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Performance improvement through mobile devices


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How to use mobile devices to transform businesses that use mobile teams?

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Performance improvement through mobile devices

  1. 1. Performance improvement in the mobile age Sawad Thotathil MD Care Coordinates MA, USA
  2. 2. Organizational complexity Organizations and systems become complex over time 3 types of complexity are endemic in healthcare or human services organizations 1. Structural complexity 2. Mission creep 3. Processes complexity Complexity is costly
  3. 3. Current approaches to tackling Cost and Quality issues Restructuring System or process improvement Reducing or limiting service offerings We believe that Mobile devices and applications provide a new approach to performance improvement
  4. 4. How can mobile apps help a human services organization? Mobile devices have become cognitive prosthesis Mobile connect knowledge workers Businesses can use this additional capability to embed continuous improvement in the system and power innovation How? 1. Data collection at point of service is seamless and can be rapidly reconfigured to accommodate changes in the environment 2. Employee can access data, information and metrics that help make informed decisions while performing tasks or making judgments 3. Employees can be connected to each other to enable knowledge sharing as well as easier group decision making
  5. 5. Common hurdles to improvement Other than cultural impediments, the 2 tactical hurdles to change are 1. Difficulty in quickly deploying and field testing redesigned processes 2. Rigid information structures that prevent iterative improvement Mobile devices can be used to overcome these hurdles as well as promote a new type of culture where performance is transparent and information/knowledge sharing is the norm
  6. 6. How do Apps help business mangers? Platforms such as Salesforce allow managers to 1. Focus on the business problem 2. Test out solutions without fear of a costly failure 3. Not be constrained by the possibilities predetermined by a software designer 4. Embed continuous improvement
  7. 7. Implementing Improvement Owning the change During App design a) Teams can map out processes and workflows that help achieve team objectives and company goals b) Obtain group consensus on performance metrics that align the company goals with individual work
  8. 8. Implementing Improvement Facilitating adoption a) Incremental deployment of features and functions b) Data streams start working immediately thereby allowing testing of all strategic or operational hypothesis c) Feedback is used for easy redesign when necessary
  9. 9. Current App scenario Most organizations face the App Gap – No in-house resources to design and maintain apps External Software developers do not have performance improvement expertise New platforms like Salesforce allow organizations to deliver apps without an in-house IT department.
  10. 10. Case study A Group of physicians and Nurse practitioners near Boston, USA providing care to patients at 18 independent skilled nursing facilities The provider group and the nursing homes are different business entities. Traditional working styles that are dependent on a) paper based information systems b) Coordination of work is dependent on meetings or phone-calls c) Field data collection is very limited thereby hampering improvement efforts
  11. 11. Business strategy Providing high quality physician/nurse practitioner care for patients at multiple skilled nursing facilities What is required to make this happen? Resources - Availability of providers when care is needed Information systems - Record keeping of each visit regarding clinical care and for billing purposes Operations competencies – Seamless coordinated care despite different providers Focus on cost and quality- Discharging appropriately while length of stay remains optimal
  12. 12. Getting to the App
  13. 13. Approaching the business problem     Is the operational structure adequate? What are the Coordination and Collaboration needs? How to use the data? How to use knowledge for repeatability? We try to explain this approach using a case study
  14. 14. Redesigning operations
  15. 15. Requirement 1: Realtime Information systems for managing operations Scenario: Each facility has their own paper and/or electronic method of clinical record keeping. Problem: 1. Provider notes in the patient records from different facilities are not integrated into one system as the facilities are different businesses. Hence they cannot be used in a single system 2. Provider notes for billing are paper based ,non-uniform and erratically prepared. Errors and missing notes are a frequent occurrence. New patient face-sheets, which are also required for the billing process, have to be collated in parallel. The information has to move from provider to corporate and from there to the billing company Solution 1. Encounter information should come directly from point of care 2. Safeguards to prevent errors and missing notes
  16. 16. Design for Req 1 Using imaging to move face-sheets direct from point of care to billing company Point of care electronic submission of encounter information Reducing missing information with mandated fields Billing process is tied to the patient follow up process required in Objective 2
  17. 17. Requirement 2: Provider availability when it is needed where it is needed Scenario– Frequency of visit to a facility based on crude estimation of need. Problem 1. No levelling of daily patient visits by each provider and hence resources stretched on some days. 2. More random visits than planned visits 3. Accurate provider resource planning not possible Solution 1. Force schedule follow up visits. 2. Plan for a certain load of emergent needs every day 3. Level out visits across the weekdays 4. Level out visits across providers
  18. 18. Design for Req 2 Planning a Follow-up visit become a mandated process when completing a patient encounter Automatic creation of follow- up lists Visual tool that helps monitor visit load across the week Central ability to reschedule evenly across weekdays and providers
  19. 19. A providers schedule seen as a week view A provider schedule in a week view
  20. 20. Communicating and aligning workflows Coordination
  21. 21. Coordination needs Scenario: On the go coordination through texting, phone calls, multiple lists (paper and Online) Problem: As the number of facilities, patients and providers increased, it became inefficient and unsafe to continue this way Solution New processed that are needed : Who will see the patient and when? (previously addressed) Knowledge of previous interactions with the patient to be shared other team members Sharing the care ‘thought process’ with the other providers Delegation of tasks between providers Ensuring closing of tasks Sharing specifics on the social/family environment of the patient
  22. 22. How to implement? Each visit information would include a note that makes aware key issues or care ‘pointers’ which are then seen by the follow up provider Task delegation by provider and date Sharing of notes about the family or other specifics on the patient record Notes about the patient directed to a specific providers but available to all providers
  23. 23. You cannot manage what you don’t measure Performance Measurement
  24. 24. Data vacuum Scenario: 1. The only ‘truth’ is the billing information available at long intervals from the billing company 2. No information on clinical metrics or for other business needs Problem Data from the visits is inadequate from clinical perspective There is no standardized data collection
  25. 25. How to implement Improvement? Data collection and the dashboard are on the same system The dashboard, report generation and data collection can be easily redesigned as new business questions or problems arise Ex: How many patient encounters related to treating cellulitis among other problems? How broad is the problem that new interventions need to be incorporated?
  26. 26. New Business question Regular operational info
  27. 27. Getting it right every time, everywhere Knowledge management
  28. 28. Repeatable service quality through utilization of explicit knowledge Explicit knowledge is knowledge that can be codified into protocols and algorithm Scenario: Knowledge sharing was currently through training sessions in the monthly staff meetings Problem: The protocols are not accessible at the point of service Ex: Best practice in Antibiotic selection
  29. 29. How is this achieved? Protocols and algorithms for areas of concern are created or obtained from expert sources This is made available on the mobile app in a searchable format Example of a treatment guideline on next slide
  30. 30. Performance improvement in the mobile age Where can you apply this approach? 1. Mobile teams in healthcare 2. Field work such as social workers, service teams 3. Wherever Plan-do-study-act cycles need to be deployed quickly 4. Other environments where there are opportunities to expedite data collection or decision making using tablets or smartphone use
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