Learning Objectives Use shadowing to define value and what patients - PDF document

IHI National Forum: Go Shadow 12/10/2013 D17 & E17 This presenter has nothing to disclose Go Shadow: See Patients’ Wants and Needs While Lowering Cost Anthony M. DiGioia III, M.D. December 11, 2013 9:30am-10:45am 11:15am-12:30pm www.pfcc.org/IHIGoShadow Learning Objectives Use shadowing to define value and what patients want and need while engaging them in the redesign of care delivery Shadowing is the standardized, simple tool to improve care experiences and outcomes, remove waste, and decrease cost Establish the connection with patients that generates urgency to change 1

IHI National Forum: Go Shadow 12/10/2013 Value in Health Care Value = Health Outcomes Cost We All Define Value Differently 2

IHI National Forum: Go Shadow 12/10/2013 The Patient and Family are the only way for all of us to understand and deliver value … 3 Keys to Delivering Value 1. View All Care Through the Eyes of Patients and Families 2. Co-Design 3. Implementation 3

IHI National Forum: Go Shadow 12/10/2013 The PFCC Methodology and Practice Provides the Steps to Success Ideal Experience More Info: 6. PFCC Project Teams www.pfcc.org to Close the Gap 5. Shared Vision of the Ideal 4. Working Group thru Touchpoints 3. Shadow, Current State, Urgency 2. Guiding Council 1. Define Care Experience Current State Value and Care Experience  Defined through the eyes of patients and families and includes everything that impacts their journey toward wellness.  Examples include outcomes, interactions with and among care providers, transitions in care, safety, costs, and everyone they are impacted by along the way. 4

IHI National Forum: Go Shadow 12/10/2013 Shadowing Ideal Experience 6. PFCC Project Teams to Close the Gap 5. Shared Vision of the Ideal 4. Working Group thru Touchpoints 3. Shadow, Current State, Urgency 2. Guiding Council 1. Define Care Experience Current State Shadowing Shadowing is repeated and independent observation of patients and families as they move through each step of their health care journey 5

IHI National Forum: Go Shadow 12/10/2013 It’s Easy We watch what people do (and do not do) and listen to what they say (and do not say). The easiest thing about the search for insight – in contrast to the search for hard data – is that it’s everywhere and it’s free … …This enlightened perception reveals the experience, not just the process. Change by Design, Tim Brown Shadowing Determines Your Current State Accurately and Efficiently Continuously Engages End Users in Real Time: Patients, Families and Care Givers (called Co-Design) 6

IHI National Forum: Go Shadow 12/10/2013 Value and Accountable Care Clinical Outcomes, Quality and Safety Patient Patient and Reported Care Family at Outcomes Experiences the Center and SDM True $ Cost $ True Costs = TDABC Time Driven Activity Based Costing Identifies true cost to deliver care and for any care experience: • Personnel • Space • Equipment • Consumables Robert S. Kaplan and Michael E. Porter “How to Solve the Cost Crisis in Health Care,” HBR 2011 7

IHI National Forum: Go Shadow 12/10/2013 The Value “Chain” TDABC Results TJR Care Experience 30 Days Prior to 90 Days Post-Op Total Hip Total Knee Replacement Replacement Consumables 54% 45% Personnel 43% 51% Space/Equipme 3% 4% nt 8

IHI National Forum: Go Shadow 12/10/2013 Ma THR TKR Care Segment p # Total Total 1 New Patient Scheduling Visit 0.1% 0.2% 1a Pre-Surgical Office Visit (30 days pre surgery) 2% 3% 1b Renaissance Billing 0.3% 0.3% 1c Administration Support - Surgery 3% 4% 2 Pre-Op Testing 2% 2% 3 Day of Surgery 3% 3% 3a Operating Room 57% 48% 3b Central Sterile 0.6% 1% 4 PACU 2.6% 3% 5a Inpatient Post-Op Day Zero 4.5% 5% 5b Inpatient Post-Op Day 1 6.9% 8% 5c Inpatient Post-Op Day 2 5.9% 7% 5d Inpatient Post-Op Day 3 3.5% 5% 6 Home Therapy & 4 week Follow-Up 5.2% 6% 7 3 Month Follow-Up (90 days Post-Op) 2.6% 3% PFCC Shadowing TDABC Helps Providers • Redesign processes Process • Eliminates steps Improvement • Reduce waste and idle time • Optimize cycle of care • Who should be doing the Personnel work? Where? and Resource • Reduce unused staff time, Utilization equipment, facilities 9

IHI National Forum: Go Shadow 12/10/2013 PFCC Shadowing TDABC A Common Platform • Generate conversations between clinical, administrative and financial leaders PFCC Shadowing TDABC is the “How To” You can develop: • Bundling, RBP • PCMH’s • ACO’s • “Care Experience” Based Homes 10

IHI National Forum: Go Shadow 12/10/2013 If Any Doubts…Go Shadow • Engages patients and families as full partners in care delivery redesign • Opens eyes and creates urgency to drive change Lisa L. Schraeder, MS Sr. OD Consultant PFCC Innovation Center of UPMC 11

IHI National Forum: Go Shadow 12/10/2013 Ready…Set…Go Shadow Start here … 12

IHI National Forum: Go Shadow 12/10/2013 Shadowing ing Resour ources ces • Gloss ssary y of Terms ms • How w to Shadow w a Patient t and Fami mily • Shadowi wing Preparati tion Checklist st • Requesti ting to Shadow a Pati tient • What t to Obse serve and Note te While Shadowi wing • Obse servati tion Temp mplate te • Samp amples es Obs bser ervati tion onal Repo port • Care Experi rience Flow w Map • Samp mple Time me Stud tudy • Samp mple Final Shadowi wing Report • Shadowing FAQ’s • Shadowi wing Thank You Card Some Terminology… Touchpoints Key moments and places within the care setting where patient and family care experiences occur. Care Giver Any person within a care setting whose work touches a patient’s or family’s experience whether directly or indirectly. 13

IHI National Forum: Go Shadow 12/10/2013 ‘Go Shadow’ 101: The Before, During and After What to Know Before You Go  Not a Secret Shopper  Beginning and End  # of Shadowers  Map CURRENT flow  How to approach 14

IHI National Forum: Go Shadow 12/10/2013 Overcoming Hurdles “We started Shadowing a year ago… Our challenge was cold calling patients over the phone to ask them about Shadowing but once we got over that, we found Shadowing to Cynthia Rasmussen, MD be extremely powerful and got so Harvard Vanguard Medical Associates much feedback .” Shadowing ing Resour ources ces 15

IHI National Forum: Go Shadow 12/10/2013 FAQ: Won’t Care Givers change their behavior if they know they are being Shadowed? A Care Giver’s Perspective Do you view care differently now? “I have gained a completely new perspective for how hard each of my colleagues work--their tireless dedication is awe-inspiring. I have become a better listener, more empathetic, and look for Pat Fustich opportunities to connect people, Administrative Assistant Pediatric Surgery processes, and ideas for improvement .” 16

IHI National Forum: Go Shadow 12/10/2013 During Shadowing: In the Field Note:  Care Givers  Touchpoints  Time  Patient Comments  Your Observations  Anxiety Anxiety  Action After Shadowing: Sharing Findings  Care Experience Flow Map  Report in Order of Experience  Tell the Story  Type of Report • Detail • Summary • Time Study  Include Recommendations 17

IHI National Forum: Go Shadow 12/10/2013 After Shadowing: Sharing Findings  Tell the Patient’s Story  Report in Order of Experience  Share Observations & Recommendations  Include Care Experience Flow Map Care Experience Flow Map What it will reveal… • Transitions in care issues • Communication gaps • Bottlenecks • Inefficiencies in process • Amount of time spent 18

IHI National Forum: Go Shadow 12/10/2013 Touchpoint Care Giver/Time Patient/Family park Patient/Family exit car trouble finding Parking Lot garage after finding right garage 7:15 A car 11:02 A Entrance to clinic Doctor's Office 7:27 A Suite Patient /Family back to Checked in with front desk Patient /Family sent to Reception desk to check out receptionist 7:28 - 7:35 A desk to get Rx for lab Desk from appointment work 9:37 A 10:26 A 60 minute wait ; called back by medical assistant, Waiting Room 8:35 A Sample: Office Visit Assessment by Care Experience Exam Room physician assistant and doctor 9:15-9:30 Flow Map Get lost on way to lab; no clear signage; Shadower intervenes and Hallway assists them with wayfinding 9:49 A lab technician performs blood draw Lab 10:14 A Patient/Family stop Parking Pay at parking window Window to pay for parking; cashier 10:42 A Sample Care Experience Flow Map Touchpoints: Care Givers: Parking Lot • Parking Attendant • Clinic Suite • Housekeeper • Reception Desk • Registrar • Waiting Room • Medical Assistant • Exam Room • Nurse Reception Desk Main Hallway • Physician Asst./Dr. Lab • Greeter Clinic Suite/Desk • Phlebotomist Pay Station • Lab Tech Parking Lot 19