Clinical redesign strategies for multi- site implementation and - - PowerPoint PPT Presentation

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Clinical redesign strategies for multi- site implementation and quality improvement initiatives at a large academic healthcare system

Luming Li, MD; Melissa Davis, MD, MBA; Brittany Branson, MD; Scott Sussman, MD; Stephanie Amport, MBA; Ian Schwartz, MD Yale New Haven Health, Yale School of Medicine

Yale New Haven Health At-a-Glance

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Westerly Hospital Bridgeport Hospital Greenwich Hospital Northeast Medical Group Lawrence + Memorial Hospital Yale New Haven Hospital

− Five Hospitals − Yale New Haven Hospital − Bridgeport Hospital − Greenwich Hospital − Lawrence + Memorial Hospital − Westerly Hospital − 2,563 Licensed Beds − 25,800 Employees − * Recently acquired Milford Hospital − Primary teaching hospital of Yale School of Medicine − 8,113 medical staff members − 790 trainees − System physician foundation: Northeast Medical Group − 990 providers − $4.6 Billion in Revenues

$4.6B

revenue*

182,655

inpatient cases*

2.4M

• utpatient encounters

25,800

employees

8,113

medical staff

271

sites

Yale New Haven Health FY18 At-a-Glance

*Does not include Yale School of Medicine **Inpatient cases and observations

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Clinical Redesign: Achievements To Date

Integrated Care Models (System/Ambulatory):

Process to improve patient-centric value through standardized care, consistent experience and improved coordination and collaboration of YNHHS, YM and community partner clinicians

• Impacted 4,618 patients since March 2019 go-live
• Standardized protocols, pathways, and evaluation tools
• Wave 1 initiatives focused on breast abnormality screening,

colonoscopy referrals for screening, abnormal prostrate screening, and evaluating asthma control and treatment

Impact Care (YNHH): A series of initiatives aimed at

enhancing patient throughput and efficiency while lightening the burden on the Emergency Department and Hospitalist Service

• Opened 18 beds additional observation status beds
• Converted a Hospitalist unit to Heart and Vascular
• Increased weekend Care Coordination resources
• Implemented a Hospitalist Service staffing model
• Saved 458 inpatient days by discharging to CT Hospice
• Saved 210 patient days through Gaylord collaboration
• 47K consults processed through connect center

BH, 32 GH, 11 NEMG, 1 LMH, 5 System, 48 YNHH, 98

FY 2015-2019 YTD Projects by Delivery Network 195 Total Geriatric Trauma (BH)

• Reduced average LOS by 7% for geriatric trauma patients

Operating Room Efficiency (GH)

• Improved first case on-time starts by 25%

Standardization of Operating Room Checklist (LMH)

• Surgical checklist and time-out procedure standardized

Procalcitonin Testing Optimization (System)

• Reduced overall usage of procalcitonin testing by 18%

Hackathon T3 (YNHH)

• Optimized Epic tools to provide patient facing transparency

Outcomes of Traditional Clinical Redesign Initiatives As Clinical Redesign has matured, it has adopted a wider scope and has addressed some of the most complex clinical issues across the health system. Outcomes of two key signature projects:

Clinical Redesign Success Formula

Ø We have developed and calibrated a methodology to drive rapid-cycle projects to completion. Clinical Redesign helps rethink how we deliver care, realign our resources to enhance patient care, and redesign processes crucial to the successful, reliable, and sustainable delivery of that care.

Idea Generation & Case Selection Senior Leadership Support 90-Day Timeline Rigorous Project Management Analytics / EPIC Optimization Clinician-Led Collaborative Teams

Ø Clinical Redesign drives value-focused improvement in care delivery across YNHHS. The initiative has a broad scope, and over the past three years has enhanced patient care across many key areas.

𝑊𝑏𝑚𝑣𝑓 = 𝑟𝑣𝑏𝑚𝑗𝑢𝑧 + 𝑡𝑏𝑔𝑓𝑢𝑧 + 𝑞𝑏𝑢𝑗𝑓𝑜𝑢 𝑓𝑦𝑞𝑓𝑠𝑗𝑓𝑜𝑑𝑓 𝑑𝑝𝑡𝑢/𝑞𝑠𝑗𝑑𝑓 𝑔𝑝𝑠 𝑞𝑏𝑧𝑓𝑠𝑡 & 𝑞𝑏𝑢𝑗𝑓𝑜𝑢𝑡

Adapted from: Porter, M. E. & Teisberg, E. O. Redefining Health Care: Creating Value-based Competition on

• Results. (Harvard Business Press, 2006).

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Clinical Redesign Team Members

Ian Schwartz, MD VP Operations Maribeth Cabie, PharmD Director, Clinical Redesign Scott Sussman, MD Senior Medical Director, Clinical Operations Patrick Kenney, MD Olukemi Akande, MD Brittany Branson, MD Melissa Davis, MD Luming Li, MD Darcy Harris, DO John Roberts, MD Crystal Clemons Kelsey Cole, PA Lynda Cook, RN Hillary D’Atri Daniel Heacock, PA Jennifer Johnson, APRN Kent Owusu, PharmD Caitlin Sculley Stephen Possick, MD

Physician Partners Project Managers

Anesta Williams, RN James Pallett, MD

Ten Elements of Success

1) Dedicated, motivated, and engaged leadership from respected clinicians 2) Full clinical team engagement 3) Administrative support from senior-level hospital leaders 4) Risks to project success identified early and mitigated throughout the case lifecycle 5) Defined scope with clear end-points and deliverables 6) Evidence-based and/or patient/family centered case goals 7) Clinically relevant data regularly delivered to units and providers 8) Competition accelerates achievement of goals 9) Physician pain points specifically addressed 10) Clear education and communication to create visibility of project goals

Adapted from: Borgstrom, M. P., Deshpande, O. M. & Balcezak, T. J. Pursuit of Value Drives Strategy to Improve Operations and Outcomes. Front. Health Serv. Manage. 34, 3–13 (2017)

Project Phases

Li, L., Davis, M., Branson, B., Amport, S., Sussman, S., Schwartz, I. “Implementation of a Clinical Redesign Intervention Leading to Improved Quality and Reduced Costs an Academic Healthcare System.” JAMA Network Open. In Preparation. 2019.

Project Timeline

Project Selection

S p

• n

s

• r

C l i n i c a l L e a d T e a m

Project Planning

D e t e r m i n e i n t e r v e n t i

• n

( s ) M e t r i c s f

• r

s u c c e s s I T c

• m

p

• n

e n t s P a t i e n t E n g a g e m e n t

Pilot Launch

3 d a y 6 d a y 9 d a y S u s t a i n a b i l i t y P l a n

Sustainability phase

90 days

Project Management Based Approach

Defined Team Roles

Role Title Responsibility

CRD Project Manager

• Organizes and leads the project team
• Executes the project against/in alignment with the project plan
• Reports to and consults with project oversight leader/Clinical Lead on progress
• Consults with medical oversight leader/CRD Physician Partner on clinical topics/issues
• Drives the project to completion

CRD Project Oversight Leader

• Consults, guides and mentors project leaders to ensure their success
• Assures adequate resources for project execution (data analytics, dedicated time by

important roles)

• Provides data analysis expertise and support
• Supports the project leaders when they need to bubble up issues

CRD Physician Partner

• Acts as a clinical resource to the project manager
• Ensures project definition and planned interventions are clinically sound
• Acts as a liaison between the project team and overall clinical community
• Coordinates clinical interventions as needed

Project Sponsor

• Helps to select appropriate core team members and expressing your desire for their

commitment to the effort.

• Intervenes if team member participation falters.
• Approves the charter which details the project objective, scope and metrics.
• Meets with the project leader to receive an update at least twice in the 90-day project

cycle.

• Keeps current with the team’s progress by reviewing meeting minutes and/or attending

a team meeting on occasion.

• Selects a Sustainability Lead
• Praises the team’s accomplishments

Defined Team Roles (Continued)

Role Title Responsibility

Local Clinical Leader

• Plans for team meetings with project manager
• An active member of team meetings
• Assists project manager with holding team members accountable for attendance

and deliverables

• Acts as a clinical resource for project manger
• Coordinates the development and deployment of clinical interventions and acts

as the change management champion as it relates to the project

• Works with project manager to meet project plan deliverables (charter,

dashboard validation, sustainability lead, summaries)

• Communicates with project sponsor as appropriate

Project Team Members

• Attends meetings and actively participates in project work as a subject matter

expert

• Completes project deliverables within the allotted timeframe
• Participates in the development and deployment of clinical interventions

Sustainability Lead

• Serve as champion to ensure that the team’s interventions are followed
• Monitor the process performance via the associated dashboard at a minimum of
• nce a week
• Intervene when the current performance trend is negative
• Celebrate with the team when the current performance is consistently positive
• Communicate the performance status to sponsor

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Dashboards and Trackers:

ED Navigator Beds Mgmt / Y-Access Nursing Resource Pool AMR EVS Patient Transport OSCE (off hours) CCC MD Lead CCC Lead Care Mgmt. Procedural Areas Pharmacy PeriOp Code Response Ambulator y TeleHealth Quality & Safety Ancillary Services Materials Mgmt. Clinical Engineering Food and Nutrition

Ex Example: Capaci city Command Center

• Collaborative environment with co-

location of key operational teams and real-time dashboards that provide unparalleled situational awareness

• Huddles at 8AM, 8PM, and 12AM
• Focus on improving flow of patients from

admissions through discharge

• Clinical Redesign to address pain points

identified

• Real time dashboards available to all

employees via Epic

Docked Located In CCC

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Example: Adjusted Cost Per Case

$12,944 $12,332 $12,076 $11,872 $11,655 $11,721

$0 $13,000 FY2013 FY2014 FY2015 FY2016 FY2017 FY2018

Yale New Haven Hospital

CMI-Adjusted Cost per Discharge

(Inflation-adjusted)

CMI-Adjusted Cost per Discharge * Linear (CMI-Adjusted Cost per Discharge *)

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THANK YOU!

• Luming_Li, MD, Medical Director of Clinical Operations
• Yale New Haven Health

@luming_li