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Creating a Culture of Excellence at USF Women's

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Creating a Culture of Excellence at USF Women's

  1. 1. Creating a Culture of Excellence at USF Women’s Health WCBF Lean Six Sigma Healthcare Summit May 2011 Louis C. Rhodes
  2. 2. <ul><li>Purpose: Introduce USF Women’s Health and its journey of transformation over the past 5 years </li></ul><ul><li>Learning objectives: </li></ul><ul><li>Identify cultural elements that support transformative efforts </li></ul><ul><li>Describe application of Lean Six Sigma techniques across various opportunities </li></ul><ul><li>Select actions to improve cultural acceptance of transformation </li></ul>Purpose and Learning Objectives
  3. 3. <ul><li>Why does Lean Six Sigma work in some organizations and not in others? </li></ul><ul><li>How does cultural acceptance and the ability of an organization to embrace change affect success or failure? </li></ul><ul><li>How do you develop a continuous process improvement culture? </li></ul><ul><li>What organizational change and development tools can be utilized to overcome barriers and resistance to change? </li></ul>Key Questions/Issues
  4. 4. <ul><li>Administrator, New York University (Department of Obstetrics and Gynecology) </li></ul><ul><li>Graduate of United States Military Academy (BS Management – Engineering) and Xavier University (MBA) </li></ul><ul><li>General Electric Certified Black Belt and Master Black Belt in Six Sigma and Lean </li></ul><ul><li>Eleven years experience in Six Sigma, Lean, and Change Management roles: </li></ul><ul><ul><li>Two years chemical industry (Millennium Chemicals) </li></ul></ul><ul><ul><li>Four years in healthcare equipment and service delivery (GE Healthcare) </li></ul></ul><ul><ul><li>Five years academic healthcare (USF Health and NYU School of Medicine) </li></ul></ul><ul><li>Expertise in curriculum development and skills transfer to clients </li></ul>Lou Rhodes, MBA, MBB
  5. 5. <ul><li>11:15 – 11:45 </li></ul><ul><li>11:45 – 12:15 </li></ul><ul><li>12:15 – 12:45 </li></ul><ul><li>12:45 – 2:00 </li></ul><ul><li>2:00 – 2:15 </li></ul>Agenda Introduction Who will get us there? Where are we headed? How will we get there? Summary and questions
  6. 6. <ul><li>Please introduce yourself including: </li></ul><ul><ul><li>Name </li></ul></ul><ul><ul><li>Position </li></ul></ul><ul><li>As a group, describe expectations for this session. </li></ul>Introductions and Expectations
  7. 7. <ul><li>Housekeeping: </li></ul><ul><ul><li>Restrooms </li></ul></ul><ul><ul><li>Safety </li></ul></ul><ul><li>Ground rules: </li></ul><ul><ul><li>Informal environment </li></ul></ul><ul><ul><li>Interactive exercises </li></ul></ul><ul><ul><li>Break individually as needed </li></ul></ul><ul><ul><li>Maintain speed </li></ul></ul><ul><ul><li>Limit cell phone use </li></ul></ul><ul><ul><li>Anything else? </li></ul></ul>Housekeeping and Ground Rules
  8. 8. <ul><li>“ What does culture mean to you?” </li></ul>Exercise: Defining Culture <ul><ul><li>Corporate culture: A blend of the values, beliefs, taboos, symbols, rituals and myths all companies develop over time* </li></ul></ul><ul><ul><li>The way people think </li></ul></ul><ul><ul><li>Actions and beliefs </li></ul></ul><ul><ul><li>Acceptance and non-acceptance of performance </li></ul></ul>* - From Entrepreneur.com What cultural challenges do you experience?
  9. 9. Cultural Transformation <ul><li>Current Culture </li></ul>Desired Culture Time and Effort You are here! Gap How do we close the gap?
  10. 10. <ul><li>Path : Operational management and improvement </li></ul>Elements of Cultural Transformation People : Leadership and change management Plan : Strategy development and execution Where do Lean Six Sigma experts fit in?
  11. 11. Background of USF Women’s Health
  12. 12. <ul><li>No state income tax </li></ul><ul><li>Reliance on real estate development as primary industry and real estate taxes for primary source of revenue </li></ul><ul><li>State university system reliant on public funds </li></ul><ul><li>State tuition levels held at very low levels </li></ul><ul><li>Continued pressure on reimbursement rates and payer mix </li></ul>Florida Government and Educational Environment
  13. 13. <ul><li>Mission: To improve life by improving health through partnership, research, education and healthcare </li></ul><ul><li>3,500 team members of educators, staff, physicians, researchers </li></ul><ul><li>Over 420 physicians, 135 allied health, and 70 nurse practitioners </li></ul><ul><li>2 new out-patient buildings with imaging and an ambulatory surgery center </li></ul><ul><li>500,000 outpatient visits </li></ul><ul><li>33% of Best Doctors in Tampa Bay </li></ul><ul><li>$350 million enterprise </li></ul><ul><li>No university hospital </li></ul>USF Health Overview
  14. 14. <ul><li>40 – 50 faculty (physicians) </li></ul><ul><li>60 – 80 staff (managers, nurses, medical assistants, administrative assistants) </li></ul><ul><li>Multiple practice locations and commitments: </li></ul><ul><ul><li>2 out-patient offices </li></ul></ul><ul><ul><li>5 out-patient clinics </li></ul></ul><ul><ul><li>Labor and delivery coverage (24/7) </li></ul></ul><ul><ul><li>Residency coverage </li></ul></ul><ul><li>~14,000 out-patient visits and 4,000 deliveries (2005) </li></ul><ul><li>Full OB/GYN service availability and access to other specialties </li></ul><ul><li>Limited focus on efficiencies, service, or brand image </li></ul>Department of Obstetrics and Gynecology (USF Women’s Health)
  15. 15. People: Leadership and Change Management
  16. 16. <ul><li>Focus on clinical training in medical and nursing schools </li></ul><ul><li>Progression from clinical to leader responsibilities </li></ul><ul><li>Growing complexity and integration of healthcare system </li></ul><ul><li>Recognition of need for: </li></ul><ul><ul><li>Leadership skills </li></ul></ul><ul><ul><li>Emotional intelligence </li></ul></ul><ul><ul><li>Business skills </li></ul></ul><ul><ul><li>Professionalism </li></ul></ul>The Need for Leadership in Medicine
  17. 17. Leadership Institute at USF <ul><li>Top talent </li></ul><ul><li>Progression planning </li></ul><ul><li>Selection process </li></ul><ul><li>Tailored classes </li></ul><ul><li>Personality evaluations </li></ul><ul><li>Mentoring </li></ul><ul><li>Team-based system level projects </li></ul><ul><li>Better leaders </li></ul><ul><li>Bench strength </li></ul><ul><li>Project delivery </li></ul>
  18. 18. <ul><li>Classes: </li></ul><ul><ul><li>Creating high performance teams </li></ul></ul><ul><ul><li>Communication and influence </li></ul></ul><ul><ul><li>Conflict management </li></ul></ul><ul><ul><li>Effective coaching and counseling </li></ul></ul><ul><ul><li>Strategy mapping </li></ul></ul><ul><ul><li>Financial acumen </li></ul></ul><ul><ul><li>Effective problem solving </li></ul></ul><ul><ul><li>Systems thinking </li></ul></ul><ul><ul><li>Streamlining flow </li></ul></ul>Content <ul><li>Evaluation: </li></ul><ul><ul><li>Myers-Briggs testing </li></ul></ul><ul><ul><li>Learning connection inventory </li></ul></ul><ul><li>Team based project: </li></ul><ul><ul><li>University level project </li></ul></ul><ul><ul><li>Diverse team </li></ul></ul><ul><ul><li>Operational mechanisms to manage and monitor delivery </li></ul></ul><ul><li>Mentoring: </li></ul><ul><ul><li>Personal mentor </li></ul></ul><ul><ul><li>Project mentor </li></ul></ul>
  19. 19. <ul><li>~80 Graduates: </li></ul><ul><ul><li>Promoted to Chairs, Assistant Deans, and Associate Deans </li></ul></ul><ul><ul><li>Improved leadership skill sets </li></ul></ul><ul><ul><li>Increased knowledge of university and associated systems </li></ul></ul><ul><li>Delivered high impact projects in the areas of: </li></ul><ul><ul><li>Customer service improvement </li></ul></ul><ul><ul><li>New service launches </li></ul></ul><ul><ul><li>Throughput improvement </li></ul></ul><ul><ul><li>Faculty mentoring </li></ul></ul>Impact <ul><li>USF Women’s Health: </li></ul><ul><ul><li>5 graduates </li></ul></ul><ul><ul><li>Interim Chair, Chief Medical Information Officer, Assistant Dean </li></ul></ul><ul><ul><li>Successful practices </li></ul></ul>
  20. 20. Change Management <ul><li>Q x A = E </li></ul><ul><li>Quality of the Solution times Acceptance of the Solution equals Effectiveness of the Solution </li></ul><ul><li>Recognition of the need for treating change as a system and process </li></ul><ul><li>Employment of tools and approaches to understand motivations </li></ul><ul><li>Development of strategies to increase support for initiatives </li></ul>
  21. 21. <ul><li>Opening people’s minds to change </li></ul>Setting the Vision Mobilizing Commitment Sustaining Improvement Creating the Need Monitoring Progress Unfreezing Stage Change Stage Refreezing Stage <ul><li>Stating the “good” that will be </li></ul><ul><li>Bringing people along </li></ul><ul><li>Eliminating slippage </li></ul><ul><li>Confirming delivery of the “good” </li></ul>Foundation: Leadership and Reinforcing Systems Change as a Process
  22. 22. Exercise: What do physicians want? Not want? <ul><li>Respect </li></ul><ul><li>Information </li></ul><ul><li>Input on decisions </li></ul><ul><li>Things-that-work </li></ul><ul><li>Incentives </li></ul><ul><li>Presence </li></ul><ul><li>Inefficiency </li></ul><ul><li>Time wasters </li></ul><ul><li>“ Small-mindedness” </li></ul><ul><li>Bureaucracy </li></ul>Want Not-Want
  23. 23. <ul><li>Alignment of goals and incentives: </li></ul><ul><ul><li>Tie of pay to financial performance of the practice </li></ul></ul><ul><li>Transparency: </li></ul><ul><ul><li>Established metrics </li></ul></ul><ul><ul><li>Department reports </li></ul></ul><ul><ul><li>Individual reports </li></ul></ul><ul><li>Additive interactions with physicians and staff </li></ul><ul><li>On-site availability and regular communication </li></ul><ul><li>“ Speaking their language” </li></ul><ul><li>Participation on initiatives and projects </li></ul>Change Management at USF Women’s Health
  24. 24. Plan: Strategy Development and Execution
  25. 25. Strategy Cycle Environment Filter Metrics Initiative Initiative Analyze Define Align Launch Manage Monitor Strategy Team Deliver Communicate Develop Implement Initiate Opportunity Opportunity Opportunity Resources
  26. 26. STAKEHOLDERS Who can help or hinder us ENVIRONMENT Where have we been What is around us Who do we serve MISSION Why we exist VALUES What’s important to us VISION What we want to be MARKET DIFFERENTIATORS What makes us different STRATEGIC OBJECTIVES Our game plan KEY PERFORMANCE INDICATORS How do we know we have gotten there DESIRED STRATEGIC OUTCOMES STRATEGIC INITIATIVES What we need to do ACTION PLAN Our specific task plan Abstract Concrete Strategy Development
  27. 27. Exercise: Threats vs. Opportunities <ul><li>Reduced funding for university </li></ul><ul><li>Continued reductions in reimbursement </li></ul><ul><li>University bureaucracy and slow speed of decision-making </li></ul><ul><li>Loss of talent </li></ul><ul><li>Leverage multi-practice availability </li></ul><ul><li>Increase transparency on performance </li></ul><ul><li>Manage brand image </li></ul><ul><li>Increase operational efficiency </li></ul><ul><li>Improve service delivery </li></ul>Threats Opportunities
  28. 28. Customers and Needs Customers What are their needs? What do we give them? Need to give them? High Risk Patient to Low risk patients <ul><li>Quality of Life </li></ul><ul><li>Health </li></ul><ul><li>Healthy Babies </li></ul><ul><li>The best most comprehensive care </li></ul>Disadvantaged Payers <ul><li>Compassion </li></ul><ul><li>The best care: Quality of Life, Health, Healthy Babies </li></ul><ul><li>We are “IT” in town </li></ul><ul><li>The best most comprehensive care </li></ul>Referring Physicians <ul><li>Efficient quality care </li></ul><ul><li>Follow through </li></ul><ul><li>Expertise - experiences </li></ul><ul><li>Continuum of subspecialty care </li></ul><ul><li>Experts </li></ul><ul><li>Quality </li></ul><ul><li>Efficiency? Fast turn around? </li></ul>Medical Students/ Residents/ Fellows <ul><li>Continuum of care/learning – From high to low risk </li></ul><ul><li>The best most comprehensive care </li></ul><ul><li>Experts - the best trainers </li></ul><ul><li>Exposure to continuum of care </li></ul><ul><li>Cutting Edge </li></ul>Donors <ul><li>Meaning </li></ul><ul><li>Individual care </li></ul><ul><li>Affiliation with Winners </li></ul><ul><li>Make a difference </li></ul><ul><li>1 st in outcomes, innovation, and care </li></ul><ul><li>Being winners </li></ul><ul><li>Experts </li></ul><ul><li>The best trainers and providers </li></ul><ul><li>Cutting Edge </li></ul>
  29. 29. <ul><li>Provide local, national and international leadership in women’s healthcare, education, and research </li></ul><ul><li>Deliver comprehensive, full spectrum healthcare services to women in a friendly, efficient, timely, effective, and compassionate environment </li></ul><ul><li>Graduate leaders from our residency, fellowship, and faculty programs </li></ul>Mission and Vision <ul><li>In 2015, an article is written about USF Health OB/GYN including the following points: </li></ul><ul><li>Top 10 programs ranked in U.S. News and World Report </li></ul><ul><li>Top 20 NIH funded programs </li></ul><ul><li>Delivering cutting edge comprehensive women’s healthcare services </li></ul><ul><li>Leading the way in friendly, timely, effective, efficient, and profitable care </li></ul><ul><li>Leading outcomes in state </li></ul>
  30. 30. Recognized Leaders in Clinical Care Efficiency and Customer Service Excellence <ul><li>Cutting Edge </li></ul><ul><li>1st in New Procedures </li></ul><ul><li>1st in Discovery </li></ul><ul><li>1st in Efficiency </li></ul><ul><li>Comprehensive care </li></ul><ul><li>Profitability </li></ul><ul><li>Entrepreneurial Academic Model </li></ul><ul><li>Cost Efficiency </li></ul><ul><li>Recognized Leaders in Clinical Care: </li></ul><ul><ul><li>Comprehensive services </li></ul></ul><ul><ul><li>Leading outcomes in state </li></ul></ul><ul><li>Cutting Edge: </li></ul><ul><ul><li>University – Innovation – cutting edge </li></ul></ul><ul><ul><li>Leadership  being 1 st </li></ul></ul><ul><ul><li>1 st Outcome </li></ul></ul><ul><ul><li>Process Engineering </li></ul></ul><ul><li>Efficiency & Customer Service Excellence : </li></ul><ul><ul><li>Customer satisfaction (Patient, Referring Physician) </li></ul></ul><ul><ul><li>Responsiveness and communication </li></ul></ul><ul><ul><li>Thank you – confirmation </li></ul></ul><ul><ul><li>Attention to details </li></ul></ul><ul><ul><li>“ Flawless execution” </li></ul></ul><ul><ul><li>“ Service recovery” </li></ul></ul><ul><ul><li>Leadership  being 1 st </li></ul></ul><ul><li>Entrepreneurial: </li></ul><ul><ul><li>In-house Management (Creativity) </li></ul></ul>Strategic Objectives
  31. 31. Branding Scheduling Service Strategic Initiative Timing Strategic Objectives Short Term FY2009 Initiatives Mid Term FY2010 Initiatives Long Term Initiatives Recognized Leaders in Clinical Care <ul><li>Increase marketing efforts </li></ul><ul><li>Publish outcome metrics </li></ul>Cutting Edge <ul><li>Grow Ultrasound Services </li></ul><ul><li>Leverage EHR </li></ul><ul><li>Improve Research processes </li></ul>Efficiency and Customer Service <ul><li>Improve internal referrals </li></ul><ul><li>Improve service levels </li></ul><ul><li>Improve scheduling/call system </li></ul><ul><li>Improve referring MD communication </li></ul>Profitability <ul><li>Improve charging </li></ul><ul><li>Improve coding </li></ul><ul><li>Increase rates of reimbursement </li></ul><ul><li>Create extra sources of revenue </li></ul>
  32. 32. Operating Mechanisms Event Participants Review Items Timing Faculty Meeting <ul><li>Faculty, Leaders </li></ul><ul><li>Strategic Initiative Report </li></ul><ul><li>Quarterly (some metrics reported on a semi-annual basis) </li></ul>Individual Meetings <ul><li>Faculty, Leaders </li></ul><ul><li>Profit and Loss Review </li></ul><ul><li>Semi-Annual </li></ul>Department Celebration <ul><li>Faculty, Leaders </li></ul><ul><li>Accomplishment Review </li></ul><ul><li>Annual </li></ul>
  33. 33. Path: Operational Management and Improvement
  34. 34. Initiative Focus <ul><li>Initiatives at USF Women’s Health: </li></ul><ul><ul><li>Improve Generalist scheduling </li></ul></ul><ul><ul><li>Brand USF Women’s Health </li></ul></ul><ul><ul><li>Launch STEP ( Strive to Excel Program ) Team </li></ul></ul>Outcomes Service Excellence Cost (or Profitability
  35. 35. Revenue Business Levers: Clinical Operations Profitability = Revenue – Cost Revenue = Direct Patient Revenue + Contracts + Research + Grants Direct Patient Revenue = (Clinical Charges + Professional Charges) * Collection Rate <ul><li>Increase collection rate </li></ul><ul><li>Improve payer mix </li></ul><ul><li>Increase reimbursement rate </li></ul>Clinical Charges = Appt./Session * Sessions * $’s/Appointment * Appt. Fill Rate <ul><li>Increase sessions </li></ul><ul><li>Improve service mix </li></ul><ul><li>Increase billing accuracy </li></ul><ul><li>Increase procedure conversion rate </li></ul><ul><li>Improve scheduling </li></ul><ul><li>Reduce no-shows </li></ul><ul><li>Improve referrals </li></ul><ul><li>Promote practice </li></ul>Appt./Session = Session Length / Time/Appt. <ul><li>Utilize all available hours </li></ul><ul><li>Extend hours </li></ul><ul><li>Eliminate constraints </li></ul><ul><li>Adjust practice </li></ul><ul><li>Increase appts. per session </li></ul><ul><li>Set minimum quantity </li></ul><ul><li>Increase outreach to service consumers </li></ul><ul><li>Increase development efforts </li></ul><ul><li>Increase outreach to research consumers </li></ul><ul><li>Increase conversion to procedures </li></ul>
  36. 36. Cost Business Levers: Clinical Operations Profitability = Revenue – Cost Cost = Salary and Benefits + Room Charge + Equipment Cost + Supplies Salary and Benefits = Physician S&B + Clinical Staff S&B + Admin Staff S&B <ul><li>Maximize efficient use </li></ul><ul><li>Maximize efficient use </li></ul><ul><li>Eliminate obsolete supplies </li></ul><ul><li>Maximize efficient use </li></ul><ul><li>Eliminate unused equipment/contracts </li></ul><ul><li>Concentrate on revenue support </li></ul><ul><li>Reduce wasted activities </li></ul><ul><li>Leave empty positions unfilled </li></ul><ul><li>Reduce positions </li></ul><ul><li>Reduce wasted activities </li></ul><ul><li>Leave empty positions unfilled </li></ul><ul><li>Reduce positions </li></ul><ul><li>Other salary and benefit actions: </li></ul><ul><li>Freeze salary increases </li></ul><ul><li>Reduce salary levels </li></ul><ul><li>Reduce benefits </li></ul><ul><li>Maximize revenue production </li></ul><ul><li>Reduce wasted activities </li></ul><ul><li>Leave empty positions unfilled </li></ul><ul><li>Reduce positions </li></ul>
  37. 37. Purpose and Relevance: Generalist Scheduling <ul><li>Purpose: To review the process for assigning OB/GYN Providers to service areas </li></ul><ul><li>Relevance: Based on analysis, there are opportunities to: </li></ul><ul><ul><li>Reduce Patient bumps </li></ul></ul><ul><ul><li>Level Provider demand on clinic resources </li></ul></ul><ul><ul><li>Increase visibility and availability of additional slots for Providers </li></ul></ul><ul><ul><li>Decrease rework in clinical operations and systems support </li></ul></ul>
  38. 38. <ul><li>Highly complex process subject to failure </li></ul><ul><li>Decentralized Provider scheduling leading to sub-optimization </li></ul>Measure: Scheduling Process Map Dr. Lynch requests scheduling issues from Faculty IDX prints bump list Faculty calls Dr. Lynch with scheduling issues Provider profile of available days Dr. Lynch identifies/ reviews contractual commitments Dr. Lynch develops Generalist grid (providers and schedule) Systems Support reviews grid and programs IDX Scheduler schedules appointments in IDX Systems Support flips/reschedules appointments Patients overload system or Providers receive limited support Limited pool Restrictive templates Limited responses Clinic de-prioritized Precedes availability Patient Waiting Last minute requirements Clinic de-prioritized Failure Points Nurse Midwife Lead develops CNM grid (providers and schedule) Multiple Grid routes
  39. 39. Analyze: Appointment Availability and Continuity Causes Process People Machine Environment Metrics Materials Appointment Availability & Continuity Individual Provider approaches to mitigating bumps Late clinic cancellations Minimal scheduling protocols (acuity) No protected time for acute appointments Limited guidelines on Provider availability Unclear Provider selection by appointment type Bumps placed as overloads Multiple routes for Provider scheduling Multiple scheduling algorithms Half-day clinic schedules at multiple sites Individualized Provider profiles Decentralization of scheduling function Multiple locations of service Multiple service types (L&D, call, clinic) Room availability Staff availability Provider Availability High demand on Providers Multiple Mission requirements Clinic de-prioritization Patient description of complaint Scheduler identification of acuity No penalty for poor service Complex Provider scheduling process requires multiple rework cycles and last minute coordination Provider controls own availability Shortage of Providers to Demand Cascading failure: Clinic cancellations lead to bumps lead to overloads lead to lengthy waits and reschedules Varying process routes result in confusion and Provider dissatisfaction
  40. 40. Analyze: Arrival* Analysis <ul><li>1800 – 2500 arrivals per month </li></ul><ul><li>Relatively stable arrivals </li></ul><ul><li>Some potential increases (among GYN practices) </li></ul><ul><li>70 – 83% arrivals/scheduled </li></ul><ul><li>Bumps: 3 – 9% </li></ul><ul><li>Same Day Cancels: 6 – 11% </li></ul><ul><li>No-Shows: 6 – 7% </li></ul>Arrivals Arrivals/Scheduled * - Arrival = Scheduled – (Bumps + Same Day Cancels + No Shows) Data: Clinical Monthly Report (8/06 – 3/07)
  41. 41. Analyze: Provider Schedule <ul><li>5 overloaded clinic spaces (<2 Rooms/ Provider) </li></ul><ul><li>Multiple open spaces: </li></ul><ul><ul><li>Primarily Wednesday mornings (Grand Rounds) </li></ul></ul><ul><ul><li>Scattered throughout rest of week (except Tuesdays) </li></ul></ul><ul><li>Utilization efficiency: </li></ul><ul><ul><li>420 available slots </li></ul></ul><ul><ul><li>254 slots utilized </li></ul></ul><ul><ul><li>60% slot efficiency* </li></ul></ul><ul><ul><li>3.47 rooms/Provider** </li></ul></ul>* - Efficiency based on slot equal to 2 rooms ** - Based on 21 room availability per half- day
  42. 42. Improve: Issues and Resolution <ul><li>Issues: </li></ul><ul><li>Multiple routes for scheduling adjustment into Systems </li></ul><ul><li>Potential sub-optimization within Division </li></ul><ul><li>Allowable last minute changes </li></ul><ul><li>Last minute publication </li></ul><ul><li>Loose controls on clinic adjustment process </li></ul><ul><li>Resolution: </li></ul><ul><li>Single leader (and conduit for information to Scheduling Support) </li></ul><ul><li>Schedule for 3 month period </li></ul><ul><li>Publish two months ahead of schedule start </li></ul><ul><li>Tighten process for clinic adjustments including space and patient considerations </li></ul>
  43. 43. Improve: Simplify Appointment Types <ul><li>Streamlined appointment types (with elimination of redundant types) </li></ul><ul><li>Set reasonable time periods for appointment length </li></ul>
  44. 44. Improve: Standardize Appointment Templates <ul><li>Set standard availability/mix of appointment types and order of appointments </li></ul><ul><li>Leveraged system flexibility to fill appointments </li></ul>
  45. 45. Improve: Level-load Provider Schedules <ul><li>Includes all Providers’ recurrent weekly schedules </li></ul><ul><li>Sums load in each clinical space and outside service demands (except L&D and non-weekly requirements) </li></ul><ul><li>Color-codes availability, overfills, and shortfalls </li></ul>Provider Names
  46. 46. Improve: Visually Manage Provider Schedules <ul><li>Published greater than 30 days before 1 st day of month </li></ul><ul><li>Clearly identifies assignments for each Provider using standard naming conventions </li></ul>Provider Names
  47. 47. Control: Daily Arrivals Baseline and Improved States* <ul><li>Stage 1 (HMT/17D): </li></ul><ul><li>Avg: 112.2 </li></ul><ul><li>Std Dev: 22.7 </li></ul><ul><li>Stage 2 (STC): </li></ul><ul><li>Avg: 111.1 </li></ul><ul><li>Std Dev: 27.6 </li></ul><ul><li>Stage 3 (Schedule process): </li></ul><ul><li>Avg: 127.5 </li></ul><ul><li>Std Dev: 14.5 </li></ul>* - Weekday arrivals, not including Wednesdays (7/2/07 – 10/9/07); n = 57 <ul><li>What’s changed? </li></ul><ul><li>Assignment matrix maximizing space utilization </li></ul><ul><li>New schedule process </li></ul><ul><li>Nurse Manager filling open slots </li></ul>15% increased volume and reduced variation
  48. 48. Control: Benefit Calculation <ul><li>Average RVU’s per generic GYN appointment = 2.97* </li></ul><ul><li>Increase in appointments = 15.3 appointments per day (Base line: 112.2 appt./day; Post-improvement: 127.5 appt./day) </li></ul><ul><li>At $38/RVU x 2.97 RVU’s/appointment x 15.3 appointments/day x 200 work days per year (excludes Wednesdays) = $345K annual benefit </li></ul><ul><li>Does not include added cost to service or downstream revenue (from procedures) </li></ul>* - GYN arrivals at HMT 450 (7/3/06 – 6/29/07); n = 4482
  49. 49. Exercise: Broader Application <ul><li>Optimize physician group office schedule </li></ul><ul><li>Improve assignment of OR block times </li></ul><ul><li>Integrate multiple scheduling processes </li></ul>Using these approaches, what broader potential applications exist within healthcare?
  50. 50. <ul><li>Purpose: To develop a brand for USF Women’s Health and put it into operation </li></ul><ul><li>Relevance: Taking control of and improving the brand will increase and improve the image of USF Women’s Health within the community leading to increased support, service delivery, and revenues. </li></ul>Purpose and Relevance: USF Women’s Health Branding
  51. 51. <ul><li>Who do we need to reach? </li></ul>Branding Design Process Identify audience Develop audience interests Specify intended actions Develop message Identify media Specify routing <ul><li>What is important to them? </li></ul><ul><li>What do they want that is difficult to get? </li></ul><ul><li>What do we want them to do? </li></ul><ul><li>What is it they need to hear? </li></ul><ul><li>What will lead them to act? </li></ul><ul><li>What is the message format? </li></ul><ul><li>Where do we place our message? </li></ul><ul><li>Patients </li></ul><ul><li>“ Give me good care.” </li></ul><ul><li>“ Don’t waste my time.” </li></ul><ul><li>“ Spend time with me and listen to me.” </li></ul><ul><li>Schedule for own and families’ care </li></ul><ul><li>Broaden use of services </li></ul><ul><li>Tell others about positive experiences </li></ul><ul><li>Wide-range of services </li></ul><ul><li>Top of the line care-givers </li></ul><ul><li>Service-oriented care </li></ul><ul><li>Brochure </li></ul><ul><li>Placement in USF Health clinics </li></ul><ul><li>Placement in partner locations </li></ul><ul><li>Other customers: </li></ul><ul><li>Donors </li></ul><ul><li>Referring Physicians </li></ul><ul><li>Students </li></ul><ul><li>Other media: </li></ul><ul><li>Posters </li></ul><ul><li>Mailers </li></ul><ul><li>Calendar of events </li></ul>
  52. 52. Design: Promotional Materials
  53. 53. <ul><li>June 2009: </li></ul><ul><li>Issue: Long lines at front desk </li></ul><ul><li>Resolution: Additional check-in station and person, system for back-up support </li></ul>Improve: Operational Actions <ul><li>October 2009: </li></ul><ul><li>Issue: Poor access </li></ul><ul><li>Resolution: Increased support for clinical messaging, adjusted lunch breaks, launched MS Office Communicator, instituted nurse training of schedulers </li></ul>Patient Comment Cards Patient Comment Cards
  54. 54. Improve: Service Line Development <ul><li>Brings together: </li></ul><ul><ul><li>Maternal Fetal Medicine </li></ul></ul><ul><ul><li>Neonatology </li></ul></ul><ul><ul><li>Pediatric Surgery </li></ul></ul><ul><li>Seamless service delivery through Nurse Coordinator </li></ul><ul><li>Multi-disciplinary case evaluation </li></ul><ul><li>Supported through regular outreach and communication </li></ul>
  55. 55. Improve: Design Principles and Realization <ul><li>Design Principle </li></ul><ul><li>Seamless movement among services </li></ul><ul><li>Delivery of all services to target specifications reflective of needs of customers (referring physicians, patients) </li></ul><ul><li>Clear communication among various services </li></ul><ul><li>One stop shopping </li></ul><ul><li>Realization </li></ul><ul><li>Patient navigator supports ease of movement; No reintroduction to central scheduling after entry </li></ul><ul><li>Established and adhered to service standards including cycle times and quality </li></ul><ul><li>Operational mechanism of weekly multi-disciplinary meeting; Care plan development and management; PRN emergency meeting </li></ul><ul><li>Bundled service delivery; Completed follow-on service coordination and education during single visit; “Care to Patient” service model </li></ul>
  56. 56. Improve: Appointment Tiers <ul><li>First Tier </li></ul><ul><li>Ultrasound </li></ul><ul><li>MFM </li></ul><ul><li>Neonatology </li></ul><ul><li>Tour of NICU </li></ul><ul><li>Second Tier </li></ul><ul><li>Pediatric Surgery </li></ul><ul><li>Adult Cardiology </li></ul><ul><li>Pediatric Cardiology </li></ul><ul><li>Additional Adult and Pediatric sub-specialties </li></ul><ul><li>Third Tier </li></ul><ul><li>Anesthesia </li></ul><ul><li>Second tier appointment types may be included in the first tier appointment based upon Patient Navigator determination </li></ul>
  57. 57. Scheduling forwards request to Patient Navigator Scheduling forwards call to Patient Navigator Physician/ CNM refers Patient to MFM Physician/ CNM office calls Patient Navigator Patient Navigator receives request and initiates/ updates medical record Patient Navigator contacts patient Patient calls Scheduling requesting an MFM appt. Patient requests an MFM appt. via USFH website Patient Navigator requests/ receives scans and test results Patient Navigator completes information sheet and schedules appointment(s) 1 week 2 weeks Patient arrives for appointment(s) USFH Physician/ CNM refers Patient to MFM USFH Physician/ CNM completes referral form (“pinkie”) Genesis Physician/ CNM refers Patient to MFM Genesis Nurse coordinates MFM appointment through Patient Navigator Improve: Patient Access Process Map
  58. 58. Exercise: Broader Application <ul><li>Establish organizational brand (promotional and operational aspects) </li></ul><ul><li>Launch service lines (women’s health center, heart health) based on leveraging and coordinating multiple practices </li></ul>Using these approaches, what broader potential applications exist within healthcare?
  59. 59. <ul><li>Purpose: To identify and address customer service issues within USF Women’s Health through a staff and physician driven team </li></ul><ul><li>Relevance: Staff and physicians, through their routine interaction with patients, are well positioned to identify and resolve service issues to increase customer satisfaction. </li></ul>Purpose and Relevance: Launch STEP* Team * - S trive t o E xcel P rogram
  60. 60. Measure: Employee Recognition Program
  61. 61. <ul><li>Poor communication (28%) </li></ul><ul><li>Long Wait Time to See Doctor (19%) </li></ul><ul><li>Front Desk Check-out Process and Lines (28%) </li></ul>Analyze: Patient Complaints* * - STEP Program Patient Comment Cards collected 11/08 (n = 21)
  62. 62. <ul><li>Top issues: </li></ul><ul><li>Excellent Patient service - Behavior (80%) </li></ul>Analyze: Patient Compliments* * - STEP Program Patient Comment Cards collected 11/08 (n = 10) <ul><li>Secondary issues: </li></ul><ul><li>Appointment on-time, Overall nice experience (20%) </li></ul>
  63. 63. Improve: Error Proof Scheduling Location Check screen added to confirm alternative location
  64. 64. Improve: Clinic Status Updates
  65. 65. Exercise: Broader Application <ul><li>Launch employee recognition program </li></ul><ul><li>Set-up service metrics with linked improvement activities </li></ul><ul><li>Initiate service standards </li></ul>Using these approaches, what broader potential applications exist within healthcare?
  66. 66. Impact
  67. 67. Outpatient Volume <ul><li>Increased outpatient visits ~150% over 4 years (’05-’09) with associated revenue* </li></ul><ul><li>Improved schedule regularity and provider satisfaction </li></ul><ul><li>Reduced bumps with associated patient frustration and rework </li></ul>* - Increase in South Providers by 42% (from 19 to 27)
  68. 68. Other Metrics <ul><li>Went from losing $1M per year to making $1M per year </li></ul><ul><ul><li>Easier discussions regarding salary increases, bonuses, and purchases </li></ul></ul><ul><li>Increased patient satisfaction </li></ul><ul><ul><li>Being listened to </li></ul></ul><ul><ul><li>Responding to their issues </li></ul></ul><ul><ul><li>Increased appointment availability </li></ul></ul><ul><ul><li>Better scheduling processes </li></ul></ul><ul><ul><li>Reduced appointment bumps </li></ul></ul><ul><li>Standard brand appearance and improved recognition </li></ul><ul><li>Improved relationships with affiliated hospital and other departments (pediatrics, surgery) </li></ul>
  69. 69. Thank you for your time. Questions?

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