Inovalon Process Redesign for raw large data collection operations… $15M in savings. Redesigned multiple org structures and processes Aspen Medical: Implemented new Customer Service process, fully redesigned supply chain process including factory locations, redesigned Dist. Center and opened 3PL operations on the east coast. Modeled the supply chain Rapiscan: Order to cash Value Stream Map. Identified $14M in savings (US and Malaysia) Restructured Mobile scanning business in UK and launched Worldwide process for ordering and building custom systems (UK) Worked with team to redesign product and manufacturing processes in new high speed baggage xray (disruptive) technology Bodycote: Redesigned (heat treating) manufacturing process and improved customer service levels by 50% Southcentral Foundation: Specified an HRIS system and completed vendor selection Arrowhead: Integrated a brass plumbing business with a brass irrigation business. Consolidated MAS90 ERP system, products, sales force and channels of distribution Nanometrics: Designed and Implemented a global performance management system in 9 countries US Postal: 18 month study of entire supplychain group and processes recommending business process changes and training employees on FAR regulations Control Devices: Consolidated 3 manufacturing plants into one Gloglanian Bakersies: Identified supply chain shortcomings and issues with the integration of two new manufacturing companies who made frozen pizza shells Pankl Aerospace: Executive Chairman leading a company restructuring of a manufacturer of (helicopter shafts) flight safety parts.
Discharge coordination of care process improvements
DISCHARGE COORDINATION OF CARE PROCESS IMPROVEMENT
A Bit About Group50®
Our Mission Is To Be The Only Consulting Partner
Needed by Middle Market Companies
• A fourteen year old consulting company that focuses on delivering industry leading
business results. Our Key Practices include:
• Our Service Areas are supported by experience, skills, 40+ assessments/ workshops and
leading edge software tools
• Headquartered in Los Angeles with over 20 consultants throughout the United States
All former operating executives from world class companies such as GE, Black & Decker,
Procter & Gamble, IBM, Verizon, Accenture, AT&T, Qwest Communications, Boeing,
Rockwell and others
C-Level and Board Members
Consultants who are fluent in over 10 languages
Led or participated in strategic execution projects in business,
healthcare, government and NGO’s
Experienced resources in every functional area
•Strategy and Execution
•Org Design & Development
•Industrial Goods & Services
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 2
Value Stream: In-Patient Flow – Discharge Coordination of Care
Primary: Quality Outcomes, Readmissions
Secondary: Cost, Patient satisfaction, LOS
The current processes and systems to communicate and coordinate patient
flow from ‘decision to discharge” to patient arrival at destination with all
support in place (DME, home health agencies, SNF.. etc) results in less than
ideal communication, coordination, patient satisfaction, family satisfaction
and employee frustration
Design, Document, Implement and Deploy a process to reduce the time from
“Butt in Bed” to “patient departure from unit with all support in place” by 25%.
Complete support will always be in step with the scheduled discharge plans.
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 3
• Establish common understanding of the current state
• Identify key individuals impacting the process
• Med Rec
• Improve communication with patient & family to understand &
come to agreement with the transition plan
• Define timeline for nursing to address ‘discharge written’
• Case management staff notified of “d/c written” within in 30
• Social Work staff coordinates referral to appropriate
community agencies and confirm receipt of information
• Social Work staff identifies DME/other needs for discharge
• Physician will identify anticipated d/c one day in advance
• Patients/Family will be notified of anticipated d/c date based
on physician input
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 4
• Understand opportunities for improvement as identified by:
• DME supplies
• Home Health Agencies
• Ancillary Services
• Case Management
• Care Navigators
• Palliative Care
• Social Work
• Private Educators
• Identify process and parameters for revenue/cost risk resolution
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 5
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 6
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 7
Understanding our Process: Wastes
Ongoing Care Day of
process in first
2 hrs of
and timing of
• Limited and
• No Rx
• Lack of
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 8
Changes and Improvements
• Rounding board pilot on 5th floor for Doctors to communicate
approximate round times for following day.
• Initiate nurse/provider rounding sheet.
• Patient Flow board
• Improved admission packet.
• “Plant the seed” of discharge on admission day to better prepare
• Noted that Pharmacy could be used in education process with
medications to free up Doctor / Nurse time.
• DME supplies identified earlier to allow time to fill “script”.
• Triangle (Social Work, UR, Case Management) better defined and
areas where they can assist.
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 9
Changes and Improvements
• Possible problems with filling scripts captured to prevent
readmission due to meds.
• Idea of “Time Buckets” discussed to allow for better planning on
discharge – used in conjunction with Rounding board.
• Consulting physicians now “sign off” earlier to prevent
numerous phone calls at time of discharge to get approval.
• Non-brand specific Liaison for HHH and Birchaven to capture
more business and assist in lowering readmission rates due to
Changes and Improvements
• Arrange transportation on day before discharge to save time on day of
• Moved more discharge processes to day before discharge to be more proactive
instead of reactive.
• Implement new belongings sheet to assist in preventing loss.
• Making follow up appointments for patients to assist with core measures.
• Located key points where HA can assist nursing with processes to free up more
time for nursing staff.
• Noted key areas for improvement for SNF, Palliative Care, Assisted Living, etc.
• Create and implement discharge planning sheet.
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 11
Changes and Improvements
•Allows for coordination
of the care team pre-
•Creates a smooth
discharge process to the
patient’s post discharge
Consulting physicians sign off for
patient discharge pre-discharge day
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 12
Patient Flow Board
Projecting the expected
patient discharge day
according to DRG &
The patient discharge checklist is to
ensure all required discharge needs
are executed before the patient is
• Visual communication
of the patient discharge
flow that is coordinated
with post discharge care
• Communication of a
patient’s LOS that will be
paid for by Medicare and
all other insurance
companies based on
• Coordination of patient
flow to ensure safe and
efficient patient discharge
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 13
Physician Rounding Board
•Allows RN to coordinate
care for a 12 hour shift
•Facilitates quality care from
Admission to Post Discharge
•Predicts rounding time of
•Smoother flow through
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 14
Metric Baseline AFTER
• 170 min
• Communication about Meds
• Patient Discharge Info
• Time to Discharge Patient
• Patients Discharged Prior to
Post Discharge Care (Medicare)
• Home Health
• 90 min
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 15
• Number of observation patient over 23 hrs.
• Patients admitted to wrong status
• UR Chart review of all patients within 24 hrs. of admission
• # of potential referral/# of total admissions
• # of actual referrals/# of total admissions
• Physician pre-discharge rounding sheet is completed
• patient discharged within 2 hrs. of attending physician
• All paperwork is physician ready before discharge rounding
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 16
• All core measures are completed before patient discharge
• # of calls to the physician on discharge day after discharge
• # of yellow and red boxes on patient flow board with no
• # of red boxes on patient flow board with no discharge
• Admission medication list is done with 60 mins.
• Referral information is all complete and no contact back to
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 17
• Patient BIB
• Ongoing Care
• Discharge – Post
• Social Work
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 18
• Better way to discharge (whole process)
• So excited about it!
• Sometimes I should just shut up!
• Gina is really very shy!
• We are all one team
• Home Health & Hospice, Pallative Care, etc, needs vital
info from beginning for continued care / smooth
• Flow Board has more info than most staff know about.
• Our current process is not effective and will take a lot of
work to improve.
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 19
• Fixing problems in the system is a team effort that is
going to take everyone’s cooperation to be successful.
• Gina is teacher’s pet.
• Creating a team to solve a problem can bring great ideas
and plans together.
• Doctor’s don’t love frequent phone calls as we previously
• Learned about the Social Work / Case Mgr / UR triangle
• Learned what Home Health does vs. Palliative Care
• Vinnie reads lips
• The flow of patient care.
• Our processes are a mess and we lose a lot of $ every
day due to processes
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 20
• We have a lot more work to do……
• Vinnie shaves his head – not really bald!!
• That we don’t have to be silos – we work well as a team.
• Collaboration between Physician / RN can’t be left to
chance – we need to commit to it!
• Critical that discharge starts at the day of admission.
• Criticality of RN / Physician rounding in coordination of
Patient Care / Service Excellence.
• Red is no $$ - Patient Flow Board
• Empowering our unlicensed staff will help facilitate
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 21
Parking Lot - Completed
• Patient life style outside of BVHS?
• Physician prediction of discharge – different on each floor
• When do we have to notify the consulting physicians for
• During the patient care what technique can be use so we
know if the consultation want to be contact at the patient
• is it a hippa violation to share patient information before
they agree to post discharge services
• physician (fox) wants to have everything ready to go day
• Hospitality is viewed differently on different floors
• Pre- discharge checklist, foley cath, IV ATB etc….
• <50% of patient records have ”Plan to discharge
• Day of admission set the expectation for discharge time
• ambulette coordination at discharge
• Best Practice of all medication education, new or old meds
• “Routine” vs. CHF,PN taking meds – detail of medication
list – pharmacy teaching
• screen people in as candidates vs screen out
• adding discharge protocol to hospitality and going over
admission packet by hospitality
• Add to nurses order “pharmacy consult”
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 22
Parking Lot - Open
• What can we anticipate based on patient diagnosis?
• Pre-authorizations from insurance companies?
• hard to find the time of death for the physicians (death and dying arrangement screen)
• Code 44 for next PI Event, decision to admit
• Medication administration time
• who is the nurse to discharge the patient and think about who is admitting them, who
knows their case the best
• charge capture process on the floor
• ED discharge to SNF – specifically Med Rec
• Computers that don’t work on the floors
• directing medication prescription to outpatient pharmacy
• Nurse to Patient Ratio
• staffing model balance
• Bridge palliative care how do we explain non branded information on HH
• What is the relationship between interdisciplanary rounds and coding?
• Observation unit or rooms dedicated to observation patients
• Computers on the nursing floors do not function properly
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 23
Group50 Contact Information
VINCENT “VINNIE” POLITO is Group50’s Healthcare Practice leader has over thirty years of experience
as an executive and executive consultant in the design and delivery of Lean, Lean Transformation and
operational Excellence in the Healthcare, Medical Device, Industrial Manufacturing, Aerospace,
Textile and Oil and Gas industries. He has held senior management roles in operations, materials,
quality, and business det.
Vinnie has pioneered Lean in Healthcare. At the forefront of Lean in Healthcare since 2003 he has provided guidance to
over 100 hospitals, physician/specialty practices, insurance health plans and home health systems in North America. He
has a grasp and appreciates of the mission and complexity of Healthcare. He translates Lean principles and techniques
into effective delivery strategies and execution specifically meeting the critical needs and culture of Healthcare. Some his
more notable Healthcare clients include, Thedacare, Denver Health, Beth Israel Deaconess, Barnes Jewish, New York
Health and Hospitals, and Priority Health. His Lean support of Healthcare has included initiatives for non-clinical
organizations including the Institute of Medicine (IOM), the Institute for Healthcare Improvement (IHI) and National
Quality Forum (NQF).
Vinnie has led and executed Lean transformation in a diverse range of industries such with a client list of Fortune 500
organizations including Boeing, Alcoa, Lockheed Martin, Rockwell-Collins, Duracell, Owens-Corning, Sandia Labs and
Group50 Consulting All Rights Reserved 2017 (909) 949-9083 Slide 24