FINAL _ T52-Structures And Processes To Enable Ongoing, Sustainable Cost-Reduction - PAltenhofen ROlm-Shipman
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FINAL _ T52-Structures And Processes To Enable Ongoing, Sustainable Cost-Reduction - PAltenhofen ROlm-Shipman
- 1. ® T52: Structures And Processes To Enable Ongoing, Sustainable Cost-Reduction Patrick Altenhofen & Robert Olm-Shipman Saint Luke’s Health System Kansas City, Missouri
- 2. ® 1 Overview - Saint Luke’s Health System of Kansas City - Project Foundation & Roadmap - Assessment-Design-Implementation - Results - Key Takeaways - Sustaining Success
- 3. ® Saint Luke’s Health System Kansas City, Missouri
- 4. 3
- 5. ® Project Foundation & Roadmap Setting the stage for a successful project
- 6. ® 5 The Imperative HealthLeaders Media, 3/9/12 Past operating savings reflect ‘low-hanging fruit,’ while future savings will be harder to achieve and will require more wrenching change… More wrenching change speaks to the next level of cost reduction and expense management, which is more about gaining efficiencies. That is taking apart the fundamental basic building blocks of patient care and recreating them all over again in a more efficient manner.
- 7. ® Focus 2015 Vision The changing external environment and health care reform are reasons for concern A strategic, deliberate, and quick response to external change will ensure our health system continues to be a success for years to come The Reality What We Are Working Towards Mutually aligned goals for sustainable long-term success Innovative and creative solutions Ensuring we always provide the best patient care How We Are Doing It Ensure our focus is strategic and deliberate Be transparent and cross-validate our findings Identify opportunities and prioritize
- 8. ® Process Overview Design ImplementationAssessment Jan-Mar, 2012 Mar-Jun, 2012 Jul 2012-Current Summary report of potential savings opportunities by functional area 2-day planning session to select areas to advance to Design phase Over 200 detailed design plan proposals outlining specific projects aimed at achieving savings 34 Teams developed design plans aimed at achieving savings opportunities identified during Assessment phase Implementation of new work flows, staffing models, supply changeovers, etc. Dashboards and reports detailing performance to plan
- 9. ® Project Governance Steering Committee System Chief Executive Officers Physicians Chief Executive Officer Chief Financial Officer Chief Medical Executive Chief Nursing Executive Senior Vice Presidents Project Management Office Saint Luke’s Hospital Saint Luke’s East Saint Luke’s South Saint Luke’s North Saint Luke’s Health System Saint Luke’s Hospital Saint Luke’s East Saint Luke’s South Saint Luke’s North Service Line Leadership Responsibilities Review results of the diagnostic assessment Review and approve all performance improvement project deliverables and recommendations Engage stakeholders in the process and assure leadership alignment Prioritize initiatives and set organizational targets Commit to rapid decision-making and open communication
- 10. ® Project Management Office • Principle - Management • Project Lead – Logistics • Project Analyst – Data • Consultant/Analyst Teams – SME’s Assigned to Functional Areas Project Management Consultant Partners • Senior Level Executives –Executive Sponsors • Vice President – Project Management Office • Operations Project Consultant – Support and Transition Functional Area Projects from Consultant Partners • Operations Project Analyst – Support and Transition Project Data from Consultant Partners Saint Luke’s Health System
- 12. ® $24.16 $18.07 $13.40 $10.15 $6.40 Clinical Non-Clinical Revenue Cycle Supply Chain/Expense Management Other Areas 50th% Benchmark (M) 25th% Benchmark (M) Assessment – Overview Project Initiation Data Normalization and Validation Roadmap and Prioritization Assessment Process Assessment Results (Millions) $24.16 $18.07 $13.40 $10.15 $6.40 $38.49 $45.11 $16.90 $18.75 $9.00 Clinical Non-Clinical Revenue Cycle Supply Chain/Expense Management Other Areas 50th% Benchmark (M) 25th% Benchmark (M) 50th%tile Opportunity $72.18M 25th%tile Opportunity $125.28M
- 13. ® Design – Overview Team Selection Data Validation & General Discovery Initiative Development Design Process Design Structure Steering Committee / Executive Leads SLHS Focus 2015 Project Teams Executive Sponsor Project Team Roles and Responsibilities PMO Facilitation Team Lead (1 per team) Team Member (3-5 per) Drives day-to-day activities for project team Provides impartial viewpoint of team objectives Represents functional area / business unit Contributes subject matter expertise and/or customer perspective Directly supports the development of the initiative and milestone plan PMO
- 14. ® Design Deliverable Templates Initiative #1 – Overview Initiative Insert Initiative Name Here Description (including any ‘trade-offs’) Include a brief description of the initiative, including: – Overall definition including break-down of initiative into its sub-components, if applicable – Strategies for implementation – Portions of the initiative where implementation is already in progress Benefit Quality/ Patient Experience Labor ($$) Non- Labor ($$) Include any qualitative observations that could lead to a benefit due to initiative implementation FTE $$ Quantified financial benefit resulting from non-labor items on an annualized basis Decrease in number of FTEs Annualized $$ benefit of FTE decrease Cost Quality/ Patient Experience Labor ($$) Non- Labor ($$) Include any qualitative observations that could lead to a benefit due to initiative implementation FTE $$ Quantified financial cost of non-labor items (e.g. supplies, training, etc.) Increase in number of FTEs Annualized $$ cost of FTE increase Ease of Obtaining Benefit [1/2/3/4] Barriers to Implementation To the left, rate initiative on scale of 1-4 with 1 being the most simple, and 4 being the most challenging Describe the barriers to implementation in detail Business Units Impacted List all of the business units and/or care sites impacted by this initiative. If the initiative has the potential to affect all of the business units, then enter the following: ‘System-wide initiative, all business units may be impacted.’ Implementation Status (Select status and give supporting detail) Not Yet Started Imminent Partially Complete Fully Complete Budgeted FY12 Details Describe rationale for implementation status selection
- 15. ® Design Deliverable Templates Lower Risk Higher Risk Risk Evaluation Criteria 1 Patient Satisfaction / Experience 2 Regulatory / Compliance 3 Physician Partnership / Efficiency 4 Staff Engagement/Satisfaction 5 Market Competitiveness 6 Investment Required 7 Internal Capabilities Overall Risk Assessment Identified Level of Risk Low 1 2 3 4 5 High Initiative #1 – Risk Assessment Potential Risks to the Organization Overall Risk Level: (Choose One: High / Medium / Low) Designate the overall initiative as being of High, Medium, or Low risk to the organization – High Risk: Strong possibility for compliance/risk or patient safety issues associated with implementation – Medium Risk: Some risks associated with initiative, but can likely be addressed with targeted mitigation strategies – Low Risk: Relatively small risk to the organization from implementation Risk Considerations Identify the specific risks related to patient satisfaction, physician satisfaction, staff satisfaction, competitiveness, investments required, and internal capabilities that may be associated with initiative implementation Risk Mitigation Strategies Describe the mitigation strategies that will be used to address each risk described above (e.g. processes, controls, communication strategies)
- 16. ® Design Results $111.54 $81.60 $0.00 $20.00 $40.00 $60.00 $80.00 $100.00 $120.00 Initiatives Designed Initiatives Advanced Design Results (Millions) Operate as a System - Shared Services - Flexible Staffing Coverage - Organizational Structure Reduce Variation - System-wide Vendor Contracts - Job Descriptions, Roles and Responsibilities - Consistent Training Improve Decision Making Data - Align Staffing Schedules - System Metrics - Data-Driven Management Decisions Design Themes
- 17. ® Implementation – Overview Implementation Process & Structure Implementation Milestones Leadership Results Tracking Implementation Milestone Plans Results Tracking Implementation Process and Structure Leadership Department Management Project Management Office
- 18. ® Implementation – Project Plan Milestone / Sub- Activity Description Owner External Dependencies Milestone? (Y/N?) Start Date Expected End Date Duration (days) 2 Systemized Employee Health Documentation Director, EH Y 1/14/2014 3/31/2014 76 2.1 Electronic Secure Employee Health Folder PMO N 1/14/2014 1/17/2014 3 2.2 Employee Health Electronic Forms (computer generated forms) Director, EH N 1/14/2014 2/28/2014 45 2.3 Conversion from PC to Laptop for Float EH RNs Director, EH Availability in IT N 1/14/2014 7/31/2014 198 # Milestone Description Owner Start Date Expected End Date Status Key Activities Next Steps 1 Exposure Management Protocol Update for each Entity Director, EH 1/13/2014 1/13/2014 Not Started 2 Systemized Employee Health Documentation Director, EH 1/14/2014 1/14/2014 Not Started 3 System Employee Health Phone Number Director, EH 1/14/2014 1/14/2014 Not Started 4 Standardize EH RN non- productive time allocation with other RN groups Director, EH 1/14/2014 1/14/2014 Not Started Status Summary Implementation Milestone Plan
- 19. ® Performance Tracking – Productivity Dashboard SAINT LUKE'S EAST - LEE'S SUMMIT 2014 Functional Area Cost Centers Metric Target 2013 2014 YTD Mar 9 Mar 22 Mar 23 Apr 5 Apr 6 Apr 19 Apr 20 May 3 May 4 May 17 Patient Care Services 610060 Medical Surgical Total Hours Worked Equivalent Patient Day 10.61 90016 36325 3542 4029 3737 3570 3599 8492 3582 366 346 361 366 376 10.60 10.14 9.68 11.64 10.36 9.75 9.57 611040 Progressive Care Unit Total Hours Worked Equivalent Patient Day 11.06 72452 22776 2454 2392 2355 2191 2253 6582 1968 200 192 195 190 201 11.01 11.57 12.29 12.48 12.09 11.51 11.20 611070 Medical Telemetry Total Hours Worked Equivalent Patient Day 11.10 101136 42941 4242 4378 4115 4129 4476 9200 4102 423 416 418 360 408 10.99 10.47 10.02 10.54 9.85 11.48 10.96 642000 Medical ICU Total Hours Worked Equivalent Patient Day 18.25 72581 32203 2927 3239 3226 3115 3154 3941 1758 188 180 148 151 171 18.42 18.32 15.60 17.96 21.78 20.56 18.48 646030 Mother/Baby Total Hours Worked Equivalent Patient Day 21.25 100050 41660 4354 4422 4180 4331 4070 5262 2136 224 226 229 221 209 19.01 19.51 19.47 19.53 18.28 19.60 19.49 650020 ICU Nursery Total Hours Worked Equivalent Patient Day 11.60 55887 21686 1942 2067 2207 2293 2466 5322 2319 223 224 229 254 263 10.50 9.35 8.71 9.23 9.64 9.03 9.38 665020 CV Recovery Total Hours Worked Equivalent Patient Day 13.75 11898 13398 1409 1467 1282 1292 1228 965.9 1131 120 107 121 95 101 12.32 11.84 11.73 13.67 10.59 13.59 12.17 Emergency Services 678000 Emergency Department Man Hours Worked Patient Visits 2.67 98311 39054 3873 4051 4019 3976 3985 38258 14829 1436 1384 1676 1424 1543 2.57 2.63 2.70 2.93 2.40 2.79 2.58 Pharmacy 730020 Pharmacy Total Hours Worked CMI Adjusted Patient Days 0.56 33979 21371 1470 1437 1369 1438 1430 73140 49245 3094 3163 3276 3201 3591 0.46 0.43 0.48 0.45 0.42 0.45 0.40
- 20. ® Performance Tracking – Action Plans Entity Cost Center Name Cost Center # Manager SLE Physical Therapy 738000 Productivity Results Issue Action Plan Completion Date Over target Reviewed overall staffing for PT cost center. Will make reduction by changing two part time techs to PRN and reducing full time tech to part time. This will reduce tech FTE from 2.276 to 0.6. There will be no tech in outpatient. Tech will cover joint camp and work Tuesday through Friday. No weekend tech coverage. Began discussions with techs 10/8/13. Will develop plan for reduction by 11/3 pay period. Develop rotation of staff for cancellation when census drops. Cancel PRN. In process. Plan for implementation by 10/20 pay period. Review utilization of all applicable charges with staff to ensure productivity is captured appropriately Discussed at staff meeting on 10/10. Target YTD July 14 July 27 July 28 Aug 10 Aug 11 Aug 24 Aug 25 Sept 7 Sept 8 Sept 21 18806.13 973.33 1078.00 1127.10 953.20 1086.00 42267.87 1952.27 2291.20 2574.00 1943.53 2029.20 0.445 0.499 0.470 0.438 0.490 0.535 0.409Service Unit Total Hours Worked Physical Therapy738000 Cost Centers Metric
- 21. ® Benefits Tracking 2014 YTD PPD5 PPD6 PPD7 PPD8 PPD9 Worked Hours Breakout Hours Exp. Hour Exp. Hours Exp. Hour Exp. Hours Exp. Hours Exp. Emergency Services Other Prod Hrs - Orientation 2,153 $43,126 324 $6,570 334 $6,213 256 $5,167 264 $5,364 233 $4,903 Other Prod Hrs - Other 1,514 $43,972 75 $2,172 122 $3,117 106 $3,359 171 $5,405 194 $5,465 CSI 1,636 $20,246 171 $1,971 102 $1,278 441 $5,489 246 $3,081 66 $826 Agency* 2,289 $137,340 269 $16,140 343 $20,580 195 $11,700 306 $18,366 279 $16,716 *Note: total bi-weekly agency expense target for ED & PCS = $36,660 Historical Performance 2011 2012 2013 Prod Ratio 3.17 3.07 2.76 Labor/ED Visit $92.81 $93.20 $85.70 Current Year Performance Q1 '14 Jan-14 Feb-14 Mar-14 Budget Actual Budget Actual Budget Actual Budget Actual EmerServ Visits 28,268 27,041 9,777 9,664 8,848 8,277 9,643 9,100 Worked Hours 82,211 75,090 28,435 26,111 25,734 23,078 28,043 25,901 Prod Ratio 2.91 2.78 2.91 2.70 2.91 2.79 2.91 2.85 Labor/visit $88.99 $83.17 $88.98 $81.44 $89.05 $83.81 $88.96 $84.43 Baseline Year Benefit Years
- 22. ® Position Requisition Control Req Number Cost Center Cost Center Description Position Title FTE New/Rep Target Actual Performance Budgeted FTE Hired FTE Posted FTE Hired, Not Yet Started FTEs Req for CC Performance to Budget Final Disposition 16936 920000 Admitting Admitting Representative 0.40 Replacement Hire N/A N/A 48.12 36.00 2.98 12.12 16935 920000 Admitting Admitting Representative 0.63 Replacement Hire N/A N/A 48.12 36.00 2.98 12.12 16418 618030 Neuro A Registered Nurse I 0.90 Replacement Hire 11.330 11.520 34.76 33.73 0.90 1.03 From 06/28/2014 16699 610200 Neuro B Registered Nurse I 0.90 New Hire 11.330 11.780 35.00 33.28 0.90 1.73 16912 643000 Neuro ICU Registered Nurse I 0.90 Replacement Hire 19.300 20.160 52.26 46.98 2.70 5.28 15554 675010 Central Services Supply Associate 1.00 Replacement Hire N/A N/A 28.23 21.05 1.78 1.00 5.40 16238 721000 Diagnostic X- Ray Radiology Technologist - Registered 0.03 Replacement Hire 85.010 81.040 23.78 21.08 0.93 2.71 From 06/21/2014 16223 721000 Diagnostic X- Ray Radiology Technologist - Registered 0.90 Replacement Hire 85.010 81.040 23.78 21.08 0.93 2.71 From 06/21/2014
- 24. ® Workflow Redesign – Central Staffing Office Decentralized Model Variability of staffing functions and structure Inability to share staff resources Competition for available float and/or agency staff Sub-optimal understanding of nursing demand & capacity Central Staffing Office Model Standardization of staffing function and structures Ability to share staff across System entities Resources dedicated to staffing projections and analytics System-view of demand and capacity Key Staffing Functions Self-Scheduling Schedule Leveling Assign PRNs Schedule Analysis Daily Staffing JIT Needs Management Assign Agency Assign Float Staff Track & Back-Fill Call-Ins Future Needs Projections Open Shift – Post/Approve Long Term Needs – FMLA Agency Competencies/Files
- 25. ® Manual to Automated Analytics – Dimensional Insight
- 26. ® Manual to Automated Analytics – Dimensional Insight
- 27. ® Results
- 28. ® Financial & Productivity Results 2011 2012 2013 2014* Patient Care Services 17.71 16.94 15.17 14.87 Laboratory 0.10 0.10 0.09 0.09 Pharmacy 0.05 0.05 0.04 0.04 Radiology 1.35 1.29 1.24 1.29 Respiratory Therapy 0.91 0.79 0.63 0.70 Rehabilitation 0.66 0.65 0.56 0.66 Emergency Services 3.17 3.07 2.76 2.77 Savings by Year $ 6,066,336 $ 21,096,980 $ 17,996,028 OVERALL SAVINGS $ 45,159,344 *2014 Q1-Q2 Annualized
- 31. ®
- 32. ® Key Takeaways
- 33. ® Key Takeaways Data owners (Finance, HIM, etc.) must understand the final deliverable in order to provide the ‘right’ data Understand the metrics & benchmarks – inclusions & exclusions Identify statistics to be refined or normalizations that must be made & hardwire them early Assessment Design Anticipate some level of “re-assessment” Put everything on the table, but beware of bogus initiative designs Perfection is the enemy of design Implementation Don’t let anxiety get in the way of appropriate implementation Data can be overwhelming but is essential to holding the gains Transition from tracking the project to tracking performance
- 34. ® Sustaining Implementation Results Senior Management Engagement & Follow Through Continuous, Real-Time Results Reporting Management Accountability for Results Continually Adjust for Change Reward Success
- 35. ® Global Enablers of Project Success And Really Any Change Management Initiative Clearly Identify the “Why” Articulate What the End-State Looks Like Acknowledge Things Will Likely Not Go As Planned Communicate With & Listen to Stakeholders Continuously Make Progress – Even If It’s Small Measure Progress & Hold Individuals Accountable Learn From Mistakes Get Ready to Change Again
- 36. ® T52: Structures And Processes To Enable Ongoing, Sustainable Cost-Reduction Patrick Altenhofen & Robert Olm-Shipman Saint Luke’s Health System Kansas City, Missouri
Editor's Notes
- PATRICK & BOBBY – Introductions Only
- BOBBY Approach to cost reduction, including detail on several of the tools we used, and Key results and enablers of ongoing sustainability
- PATRICK
- PATRICK (1 min or less) Saint Luke’s began in 1882 as a small hospital in Kansas City. Today Saint Luke’s is an integrated health system of 10 entities with key product lines consisting of Cardiovascular services, neurosciences, oncology, trauma centers, home care and hospice. Our primary service area consists of the metropolitan KC area of 2 million people, and spans 67 counties in Missouri and Kansas. A few facts about our health system; we have over 8,000 employees, with more than 45,000 admissions, 250,000 patient days, 145,000 emergency department visits, and 6,500 deliveries.
- BOBBY Begin by providing some background and a high-level overview of where and how we began this work
- BOBBY Work started in 2011 Coming off a good year as a health system, but obviously concerned about changes on the horizon Changes would require not just tweaks to our operations, but large-scale transformations
- BOBBY Going back to 2011, we established a vision for a project we coined Focus 2015 Purpose of this vision was to articulate a clear, consistent message related to why we were undertaking this work, what we were working towards, and our commitment to being deliberate, thoughtful, and as transparent as possible
- BOBBY In addition to establishing a vision, we settled on a clearly defined, 3-phase approach to this work, really modeled after other quality type methodologies such as PDCA Assessment phase was geared towards establishing quantifiable targets/objectives Design phase focused on development of initiatives to achieve the targets from the assessment phase Implementation phase where we put designs in place and then established processes to monitor performance and make adjustments as needed
- BOBBY From an overall project leadership/governance perspective, established a project steering committee at the outset Committee was comprised of system senior leadership, hospital executives, and a number of physicians As many physicians on the steering committee as non-physicians Steering Committee structure was crucial for decision making, establishing accountability, sharing communications/intelligence, and eliminating barriers/challenges
- BOBBY Finally, knew this was going to be a large project from the outset, so we engaged outside help from Deloitte consulting Deloitte brought manpower, structure, and subject matter experts From the initial project team we grew our own PMO over the course of the project to support the initial gains and continue building on this work
- BOBBY Set the foundation – now discuss the actual work itself
- BOBBY Assessment phase lasted roughly 3 months, Jan-Mar of 2012 Consisted of reviewing our performance against UHC benchmarks in a number of areas – clinical, non-clinical, rev cycle, supply chain, etc. Found that if we were to achieve 50th percentile performance we could realize $72M in annual opportunity If we achieved 25th percentile we could realize $125M in opportunity Findings were presented to the Steering Committee to establish final targets for functional areas and specific departments
- BOBBY Once targets were finalized by SC in assessment phase, design teams were chartered to develop initiatives that would yield the target expense reductions Some degree of revisiting the data and targets for further validation – to be expected Will talk a bit more about the details of the initiatives in the next couple of slides Structure of design teams: each team had an executive sponsor that was a member of the steering committee Project teams were facilitated by members of the PMO – operations consultants and analysts Each team had a leader and a series of team members, not necessarily associated with the dept or functional areas where they worked to enable fresh eyes/insights on business operations
- BOBBY Design teams worked towards development of a series of design initiatives Each initiative was structured in a consistent format, describing things such as the potential impact, costs/investments needed to realize benefit, difficulty to achieve, etc. So each team created a series of these documents for each initiative they proposed PATRICK
- BOBBY In addition to the design templates, each initiative has a corresponding risk assessment Risks categorized as patient satisfaction, physician partnership, investments, etc. But for each risk a risk mitigation strategy had to be proposed
- BOBBY After 3 months of design, 34 design teams developed over 200 initiatives that were presented to the steering committee for consideration The 200+ initiatives totaled greater than $110M in annual cost reductions Of those 200+ initiatives approximately 150 were advanced, totaling about $81M in savings Key themes of those initiatives emphasized leveraging system capabilities, reducing variation, and better use of data to drive decisions
- Patrick Up to this point we have gone through the assessment and design, and the final step in the process is implementation. With a top-down approach, our Steering Committee (leadership) approved all design intiatives to move forward into implementation. With the approval, the project management office began working with implementation leads and executive leadership to setup a detailed implementation plan. Following the implementation plan it is the implementation lead’s responsibility to implement and meet the milestones while the project management office tracks and ensures that key dates are being met. As initiatives begin being implemented it is just as important to track the financial and performance metrics to ensure that initiatives are having the desired impact.
- Patrick ( speed slide <30sec) 2 Major tools to facilitate implementation process - 1st tool is a status summary tool to communicate progress to the steering committee. Key milestones, owners, dates, and status - 2nd tool is a more detailed tool used by the implementation leads to manage the specific steps to achieve the milestones
- Patrick – overview of slide -We have touched on the implementation plan and just as important as implementation is sustaining the progress made. - One of the tools that we developed to sustain performance is a series of biweekly productivity dashboards
- Patrick (30-45 sec) It is one thing to measure productivity but how do ensure those depts that are not currently hitting their targets are putting plans in place to work towards achieving the target.
- BOBBY Patrick explained how we tracked these results operationally using tools such as the productivity dashboards We also tracked the results from a financial perspective using results realized in our general ledger where we track Actual versus budget volumes, productivity, labor expense, and then Specific pay codes or labor expenses associated with things like orientation, special staffing incentives and agency utilization
- BOBBY One of the most important things we had to become more disciplined about was controlling positions coming into the organization Created a tool, reviewed on a weekly basis, looked at every position requisition, Assessed whether the department was on a productivity target or not, and Current hired versus budgeted FTE complement Tool gave considerably more data and rigor to the position review and approval process
- BOBBY Mentioned up front that to achieve the type of savings we were aiming for we had to make transformational changes…
- BOBBY Example of one of those transformations was the development of a centralized nurse staffing office Baseline we had distinct staffing offices/functions at each hospital – would cancel some staff but be using agency and on diversion at another entity Broke apart the key staffing office functions and requirements Rebuilt the function as a shared service No float staff across hospitals, better manage overtime, temp help, schedules are smoothed across weekday and weekend coverage, etc.
- Patrick - One of the key transformational changes was moving from manual to automated analytics. - 2 big changes was automating the productivity reporting as well as automation of the position requisition
- Patrick By clicking on the productivity summary button (put mouse point on button), it will take you took the departments productivity, the hours worked per unit of service, pat equivalent day in this instance, compared to the target. What it shows here is that the green signifies that the hours worked per patient equivalent day is current running at 10.32 compared to the target of 10.61. With the understanding that the dept is currently under budget and running below their target, I would assume that if a position was trying to be pushed through leadership would approve the position to be posted for hire. Bobby- to point out red/green format
- We have told you what are processes have been, the tools, and so on
- Patrick (Bobby) Now lets touch on our actual results from the projects and initiatives We have discussed productivity a lot up to this point and mainly at the department level. What you see in this slide is the summarization of productivity results at the System level functional area level; PCS, Lab, Pharmacy and so on, by year, so in this care 2011 – 2014. In our case 2011 was really a baseline to see how far we have come. Just quickly highlighting how far some of our areas have come; patient care services went from operating at 17.71 hours worked per patient equivalent day as a whole in our system to currently running at 14.87 in 2014, Radiology has gone from operating at 1.35 hours worked per procedure to 1.29 in 2014. Last one I want to point out is emergency services which dropped from 3.17 in 2011 to 2.77 in 2014. Bobby - Discuss how savings tied to productivity and what gains we have shown by improving productivity in each of these functional areas year over year ORIENT TO THE SLIDE DEPARTMENTS WERE CATEGORIZED INTO WORKSTREAMS BASED ON THE ASPECT OF THE ENTERPRISE THEY REPRESENTED AND TEAMS WERE ORGANIZED BASED ON THE FUNCTION WITHIN THE HEALTH SYSTEM THEY PERFORMED; FOR EXAMPLE, UNDER ADMIN & SUPPORT SERVICES SOME EXAMPLES OF TEAMS WERE BIOMED, FACILITIES, CASE MANAGEMENT, EDUCATION, ETC. UNDER CLINICAL PRODUCTIVITY YOU HAD TEAMS SUCH AS LAB, NURSING, EMERGENCY DEPT, PHARMACY INITIAL ESTIMATED SAVINGS REPRESENTS WHAT WE BELIEVED WE COULD ACHIEVE INITIALLY COMING OUT OF DESIGN PHASE – ESSENTIALLY A BEST ‘EDUCATED ESTIMATION’. CURRENT ACTUAL REPRESENTS WHAT WE HAVE ACHIEVED OR ARE PREDICTING WE WILL, ANNUALIZED, AS SOME OF THESE IMPLEMENTATIONS GET FURTHER FLESHED OUT AND ACTUALLY GO LIVE. EXPLANATION FOR THE DELTA BETWEEN INITIAL & CURRENT – AS WE’VE GOTTEN INTO IMPLEMENTATION – HAVE DROPPED IN VALUE AS WE GOT INTO EXECUTING THEM. THE FACILITIES TEAM HAD SEVERAL RECOMMENDATIONS FOR GREENING INITIATIVES, MANY OF WHICH REQUIRED SUBSTANTIAL UP-FRONT INVESTMENTS WITH LONGER-TERM PAYOFFS – 5, 7, 10 YEARS DOWN THE ROAD. SO WE AGREED WE WOULD LIKELY DO SEVERAL OF THOSE AND HAVE INCORPORATED THEM INTO THE FACILITY MASTER PLAN WHERE IT MAKES SENSE, BUT DIDN’T FEEL LIKE WE COULD REALLY INCLUDE THEM IN THIS WORK. ANOTHER EXAMPLE IS IN THE LAB AREA. WE BELIEVED WE COULD SAVE $1M BY SWITCHING OUR VENDOR FOR HIGHLY SPECIALIZED TESTS THAT WE CAN’T PERFORM IN HOUSE. AS WE DID DUE DILIGENCE ON THE PROPOSED VENDOR COMING OUT OF DESIGN WE REALIZED THEY WERE NOT A GOOD FIT, AND AS A RESULT WENT WITH ANOTHER VENDOR, LABCORP. THE SAVINGS THERE ENDED UP BEING CLOSER TO $600K. WHERE ARE THE SAVINGS IN THE BOTTOM LINE? IN REALITY THEY ARE REALLY PEPPERED THROUGHOUT THE FINANCIALS. WE HAVE REALIZED SOME OF THIS BENEFIT IN 2012 AS DEPARTMENTS STARTED TIGHTENING UP POSITIONS IN AN EFFORT TO STAVE OFF LAYOFFS. WE’VE RECOGNIZED CONSIDERABLE BENEFITS THUS FAR THIS YEAR, AND WE WILL CONTINUE TO SEE BENEFITS INTO 2014. SAVINGS HAVE ALSO BEEN SOMEWHAT OFFSET BY EXPENDITURES IN OTHER AREAS SUCH AS INVESTMENTS IN PHYSICIAN PRACTICES, TECHNOLOGY, ETC.
- BOBBY Hub hospital is a 3x magnet designation organization – quality is very important As we are doing this work around productivity we wanted to be sure quality didn’t suffer, so tracked in parallel a number of quality indicators Here we’re looking at fall rates and patient satisfaction scores Noted that several indicators didn’t worsen, but in fact improved as a result of redesigned work flows and processes
- BOBBY Might recognize these UHC dashboard reports Top graphic shows inpatient mortality trending down to best decile performance Bottom shows 30-day readmits trending down –not yet at where we want to be, but making progress
- BOBBY Finally, a summary we prepare on a quarterly basis showing, for our 4 main hospitals, all metrics where we are performing at top-decile Purpose of these indicators is really to state that standardization, reducing variation, and workflow redesign can yield significant cost savings, while improving quality – in other words – deliver significant value
- BOBBY Summary of key takeaways by phase Assessment – get the right people around the table early such as finance, health information management and the end users – this will yield a better, more realistic picture of savings oppportunities up front Design – be creative; but look out for clearly bogus initiatives – such as moving to DSL or something like that for network – don’t let perfection be the enemy of good Implementation – this is where it gets real; continue to move forward… tracking is as critical to implementation as the change itself to ensure gains are held
- Patrick (30 seconds) One thing that we have found very important in all of our work thus far is how to sustain the results. First and foremost a health system or hospital will not get very far without the engagement and buy-in from senior management. That means buy-in and hands on participation from the initial assessment whether that was 5 years ago to 5 years from now. This type of change, as you can imagine, is not easy. If senior leadership doesn’t agree or buy-in to the change then the wheels will fall off quickly and sustaining results will be impossible. A huge change for SLHS was tracking real-time results. This includes everything from productivity tracking, action plans, position requisition, results tracking, etc. Staff who have not yet bought into the changes will do (as you imagine) whatever possible to poke holes. We have found that the more continuous and real-time the data was the more worthwhile it was and people seemed to get used to it and trust it and use it more so than simply fighting it. It only go so far to track results, of course you must place accountability. This means department, leadership and even system leadership accountability. One of the most important in my mind is continually adjusting to change. Not only does this mean job security for those of us in the PMO but it keeps things from getting stale, it brings new life and alternative, better ways to accomplishing the goal at hand. The best example I want to bring up is Dimensional Insight. It was a huge undertaking to switch from our manual productivity dashboard but it gave the dept managers, entity leadership, and system leadership the capability to dive into their own data and see things real time. Lastly, of course, reward success. The change is not easy. Rewarding those that have been stars in the changes we have made has been crucial to sustaining our results
- BOBBY At the end of the day, our Focus 2015 project, and the subsequent cycles we’ve completed, are really just giant change management exercises… Good project management, facilitation, accountability and consistent focus are the key to ensuring success.
- Questions???