Recipe for Sustainability Ginger A Wirth, DCS Brent Walker, DCS - PowerPoint PPT Presentation

Recipe for Sustainability Ginger A Wirth, DCS Brent Walker, DCS Alliance Operating Unit

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Is this scenario familiar? Identified the problem/goal Gathered your team Created a plan Tested processes Evaluate results Modified/altered procedures Achieved goal/target Celebrations happened Targets stayed good…….. 3

Until….. Next initiative gets added to the team (focus gets diverted)  Nobody is watching prior processes  Focus and resources are shifted to new goal  Team goes back to “what is easy and familiar” Somehow you are back to baseline and you are underperforming Everyone wonders what happened? Nay-sayers “I told you that wouldn’t work!” Initiative becomes the latest “flavor of the month” 4

Recipe for sustainability Determine your flavor of “cookie”  set your process goal Gather ingredients  Select your team Set up your “test kitchen”  Make “small batches of dough”  Follow the PDSA model to trial processes Evaluate your product/taste results  Decide what needs adjusting-make modifications as necessary 5

Sustainability Sustainability is one of the most challenging aspects of any process redesign. Redesign by nature is continuous Sustainability is the ability to maintain. Requires consistency of practice, adaptability, and communication. 6

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Sustainability Three key elements of sustainability  Standard work  Maintenance  Continuous Improvement 8

Standard Work Clearly document new processes Eliminate variation Education is key Training new team members is essential Monitor performance and reeducate as necessary 9

Maintenance Keep your “Champion/head chef” in place Monitor your results regularly-  Don’t take your foot off the gas Continue to report progress to the team Continual maintenance of your processes ensure that the improved practices become embedded in the culture and processes of your department and organization 10

Continuous Improvement Monitor and report your data/results Provide feedback to team members and leaders Accountability must be maintained for all Continue to share the wins and celebrate successes Make changes as necessary, understanding that most processes and goals are dynamic and never static 11

Winning the “Blue Ribbon” over and over Core ingredients have to remain constant  You cannot replace salt for sugar You have to be willing to make incremental improvements on the recipe  May need to add ingredients  Someone may have an allergy (gluten, nuts, etc.) Do not keep your recipe a “secret”  Make sure all new team members are educated 12

Case Study: Lake City Medical Center 13

Lake City Medical Center: Patient/Day 125.0 115.0 105.0 95.0 85.0 75.0 Start 65.0 14

Lake City Medical Center: LWBS + LPT + AMA 7.0% 6.0% 5.0% Start 4.0% 3.0% 2.0% 1.0% 0.0% 15

Lake City Medical Center: ER Throughput 220 210 200 190 180 170 160 150 140 130 120 110 Star 100 90 t 80 70 60 50 40 14-Jul Aug Sept Oct Nov Dec 15-Jan Feb March April May June July August Sept Oct Nov Dec 16-Jan Feb March April May June July August Sept Oct Nov Dec Jan-17 Feb March May June July August Sept Oct Nov April greet to adm dispo DC LOS ESI 4/5 LOS 16

Lake City Medical Center: Door to Doc 18 16 14 12 10 Start 8 6 4 2 0 17

Lake City Medical Center: Press Ganey 95 90 85 80 75 70 65 60 55 Start 50 18

Seasons of Change Year 1 Year 2 Year 3 Loss of ER RN Director Interim ‘Brand New’ ER RN Full Time RN Director Travel Nurses Director ER Staff New ER Managers Multiple Openings No Locums Stable ER Staff Loss of Director Quality Lots of Turnover New CNO New CEO New Lab Director New QI Director Hospital New CNO Loss of Rad. Director New Rad. Director Staffing Loss DAC, new DAC Loss DAC, new DAC Loss DAC, new DAC Changes Loss Reg. Director New Reg. Director New Floor RN Director Interim QI Director New 3 rd Floor Physical ER Construction Plant new ICU ER Capacity Doubled Changes Second CT Scan Joint Stroke Accreditation Chest Pain Accreditation Stroke / Sepsis Initiatives Sepsis Accreditation 19

Results Lost Business Admission ER Volume (LPT, LPMSE, AMA) Percentage 2014 numbers 27611 (Total ER Visits) 1262 (Total 2016) 16% 2015 32188 (Gross Increase 483 (62% Reduction) 16% (compared to 2014) 4577 or 15%) 2016 38329 (Gross Increase 418 (13% Reduction) 17% (compared to 2015) 6730 or 17%) Projected 2017 42162 (Gross Increase 333 (20% Reduction) 17% (compared to 2016) 3833 or 10%) 20

Financial Estimates Revenue Change Revenue Increase 2014 to 2015 $4,508,800 Revenue Increase 2015 to 2016 $6,257,750 Revenue Increase 2016 to 2017 (est.) $3,588,025 Total Increased Revenue in Three Years $14,354,575 21

Nieman Marcus $250 cookie recipe THE ORIGINAL "NEIMAN MARCUS" COOKIE RECIPE 1 c. soft butter 1 c. sugar 1 c. brown sugar 2 eggs 1 tsp. vanilla 2 c. flour 2 1/2 c. blended oatmeal (plain uncooked) 1/2 tsp. salt 1 tsp. baking soda 1 tsp. baking powder 12 oz. chocolate chips 9 oz. grated Hershey bar 1 1/2 c. chopped nuts Cream butter, sugar and brown sugar. Add eggs and vanilla. Mix flour, oatmeal, salt, baking soda and baking powder. Add chips, Hershey bar and nuts. Roll into small balls and place 2 inches apart on lightly greased of "Pam" sprayed cookie sheets. Bake for 6 minutes at 375 degrees. Do not overcook or cookies will be dry. Keep cookies small, they are very rich! Makes approximately 5 dozen. 22

Thank you!!! Thank you 23

Contributors “It’s a Southern Thing” http://facebook.com/itsasouthernthing Implementing and sustaining transformational change in health care: lessons learnt about clinical process redesign-Katherine M McGrath, Denise M Bennett, David I Ben-Tovim, Steven C Boyages, Nigel J Lyons and Tony J O’Connell. MJA 2008; 188: S 32 –S 35 Dr Michael White, SMD Lake City Medical Center Cooks.com http://www.cooks.com/recipe/e639g9hj/the- original-neiman-marcus-cookie-recipe.html Edible Art Bakery www.edibleartnc.com 24