Women’s Radiology Suite • Maternal and Fetal Center • Concierge Services • Patient Support Services • Education / Conference Center • Physician Offices / Clinics • Support / Logistic Services • Milk Bank • Lab / Blood Bank • Cord Bank • Psychological / Social Support Center Page 34
Benchmarking Pediatric facilities University of Iowa University of Nebraska Vanderbilt Adult facilities Sharp Mary Birch Hoag Hospital Prentice Page 35
Organizational Concepts NICU NICU Vertical Travel Distance: 225’ LDR LDR NICU Horizontal Travel Distance: 615’ LDR Page 36
Test Fits Page 37
STACKING: 3,500 Births Growth Concepts Page 38
STACKING: 5,000 Births Growth Concepts Page 39
Interiors Page 40
Translating Feedback into Customer Experience + Page 41
The “Stork” Cart + Page 42
Initial Design Concept Page 43
Refining the Design February May Page 44
Designed Parking into Patient Rooms Stork Cart Parking Assessment Page 45
Designed Parking into Patient Rooms Stork Cart Parking Labor and Delivery Page 46
Designed Parking into Patient Rooms Stork Cart Parking Mother Baby/Ante Partum Page 47
Family Launch Zone Page 48
Launch Zone Page 49
CONTINUOUS ENGAGEMENT Page 50
Our New Vision Lead the advancement of healthcare for women and newborns through innovation and excellence in patient care, education and research. Page 51
Shared Leadership Model Page 52
Pavilion for Women Activation Team Structure Linda Aldred Myra Davis Susan MacDonald Bart Putterman, MD Wycke Baker, MD Executive Steering Mary Jo Andre Pete Dawson Sandy McElligott Laura Shuford Cris Daskevich Committee Michael Belfort, MD Ed Yosowitz, MD Ben Melson Alec King Monju Monga, MD Amber Tabora Mark Mullarkey Steve Welty, MD Randy Wright Marcia Katz, MD James Versalovic, MD Mark Skolkin, MD Michael Belfort, MD Wycke Baker, MD Manisha Gandhi, MD Liz Bolds, RN Emily Weber, RN Stephanie Martin, MD David Zepeda, MD Jessica Ohlemacher, MD Kirsten Benjamin, RN Steve Welty, MD Clinical Steering Bart Putterman, MD Carol Forsberg, RN Nancy Hurst, RN Elaine Whaley, RN Sandy McElligott Committee Patti Heale, RN Brian Kirshon, MD Michael Speer, MD Edwina Popek, MD Cris Daskevich Gary Dildy, MD Judy Swanson, RN Chanda Cashen Ed Yosowitz, MD Activation Project Coordinator – Christina Kadavil-Kunnacherry Outpatient Clinical Inpatient Clinical Clinical Support Facilities Preparation Business Operations Support Services Services Services Services Jill Pearsall Joann Lee Bert Gumeringer Chanda Cashen Carol Forsberg Sarah Maytum Rick McFee Christina Kadavil- Jennifer Borders Liz Bolds Jennifer Upshaw Emily Weber Ted Gillis Kunnacherry Brian Murry Ashley Miller Patty Eng Roula Zoghbi Renee Williams ACTIVATION LEADERSHIP TEAM Women’s Triage Fetal Center BCM OB/Gyn Specialty Unit Rec. Business Facilities Facilities EPIC/IRIS Spiritual Biomed Biomed Therapy/ Services Ops Ops Care L&D Child Life Epic REI/IVF TCWS Guest NICU Supply Finance Pt & Fam MBU Property IS/Telecom HIM Services IS/Telecom Chain Services Operations & NBN Accounting ICU Surgical Svcs Volunteer Social Work Services Security Safety Ancillary Services Human Cashier Safety Security Resources Room Care Mgmt. Mgmt. Emergency Food & Facilities Mgmt. Nutrition Supply Retail Planning & (Retail) Food & PSO Milk Bank Pathology DI Chain Developmnt Nutrition Transit Center Legal / Regulatory Move Pt. Ed./ Psychosoc. PT/OT RT Pharmacy Coord. Childbirth Support Ed Facilities and Support Team Coordinator Physician involvement at the Executive Steering Committee, Clinical Steering Committee and Activation Team levels; Quality integrated across all teams Page 53
Outpatient Flow Redesign Median R esolution Time for Urgent C alls (minutes) 42 33% ycle Time (Minutes) 45 40 33 31.5 35 28 28 30 25 20 15 10 5 Median C 0 Baseline Improve Improve Control Nov '12 (F eb '12) (Mar '12) (Apr '12) (May '12) Improvement Stages G oal Actual Page 54
Outpatient Access Improvement 3rd Next Available for Annual Exams (days) 80 70 60 40 20 3 0 Baseline Current Page 55
Process Improvement: Positive Impact on Patient Satisfaction 90.9% Medical Practice (August ‘13) Texas Children’s Pavilion for Women Overall 91.1% Page 56
Growth Management Requires Physicians Admit Launch Assess/ Family Triage Mother Labor & Baby Delivery Care Page 57
Inpatient Flow Redesign Page 58
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