Richmond Community Health Access Center (CHAC) Integrated Facility - PowerPoint PPT Presentation

Richmond Community Health Access Center (CHAC) Integrated Facility Design Functional Design Event January 15 – 19, 2018

Date / time Activities Monday Morning • Review process & outcome of the week • Mini Lean Education • Review guiding principles / decision to date • Map 7 flows on proposed floor plan (baseline) • Assess and adjust the floor plan Monday afternoon • Elder Roberta blessing • Test scenarios in mock up and adjust the design • Detail design for selected rooms (if time permits) • Physician tour at 5pm Tuesday morning • Plan the tour (develop survey questionnaire and planning) • Review functional program (leaders only) Tuesday afternoon • Guest tour • Review comments from the tour guests • Assess and adjust the design • Physician tour at 5pm Wednesday morning • Physician tour at 7:30 am • Continue the design adjustments • Detailed design for selected staff area (if time permits) • Prep for the report out Wednesday afternoon • Report out • Document the design / functional program • Demolish clinical area / build staff area Thursday • Test scenarios for staff area • Assess and adjust 3D • Plan and prep for the tour Friday • Guest tour • Review comments from the tour guests • Assess and Adjust layout • Document the design and functional narrative (functional program)

Introduction

Opening and Welcoming Jennifer MacKenzie Chief Operating Officer

Outcomes of the Week • Confirmed physical layout of the 3 rd floor • Continue to develop functional narrative (Functional Program) • Complete the detailed design for selected rooms

Integrated Facility Design (IFD) Components & Timelines 1. Evaluation & Planning Stage 2. Design & Development Stage Project Orientation Management Future Service & Planning/ & Functional model discussion Acclimation Resourcing Governance Design Jul ’17 – Jul ’17 – Sept ‘17 Jul ’17 – Jul ‘17 Jan ‘18 Sept ‘17 Aug ‘17 – Dec ‘17 Sept ‘17 Detailed Analysis & Conceptual Future Service Design Evaluation Design model discussion 3. Delivery & Implementation Stage Daily Plan for Move Work Design Accountability In Fall ‘18 Process & Visual Move in Leader Management Standard Work 6

Lean Education

What Is Lean / Lean Principles? Mindset of Continuous Improvement (Focus on maximizing what is of value to the client / patient) Methods Management System • Waste elimination • Engaging • Standardization • Empowering • Scientific Problem • Aligning all Solving (A3, STP, improvements Correction Action, PDSA)

Mindset • Relentlessly pursue improvements to increase patient/client value • Simultaneously improve quality and cost wastes

8 Types of waste Any activity that uses resources but creates no value Defects – error in paperwork, product quality or delivery Overproduction – producing more or sooner than customer needs Waiting – long periods of inactivity: people, information, machinery, or material Non-utilized staff – intellectual waste Transportation – Excessive movement of people, information or material Inventory – Excessive storage and delay of information or products Motion – Search for patient charts or supplies Extra processing – Re-tests or re-exams The most dangerous kind of waste is the waste we do not recognize Shigeo Shingo

Process Complexity 939 & abnormal Transcribe into Send Referral in Generate Outstanding Dictated 939s X-ray iPHIS iPHIS Validation Sheet referrals iPHIS Pick up mail File X-ray Request Reliability: 0.99 Previous Files? Discharge Abnormal Summary Enter treatment Outbox to 939 & Tape required into iPHIS Pharmacy Open & date stamp 939 Validate Update Yes Upd? printed Proof narratives Probability of Success of the system: iPHIS report Normal / Normal report Abnormal Triage Abnormal - Type 1 contact - Detox 939 & Normal - Children report Enter “No Separate Print narratives - Symptomatic Normal / Normal Print upd 52% Evidence” into - health units Abnormal report iPHIS -physicians Pull previous Yes record All documents Hold No Review by Dr. Enter end date into Pre-addressed, Discard extra received unmatched Elwood iPHIS pre-stamped copies Abnormal envelop  Mail Normal / Dictation Yes Onsite or Request offsite Abnornal No Offsite record CD Check CD Create small Normal Withdraw envelop X-ray or CD? CD - name Send pick & yellow envelop & Batch CDs, read in & mail - report Yes copies to Health withdraw card Reading room Units Check “No X-ray Evidence” Box Check iPHIS Yes for previous Enter into iPHIS X-ray or CD? record Separate Field CD To VGH for Radiologist Ops & Vancouver Match CD & File 939 X-ray Yes Radiology review X-rays 939 Report? X-ray Resulting system performance Enter Radiology File No More report copy dictations? return Radiologist Enter To Dr. Review Radiology Date stamp Elwood for Request abnormal No report into upon arrival review X-ray report iPHIS Initial File 939 File CD comments • Increased reliability • Probably also faster and lower cost X-rays Incoming mail Enter skin test Complete/ Complete X-ray / CD X-ray result Radiologist to Incomplete? review CD Incomplete Dr. Elwood reviews Are they important? Probability of Transcribe into Enter “No Dictation iPHIS Evidence” No Success of the CD & white 939 to Maria Hold for 5 days Enter Radiology Separate pink & Report yellow 939 Yes system: 79% CD Send to Radiology Print 2 validation Receive complete sheets Send report to Return to Sender CD? documents - Angela Angela - Dr. Elwood Radiology to read No Validate printed File white 939 Enter Radiology report Report File

Mindset • Andon - never pass along known defects or incomplete work to downstream. Inspection at the end of the process is too late and is the least effective methods to assure quality. • Plan-Do-Study-Adjust (PDSA) to achieve the perfection - Learn from failures more than success and be not afraid of making mistake!

Basic Lean Principles • Make the process flow 7 flows of medicine – Patient / Client flow – Family flow – Provider flow – Information flow – Medication flow – Equipment flow – Supply flow • Pull processing to minimize blocked and congested flow through a facility or process

Methods • Standard Work – the most effective of performing work – the simplest way therefore the fastest way – has 4 components: Content, Sequent, Outcome, Time

Methods • Visual management of signals for move or produce is essential for synchronized rapid response

Methods • Work is performed in a single piece , just in time , continuous flow manner.

Management • Lean management system (LMS) - Three elements

Management • Daily management system (DMS) – Provide direction and purpose for the day – Engage, coach and mentor frontline staff in problem solving – Focus on daily process to monitor, maintain, and continuously improve their work  Everyone has two jobs ◦ For leaders: to lead and to develop leaders ◦ For staff: do work and improve work

Lean Facility Design Principles • Design around flow (patient streams) not departments or provider groups • Create multiple simple flows rather than single complex flows – Simple flows are more reliable, easier to control and nevigate • Link process steps together without inter- process waiting. Waiting can be reduced by increasing department flexibility • Focus on the process within, make the building flexible (build camping tents, not castles)

Lean Facility Design Principles • Create Line-of-Sight Improves safety, communication, ability to level-load • Separate Front-of-House from Back-of-House Benefits patient experience and efficiency of support functions • Make Work Areas “narrow-and-deep” not “wide-and-shallow” Reduces travel and improves communication • Avoid too much space Increases travel, encourages clutter, conceals waste

VCH-Richmond Community Health Access Center IFD Event January 15-19

Guiding Principles • Centered on clients, families and caregivers • Be evidence informed • Focus on transformation - not be limited by current models or systems/processes • Integration and coordination driven by client need, outcomes and ease of access • Optimize a continuous pathway of care for patients between all services and providers • Service delivery will be in the location best suited for the client, i.e. clinic based or outreach based • Model of Care will be based on the Triple Aim – Improve health and wellness of all population holistically (physical, emotional, social and spiritual) – Improve client, family, caregiver, provider and support staff’s experience of care – Improve per capital cost of care without compromising quality effectiveness and appropriateness