Value Stream Mapping # 2 Report Discharge Process (July 2017) - PowerPoint PPT Presentation

Value Stream Mapping # 2 Report – Discharge Process (July 2017) Presented at the JCC Meeting, November 14, 2017 by Regina Gomez, Director of Quality and Jennifer Carton-Wade, Assistant Hospital Administrator

The Team

Gemba Sub-Teams We broke into teams in order to observe: • Case conferences • Discharge huddles • Resident care conferences • Interdisciplinary resident care teams • Individual members of the care team

Going to the Gemba

Processes Observation Summary Processes Observed Residents RN MD MSW Rehab Case conference 4 10 12 8 6 (initial) Discharge assessment 2 5 Counseling plan 1 5 8 1 Medication pass 2 4 Therapy 1 5 3 Psychosocial support 1 6 1 2 Home evaluation 8 2 Patient education 2 6 5 1 Pack belongings 2 TOTAL: 113 8 26 29 35 15 105 hours of observation, 113 processes observed!

Education – lean overview and value stream mapping

Mapping the Current State Blue stickies for ideas Hot pink stickies for waiting Pink stickies for process steps Yellow stickies for observations and wastes

Current State Data Summary PMS S2 Unit: Care DC Care DC Time Planning Process Planning Process LT 1,490 46,750 2,925 75,460 LT in days 1 day 32 days 2 days 52 days CT 50 490 45 500 WAIT 1,440 46,260 2,880 74,960 VA 50 465 22 380 NVA 1,1440 46,285 2,903 75,080 VA % 3.4% 1% 1% .5%

Summary of current state issues • No clear signal/notification of discharge date • Home not ready (home eval not scheduled soon enough) • Durable medical equipment (DME) delays • Resident participation in discharge meeting • Lack of a comprehensive discharge plan of care • Non-standard discharge care plan meeting • Multiple forms of discharge documentation • No standard work for linkage/continued care referrals

Idea Generation

Idea Generation Reporting

Future State Map mutual goals care coordination care transitions resident empowerment fostering confidence health and wellness

Lean Concepts to Reflect in the Future State

Future State Data Summary Total time for discharge post identification of DC date: 12.2 days in the future vs 32-52 days currently Future Current PMS Current S2 “Short Stay” Care DC Care DC DC Process Only Planning Process Planning Process LT 1,490 46,750 2,925 75,460 17,550 LT in days 1 day 32 days 2 days 52 days 12.2 CT 50 490 45 500 270 WAIT 1,440 46,260 2,880 74,960 17,280 VA 50 465 22 380 265 NVA 1,1440 46,285 2,903 75,080 17,305 VA % 3.4% 1% 1% .5% 1.4%

Our Vision of the Future • Length of stay for short stay residents will drop from 84 to 54 days (a reduction of 36%) • Lead time from identification of discharge to actual discharge will drop from a range of 32-52 to 12.2 days while maintaining time for treatment and care and maintaining a safe and supportive environment • Characteristics of the future state include:  Resident developing self-confidence for self-care  Enabling health and wellness of the resident post- discharge  Fully integrating linkages to community resources for the betterment of resident outcomes post- discharge

Problem Statement The number of residents discharged from Laguna Honda has been declining over the past 3 fiscal years. Availability of housing for the population served is increasingly more limited in San Francisco. There is a need to focus on discharge planning processes of residents who are able to return to their prior living situation where housing is not a barrier to discharge.

Targets and Goals By the end of FY 17-18, 1. Increase by 25% the number of residents (who are short stay and have a home) discharged back to the community within 60 days of admission. 2. Reduce average LOS by 30% by improving internal and external discharge planning care coordination processes and reducing wait times between processes. (Average LOS for S2 from 263 to 184 days, PM from 77 to 54 days)

Implementation Plan Next Steps: Just Do Its - 4 Kaizens - 3

Questions & Answers Thank you.