The Magic and Mystery of Time in Healthcare Transformations Gaines - PowerPoint PPT Presentation

The Magic and Mystery of Time in Healthcare Transformations Gaines W. Hammond Jr. MD, FACS ______________________ Depart ment of S urgery and Urology Baylor S cot t and Whit e 1

Time to change is fleeting and requires momentum and consensus 2

Magic and Mystery Magic when it works - Time is critical Mystery when it doesn't - Time is critical “Space between the notes makes the music and coordination of the individual musicians makes a symphony” 3

Transformation Basics Types of Transformation Leadership Styles Healthcare Transformation Uniqueness Reasons for Failure 4

Pick Your Style Pick Success or Failure Style Method Impact Transactional Force and demand Short Term Dictatorial Distributive Bargaining One Time Working together Transformative Trust Long Term Integrative Common Vision 5

Charlie Strong Demanding Change in Texas Football Texas coach Charlie Strong was hired to bring an immediate change to the Longhorns' football fortunes. He is wasting no time in creating a culture of discipline and responsibility. 6

Transformational Leadership “ When engagement in a group results in leaders and followers raising one another to increased levels of motivation and morality” 7

People Skills Transformation requires understanding of how people work alone and together Negotiate Strive Compete Incentivize 8

Transformation Challenges in Healthcare Physicians are not followers Impatient Usually not team players Lack Vision on a Global perspective Overburdened with time commitments 9

Patient’s View The time between events in healthcare is often overlooked by providers and institutions They feel as if “not at the table for change” Anxious and focused on issues at hand not global change agenda items Intimidated by the entire healthcare process 10

Value - Perception vs. Science Perception of value is in the eyes of the patient Outcomes based on facts is science but may not be perceived as value by the patient Outcome science and perception / time to resolution 11

Transformation Projects Surgeon’s Office Surgical Services Medical Device Innovation 12

Escape Velocity Escape Velocity is the speed at which the sum of an object's kine It is the speed needed to “break free” from the gravitational att 13

Transformation vs Status Quo Escape Velocity Status Quo 14

Time and Success Sustainable Success Start Time Abandon The chance of success is inverse reciprocal to time 15

Time Works Against Success Do not start until execution can be accelerated Define needs for Transformation Study Issues, Components, and Constituents Impacted Measure Perception of Problem Define Steps for Execution Begin Transformation Project racing against time 16

17 Surgical Office Transformation

Surgical Office Define Process of Triage Understand Service Define Time Efficiency Define Time Flexibility Execute 18

Problem Define/DX Call Reason for Visit #1 #2 #3 Appt Time ( #1 now) Information to Triage #1 #2 #3 Visit Smile Problems DX Stones CT CMP UA Hematuria Gross with Clots CT ‐ Cystoscopy Microscopic UA CS CMP Cysto CT Cytology Elevated PSA / Nodule Rectal ‐ Repeat PSA II ‐ Pus Bx Infection Complicated ‐ Back pain ‐ fever ‐ chills CT r/o obstruction ‐ CS Uncomplicated UTI ‐ no fever or back pain UA CS Cysto optional Retention Prostate PVR ‐ UA ‐ PSA ‐ CMP ‐ Neurogenic Urodynamic ‐ Post Op transient Incontinence UA ‐ PVR ‐ Exam ‐ UDS 19

Urology Office Schedule Template 6:00 Rounds 15 6:15 Rounds 15 6:30 Rounds 15 6:45 Rounds 15 7:00 Surgery 15 7:15 Surgery 15 7:30 Surgery 15 7:45 Surgery 15 8:00 1 1 2 2 3 3 6 8:15 1 2 3 3 4 8:30 1 2 2 8:45 Open 9:00 1 1 2 2 3 3 6 9:15 1 2 3 3 4 9:30 1 2 2 9:45 Open 10:00 1 1 2 2 3 3 6 10:15 1 2 3 3 4 10:30 1 2 2 10:45 Open 11:00 1 1 2 2 3 3 6 11:15 1 2 3 3 4 11:30 1 2 2 11:45 Open 20 12:00 Surgery 15 12:15 Surgery 15

14:00 1 1 2 2 3 3 6 14:15 1 2 3 3 4 14:30 1 2 2 14:45 Open 15:00 1 1 2 2 3 3 6 15:15 1 2 3 3 4 15:30 1 2 2 15:45 Open 16:00 1 1 2 2 3 3 6 16:15 1 2 3 3 4 16:30 1 2 2 16:45 Open 17:00 Surgery 15 17:15 Surgery 15 17:30 Surgery 15 17:45 Surgery 15 18:00 Surgery 15 18:15 Surgery 15 18:30 Surgery 15 18:45 Surgery 15 19:00 Surgery 15 15 min Surgery blocks 21 315 15 min Rounds blocks 4 Category 1 28 2 28 3 28

Surgical Services Department Transformation 22

Symptoms of current processes • Late Surgeons • High Rate of Add on cases • Case Juggling • Holes in Schedule • Extended Preoperative LOS • Decreased Morale: pressure on overtime • Extraordinary demand to be “first case” • Block Schedule with vague metrics, policy and processes • Difficult to Add cases on for emergent (non trauma) cases • Perceived need for more anesthesia coverage • Cancellation rate being discussed 23

Capital Responsibility and Operational Overhead Burden Quality of care is economically imperative All Constituent Groups must understand the community responsibility to be good stewards of capital. 24

Surgical Services Task Force Goal: High Level Long Range Goals: Process from start to finish that works for the benefit of outpatients Strive to be and maintain the best Surgical Services as perceived by: • Patients and their families • Surgical Physicians • Anesthesia Providers • Surgical Department Staff 25

Surgery Capacity and Fixed Overhead Expense OR Suite 1 10 20 $ Minute 40 40 40 $ Hour 2400 24,000 48,000 $ Day 57,600 576,000 1,152,000 $ Month 1,728,000 17,280,000 34,560,000 $ Year 20,736,000 207,360,000 414,720,000 Capacity 24 hours/day 24 240 480 Utilization 1 10 20 100% 24 240 480 50% 12 120 240 10% 2.4 24 48 Cases Time Cost 1 2,400 1.5 3,600 2 4,800 3 7,200 4 9,600 26 5 12,000

Surgical Services Transformation OR Capacity Total minutes per day available for procedures/ room 24 hr 60 min 1440 minutes per OR/day Fixed Expense $40/min $57,600 per day /per OR 10 Main OR 4 HSC 4 Endo 3 Labor and Delivery 21 total venues. = 30,240 minutes each day $1,209,000 per day fixed expenses $36,286,000per month fixed expenses Late starts, delayed starts, slow turnover are significant loss of opportunity impacting negatively the entire Institution. 27

Perception Metrics Pre Pilot Project 1 good Patients wait a minimum period of time prior to start of surgery 1 2 3 4 5 Surgeries start on time 1 We cancel few cases on the day of Surgery 1 2 We practice “Truth in Scheduling” 1 2 We have adequate nursing staff support 1 2 3 We have adequate technician support 1 2 3 4 We have the ability to add non-elective procedures 1 2 3 4 We have short turnaround times between cases 1 2 3 4 We have reliable high quality equipment and supplies 1 2 3 4 5 Surgeons are on time 1 Anesthesiologists are on time 1 2 We get the required instruments properly cleaned and on time 1 2 3 4 5 We have reliable communication mechanisms across the OR 1 2 3 4 5 28