South central foundation Alaska
If you are in a mechanical manufacturing environment then hitting a target is a matter much like the throwing of a rock – figuring out speed trajectory
If you are in a messy, human, complex, adaptive environment it is like throwing a
bird at a target – it is all about the ‘attractor’
Healthcare mostly throws birds at targets and only thinks about the throwing part than wonders why the Human fails to hit the target
The discovery of X-rays and the phenomenon of radioactivity and their application to the examination of objects provided the starting point for the advancement of industrial radiography. This technique is one of the most widely used for the detection of internal defects such as voids and porosity. Planar defects can also be detected by radiography with some proper orientation. Radiography is also suitable for detecting changes in material composition, thickness measurements and locating unwanted or defective components hidden from view in an assembled part.
The discovery of X-rays and the phenomenon of radioactivity and their application to the examination of objects provided the starting point for the advancement of industrial radiography. This technique is one of the most widely used for the detection of internal defects such as voids and porosity. Planar defects can also be detected by radiography with some proper orientation. Radiography is also suitable for detecting changes in material composition, thickness measurements and locating unwanted or defective components hidden from view in an assembled part.
Gain an understanding of the practical application of relationship‐based care
and what it takes to change our mindsets as healthcare professionals to
enable people to take charge of their own wellbeing. Find out how NHS Fife has begun to adapt this idea within their own healthcare setting.
ACFI is primarily a funding tool but proper usage by carers can improve care delivery. It provides a mental checklist for carers to tick off with each resident. The added benefit being that such attention to detail can also increase your revenue. Great webinar by Tiffany Wiles RN from Key 2 Care.
This webinar will have two perspectives.
Jasveen will be presenting about the impact of cancer and treatment on a person’s physical, cognitive & mental health and how an Occupational therapist can work with the person to gradually overcome these challenges to return to work with or without modifications. The presentation will cover some case studies of past success with the opportunity to answer questions at the end.
Then we will hear from Jen who has experienced her own journey with breast cancer and how she advocated for herself and occupational therapy to help her return to full time employment.
The factors that distinguish highly effective healthcare organizations are discovered through generative internal investigation via Appreciative Inquiry. When the cross section of internal members of the organization are invited to express what happens when extraordinary care is provided, the key strengths are revealed.
The focus on productivity remains a key priority for government. In the session we looked at the impact of health and well being initiatives on increasing productivity.
Implementing the National Standard for Psychological Health and Safety in the...healthycampuses
This session was a Pre-Summit Workshop at the 2016 Healthy Minds | Healthy Campuses Summit in Vancouver, BC. Participants were introduced to the National Standard and the 13 factors specifically within the unique context of post-secondary education.
This workshop was presented at the Queensland Mining Industry Health and Safety Conference 2014 and presents progress on the Working Well Program and ways to support mental health in the workplace.
The Patient-Centered Medical Home in the Transformation From Healthcare to He...Paul Grundy
Surgeon General of the Navy VADM Matthew L. Nathan, MC USN
Fortunately, we have a way to address this crisis—the
Patient-Centered Medical Home (PCMH) model launched at Naval Hospital Pensacola and Walter Reed National Military Medical Center, Bethesda, Maryland (formerly the National Naval Medical Center) in 2008. It is now being implemented throughout the Military Health System (MHS) and carries great promise. It provides the clinical framework we need to meet our strategic objectives in terms of quality of care, impact on costs, population health, and readiness. One of the most significant benefits of the team-based, collaborative approach is that it allows us to embed within a primary care environment the psychologists, nutritionists, tobacco cessation specialists, mind-body medicine therapists, and health educators our patients need in order to develop and maintain mindful, healthy behaviors—along with the “mental armor,” our active duty military personnel need to increase their operational effectiveness and their resiliency in bouncing back from stressful situations. As we move ahead with this more comprehensive approach to health, we can begin to better address so many of our patients for whom we can find no specific reason for pain and discomfort. The PCMH model also provides a positive impact on our costs. Early data reporting from the PCMH clinics at Bethesda show reduced visits to the emergency room, lowered pharmacy costs, and significant per beneficiary per year savings and improved Healthcare Effectiveness Data and Information Set metrics, access, and patient satisfaction and trust. These positive impacts on the bottom line can be applied directly to improved costs or toward the reallocation of resources from reimbursing those who are sick to the population health-based programs that can make and keep our patients healthy.More significant, however, the PCMH environment allows us to go beyond mere collaboration and to a much more proactive approach to managing our patient populations. It is within the context of the medical home that we can begin to surround our patients with the tools and resources they need to move them from health care to health.
Patient-centered medical homes (PCMHs) are intended to actively provide effective care by physician-led teams, Where patients take a leading role and responsibility. Objective: To determine whether the Walter Reed PCMH has reduced costs while at least maintaining if not improving access to and quality of care, and to determine
whether access, quality, and cost impacts differ by chronic condition status. Design, setting, and patients: This study
conducted a retrospective analysis using a patient-level utilization database to determine the impact of the Walter Reed PCMH on utilization and cost metrics, and a survey of enrollees in the Walter Reed PCMH to address access to care and quality of care. Outcome measures: Inpatient and outpatient utilization, per member per quarter costs, Healthcare Effectiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communication, and customer service are included. Results: Costs were 11% lower for those with chronic conditions compared to 7% lower for those without. Since treating patients with chronic conditions is 4 times more costly than treating patients without such conditions, the vast majority of dollar savings are attributable to chronic care.
Gain an understanding of the practical application of relationship‐based care
and what it takes to change our mindsets as healthcare professionals to
enable people to take charge of their own wellbeing. Find out how NHS Fife has begun to adapt this idea within their own healthcare setting.
ACFI is primarily a funding tool but proper usage by carers can improve care delivery. It provides a mental checklist for carers to tick off with each resident. The added benefit being that such attention to detail can also increase your revenue. Great webinar by Tiffany Wiles RN from Key 2 Care.
This webinar will have two perspectives.
Jasveen will be presenting about the impact of cancer and treatment on a person’s physical, cognitive & mental health and how an Occupational therapist can work with the person to gradually overcome these challenges to return to work with or without modifications. The presentation will cover some case studies of past success with the opportunity to answer questions at the end.
Then we will hear from Jen who has experienced her own journey with breast cancer and how she advocated for herself and occupational therapy to help her return to full time employment.
The factors that distinguish highly effective healthcare organizations are discovered through generative internal investigation via Appreciative Inquiry. When the cross section of internal members of the organization are invited to express what happens when extraordinary care is provided, the key strengths are revealed.
The focus on productivity remains a key priority for government. In the session we looked at the impact of health and well being initiatives on increasing productivity.
Implementing the National Standard for Psychological Health and Safety in the...healthycampuses
This session was a Pre-Summit Workshop at the 2016 Healthy Minds | Healthy Campuses Summit in Vancouver, BC. Participants were introduced to the National Standard and the 13 factors specifically within the unique context of post-secondary education.
This workshop was presented at the Queensland Mining Industry Health and Safety Conference 2014 and presents progress on the Working Well Program and ways to support mental health in the workplace.
The Patient-Centered Medical Home in the Transformation From Healthcare to He...Paul Grundy
Surgeon General of the Navy VADM Matthew L. Nathan, MC USN
Fortunately, we have a way to address this crisis—the
Patient-Centered Medical Home (PCMH) model launched at Naval Hospital Pensacola and Walter Reed National Military Medical Center, Bethesda, Maryland (formerly the National Naval Medical Center) in 2008. It is now being implemented throughout the Military Health System (MHS) and carries great promise. It provides the clinical framework we need to meet our strategic objectives in terms of quality of care, impact on costs, population health, and readiness. One of the most significant benefits of the team-based, collaborative approach is that it allows us to embed within a primary care environment the psychologists, nutritionists, tobacco cessation specialists, mind-body medicine therapists, and health educators our patients need in order to develop and maintain mindful, healthy behaviors—along with the “mental armor,” our active duty military personnel need to increase their operational effectiveness and their resiliency in bouncing back from stressful situations. As we move ahead with this more comprehensive approach to health, we can begin to better address so many of our patients for whom we can find no specific reason for pain and discomfort. The PCMH model also provides a positive impact on our costs. Early data reporting from the PCMH clinics at Bethesda show reduced visits to the emergency room, lowered pharmacy costs, and significant per beneficiary per year savings and improved Healthcare Effectiveness Data and Information Set metrics, access, and patient satisfaction and trust. These positive impacts on the bottom line can be applied directly to improved costs or toward the reallocation of resources from reimbursing those who are sick to the population health-based programs that can make and keep our patients healthy.More significant, however, the PCMH environment allows us to go beyond mere collaboration and to a much more proactive approach to managing our patient populations. It is within the context of the medical home that we can begin to surround our patients with the tools and resources they need to move them from health care to health.
Patient-centered medical homes (PCMHs) are intended to actively provide effective care by physician-led teams, Where patients take a leading role and responsibility. Objective: To determine whether the Walter Reed PCMH has reduced costs while at least maintaining if not improving access to and quality of care, and to determine
whether access, quality, and cost impacts differ by chronic condition status. Design, setting, and patients: This study
conducted a retrospective analysis using a patient-level utilization database to determine the impact of the Walter Reed PCMH on utilization and cost metrics, and a survey of enrollees in the Walter Reed PCMH to address access to care and quality of care. Outcome measures: Inpatient and outpatient utilization, per member per quarter costs, Healthcare Effectiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communication, and customer service are included. Results: Costs were 11% lower for those with chronic conditions compared to 7% lower for those without. Since treating patients with chronic conditions is 4 times more costly than treating patients without such conditions, the vast majority of dollar savings are attributable to chronic care.
National Conference on Health and Domestic Violence. Plenary talk Paul Grundy
explaining how the Patient Centered Medical Home (PCMH) platform for healthcare deliver is more likely to support domestic violence prevention and creat a safer environment than the FFS episode of care system we are in now. The medical Home is a home for the data where the all the data goes and is held accountable this idea was first articulated by Dr. Calvin C.J. Sia, a Honolulu-based pediatrician in 1967.
This concept of the medical home was integrated with Ed Wagners Chronic disease Model and Thomas Bodenheimer Kevin Grumbach advanced/proactive primary care at the request of the Patient Centered Primary care Collaborative into a set of principles Know as the Joint principles of the Patient centered medical home.
The patient-centered medical home (PCMH), is a team based health care delivery set of principles led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults" The provision PCMH medical homes allow better access to health care, increase satisfaction with care, and improve health. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[10] Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage coordination.
PCMH implementation, highly associated with important outcomes for both patients and providers. The rate of emergency department visits was significantly
lower in sites with more PCMH effective implementation. Efficient PCMH implementation favorably associated with patient satisfaction, staff burnout, quality of care, and use of health care services.
A systematic review of the challenges to implementation of the patient-centre...Paul Grundy
review the available literature to identify the major challenges and barriers to implementation and adoption of the patient-centred medical home (PCMH) model, topical in current Australian primary care reforms. documents the key challenges and barriers to implementing the PCMH model in United States family practice. It provides valuable
evidence for Australian clinicians, policymakers, and
organisations approaching adoption of PCMH elements
within reform initiatives in Australia.
"'I am proud that MaineCare has been working in partnership with other payers to advance payment reform through greater investment in primary care to both improve outcomes for patients and reduce preventable high cost spending in emergency departments and avoidable inpatient admissions.
– Mary C. Mayhew, Commissioner, Maine Department of Health & Human Services
Effective integration of specialty practices into medical neighborhoods is likely to require several important environmental precursors. First, a sound infrastructure
design can connect PCMHs to the spectrum of surrounding
specialty practices. An aligned information architecture
will be vital to adequate patient access, care coordination, and communication. Second, a patient centered
neighborhood will rely on an organizational culture that
supports shared learning and transparency of performance and cost data among participating practices. Third, payment incentives will have to be aligned around shared accountability for outcome and cost. Responsibility
for outcomes and total cost of care will have to rest not only with primary care clinicians, but also with specialists who perform(often expensive) procedures and specialty services.The launch of the NCQA’s PCSP recognition program is a sign of a new phase of delivery system reform
Summary -- Patient Centered Medical Home the Necessary Foundation for Accountable Care and Population Management.
In the next 10 years, we will be living in 1) mobile world 2) in the middle of an aging and chronic disease epidemic and 3) data. But , we will also have the ability to analyze data in a cognitive way this will do for doctors’ minds what X-ray and medical imaging have done for their vision. How? By turning data into actionable information. Take, for instance, IBM’s intelligent supercomputer, Watson. Watson can analyze the meaning and con-text of human language and quickly process vast amounts of information. With this in-formation, it can suggest options targeted to a patient’s specific circumstances.
We need the basic foundation to support this transformation a system integrator where data at the level of a patients flows and is held accountable and that model is the Patient Centered Medical Home. (PCMH) starts to happen when clinicians/ healers step up to comprehensive relationship based care empowered by tools to manage the data and communicate effectively. This move to PCMH level care requires the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system and all of that is power by data made into meaningful information.
But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.
The Patient-Centered Medical Home (PCMH) lies at the center of the effort to get at population health, integrated and coordinated care. PCMH is where the Primary care healer leads an organization that delivers clinician-led primary care, with comprehensive, accessible, holistic, coordinated, evidence-based coordination and management. In the USA this is now the standard in the US Veterans Administration and the US Military and under the ACA.
OVERVIEW -- Care by Design - Putting Care back into healthcare the University of Utah experience in building PCMH level care over the decade of 2001 to . 2011
Care by design magill lloyd successful turnaroundPaul Grundy
The University of Utah purchased a 100-clinician, 9-practice multispecialty primary care network in 1998. The university projected the network to earn a profit the first year of its ownership in a market with growing capitation; however, capitation declined and the network incurred up to a $21 million operating loss per year. This case study describes the financial turnaround of the network.
Care by design 2 bodenheimer teams 2 utah chapterPaul Grundy
Putting Care back into healthcare the University of Utah experience in building PCMH level care. this talks about the team base experice as written up in 2007 by Tom Bodenheimer.
New zealand cantabury timmins-ham-sept13Paul Grundy
This is a great example of a community in New Zealand of the interrogation of social services and healthcare. They are changing the demand curve and getting away from “we need more and more resources to see more patients”. The language we use, very deliberately, is “right care, right place, right time”. Once you start getting the whole
system to work as one system, it starts flushing out unnecessary expenditure. So you can do more and/or do it better.’ worth a read.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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1. Southcentral Foundation
The SCF Nuka Model of Care
Th SCF N k M d l f C
Customer-Owners Driving Healthcare
Charles Clement, Vice President Operations, Chief
Operating Offi
O
ti
Officer
April Kyle, Human Resources Administrator
Steve Tierney, Medical Director Quality Improvement
Michelle Tierney, Vice President Organizational
Tierney
Development and Innovation
2. Today…
y
Share the SCF Story
Transformation of our system –
resulting SCF Nuka Model of Care
Describe how a customer-owner
customer owner
system shapes and improves health
performance in outcomes,
satisfaction, experience of care, and
ti f ti
i
f
d
overall cost.
Describe some of our key
improvements to our systems
transformation
3.
4. Southcentral Foundation
25+ years of history
Innovative, relationship based, customer
owned systems
d
t
1,400 staff
140,000 statewide customers
55,000 ‘local’ customer-owners including
10,000 i
10 000 in over 50 remote villages
t
ill
Expanding local population
5. Southcentral Foundation
Medical Services – Primary Care, Women’s
Health, Pediatrics, Optometry, Urgent
Care
Dental
Behavioral Health – clinics residential
clinics,
treatments, after-care, youth, elders
Family Wellness Warriors – abuse and
neglect treatment and prevention
Tribal and Traditional Services
Chiropractic, massage, acupuncture
Southcentral
Foundation
6. Alaska Native Medical
Center
150 Bed Hospital
Over 400,000 outpatient visits last year
Local primary care, regional community
hospital, and tertiary care statewide hub
Level II Trauma Center, Magnet Status
Combined project of SCF and ANTHC
Full system – includes medications, etc.
Southcentral
Foundation
7.
8. Our Choice
The Alaska Native people were given
this choice and we chose to assume
the responsibility for our own health
care
Change everything
Total redesign
g
With our choices, values and ……
9. Where we were in Jan. 1993
100 % increase in Native population in 10 yrs
Long waits for scheduled appointments,
4 to 6 hour waits in ER/Urgent Care
common
Long waits on phone, pharmacy
phone pharmacy,
everywhere
Poor continuity, little coordination across
depts,
Increase age, illness burden, space issues
Little
Littl customer i
t
input, not used in planning
t
t
di
l
i
System not designed around the customer
10. Everyone was frustrated…
y
Customers frustrated – waiting
waiting,
impersonal, paternalistic, crowded,
unfriendly
y
Clinical staff frustrated – too many
p p ,
people, not enough time, no personal
g
,
p
relationship, too many demands
Management frustrated – lots of
unhappy people, hard to motivate staff,
poor financial performance, poor
facilities
f iliti
11. What If
If….
What would a healthcare system based on
Alaska Native community values look like?
What if you actually threw out EVERYTHING in
the
th medical system and started with Alaska
di l
t
d t t d ith Al k
Native community structures and strengths as
the base?
Asset based philosophy, structures, systems
So…..
We declared nothing would remain the way it
was unless we decided to do it that way.
12. So
We wanted Alaska Native people to own
d l k
i
l
their own healthcare
We wanted to have a system where the
values, goals, and strengths of the
customer drove the system design
We wanted to get to whole person care –
physical, mental, emotional, spiritual
We wanted family and community to
y
y
matter & to be known personally
And – we wanted the best that modern
medicine has to offer
13. Why is Customer Owned Important
y
p
Efforts of “experts” who know
o ts o e pe ts
o
o
what is best for Alaska Native
people (healthcare professionals,
missionaries, government officials)
Result has been loss of self esteem
and confidence leading to
d
fid
l di
t
dependency
Healing and progress on the journey
towards health only is possible when
the customer/owner takes control
and l d the change.
d leads h h
14. Scotland
Caring and compassionate
C i
d
i
staff and services
Clear communication and
explanation of conditions and
l
f
d
d
treatment
Effective collaboration
Continuity of care
Good access
Clinical excellence
Alaska
Services and systems built on
S
i
d
b il
strengths of Alaska Native
cultures
Not complicated but simple
and easy to use
Together with the customer
as an active partner
Relationships between
customer owner, family and
provider must be fostered
and supported
Access is optimized and wait
A
i
ti i d
d
it
times are limited
Outcome and process
measures to continuously
evaluate and improve
16. Why Listen to our story
Complete system redesign on Alaska
Native values
Decrease
Decrease
Decrease
Decrease
in ER/Urgent Care over 40%
specialty care by over 50%
in primary care visits by 20%
in admissions and days by over 35%
Improved health outcomes
Improved satisfaction indicators –
customer and employee
17. Question Assumptions
Medical Model not questioned in 100
years, but optimally effective for
population health
‘Healthcare’ tries to build on one
p
philosophy – why? Span is so huge
p y
y
p
g
Knowledge – clinical, system design,
change management, operational
management – h
t have evolved hugely – b t
l dh
l
but
not the basic healthcare paradigm – why?
18. Analogy - Hitting the target
target…
If you are in a mechanical, manufacturing
mechanical
environment then hitting a target is a matter
much like the throwing of a rock – figuring out
speed, t j t
d trajectory, etc.
t
If you are in a messy, human, complex,
adaptive environment – it is like throwing a
bird at a target – it is all about the ‘attractor’
Healthcare mostly throws birds at targets and
only thi k about th throwing part…
l thinks b t the th
i
t
19. Reality – various ‘platforms’
platforms
Healthcare has several ‘platforms’
ICU/ER/OR – high tech, linear, mechanical
Procedures – linear, mechanical
Consultative – time limited, specific issue
limited
focused, additive expert support
Longitudinal relationship over time –
chronic conditions, outpatient, residential,
h
i
diti
t ti t
id ti l
behavioral health, primary care
One size does not fit all – first two are
product, manufacturing efforts – second two
are service and knowledge efforts primarily
20. Control: Who really makes the decisions
100
Patient/Family
“Control”
The “System”
y
0
Low
Acuity
High
1. Control – who makes the final decision influencing outcome?
2. Influences – family, friends, co-workers, religion, values, money
3. Real opportunity to influence health costs/outcomes – influence
on the choices made – behavioral change
4. Current model – t t diagnosis, treatment (meds or procedures)
4 C
t
d l tests, di
i t
t
t( d
d
)
21. Reality
y
Health is a longitudinal journey
g
j
y
Across decades
In a social, religious, family context
Highly i fl
Hi hl influenced b values, beliefs, habits,
d by
l
b li f h bit
and many ‘outside’ voices.
Office visits are brief, reactive stop-gaps
Hospitalizations are brief, intense interruptions
MUST fix basic, underlying primary care
platform first or nothing else will work well
22. Purpose of Primary Care
p
y
Is a Service Industry – NOT a product industry
– coaching, teaching, partnering are central –
pills and procedures supportive
Changes what we think we do, who we hire,
how we train, how we structure, how we
reward, and how entire system is constructed
as a system.
We must optimize relationship – personal,
trusting, accountable – minimize b i
t
ti
t bl
i i i barriers
23. The General Framework
Vision, Mission, Key Points
Leads to Operational Principles –
these are specific enough to be used
to evaluate and even score new
ideas for whether to implement
them into SCF or not
24. Mission, Vision, Key Points
Vision: A Native Community that
enjoys physical, mental, emotional
and spiritual wellness
Mission: Working toget e with the
ss o
o
g together t t e
Native Community to achieve
oug
a
a d
a d
wellness through health and related
services.
25. Key Points
Shared Responsibility
We value working together with the individual, the family, and
g g
,
y,
the community. We strive to honor the dignity of every
individual. We see the journey to wellness being traveled in
shared responsibility and partnership with those for whom we
p
provide services.
Commitment to Quality
We strive to provide the best services for the Native
Community. We employ fully qualified staff in all positions
and we commit ourselves to recruiting and training Native
staff to meet this need. We structure our organization to
optimize the skills and contributions of our staff.
Family Wellness
We value the f
l
h family as the heart of the Native Community.
l
h h
f h
C
We work to promote wellness that goes beyond absence of
illness and prevention of disease. We encourage physical,
mental, social, spiritual and economic wellness in the
individual, h f
i di id l the family, the community, and the world in which
il
h
i
d h
ld i
hi h
we live.
26. SCF Operating Principles
Relationships between the customer-owner, the
family, and provider must be fostered and
supported
Emphasis on wellness of the whole person,
family, and community including; physical
y,
y
g; p y
mental, emotional, and spiritual wellness
Locations that are convenient for the customerp
owner and create minimal stops for the
customer-owner.
Access is optimized and waiting times are
limited
Together with the customer-owner as an active
partner
Intentional whole system design to maximize
y
g
coordination and minimize duplication
27. Operating Principles
Outcome and process measures to continuously
evaluate
e al ate and improve
imp o e
Not complicated, but simple and easy to use
Services are financially sustainable and viable
y
Hub of the system is the family
Interests of the customer-owner drive the
system to determine what we do and how we do
it
Population-based systems and services
Services and systems build on the strengths of
Alaska Native cultures.
28. Customer-owner Changes for
Effective Relationships
Be active not passive
Take responsibility for your health
Get information about your health
Ask questions about advice
Ask for options
s o opt o s
29. Healthcare Provider Changes
for Effective Relationships
No longer a hero but a partner
Control does not equal compliance
Replace blaming with
understanding
Give customer options not orders
Provide customer with resources
Make it simple
p
30. Some of our improvements
Leadership
Mission, vision, key points, principles –making
part of f b i of day to day work
t f fabric f d
t d
k
Functional structure
Training and development – succession
planning
Standardize Improvement Processes and
Tools
Facility Design
31.
32.
33. Some of our improvements
Strategic Planning
Continuous planning cycle
p
g y
Linkage from 20 years to today
Automated planning tool and reports
p
g
p
Measurement of how we are doing at
macro and micro levels
34. Some of our improvements
Customer focus
Listening p
g posts continuously updated
y p
and evaluated
Benchmarked feedback tool for
satisfaction
Gatherings, listening conferences,
customer service reps, and family
35. Some of our Improvements
p
Measurement and Analysis
y
Development of Balanced Scorecards
and Dashboards for every
department coordinated and
connected throughout the
organization
i ti
Data Mall for segmentation,
understanding performance and
registry type information
40. Some of our Improvements
p
Workforce improvements
Recruitment Processes: group interviewing,
behavioral based interviewing, change how
we recruit, online tool for applications,
same d
day offers
ff
On-boarding including orientation
Core Concepts training on building effective
p
g
g
relationships
Job progressions and career ladders
Development Center
p
• Upfront training for administrative support and
Certified Medical Assistants
• Learning centers tied to workforce competencies
41. Some of our Improvements
Process and clinical improvements
Microsystem Optimization -teams
• Primary Care: MD, RN, Certified Medical
y
,
,
Assistant, Admin Support
• Human Resources, HR Generalist and Assistants
Redefine work
• Move from episodic, reactive care to long-term
relationship
•M
Move from only one-to-one visits t use of
f
l
t
i it to
f
groups, phone, email, fax
• Move from doctor-centric to team based approach
in l ti
i relationship
hi
42.
43. Some of our Improvements
Process and clinical improvements
ocess a d c ca
p o e e ts
Customer-owner choice of healthcare
provider
Behavioral Health Consultants
Case management and chronic
illness management
•Depression, asthma, chronic pain,
diabetes, HIV etc.
di b t
HIV, t
Advanced Access – appointments
when the customer wants
45. Some of our Improvements
Process and clinical improvements
Integration of Complementary Medicine
Telehealth, telepharmacy and
telemedicine
t l
di i
Family Wellness Warriors Initiative
Service A
S
i Agreements
t
Hospitalists
46. Southcentral Foundation
VISION
A Native community that enjoys
emotional, physical, mental, and
spiritual wellness.
MISSION
Working together with the Native
community to achieve wellness through
health and related services.
48. Relationship-Based System
R l ti
hi B
dS t
Tribal Governance Relationships
Employee Relationships
Community Relationships
Provider Relationships
49. Customer/Owner Listening
Not just one method of listening
Personal
P
l
interaction with
staff
Group visits
Comment cards
Customer
C t
Satisfaction
surveys
y
SCF internet
Annual
Gathering
24-hour hotline
24 h
h tli
Listening
Conference
Governing board
Advisory
committees
Focus groups
g
p
Service
agreements
50. Using the Voice of the
Customer/Owner
54% of SCF employees are Alaska Native
and American Indian people, we bring the
voice of the customer interactions
throughout the organization
Alaska Native and American Indian people
recognize our families will utilize these
services for generations to come
g
51. Core Concepts
W ork together in relationship to learn and
grow
E ncourage understanding
L isten with an open mind
L augh and enjoy humor throughout the day
N otice th di it and value of ourselves and
ti the dignity
d
l
f
l
d
others
E ngage others with compassion
S hare our stories and our hearts
S trive to honor and respect ourselves and
others
52. Listening Conference
Yearly Since 2003
Panel of Board Members,
President/CEO and Vice Presidents
Open microphone
All customer/owners, community
invited
No agenda
53. Listening Conference
continued
Starts with a small presentation
SCF History
Listening
Setting Priorities
Looking to the future
Driving change
We re
We’re owning the system
Your voice matters
Thank you /explain the process
y
p
p
54. Listening Conference
Microphone is passed around the
room to customer/owners
Ask questions
Opportunities for improvement
Compliments
C
li
t
Suggestions
Notes are taken during the whole
conference
55. Listening Conference
Transcripts are reviewed
Entered into our customer comment
database
Forwarded to appropriate
department/committee/employee
Every customer comment is followed
up on
Tracking and trending
56.
57. The Gathering
Yearly since 1997
l i
99
Convention center
161 Booths of all kinds
Education
Healthy life styles
SCF departments
Community (Education, Regional Native
Corporations, etc.)
p
)
Activities
Entertainment
58. The Gathering
g
Interactions with employees
Feedback from customer/owners
Examples
•
•
•
•
More help for elders
Parking
More cancer support
Better customer service when checking in for an
appointment
• Helping the homeless/emergency financial situation
Information f ll
I f
ti
follow through on survey results by
th
h
lt b
committee/managers
Tracked through electronic feedback system
ensure appropriate action is taken
k
61. Strategic Planning Cycle
W hat are w e trying to accom plish?
H ow w ill w e know that a
change is an im provem ent?
W hat changes can w e m ake
that w ill result in im provem ent?
AC T
- W ha t cha ng e s
are to be m a d e?
- N e xt C ycle?
ST U D Y
- C o m p lete th e
a na lysis of the d ata
- C o m p are d a ta to
p re di ti n s
dictio
- Su m m arize w h a t
w a s le a rn ed
PL A N
- O b je ctive
- Q u estio n s a nd
P re dictio n s (w hy)
- Pla n to carry o ut
th e cycle (w h o,
w h a t, w h ere , w h en )
DO
- C a rry ou t th e p la n
- D o cu m en t p rob le m s
an d un exp e cte d
ob servatio n s
b
ti
- Be g in a na lysis
o f the da ta
62. Planning and Improvement Linkages
August 2006
Planning and Improvement Linkages
Green = Core foundation
Pink = Initiatives
Orange = Work Plans/Action Items
Rose = Employee Evaluation
Blue = Improvement Tools
Grey = Other Useful Tools
Double Line Box = Part of Annual Planning Tool
Mission, Vision, Key Points, Operational Principles
Established by Vice President Leadership Committee and approved by Board of Directors
Annual Planning Process
and Cycle, Baldrige
Process, Improvement
Cycle, and Committee
Structure
Str ct re are the
approaches and systems
in which these tools are
deployed.
Corporate Goals
ESTABLISHED AT CORPORATE LEVEL
Established by Vice President Leadership Committee and approved by Board of Directors
and are derived from the Mission Vision, Key Points and Operational Principles
Balanced Scorecard (BSC)
Linked to Corporate Objectives and
p
j
measure progress on achieving Corporate
Objectives
Corporate Objectives
ESTABLISHED AT CORPORATE LEVEL
Reviewed and updated annually by Vice President Leadership Team as part of Planning
Cycle with input from employees/customers
Because initiatives tie to Objectives
and they are longer term, they
should be linked to BSC.
4 Oval Structure
Functional Structure
Committee Initiative
Functional Structure
Committee Work Plan/
Action Item
Division
Work Plan/Action
Item
Department Work
Plan/Action Item
OTHER USEFUL TOOLS
Project Team Charter
Assessment
Conference Lessons
Learned
BSC/DB Definitions
Medelearn
Intranet Tools
including forms
Policy & Procedure
Templates
Committee Reporting
Form
Employee
Performance Action
Plan
Functional Structure
Committee
Work Plan/Action Item
Division Initiative
Department
Initiative
Department
Work Plan/Action
Item
Department
Work Plan/Action
Item
Work Plan
W k Pl or Action Item
A ti It
Details the short term action items (tests of change
or less than quarter in duration) that will be
completed and/tested to achieve an initiative. Work
plans may be developed at all levels of the
organization
Department
Work Plan/Action
Item
Link to
Improvement
Tools
Initiatives
Strategic activities identified that are
longer term (occur in 1-2-3 years) to
achieve the corporate objectives.
Initiatives may be developed at all
levels of the organization.
Corporate
Initiative
Employee Performance Action Plan
Employee
Employee
Performance Action Details for each employee their action Performance Action
items for the year linked to initiatives
Plan
Plan
and work plans.
ADLI
Change Concepts:
Survey Monkey:
Baldrige Assessment and
Developed for most
initiatives to outline the
details of the initiative.
PDSA
Developed for work
plans that involve
improvement activities to
outline the details of the
work plan. Changes are
tested in Rapid Cycle,
with one cycle building
on another.
Employee
Performance Action
Plan
Improvement Tools
Operational Principles:
Measurement Rules Template:
Committee Manager:
Project or Project
Team Charter
Used to test ideas or concepts to ensure consistency with MVKP&Corporate Goals
Developed to assist with defining BSC / Dashboards measures. Part of the intranet tool
Used to develop Project Team in order to communicate changes, meeting minutes etc
corporate wide
Approach, Deploy, Learning, Integration: From Baldrige used to evaluate PDSA cycles.
Change concepts are used in improvement to assist in generating new ideas when
making changes
Used to measure success for process changes
Feedback: Survey that can be used to assess where the organization/department/committee is based
on Baldrige Criteria
Dashboards (DB)
Operational Measures that monitor
the day to day operations. These
measures inform where
improvement may be targeted. If the
annual plan is used as an
operational work plan in addition to a
strategic plan, DB items may be
linked to these operational initiatives/
work plan items.
Measurement Rules
Template
Data and Information drives all aspects of the Improvement Process and is part of all tools. Data are reviewed from the 4 perspectives: Finance/Workload, Organizational
Effectiveness, Customer, & Workforce including National Research Corporation-Customer Satisfaction; Morehead Associates-Employee Satisfaction; BSC/DB, Hedis etc.
65. Improvement Model:
From The Improvement Guide. A Practical Approach to Enhancing Organizational Performance by
Langly, Nolan K., Nolan T., Norman, and Provost
66. Continuous Improvement
A P
A
A
P
P
S
S D
D
S D
S D
Situation as it is
From The Improvement Guide. A Practical Approach to Enhancing Organizational Performance by
Langly, Nolan K., Nolan T., Norman, and Provost
Impr
rovement
n
A
P
Situation
as it
Should
Be
67.
68. SCF Facilities Supporting
Health
The key determinant of health (and
success in education and finances) is
Self Confidence
Se Co de ce d a s o p de,
Self Confidence draws from pride,
honor, dignity, respect
Outstandingly beautiful facilities are
a key piece of improving Alaska
Native pride honor dignity - self
pride, honor,
confidence
69. Customer-Owner Design
Easy to find, welcoming spaces
Beauty, light, comfort, colors and
textures that are familiar
Native feel but not any specific one
feel,
culture
Dignity, pride respect, honor,
Dignity pride, respect honor
relationship
Privacy, ti
P i
time, li t i
listening
Family and friends welcome
70.
71.
72. Facility design
Smaller, quieter, more personal feeling
Not on top of each other spreading
infection and being disruptive
Accommodates family and privacy both
Comfortable exam spaces and on the
same level as the clinical people – respect
Self management, customer-owner
customer owner
control
Visual, sharing, listening, professional
73. Facility Design
Group sociology – Family dynamics - max
15 people, Team dynamics up to 65, over
65 – bureaucracy
Back to smaller ‘team’ practices – 6
‘primary care’.
Decentralized Health Information C t
D
t li d H lth I f
ti
Centers
into every waiting area
Shared specialty rooms and equipment central spine
Extensive use of glass, natural light, semig
,
g ,
privacy
74. Facility Design
Emphasis shifted towards more team
space and more importance of
g
p
integrated team space
More and more team care, ‘virtual’ care
(email and phone and home visitors),
less visits.
l
i it
No ‘nurses station’
CMS and CMA s with teams – phone
CMA’s
traffic direct to teams
Shared resources – behaviorists,
dieticians, pharmacists, coverage staff visible/accessible
75. Facility Design
Structural alignment with shift in
power to be more balanced – spaces
de-medicalized
d
di li d
Family rooms
Group rooms
G
Co-located Mental Health therapists
Experiments with merged
h
d
pharmacist, pregnancy and pediatric
care
78. Diabetes: HbA1C Poor Control
40
%
23.0
24.2
26.9
26.5
23.7
22.5
22.5
22.8
Mar
Jun
Sep
Dec
Mar
Jun
Sep
Dec
20
0
2008
SCF
2009
2008 HEDIS 10th Percentile (32.60)
79. Diabetes: LDL < 100mg/dl
%
100
50.3
49.8
48.5
49.1
48.3
52.1
54.0
52.9
Mar
Jun
Sep
Dec
Mar
Jun
Sep
Dec
50
0
2008
SCF
2009
2008 HEDIS 90th Percentile (42.31)
80. Diabetes: B/P < 130/80
%
100
34.0
50
39.4
39.8
Jun
Sep
Dec
0
Mar
Jun
Sep
2008
SCF
Dec
Mar
2009
2008 HEDIS 90th Percentile (41.30)
81. Cardiovascular: LDL < 100mg/dl
g
%
100
50
49.2
49 2
51.0
51 0
50.3
50 3
49.1
49 1
Mar
40.3
Jun
Sep
Dec
0
Dec
2008
SCF
2009
2008 HEDIS 90th Percentile (52.87)
82. 50
SCF Overall
5 to 9 yrs
10 to 17 yrs
Dec
Nov
Oct
Dec
Nov
Oct
Dec
Nov
Oct
Dec
Nov
0
Oct
%
100
Asthma: Appropriate Meds
97 95 96 95
87 86 87 96 96
84 82 83
18 to 56 yrs
2009
SCF
2008 HEDIS 90th Percentile (Overall 91.94)
83. Cancer Screening: Colorectal
(Flex sig and Colonoscopy)
%
100
50
48.9
48 9
50.3
50 3
52.2
52 2
55.6
55 6
57.0
57.8
58.2
58.6
Mar
Jun
Sep
Dec
Mar
Jun
Sep
Dec
0
2008
SCF
2009
2008 HEDIS 90th Percentile (65.72)
86. Complex Utilizer: Annual Behavorial Visit
100
%
52.3
53.2
55.6
58.4
58 4
59.0
59 0
Dec
Mar
Jun
Sep
Dec
50
0
2008
2009
SCF
SCF Target (75%)
87. Controlled Medications: Annual Behavorial Visit
%
100
50
30.3
28.8
30.4
32.8
32 8
35.4
35 4
Dec
Mar
Jun
Sep
Dec
0
2008
2009
SCF
SCF T
Target (50%)
88. Access to Recovery: 6 Month Follow-Up of Intakes
94.0
%
100
80.7
50
0
2008 (N=151)
SCF
2009 (N=657)
Avg
A All G
Grantees (2008 64 % 2009 63 %)
(2008:64.7% 2009: 63.7%)
89. Access to Recovery: Alcohol & Drug Abstinence
100
%
72.7
50
46.1
66.4
76.8
65.5
62.8
70.9
50.0
50 0
0
Intake 6 mo Intake 6 mo Intake 6 mo Intake 6 mo
FY09-Q1
FY09 Q1
n=128
FY09-Q2
FY09 Q2
n=122
FY09-Q3
FY09 Q3
n=142
FY09-Q4
FY09 Q4
n=86
90. Access to Recovery: Employment & Education
%
100
39.1
39 1
50
18.8
23.8
33.6
28.2
37.3
37 3
29.1
34.9
0
Intake 6 mo Intake 6 mo Intake 6 mo Intake 6 mo
FY09-Q1
n=128
FY09-Q2
n=122
FY09-Q3
n=142
FY09-Q4
n=86
91. Su
uicides pe 100,00
er
00
Crude Rate: AN Suicides
Anchorage & MatSu Residents
100
50
46.70
24.60
0
2004
#Suicides=16
2006
#Suicides=9
2008
#Suicides=3
92. Emergency Dept Visits per 1000 Member Months
Visit per 100
ts
00
100
50
42.76
43.97
2008
2009
0
SCF
HEDIS 10th Percentile (40.59)
93. Monthly
M thl ED Visits Per 1000 Customers
Vi it P
C t
(Historical)
19% Decrease Since 2000
48
40
39
2007
2006
2005
2004
2003
2002
2001
0
2000
Visits per 1000
80
94. Visit per 1000
ts
0
Total Outpatient Visits per 1000 Member Months
400
299.35
322.25
2008
2009
200
0
SCF
HEDIS 25th Pctile (274.04)
HEDIS 50th Pctile (324.01)
107. Relat
tive % chan from baseline
nge
b
Cumulative Per Capita Expenditures
Relative % Change with 2004 as Baseline
30
27
26
26
25
20
15
15
10
5
5
0
-5
2004
2005
2006
2007
2008
-10
SCF Cumulative Primary Care
SCF Cumulative Hospital Services
National Health Spending
National Hospital Care Expenditures
National Physician and Clinic Services Expenditures