We offer collaborative safety training services including child welfare,health services,systemic critical incident reviews for all Nashville industries.
We offer collaborative safety training services including child welfare,health services,systemic critical incident reviews for all Nashville industries.
There are several reading materials available on the website to help you to learn about Health and Human Services, collaborative models and its working, visit our website
R&I Best Practices to Help Improve Medicare Star RatingsLisa Kuehl
Finding ways to improve or maintain an organization’s Star Rating has become a critical component of every MA Plan’s strategic planning. The use of rewards and incentives programs to drive member engagement is a proven strategy to impact Star Ratings, helping plans to put the focus on closing gaps in care.
Entertainment Rewards & Incentives has worked with dozen of health plans meet or exceed their engagement goals with members to help move the needle on specific HEDIS scores.
rewards.entertainment.com
REPORT: How healthcare systems are optimizing their workforceMichele Ertl-Rosner
Healthcare industry survey and research showcase the most effective workforce management initiatives and key success factors. Features customer success stories focused on patient centered care and staffing.
Public Health Agencies have been primed by the CDC to Strengthen Public Health Infrastructure for Improved Health Outcomes by becoming Enterprise Performance Management focused organizations.
The question many Public Health Officials are asking:“So...how do we do it?”
in order to meet cost reduction targets, CMOs
* Share patient data across ecosystems
* Embed shared organizational intelligence
* Establish guidance for quality & cost within physician workflows
* Prepare physician leaders to create a culture of continual improvement
Avoid PRM failures by avoiding ensuring it's not simply a repository for documenting simple tasks. PRM failures occur when the IT solutions only serves to document activities instead of serving to streamline the physician experience.
Patient management encompasses oversight of all functions related to the admission/registration processes for new and returning patients. The importance of effective front and back-end management cannot be undervalued, as one mistake in patient access services may result in a patient safety issue, a legal issue, a customer service issue, a patient billing issue, or a revenue issue for the facility.
In an article for Healthcare Executive, Don Seymour, Kevin Talbot, and Chad Stutelberg share their insight on developing compensation strategies that link executive and physician compensation models to acute care outcome-based payment methodologies.
There are several reading materials available on the website to help you to learn about Health and Human Services, collaborative models and its working, visit our website
R&I Best Practices to Help Improve Medicare Star RatingsLisa Kuehl
Finding ways to improve or maintain an organization’s Star Rating has become a critical component of every MA Plan’s strategic planning. The use of rewards and incentives programs to drive member engagement is a proven strategy to impact Star Ratings, helping plans to put the focus on closing gaps in care.
Entertainment Rewards & Incentives has worked with dozen of health plans meet or exceed their engagement goals with members to help move the needle on specific HEDIS scores.
rewards.entertainment.com
REPORT: How healthcare systems are optimizing their workforceMichele Ertl-Rosner
Healthcare industry survey and research showcase the most effective workforce management initiatives and key success factors. Features customer success stories focused on patient centered care and staffing.
Public Health Agencies have been primed by the CDC to Strengthen Public Health Infrastructure for Improved Health Outcomes by becoming Enterprise Performance Management focused organizations.
The question many Public Health Officials are asking:“So...how do we do it?”
in order to meet cost reduction targets, CMOs
* Share patient data across ecosystems
* Embed shared organizational intelligence
* Establish guidance for quality & cost within physician workflows
* Prepare physician leaders to create a culture of continual improvement
Avoid PRM failures by avoiding ensuring it's not simply a repository for documenting simple tasks. PRM failures occur when the IT solutions only serves to document activities instead of serving to streamline the physician experience.
Patient management encompasses oversight of all functions related to the admission/registration processes for new and returning patients. The importance of effective front and back-end management cannot be undervalued, as one mistake in patient access services may result in a patient safety issue, a legal issue, a customer service issue, a patient billing issue, or a revenue issue for the facility.
In an article for Healthcare Executive, Don Seymour, Kevin Talbot, and Chad Stutelberg share their insight on developing compensation strategies that link executive and physician compensation models to acute care outcome-based payment methodologies.
M Heenan_PhD Dissertation Lecture_eHealth Lecture_Engaging Leaders in KPI Sel...Mike Heenan
Presentation of the proliferation of measurement in health care and how organizations should redesign indicator selection processes to engage and motivate managers to improve performance. Presentation to eHealth students based on 2023 PhD dissertation.
• Performance management overview and relevance to public health
• Turning Point Performance Management System Framework overview
• Turning Point Performance Management System Framework 2012 refresh
• Tools to help your organization assess performance management capacity
• Performance management resources
Lessons from the US Perfromance Management System by Donald MoynihanOECD Governance
Presentation by Donald Moynihan at the 10th annual meeting of the Senior Budget Officials Performance and Results Network held on 24-25 November 2014. Find more information at http://www.oecd.org/gov/budgeting
This 'how to' guide builds upon the overarching framework set out in The route to success in end of life care - achieving quality in acute hospitals, published in 2010. The route to success highlighted best practice models developed by acute hospital Trusts, providing a comprehensive framework to enable hospitals to deliver high quality care to people at the end of life.
This 'how to' guide aims to help clinicians, managers and directors implement The route to success more effectively, drawing on valuable learning from the NHS Institute for Innovation and Improvement's Productive Ward: Releasing time to care™ series.
This guide contains individual sections that can be worked on in any given order, dependent upon the individual hospital and its current end of life care provisions. These can be downloaded below:
Introduction
Section 1: prepare
Section 2: assess and diagnose
Section 3: plan
Section 4: treat
Section 5: evaluate
Section 6: sustain
Section 7: further resources
Cover
It places emphasis on existing 'enabling' tools and models, which support and follow a person-centred pathway. These are Advance Care Planning, Electronic Palliative Care Co-ordination Systems (EPaCCS), AMBER Care Bundle, Rapid Discharge Home to Die Pathway, and the Liverpool Care Pathway.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
How to Improve Healthcare Reporting Management System.pptxFlutter Agency
Here in this article, you will see the tips about the healthcare reporting management system. Read these top 8 tips to improve the Healthcare Reporting Management System.
Surviving Value-Based Purchasing in Healthcare: Connecting Your Clinical and ...Health Catalyst
Reducing healthcare costs is a major driving force in bundled payments, home-centered medical care, and accountable care organizations. But each new delivery model is built on the premise of reducing revenue per patient. So how can a health system win? Find out what you can do financially survive in today’s environment.
Escalating healthcare costs, heightened awareness of medical errors, and a higher-than-ever number of insured Americans have drawn attention to the need for quality improvement in US healthcare. Today, many efforts around patient outcomes and safety, care coordination, efficiency, and cost-cutting are underway and care redesign initiatives are being evaluated to guide future healthcare quality improvements. The following tips may aid you in your healthcare improvement efforts.
The Data Maze: Navigating the Complexities of Data GovernanceHealth Catalyst
Most organizations struggle to turn their data into a strategic asset. Oftentimes they lack the data they need, and don’t trust the data they have. This results in a struggle to surface meaningful opportunities, quantify the value of those opportunities, and transform insight into action. In this webinar, your host Tom Burton shares strategies for improving data literacy, ensuring data quality, and expanding data utilization.
This interactive, “choose your own adventure” style experience, allowed attendees to discover how investing in a deliberate, principle-based strategy can help them navigate the complexities of data governance and maximize the value of data for outcomes improvement.
View the webinar and learn:
- Demonstrate how to unleash data at your organization with efforts across the improvement spectrum.
- Recognize how to sustain and spread improvements across your entire organization.
- Illustrate the importance of investing in analytics training and infrastructure to prepare for massive improvement in healthcare outcomes.
- Understand the 5 key stages of the Data Life Cycle.
- Demonstrate strategies to overcome the common challenges around data quality, data utilization, and data literacy.
- Show how a data governance framework can accelerate improvement in clinical, cost, and experience outcomes.
OverviewConduct a health information technology needs assessment.docxjacksnathalie
Overview
Conduct a health information technology needs assessment. Then, present your findings and recommendations, in a 4–5-page executive summary, regarding a new or upgraded telehealth technology for your organization or practice setting.
Note:
Each assessment in this course builds upon the work you have completed in previous assessments. Therefore, complete the assessments in the order in which they are presented.
SHOW LESS
Nurse leaders play a key role in the decision-making processes associated with the purchase of a health information technology and any subsequent technology upgrades and improvements. A thorough and accurate needs assessment establishes a foundation for evaluating the overall value to an organization of the various technologies that can be used to support nursing and improve patient care.
The needs assessment you will conduct in your first assessment enables you to take a systematic approach to developing knowledge about a new or upgraded telehealth technology that would impact nursing practice. The needs assessment also identifies assessment work that may already have been completed and any gaps that still exist and must be addressed. The goals of completing the needs assessment are to:
Identify gaps in practice that must be addressed to improve patient care.
Understand the nature and scope of needed changes and identify associated opportunities and challenges.
Enable a thoughtful and systematic approach to change implementation and management.
This assessment provides an opportunity for you to work through the needs assessment process and present your findings in a way that will help you gain the support of executive leaders.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Competency 1: Evaluate technologies used to gather patient data; inform diagnoses; and enhance care quality, safety, and outcomes.
Explain the relevance and importance of a needs assessment.
Identify the safety requirements and regulatory considerations when using a new or upgraded telehealth technology.
Competency 2: Develop a collaborative technology integration strategy.
Describe the potential impact of internal and external stakeholders and end users on the acquisition of a new or upgraded telehealth technology.
Competency 3: Develop a strategy for managing technology use that enhances patient care and organizational effectiveness.
Identify the key issues in nursing care affecting patient outcomes that a new or upgraded telehealth technology will address.
Competency 4: Promote effective technology use policies that protect patient confidentiality and privacy.
Identify the patient confidentiality and privacy protections that a new or upgraded telehealth technology must address.
Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with applicable o.
Paying attention to outcomes pays off in big ways. Yet many companies fail to take the time to systematically figure out how to measure performance. As a result, the business doesn't flourish as it should. Instead, it stagnates. This presentation highlights the nine success factors of a balanced performance scorecard.
Similar to NTI2010 Increasing Quality And Safety (20)
RMD24 | Debunking the non-endemic revenue myth Marvin Vacquier Droop | First ...BBPMedia1
Marvin neemt je in deze presentatie mee in de voordelen van non-endemic advertising op retail media netwerken. Hij brengt ook de uitdagingen in beeld die de markt op dit moment heeft op het gebied van retail media voor niet-leveranciers.
Retail media wordt gezien als het nieuwe advertising-medium en ook mediabureaus richten massaal retail media-afdelingen op. Merken die niet in de betreffende winkel liggen staan ook nog niet in de rij om op de retail media netwerken te adverteren. Marvin belicht de uitdagingen die er zijn om echt aansluiting te vinden op die markt van non-endemic advertising.
What are the main advantages of using HR recruiter services.pdfHumanResourceDimensi1
HR recruiter services offer top talents to companies according to their specific needs. They handle all recruitment tasks from job posting to onboarding and help companies concentrate on their business growth. With their expertise and years of experience, they streamline the hiring process and save time and resources for the company.
Improving profitability for small businessBen Wann
In this comprehensive presentation, we will explore strategies and practical tips for enhancing profitability in small businesses. Tailored to meet the unique challenges faced by small enterprises, this session covers various aspects that directly impact the bottom line. Attendees will learn how to optimize operational efficiency, manage expenses, and increase revenue through innovative marketing and customer engagement techniques.
Falcon stands out as a top-tier P2P Invoice Discounting platform in India, bridging esteemed blue-chip companies and eager investors. Our goal is to transform the investment landscape in India by establishing a comprehensive destination for borrowers and investors with diverse profiles and needs, all while minimizing risk. What sets Falcon apart is the elimination of intermediaries such as commercial banks and depository institutions, allowing investors to enjoy higher yields.
Accpac to QuickBooks Conversion Navigating the Transition with Online Account...PaulBryant58
This article provides a comprehensive guide on how to
effectively manage the convert Accpac to QuickBooks , with a particular focus on utilizing online accounting services to streamline the process.
Putting the SPARK into Virtual Training.pptxCynthia Clay
This 60-minute webinar, sponsored by Adobe, was delivered for the Training Mag Network. It explored the five elements of SPARK: Storytelling, Purpose, Action, Relationships, and Kudos. Knowing how to tell a well-structured story is key to building long-term memory. Stating a clear purpose that doesn't take away from the discovery learning process is critical. Ensuring that people move from theory to practical application is imperative. Creating strong social learning is the key to commitment and engagement. Validating and affirming participants' comments is the way to create a positive learning environment.
Taurus Zodiac Sign_ Personality Traits and Sign Dates.pptxmy Pandit
Explore the world of the Taurus zodiac sign. Learn about their stability, determination, and appreciation for beauty. Discover how Taureans' grounded nature and hardworking mindset define their unique personality.
What is the TDS Return Filing Due Date for FY 2024-25.pdfseoforlegalpillers
It is crucial for the taxpayers to understand about the TDS Return Filing Due Date, so that they can fulfill your TDS obligations efficiently. Taxpayers can avoid penalties by sticking to the deadlines and by accurate filing of TDS. Timely filing of TDS will make sure about the availability of tax credits. You can also seek the professional guidance of experts like Legal Pillers for timely filing of the TDS Return.
Explore our most comprehensive guide on lookback analysis at SafePaaS, covering access governance and how it can transform modern ERP audits. Browse now!
India Orthopedic Devices Market: Unlocking Growth Secrets, Trends and Develop...Kumar Satyam
According to TechSci Research report, “India Orthopedic Devices Market -Industry Size, Share, Trends, Competition Forecast & Opportunities, 2030”, the India Orthopedic Devices Market stood at USD 1,280.54 Million in 2024 and is anticipated to grow with a CAGR of 7.84% in the forecast period, 2026-2030F. The India Orthopedic Devices Market is being driven by several factors. The most prominent ones include an increase in the elderly population, who are more prone to orthopedic conditions such as osteoporosis and arthritis. Moreover, the rise in sports injuries and road accidents are also contributing to the demand for orthopedic devices. Advances in technology and the introduction of innovative implants and prosthetics have further propelled the market growth. Additionally, government initiatives aimed at improving healthcare infrastructure and the increasing prevalence of lifestyle diseases have led to an upward trend in orthopedic surgeries, thereby fueling the market demand for these devices.
Personal Brand Statement:
As an Army veteran dedicated to lifelong learning, I bring a disciplined, strategic mindset to my pursuits. I am constantly expanding my knowledge to innovate and lead effectively. My journey is driven by a commitment to excellence, and to make a meaningful impact in the world.
Memorandum Of Association Constitution of Company.pptseri bangash
www.seribangash.com
A Memorandum of Association (MOA) is a legal document that outlines the fundamental principles and objectives upon which a company operates. It serves as the company's charter or constitution and defines the scope of its activities. Here's a detailed note on the MOA:
Contents of Memorandum of Association:
Name Clause: This clause states the name of the company, which should end with words like "Limited" or "Ltd." for a public limited company and "Private Limited" or "Pvt. Ltd." for a private limited company.
https://seribangash.com/article-of-association-is-legal-doc-of-company/
Registered Office Clause: It specifies the location where the company's registered office is situated. This office is where all official communications and notices are sent.
Objective Clause: This clause delineates the main objectives for which the company is formed. It's important to define these objectives clearly, as the company cannot undertake activities beyond those mentioned in this clause.
www.seribangash.com
Liability Clause: It outlines the extent of liability of the company's members. In the case of companies limited by shares, the liability of members is limited to the amount unpaid on their shares. For companies limited by guarantee, members' liability is limited to the amount they undertake to contribute if the company is wound up.
https://seribangash.com/promotors-is-person-conceived-formation-company/
Capital Clause: This clause specifies the authorized capital of the company, i.e., the maximum amount of share capital the company is authorized to issue. It also mentions the division of this capital into shares and their respective nominal value.
Association Clause: It simply states that the subscribers wish to form a company and agree to become members of it, in accordance with the terms of the MOA.
Importance of Memorandum of Association:
Legal Requirement: The MOA is a legal requirement for the formation of a company. It must be filed with the Registrar of Companies during the incorporation process.
Constitutional Document: It serves as the company's constitutional document, defining its scope, powers, and limitations.
Protection of Members: It protects the interests of the company's members by clearly defining the objectives and limiting their liability.
External Communication: It provides clarity to external parties, such as investors, creditors, and regulatory authorities, regarding the company's objectives and powers.
https://seribangash.com/difference-public-and-private-company-law/
Binding Authority: The company and its members are bound by the provisions of the MOA. Any action taken beyond its scope may be considered ultra vires (beyond the powers) of the company and therefore void.
Amendment of MOA:
While the MOA lays down the company's fundamental principles, it is not entirely immutable. It can be amended, but only under specific circumstances and in compliance with legal procedures. Amendments typically require shareholder
43. Standardized Clinical Processes: Refine the Design using Small Tests of Change Design Conference Rooms Approve (if necessary) Real World Test and Modify Test and Modify Test and Modify Implement
52. Leadership Leverage Points Self-Assessment Tool for System-Level Results Board has adopted the aims and is overseeing their achievement using system-level measures of progress against the aim. Senior Leadership team has developed specific “how much, by when” aims for system-level measures of quality and safety. 1. Establish and Oversee Specific System-Level Aims for Improvement at the Highest Governance Level By When By Whom Action Needed / Action Planned Leadership Leverage Points
53. Leadership Leverage Points Self-Assessment Tool for System-Level Results Senior Leadership team has resourced the projects that are necessary to achieve the aim with effective leaders. Senior Leadership team has developed a plan to achieve the aims that is focused on the right drivers, and had the necessary scale and pace. 2. Develop an Executable Strategy to Achieve the System-Level Aims and Oversee their Execution at the Highest Governance Level By When By Whom Action Needed / Action Planned Leadership Leverage Points
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56. Improving & Executing System Level Change Utilizing Leadership Frameworks & Toyota Production Specifications
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66. Achieve Strategic Goals Manage Local Improvement Build Capability ENVIRONMENT INFRASTRUCTURE Spread and Change Provide Leaders for Large System Change Spread and Change Provide Leaders for Large System Projects Provide Day to Day Leaders for Microsystems Core Elements for Process Improvement
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70. “ It is Leadership’s job to build the will for change among busy professionals, implement systems to capture new ideas and spread them to the right people within the organization, and design and implement an effective strategy” Bisognano, Schummers, McCannon
71. Whole System-Measures and Toyota Specifications – System Level Whole System Measures and Toyota Specifications: System Level. IHI, 2008 $3,000 per capita Per capita health care expenditures Efficient 5% of Adults self-rate their health status as fair or poor. (Response rate will not differ by income) Self-Reported health status Effective and Equitable 72% of Patients report, “They give me exactly the help I want (and need) when I want (and need) it.” Patient Experience Score ( Response to the question in the How’s Your Health Database, “They give me exactly the help I want (and need) exactly when I want (and need) it.” Patient Centered Toyota Specifications Whole System Measure IOM Dimension of Quality
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73. Whole System-Measures and Toyota Specifications: Component Level HSMR = 57 Hospital Standardized Mortality ratio (HSMR) Effective Care Primary Care: Same Day Access Specialty Care: Within 7 Days Days to third next available appointment Timely Access to Care 5 Adverse events per 1000 pt. days Adverse Events per 1000 pt. days Safe Care Reliability Levels 10 2 Pervasive Reliability Evidence Based Care Performance Specifications Measure Dimension
75. Whole System-Measures and Toyota Specifications: Component Level 81% of Patients are Satisfied Patient Satisfaction Patient – Centered Care $5,026 per enrollee Medicare Reimbursement Efficient Care 7.24 Hospital Days per Decedent during last six months of life Hospital Days per Decedent during the last six months of life Efficient Utilization and Resource Use 0.2 Cases with lost work days/100 FTE’s/Year Occupational Injuries and Illnesses Safe Work Place 30-Day Hospital Readmission = 4.69% Hospital Readmission Percentage Effective Care that Crosses Barriers HSMR = 57 Hospital Standardized Mortality ratio (HSMR) Effective Care Primary Care: Same Day Access Specialty Care: Within 7 Days Days to third next available appointment Timely Access to Care 5 Adverse events per 1000 pt. days Adverse Events per 1000 pt. days Safe Care Reliability Levels 10 2 Pervasive Reliability Evidence Based Care Performance Specifications Measure Dimension
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82. Step 3: Key Stakeholders/Customers Who may be affected by changing of the current state? Example: Specific departments, people, customers Step 4: Context (External, Internal Factors Driving the Need for Change) Example: Why would changing from the current state matter? Step 5: Approaches/Actions What possible ways could this issue be resolved? Example: Education program, change in policy, PDCA team, brainstorming Strategic Conversations Step 1: Current State What is the current situation that is driving the change? Example: What is not occurring? Step 2: Future State What would be the ideal situation after the change? Example: That particular “something” would be occurring.
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84. Whole System-Measures and Toyota Specifications: Component Level 81% of Patients are Satisfied Patient Satisfaction Patient – Centered Care $5,026 per enrollee Medicare Reimbursement Efficient Care 7.24 Hospital Days per Decedent during last six months of life Hospital Days per Decedent during the last six months of life Efficient Utilization and Resource Use 0.2 Cases with lost work days/100 FTE’s/Year Occupational Injuries and Illnesses Safe Work Place 30-Day Hospital Readmission = 4.69% Hospital Readmission Percentage Effective Care that Crosses Barriers HSMR = 57 Hospital Standardized Mortality ratio (HSMR) Effective Care Primary Care: Same Day Access Specialty Care: Within 7 Days Days to third next available appointment Timely Access to Care 5 Adverse events per 1000 pt. days Adverse Events per 1000 pt. days Safe Care Reliability Levels 10 2 Pervasive Reliability Evidence Based Care Performance Specifications Measure Dimension
Reference PHVS’s GPS model – MVV, Strategic Objectives, Planning and aligning, Executing Plan, Development
Establishing system-level performance helps answer two questions. What are we trying to achieve How are we doing at it? These two main questions really summarize How Good We Are .
Reference Performance Improvement Committee’s based on Malcolm Baldrige – 7 Teams: Leadership Team Strategy Team Customer Service Steering Committee Knowledge Management Team Workforce Team Process Improvement Team Key Measures Team
This type of system ensures that leaders take timely action to resolve issues that may be prohibiting execution (e.g., break down barriers, provide resources for project leaders, or replace project leadership). If the project is well executed, and little progress on system-level is seen, the senior team must take action to revise the strategic project portfolio. This can be accomplished through multidisciplinary teams, PDCA team or Quality Improvement processes utilized in your institutions.
The most commonly cited reason for failure of organizations to reach breakthrough aims is the failure of the senior leadership group to function as an effective team, with the appropriate balance of skills, health relationships, and deep personal commitments to achievement of the goals. Most important is that these principles must be translated into specific structural and process changes if they are to have an effect on the organization’s culture: The most powerful of these structures and process is putting the patient in the room Self-Serving Conversations cease – Many complaints (e.g., “We can’t do it that way because that would require us to cooperate with that other cardiology group which we compete with”) sound unseemly when patients and families are in the room. The whole system of Care Comes into Play: Patients experience care across mulitple departments, medical groups, and organizations. They want solutions that work for them, not just for one part of the system. Better, more Innovative Ideas come forward: Patients and families are a tremendous wellspring of ideas for improvement and redesign. Physicians and Nurses feel supported and inspired: When patients are on committees and task forces, they become a source of energy and positive reinforcement for care professionals.
Organizations are now beginning to understand the financial impact of harm events such as falls, medication errors, and delayed care are having. Utilization of Evidence Based care protocols are demonstrating a significant cost reduction when utilized. Eliminating errors and clinical waste also have a significant impact in cost savings. Cost reduction efforts commonly have been a reaction to external changes in the market or payment systems and are generally one-time events focused on: Reducing the cost of labor Reducing the cost of supplies Changing vendor contracts Compared to other CFO’s in other industries, health care CFO’s typically do not focus on improving the processes themselves – Taking out wasted time and effort Eliminating defects that require rework. The core process of health care – diagnosing, treating and communication with patient has been a “Black Box” and off limits to CFO’s
Strongest Examples of Leverage Point Five: Virginia Mason Medical Center, Washington Park Nicollet Health Services, Minnesota Using Lean techniques – Process 64 patients daily through their same day endoscopy facility that once struggled to care for 30 – 32 patients daily. $3 million in capital expenditures were avoided by utilizing Lean methodology ThedaCare, Wisconsin Extensive reduction in waste in their first couple years of operation by utilizing Lean methodology – CFO built a long-range financial plan that does not require any price increases. McLeod Regional Medical Center, South Carolina Eliminate 112 minutes of wasted nursing documentation time per cardiac patient, thus freeing up nursing to provide higher levels of quality and safety. All have adopted lean management principles (Toyota Production System)
Physician Engagement: At PVHS – 2009 Gallup poll taken by physicians – placed their level of engagement in the 96 th Percentile. Equally, physician-nurse communication/collaboration was ranked in the 96 th percentile as well.
1.1 The key idea is to learn what the physicians’ quality agenda is and harness the organization’s quality efforts to their agenda. Physicians are less excited about improving the hospital’s publically reported data, reducing length of stay or removing waste in the supply chain – “Not my problem, it’s the hospitals” 1.2 Physicians care about mortality and harm – quality and safety outcomes. One way to engage them is make sure that organization’s aims focus on outcomes meaningful to physicians. Example: Instead of being in the top 10 th percentile of CMS Core Measures – Aim for “reducing the risk of needles deaths in the hospital.” One strategy might be to improve the reliability of CMS Core Measures for acute myocardial infarction and pneumonia. Another might be to increase the amount of smoking cessation education provided to patients or the development of Centers of Excellence
Reframe Values and Beliefs Organizations need to reexamine and reframe some of their core values and beliefs if true engagement in quality and safety is to occur. Doctors must begin to see their responsibility for the system’s quality results, and not just for their own personal quality performance. One example of redesign is the traditional “Morbidity and Mortality Conference”. In general this conference asks “Did someone make an error of judgment or of technique in this case?”. The new redesigned process requires physicians and administrators to ask the following question: “ What were the systems factors – culture, structure, processes that contributed to this death and what can we do together to change these factors?” Ask Physicians what they need.
Team – Should be about 10 members including those who work closely with physicians (major nursing units, medical office staff, high volume outpatient departments and admitting) Data – Information from physician satisfaction surveys – (Thomson Reuters, AVATAR, Gallop) is utilized as a springboard for brainstorming for optimal environments for physicians. Goals – Set 90 day action plan is shared with leaders. Monthly targets are set along with outcomes for the year.
Reframe Values and Beliefs Organizations need to reexamine and reframe some of their core values and beliefs if true engagement in quality and safety is to occur. Doctors must begin to see their responsibility for the system’s quality results, and not just for their own personal quality performance. One example of redesign is the traditional “Morbidity and Mortality Conference”. In general this conference asks “Did someone make an error of judgment or of technique in this case?”. The new redesigned process requires physicians and administrators to ask the following question: “ What were the systems factors – culture, structure, processes that contributed to this death and what can we do together to change these factors?” Ask Physicians what they need.
3.1. Not all physicians need to be engaged in any particular quality initiative. Those who are engaged do not need to be engaged in exactly the same way. 3.2. Plan segmentation through physician champions, physician members of the actual improvement team, structural leaders of the medical staff who might need to adopt a new policy. 3.3. Engage those physicians who are more likely to “block” recommendations that emerge from the project team or policies recommended by the structural leaders.
4.1. Physicians are often cynical about quality improvement based on methods utilized in the past that really disengaged them previously. (Example: Don’t ask physicians to join improvement teams that meet twice a month during times when physicians are making rounds; utilizing the time for activities that do not require physician input; gathering data without testing any changes, then sending out flawed performance data on quality measures asking them to improve on it). See fig’s. Next slides on what this process looks like and what it should look like.
As a guideline, use small tests to refine the design for the local setting. Do not spend more than one meeting on the WHAT of a guideline. There are relatively good “Starter Kits” for a clinical guideline or protocol available from a national, reputable source. Do not spend time reinventing the wheel or the science behind the project. Focus on how to make the exiting protocol work within the local context. The TEAM tests various methods for the how, who, when, where , initially on a very small scale, making frequent changes to improve implementation. Tests of change increase in scale, until most physicians find themselves able to use the protocol in their patient care, at which point the protocol is adopted with the expectation that physicians opt out if they do not wish to use it.
5.1. Change is required to make improvements in quality and safety, yet it is often met with set back through what is called Monovoxoplegia or “paralysis by one loud voice.” Physicians are among the most powerful voice in healthcare organizations and their collegial nature makes them reluctant to challenge other physicians. This paralysis is common place in physician meetings, improvement teams, executive teams and even board rooms, where lay members sit silent when one physician speaks up against a proposed change. There is no simple solution to Monovoxoplegia , however, the basis of an effective approach relies on building an organizational culture of courage – The Courage to ask questions The Courage to challenge the status quo The Courage to support the physicians and nurses WHO do wish to make improvements. Courage could be illustrated best by Donna Isgett from McLeod Regional Medical Center and the question she asks physicians when they balk at Evidence Based Practice. “Are you saying that you value your individual autonomy more than you value your patient’s outcomes?” Knowing they will be supported all the way to the board enables all clinicians, including physicians to ask tough questions… Courage is infectious
6.1. When involving physicians – don’t hand them a final or near-final version of proposed changes and expect acceptance. 6.2. Work with real leaders – Usually there are one or two opinion leaders. Although they might not be leaders within the organization per se’ they have earned the respect of their peers and have the ability to influence others. These leaders MUST be involved in the improvement changes. 6.3. Choose messengers and messages Carefully: Credibility is generally view as credible by the whom delivers the message, so it is important on who delivers the message (specialist, general practitioner, or someone with specific specialty certifications. Communication should be designed to be engaging rather than inflammatory. 6.4. Be Transparent, especially with data – Physicians usually do not trust interpreted data. Give them access to raw data. Even if they do not look at the data, they will value knowing that you trust them to do so. 6.5 Value Their time with you Time:
The self assessment should be completed by senior leadership – initially as individuals, then as a team in order to review results and action plans
Continue completing all 7 Leverage points with action plans.
Customer Services & Patient/Family Center Care – PVHS Team committee:
PVHS – Customer Service Steering Committee
Organizations that are to consistently improve system-level performance will have capabilities in three areas: System-Level Aims, Local management and supervision, and development of sufficient number of employee’s:
This slide represents the differences between the Institute of Medicine and TPS based on Cost per capita for severely ill persons with multiple chronic diseases.
Pitfalls – Often encounter resistance to the ambition of the goal. Response: Reduce the ambition of the goal by moving to a lower level in the system that requires less integration (Cost per case in a hospital, rather than total costs With many opportunities for improvement, setting too many goals will underscore the ambitions. Typically leading to under-resourcing. The goal for organizations now is to look at the future of healthcare. Suggestions: Keep discussions centered on the patient’s experience over time Use the Toyota specifications as a comparison for the level of ambition Concede that one project may not be sufficient to accomplish the goal
HSMR – is the calculation used to compare a hospital’s actual mortality rate to the risk-adjusted expected mortality rate
HSMR – is the calculation used to compare a hospital’s actual mortality rate to the risk-adjusted expected mortality rate Discuss Fall Program/protocol and video monitoring – Graph? Patient-Family Center Care @ PVHS
IHI’s 100,000 Lives Campaign as well as 5 Million Lives campaign are two strategic goals adopted by 3,700 hospitals and health systems. Stories of PVHS – Malcolm Baldrige Teams-
Utilization of the Rapid Cycle PDCA’s (PDSA) can implement change in a shorter period of time. These are not meant to be dragged out 6-10 months, but 3-6.
HSMR – is the calculation used to compare a hospital’s actual mortality rate to the risk-adjusted expected mortality rate Discuss Fall Program/protocol and video monitoring – Graph? Patient-Family Center Care @ PVHS