Increasing On-Time Resident Task Completion Melissa Wheeler, M.A., C-TAGME Residency Education Coordinator, Orthopaedic Surgery 11/27/18
Agenda • Define Problem and Clarify Scope • Identify What is Important to Customer • Establish Baseline Metrics and Verify Measurement System • Visualize Current State and Identity Primary Root Cause(s) • Identify Solutions Addressing Root Cause(s) • Define Risks with Implementation and Risk Mitigation Plan • Implement New Process and Develop Control Plan for Long Term Sustainability • Lessons Learned • Next Steps • Questions and Answers 2
Define 3
Project Charter Project: Increasing the On-Time Completion of Required Resident Tasks Problem Statement Goal Statement/Financial Impact From the period of April 2018 – June 2018 38% (62 out of 163 opportunities) of resident tasks were not completed on time and were The primary goal is to decrease the resident task delinquency rate from 38% therefore, delinquent. This is bad because, these tasks are requirements for to 23% by 9/30/18. ACGME, Medical Education, and/or the Ortho Program. If resident tasks are not completed on time it can result in the Resident being dismissed from the residency program. Business Case Project Timeline Risk Reduction – By increasing the on-time completion rate of residency tasks, we are effectively reducing the risk of Residents being dismissed from the program. CMS pays Summa Health approximately $103,000 annually Define Measure Analyze Improve Control per resident so if they were dismissed from the program Summa would run the risk of losing those dollars. Additionally, by increasing the on-time completion rate we are increasing 5/23/18 5/31/18 6/31/18 7/1/18 9/30/18 Resident and Program Coordinator job satisfaction. This in turn, ensures the sustainment of the program by effectively reducing the time spent remediating poor performance and reducing the risk of resident dismissal. Project Scope Team Roles Current Scope: Project Sponsor — Dr. Junko Team Lead — Melissa Wheeler Process Starts – Orientation for New Ortho Residents Process Engineer — Ashley Sedorovich Process Ends – Checkpoint Evaluation Core Team Members — Melissa Maddie and Scott Gelman Subject Matter Experts — Ortho Attendings and Residents 4
SIPOC Analysis Supplier Input Process Output Customer ACGME Too many requirements Total delinquency rate Residents Graduate Medical Not enough time Attendings Education Duty Hour Restrictions Residency Director Orthobullets Personal motivation Residency Coordinator Ortho Program Don’t remember to do it Tedious & time consuming Don’t see the value Duty Hour reporting Case Logs Orthobullets Milestone exam Orthobullets test completion Orthobullets skill masters Orthobullets evaluations Other ACGME requirements Other Graduate Medical Education Requirements If deadline passed, Residents reminded Resident pulled from Orientation for New Ortho reminded again and to complete surgical duty until task Checkpoint Evaluation Residents notify Residency requirements is completed Director 5
Voice of the Customer Customer VOC Affinity CTQ Coordinator I am constantly having to remind residents to complete their tasks. I use multiple Ensuring Residents 1. % of tasks avenues to remind them and if they still don’t then I involve the program director. complete tasks completed on time I literally have placed myself in front of the exit so they can’t leave until a task is 2. Time spent completed. following-up with Resident Adam Domico Tasks don’t get completed because they are low on the priority list of things to do Managing priorities Amount of time to dedicate to non- patient care duties Jason Boyd I have survey fatigue, you can’t even buy a shirt without someone wanting a Too many surveys # of surveys being survey about your experience and if it’s not part of my routine, I will likely forget requested to do it James Ohliger I wait until I get the 14 days past due reminder from NI for duty hours. Trigger needed to Frequency of remember to reminders sent complete tasks Tim Jay I like to wait until I have a lot to enter (i.e. case logs or duty hours) because it takes Lengthy process to Amount of time to 6 minutes to get all set up so I don’t want to do it daily, that’s a waste of time. enter information enter information into the system Kyle Petersen Time/convenience of task, example, if I open a survey for example and it’s quick, Process for Evaluate and I’ll just do it on my phone, but if it’s going to take 10 - 15 minute, I’ll probably save it documenting address non-value for later but may forget about it because the e- mail is “read” now. Just requirements added activities in remembering I need to do it and/or having the time to do it. workflow 6
Kano Model Excitement Quality Performance Accountability Board Satisfaction Customer Quality Reduction in the number of Decreasing # of required tasks “Linear” reminder Increasing # of requests completed tasks Amount of time spent following- up with “Delighter” Residents Degree of CTQ achievement Completing Patient Charts “Must Be” Base Request Resident Quality evaluations Reminders Complete Logging Tasks milestone exam 7
Measure 8
Data Collection Plan Data Collection Plan How Target Sample Measure Measure Type Data Type Data Source? How? Often? Size Contact? Operational Definition Delinquent ACGME Case Log Monthl Delinquent if more than 1 X Discrete Case Logs System y month behind. Delinquent if more than 5 New Innovation weeks behind or past the Delinquent Resident 15 th of the following X Discrete Duty Hours Management Data is month for the previous System self- month. reported Delinquent Delinquent if previous by X Discrete Test Master month not completed. Residents into each Delinquent if 5 or less system Collecting full Melissa tests not completed. Twice and then data set Wheeler Delinquent X Discrete Automatically delinquent per manually Total Tests Orthobullets if milestone exam is not month extracted Website complete. by Program Delinquent Delinquent if less than 12 X Discrete Coordinato Skill Master are completed r. Delinquent Delinquent if less than 1 X Discrete Evaluations are completed. Task The number of delinquent Delinquency Y Discrete Manual Calculation tasks divided by the total Rate 9
Measurement System Drilldown Measurement: % of tasks completed on time by residents Amount of tasks each Rotation & Time Scheduled month varies (vacation, Nights, research) Defined as the number of monthly required tasks needed to be completed by the orthopaedic residents, which are identified on the tracking board. 10
Before Pictures – Requirements listed throughout 15 page Resident Guidelines 11
Number Residents Not Completing Tasks by Task Type April – June 2018 60 16.6% 50 23.9% 22.7% 43.9% 40 Count 30 35.0% 35.0% 20 10 0 Test Master Total Tests Skill Master Evaluations Duty Hours Case Logs Task Type Not Delinquent Delinquent *Percent delinquent displayed above the bars on graph 12
Analyze 13
Activity Flow Chart ACGME New Innovations Orthobullets N Complete set Discuss Show Residents how Residency Coordinator Present up of Resident program to use online Residents to Halfway logs in to task platforms New Resident overview of Residents accounts in expectations platforms for verify online through the to review current Y Orientation Resident track tasks online for completing documenting task accounts work month? progress and provide guidelines platforms tasks on time completion update ACGME Update Excel Y New Innovations tracking sheet Orthobullets N Residency Coordinator Update Excel Tracking Residents Halfway or more logs in to task platforms Monthly Sheet and send email to Completed by 1 st Monday continue # of Times towards monthly Y to review current goal N >1 alert Resident that tasks mid month Y progress on of Month Delinquent goal progress and provide completed? are not completed and check? monthly tasks update need to be finalized Update Excel tracking sheet 1 Y and email N N Update Excel Tracking Resident with Sheet and send email to reminder to alert Resident that tasks track are not completed and need to be finalized Send second Email program alert Tasks Task director requesting for Completed Update excel sheet with task completed regarding tasks to be N by Mid- Y completion data (reported by end of delinquency documented Month out in 6 month evaluation month? status copy by end of Check? Resident month Y N Dismissal from Program 14
Brainstorm – Potential Root Causes • Too many requirements • Task list is not visually represented to • Not enough time residents • Duty Hour Restrictions • Tasks can change monthly • Personal motivation • No incentive to complete tasks • Don’t remember to do it • No accountability structure if the tasks • Tedious & time consuming are not completed • Don’t see the value • Platforms are not easily accessible • Multiple platforms are required to complete the tasks • No hard stop in place that makes residents complete tasks – only verbal reminders • No easy way to visualize all that needs to be completed 15
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