An Interdisciplinary Approach to Subacute Census Growth Jim Schneider, MBA, PMP Dana Cartin, PT, MPA Solaris Health Systems Edison, New Jersey

Overview Background Solaris Health System Organization Program Management Office (PMO) History Project Management (PM) Methodology Process Improvement (PI) Methodology The integration of PM and PI Methodologies Case Study The Hartwyck Initiative An working illustration of using an interdisciplinary approach to increase admissions to a Subacute facility

Background Solaris Health System

Organization

Program Management Office (PMO)

History

Project Management (PM) Methodology

Process Improvement (PI) Methodology

The integration of PM and PI Methodologies

Case Study

The Hartwyck Initiative

An working illustration of using an interdisciplinary approach to increase admissions to a Subacute facility

Solaris Health System Location: Edison, New Jersey History: Established in 1997 through the consolidation of JFK Medical Center and Muhlenberg Regional Medical Center (MRMC). Services: Two acute care hospitals, inpatient and outpatient rehabilitation centers, nursing and convalescent facilities, and specialized treatment programs.

Location:

Edison, New Jersey

History:

Established in 1997 through the consolidation of JFK Medical Center and Muhlenberg Regional Medical Center (MRMC).

Services:

Two acute care hospitals, inpatient and outpatient rehabilitation centers, nursing and convalescent facilities, and specialized treatment programs.

Solaris Health System

Solaris Health System PMO History Started in October 2002 as a joint venture between Solaris Health System and McKesson Oversight by a Governance Board composed of Solaris and McKesson senior management. PMO Original Mission: Integrate information solutions Streamline processes

PMO History

Started in October 2002 as a joint venture between Solaris Health System and McKesson

Oversight by a Governance Board composed of Solaris and McKesson senior management.

PMO Original Mission:

Integrate information solutions

Streamline processes

Solaris Health System PMO Today Oversight Solaris Health System Executive Management Mission: Support the goals of the organization including enhanced patient safety, quality of care, and increased operational efficiency; Facilitate the integration of projects into the business environment; Assist in the ongoing development of quality and customer focused processes; and To build organizational and individual competencies in project management.

PMO Today

Oversight

Solaris Health System Executive Management

Mission:

Support the goals of the organization including enhanced patient safety, quality of care, and increased operational efficiency;

Facilitate the integration of projects into the business environment;

Assist in the ongoing development of quality and customer focused processes; and

To build organizational and individual competencies in project management.

Program Management Office

Project Management Methodology Providing project portfolio management across the enterprise by implementing, reviewing, and maintaining a Program Management plan; Using industry standard process and project management methodologies to ensure success; Identifying and proactively managing project issues and risks; Implementing common processes and practices across the entire organization; and Improving project team communication by having common processes, deliverables, and terminology. Program Management Office

Project Management Methodology

Providing project portfolio management across the enterprise by implementing, reviewing, and maintaining a Program Management plan;

Using industry standard process and project management methodologies to ensure success;

Identifying and proactively managing project issues and risks;

Implementing common processes and practices across the entire organization; and

Improving project team communication by having common processes, deliverables, and terminology.

Process Improvement Methodology Assist in the development of customer and quality focused processes that support the PMO Mission. Lead and direct teams in executing projects through the use and deployment of standard strategies and methodologies Six Sigma Lean Sigma Work Out CAP Program Management Office

Process Improvement Methodology

Assist in the development of customer and quality focused processes that support the PMO Mission.

Lead and direct teams in executing projects through the use and deployment of standard strategies and methodologies

Six Sigma

Lean Sigma

Work Out

CAP

Operational Improvement PI PM Define Goals Business Need Identified Business Need Satisfied Design Performance Measures Establish Baseline Identify Opportunities Recommend Improvements Define Scope Develop Plan Manage Execution Monitor Scope, Schedule, Resources, Risk Achieve Final Result Integrated Approach

Case Study The Hartwyck Initiative

Hartwyck Initiative Business Problem Declining admissions to Hartwyck Edison Estates from JFK Medical Center Business Objective Develop strategies and processes to increase and sustain Subacute admission growth at the Hartwyck Edison Estates from JFK Medical Center Project Goal Increase admissions to Hartwyck at Edison Estates from JFK 50% of potential SA discharges to Edison Estates

Business Problem

Declining admissions to Hartwyck Edison Estates from JFK Medical Center

Business Objective

Develop strategies and processes to increase and sustain Subacute admission growth at the Hartwyck Edison Estates from JFK Medical Center

Project Goal

Increase admissions to Hartwyck at Edison Estates from JFK

50% of potential SA discharges to Edison Estates

Hartwyck Initiative Initial Kick Off January 2007 Coordinated by Hartwyck Senior Vice President Interdisciplinary Team Involvement Initial Project Scope/Charter developed PMO invited to join team June 2007

Initial Kick Off January 2007

Coordinated by Hartwyck Senior Vice President

Interdisciplinary Team Involvement

Initial Project Scope/Charter developed

PMO invited to join team June 2007

Initial Scope Tracking Discharges Physician Strategy Staff Education Team Building

Tracking Discharges

Physician Strategy

Staff Education

Team Building

Integrated Approach Project Manager assigned to manage overall initiative Process Improvement team assigned to evaluate current processes and identify opportunities for improvement

Project Manager assigned to manage overall initiative

Process Improvement team assigned to evaluate current processes and identify opportunities for improvement

Integrated Project Lifecycle Project Charter Project Scope High Level Milestones Key Tasks Resources Timeline Process Strategy Marketing Strategy Perform planned tasks Manage Team Expectations Implement approved process changes Implement Marketing Activities Control Schedule Status Reports Status Meetings Control Scope Monitor and Control Risks/Issues Process Marketing Initiating Planning Executing Monitoring & Controlling Closing

Establish Baseline Staff and Physician Interviews Process Observation Referral Process Internal External Bed Management at Edison Estates

Staff and Physician Interviews

Process Observation

Referral Process

Internal

External

Bed Management at Edison Estates

Data Search Acute Discharges Subacute referrals Medical and Financial Clearance Edison Estates Admissions Physician Referral Patterns Social Work Referral Patterns Establish Baseline

Data Search

Acute Discharges

Subacute referrals

Medical and Financial Clearance

Edison Estates Admissions

Physician Referral Patterns

Social Work Referral Patterns

Baseline Findings Process Variation Marketing Challenges Communication Barriers Staff & Physician Bias Incomplete Data

Process Variation

Marketing Challenges

Communication Barriers

Staff & Physician Bias

Incomplete Data

Project Strategies Physician Strategy Referral Patterns Preferences MARKETING STANDARDIZATION Data Strategy Standardization Benchmarking Process Strategy Bed Management Current Referral Process New Referral Process Process Control External Strategy Brochures Media Campaign Internet Communication Strategy Biases Behavior Education Video Fact Sheet Internal Staff Strategy Perception Promotion Awareness

Physician Strategy

Referral Patterns

Preferences

Data Strategy

Standardization

Benchmarking

Process Strategy

Bed Management

Current Referral Process

New Referral Process

Process Control

External Strategy

Brochures

Media Campaign

Internet

Communication

Strategy

Biases

Behavior

Education

Video

Fact Sheet

Internal Staff Strategy

Perception

Promotion

Awareness

Standardization Team Work Outs Process Internal Subacute Referral Process Subacute Bed Availability Assessment Communication Review/Revise Current Internal Documents and Communication Strategies Data Analysis Benchmarking Internal

Team Work Outs

Process

Internal Subacute Referral Process

Subacute Bed Availability Assessment

Communication

Review/Revise Current Internal Documents and Communication Strategies

Data Analysis

Benchmarking

Internal

Deliverables Standard documentation packet and standard process to provide to patients Scripting to continuum of care at Solaris Subacute Facilities Standard process to assess and communicate bed availability at Edison Estates Standard interdisciplinary process to refer internal patients to Solaris Subacute facilities Outcome and Process Control Metrics

Standard documentation packet and standard process to provide to patients

Scripting to continuum of care at Solaris Subacute Facilities

Standard process to assess and communicate bed availability at Edison Estates

Standard interdisciplinary process to refer internal patients to Solaris Subacute facilities

Outcome and Process Control Metrics

Marketing Strategy Create Positive Messages Identify benefits of continuum of care Identify and build on “Unique Selling Points” Onsite Physiatry Orthopedic Unit Certified Rehabilitation Nurses JCAHO Certification Identify specialty service opportunities Wound Care Ostomy Care Improve relationships between referral staff and Edison Estates

Create Positive Messages

Identify benefits of continuum of care

Identify and build on “Unique Selling Points”

Onsite Physiatry

Orthopedic Unit

Certified Rehabilitation Nurses

JCAHO Certification

Identify specialty service opportunities

Wound Care

Ostomy Care

Improve relationships between referral staff and Edison Estates

Target Market Segments Physicians Includes physicians identified as high referrers Other specialties likely to refer patients for subacute care Orthopedic Infectious Disease Internal Solaris Staff Includes Social Work, Case Management, Client Services, Nursing, and PT / OT External Includes Patients, Families, and Community

Physicians

Includes physicians identified as high referrers

Other specialties likely to refer patients for subacute care

Orthopedic

Infectious Disease

Internal Solaris Staff

Includes Social Work, Case Management, Client Services, Nursing, and PT / OT

External

Includes Patients, Families, and Community

Communication & Marketing Video Written Material Interviews Socialization Facility Tours Video Written Materials Scripting Education Sessions Education Sessions Video Tools Increase awareness of unique services offered at the Hartwycks External Identify best referral opportunities Physicians Improve staff relations between JFK and Edison Estates Build patient awareness of the Continuum of Care offered at Edison Estates Increased staff awareness of available services at Edison Estates Altering negative perceptions of Edison Estates Internal Staff Strategy Target Segment

Communication & Marketing Service Recovery Process Objective Prompt response to complaints Swift resolution of issues Rapid communication of outcomes Methodology Team Work Out

Service Recovery Process

Objective

Prompt response to complaints

Swift resolution of issues

Rapid communication of outcomes

Methodology

Team Work Out

Outcomes

Outcomes

Outcomes Estimates based on a 20-day LOS at $400 per day Sustaining an average of 12 new patients per week results in of $4.9 million of revenue

Process Metrics Number of referrals made to Service Quality and Recovery Number of conversions from “NO” to admission at Edison Estates Number of referrals to Client Services

Number of referrals made to Service Quality and Recovery

Number of conversions from “NO” to admission at Edison Estates

Number of referrals to Client Services

Key Learnings Integrates Methodologies Global Approach (PM) Focused Approach (PI) Facilitates establishment and adherence to timelines Focuses on Control and Sustainability

Integrates Methodologies

Global Approach (PM)

Focused Approach (PI)

Facilitates establishment and adherence to timelines

Focuses on Control and Sustainability

Key Learnings If you always do what you’ve always done…. Value the Data Patience Build Trust

If you always do what you’ve always done….

Value the Data

Patience

Build Trust

Questions Thank you

Thank you