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Improving the Patient Experience for Joint Replacements by Using a Guided Process

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Hospitals must find ways to differentiate their services and programs from their competition, while facing the obstacles of reduced reimbursement, a larger focus on patient satisfaction, and......

Hospitals must find ways to differentiate their services and programs from their competition, while facing the obstacles of reduced reimbursement, a larger focus on patient satisfaction, and increased accountability and quality requirements.
The Avera Orthopedics department did an evaluation of the patient experience for their Total Joint Replacements program from end-to-end, including an assessment of their online experience for e-patients. A care path was then optimized with transition gaps resolved and duplicative work eliminated. A web-based patient guidance system was implemented that provided patient benefits in convenience and efficiency.
Avera found that guided patient engagement through the total episode of care improves patient readiness, increases treatment adherence, reduces risks of setbacks, and speeds up recovery.
In this session you will learn
The problems faced by the Avera ortho dept
Defining a process to evaluate hospital service line patient experience from end-to-end
Addressing pain management scores through multiple initiatives
Innovative concepts that used lean processes to positive outcomes
The effects of purposeful hourly rounding and leader rounding
How to create a streamlined care path, reducing variances and duplicative work
Benefits seen in setting patient expectations early and offering convenience of online e-patient engagement
About the Speaker:
Benz Julie_color_smallJulie Benz is the Director of Outpatient Therapy Services at Avera McKennan. Julie has been employed with Avera McKennan for 30 years. She received her degree in Physical Therapy from the University of Iowa and Masters in Administrative Studies from the University of South Dakota.

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  • 1. Improving the Patient Experience for Joint Replacement by Using a Guided Process Julie Benz Director of Outpatient Therapy Services March 20, 2014
  • 2. Avera McKennan – Sioux Falls SD * Hub of the Avera Health System * Established over 100 years ago
  • 3. Within the Avera McKennan network… • 13 regional hospitals • Avera Behavioral Health Center • Avera Heart Hospital of South Dakota • 85 primary and specialty care clinics
  • 4. We are nationally recognized for excellence in: Cancer treatment Stroke care and neurosciences Orthopedics Women’s health care Pediatrics and neonatal intensive care Behavioral health Emergency, trauma and critical care Surgery Gastrointestinal care Avera McKennan’s flagship facility is our 545-bed tertiary care hospital in Sioux Falls.
  • 5. Our Aspiration Through service and process excellence, Avera McKennan will lead the nation in high quality, affordable health care.
  • 6. Rural Innovative Most advanced use of e-services Strives to be at the forefront of innovation Top 10 Trailblazing Hospitals
  • 7. “Goals determine what you are going to be." Julius Erving
  • 8. Objectives 1. Identify problems facing the Orthopedic Unit 2. Identify innovative concepts that improve the processes to positive outcomes.
  • 9. Orthopedics at Avera McKennan •32 – bed unit •700 Jt Replacements/year •2 - Primary Orthopedic Groups •1987 established Easy Street •2002 initiated Joint Camp
  • 10. Challenges Competitive environment  Reducing volumes Patient Satisfaction below the Top Box performers.  * Quality Outcomes  Falls  Pain Management
  • 11. Innovative Ideas & Proven Concepts • Process Excellence - Lean • Purposeful Hourly Rounding • Leader Rounding • Pain Team – one call response • Total Care - PGS
  • 12. Lean – Process Excellence
  • 13. Visual Management Control •To clearly and immediately notify management and workers whether the work area is normal or abnormal. –Shadowing/Labeling –Andon Signals –Downtime Clocks –Process Control Centers © 2007 OpEx, Inc. All Rights Reserved.
  • 14. Supplies at POU on 2WB pod
  • 15. Purposeful Hourly Rounding
  • 16. Visual Management Control Patient out of room Even Hour Round Complete Odd Hour Round Complete
  • 17. Intentful Leader Rounding Leader with staff Daily with staff on shift Quarterly with every staff Senior Leadership - weekly
  • 18. Pain Team Instituted a Pain Team – Anesthesiologist - Pharmacist Pharmacist on the floor during the day and available at night for med review
  • 19. What were we challenged by- Getting the right information to the patient and their family at the right time
  • 20. “To shoulder greater accountability for outcomes, health systems must partner with patients to close gaps in communication and coordination while managing care beyond the acute care or physician office setting” » The Advisory Board
  • 21. Program Goals 1. Improve patient experience 2. Ensure patient adoption and engagement 3. Improve Patient Satisfaction 4. Drive staff efficiency 5. Create a compelling competitive differentiator
  • 22. Reports Available To numerous to mention but valuable information that drives our process changes.
  • 23. Weekly Report Summary March 3, 2014 - March 9, 2014 Patient Activity New Enrollments 4 New Registrations 4 Total User Logins 46 Unique User Logins 22 Item Completion 1st Functional Outcome 5 Preparedness Survey 1 Hospital Experience Survey 2 Recovery Survey 1 Surgeon Experience Survey 2 Transition Experience Survey 1 2nd Functional Outcome 1 Avera TotalCare Program Survey 0 6 Month Functional Outcome 0
  • 24. Other Changes • Aquatic Therapy Post Op Day1 • Dietary Aid on the floor 8hours/day to assist with nutritional need of the patient. • Daily Rounds with RN, Case Manager, Social Worker, Therapy and physician liaison
  • 25. Results of our Efforts
  • 26. Fall Reductions 3.06 5.59 8.03 10.70 5.37 13.16 4.58 5.88 15.97 2.81 1.74 3.64 0.00 2.00 4.00 6.00 8.00 10.00 12.00 14.00 16.00 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Rateper1,000PCD 2 West Ortho Falls Jan-Dec 2012 Fall Rate Magnet BenchmarkMagnet Benchmark is the average rate for 8 quarters. Actual 5.61 1.95 3.453.44 1.58 9.12 1.59 0.00 3.42 5.84 5.37 3.45 2.97 0.000.00 2.00 4.00 6.00 8.00 10.00 12.00 14.00 16.00 Jan FebMar AprMayJun Jul AugSep Oct NovDec Jan Feb Rateper1,000PCD 2 West Ortho Falls January 2013-February 2014 Fall RateMagnet Benchmark is the average rate for 8 quarters . Actual
  • 27. Patient Satisfaction Question Mar – 12 to Feb 13 Mar-13 to Feb-14 Overall Rating of Hospital 70.7% 75.5% Likelihood to Recommend 75.3% 86.8% Transitions of Care 59.6% 64.5% Pain Management 68.1% 74.6%
  • 28. Surgical Growth
  • 29. Total Care Avera Total Care
  • 30. Nationally Recognized Quality 2014 Healthgrades Awards Five-Star Awards in: • Orthopedics • Neuroscience • Gastrointestinal services • Critical care
  • 31. Nationally Recognized Quality One of the 100 Top Hospitals® in the nation in 2013 as named by Truven Health Analytics
  • 32. Nationally Recognized Quality • No. 1 hospital in South Dakota in 2012-13 and 2013-14
  • 33. Nationally Recognized Quality • QUEST High Performing Hospital in 2013 Premier Health Care Alliance
  • 34. Nationally Recognized Quality • Community Value Leadership Award • Community Value 100® Hospitals list Cleverley + Associates
  • 35. Questions Thank you