Engaging Physicians and Families as Partners Childrens Hospital - - PowerPoint PPT Presentation

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Engaging Physicians and Families as Partners Childrens Hospital - - PowerPoint PPT Presentation

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From Conception to Birth: Engaging Physicians and Families as Partners Childrens Hospital Association Annual Conference 2013 AGENDA Introduction Engaging Physicians and Families Fostering Collaboration Continuous Engagement

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Children’s Hospital Association Annual Conference 2013

From Conception to Birth:

Engaging Physicians and Families as Partners

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AGENDA

  • Introduction
  • Engaging Physicians and Families
  • Fostering Collaboration
  • Continuous Engagement
  • Results
  • Q & A
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INTRODUCTION

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Texas Children’s Hospital: Who We Are

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Vision 2010: Excellence to Eminence

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Pavilion for Women

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Houston Market

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Risks

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Texas Children’s and SLEH sign a contract to construct adjoining buildings and operate under joint

  • administration. This

arrangement continues for 35 years.

1950s

The partnership provides community with unique resources and immediate access to high-risk

  • bstetrics experts

and >40 pediatric subspecialties in

  • ne location.

2006

  • St. Luke’s notified Texas Children’s of intent to get
  • ut of OB services. Texas Children’s and St. Luke’s

enter a management agreement for obstetrics service line

1980 – 1990s

Texas Children’s and

  • St. Luke’s separate in
  • 1987. Texas Children’s

continued to grow and has become one of the largest freestanding children’s hospitals in the nation. Pavilion for Women provides comprehensive care with centers of excellence in specialties including:

  • Maternal Fetal Medicine
  • Infertility
  • Fetal Intervention & Surgery
  • Fetal Cardiology
  • Reproductive Genetics
  • Perinatal Nutrition
  • Neonatology
  • Reproductive Mental Health
  • Gynecology

Today

We Had No Choice

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Our Initial Vision

Improve neonatal

  • utcomes by taking care
  • f women prior to and

during their pregnancy

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Executing the Vision

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Changing the Model of Care

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ENGAGING PHYSICIANS & FAMILIES

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The Red Zone

  • Culture Changes
  • New Market Entry
  • Partnership Formation
  • Competitive Response
  • Operational Challenges
  • A New Facility

Today’s Business Model Future Business Model

Transformation Required

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Patient Experience Management

Source: Gelb/APQC/Beryl Institute Benchmarking Study

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Source: Gelb Benchmarking Study

Physician Experience Management

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Customer Enchantment

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Functional

Recognize Needs

Emotional

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Engagement Process

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Primary Experience Stewards Key Touchpoints Awareness

  • Physician

Liaisons

  • Faculty/Staff

Need

  • Front Desk Staff
  • Faculty/Medical

Staff

Scheduling

  • Faculty/Medical

Staff

  • Support Staff

Transition

  • Faculty/Medical Staff
  • Support Staff

Treatment

  • Faculty/Medical

Staff

  • Support Staff

Experience Map

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Video / Audio Recordings Physical Environment Communications

1.

Interview Transcripts

2.

From Data…

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3. 4.

…to Insights

Detailed Findings Day in the Life Touchpoint Assessment

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Handle with Care OB - Driven

Segmenting Patients

In Control Support Seekers

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Want OB leadership, not pediatrics Concerned about lack

  • f adult care focus at

Texas Children’s Feel existing OB nursing team highly skilled and capable

Physician Partners

Convenience and access in the Texas Medical Center can be challenging

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Change in Perspective

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Selling the Vision

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FOSTERING COLLABORATION

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It’s not the building…

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Guiding Principles

  • Create a significant architectural landmark
  • Fit into existing TCH campus
  • Provide flexibility for change over time
  • Respond to physician and staff needs
  • Support cutting edge patient care and services
  • Provide the ultimate customer experience
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Inclusion

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Transparency

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Why is Input Critical?

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Physician Experience Management

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Family Experience Management

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Program Components

  • LDRs (Not LDRPs)
  • Emergency C-Section ORs (On same floor as LDRs)
  • Scheduled C-Section & GYN / Fetal Intervention ORs (On dedicated floor)
  • Assessment / Triage Center
  • Women’s Specialty Unit
  • Mother Baby Unit
  • NICU (Level 2 & 3)
  • Family Fertility Center with IVF Lab
  • Women’s Radiology Suite
  • Maternal and Fetal Center
  • Concierge Services
  • Patient Support Services
  • Education / Conference Center
  • Physician Offices / Clinics
  • Support / Logistic Services
  • Milk Bank
  • Lab / Blood Bank
  • Cord Bank
  • Psychological / Social Support Center
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Sharp Mary Birch Hoag Hospital University of Iowa University of Nebraska Adult facilities Pediatric facilities Vanderbilt Prentice

Benchmarking

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LDR NICU LDR NICU

Horizontal Travel Distance:

615’

Vertical Travel Distance:

225’

LDR NICU

Organizational Concepts

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Test Fits

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STACKING: 3,500 Births

Growth Concepts

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STACKING: 5,000 Births

Growth Concepts

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Interiors

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Translating Feedback into Customer Experience

+

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The “Stork” Cart

+

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Initial Design Concept

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Refining the Design

February May

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Assessment Stork Cart Parking

Designed Parking into Patient Rooms

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Labor and Delivery Stork Cart Parking

Designed Parking into Patient Rooms

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Mother Baby/Ante Partum Stork Cart Parking

Designed Parking into Patient Rooms

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Family Launch Zone

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Launch Zone

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CONTINUOUS ENGAGEMENT

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Our New Vision

Lead the advancement of healthcare for women and newborns through innovation and excellence in patient care, education and research.

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Shared Leadership Model

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SLIDE 54 Page 53 Executive Steering Committee Clinical Support Services Sarah Maytum Liz Bolds Patty Eng Business Operations Joann Lee Christina Kadavil- Kunnacherry Inpatient Clinical Services Carol Forsberg Emily Weber Ashley Miller Facilities Preparation Jill Pearsall Rick McFee Ted Gillis Renee Williams Outpatient Clinical Services Chanda Cashen Jennifer Upshaw Roula Zoghbi Support Services Bert Gumeringer Jennifer Borders Brian Murry BCM OB/Gyn Fetal Center TCWS REI/IVF Triage Women’s Specialty Unit L&D Epic NICU Ancillary Services Milk Bank RT Food & Nutrition Pharmacy Pathology PT/OT DI
  • Pt. Ed./
Childbirth Ed Guest Services Social Work Pt & Fam Services Volunteer Services Rec. Therapy/ Child Life Spiritual Care HIM Human Resources Finance Operations Cashier EPIC/IRIS Retail Business Services Property Accounting Safety IS/Telecom Security Facilities Ops Supply Chain Biomed Facilities Planning & Developmnt Supply Chain Safety IS/Telecom Security Facilities Ops Food & Nutrition (Retail) Biomed Linda Aldred Myra Davis Susan MacDonald Bart Putterman, MD Wycke Baker, MD Mary Jo Andre Pete Dawson Sandy McElligott Laura Shuford Cris Daskevich Michael Belfort, MD Ed Yosowitz, MD Ben Melson Alec King Monju Monga, MD Amber Tabora Mark Mullarkey Steve Welty, MD Randy Wright Marcia Katz, MD James Versalovic, MD Mark Skolkin, MD Psychosoc. Support Facilities and Support Team Coordinator Activation Project Coordinator – Christina Kadavil-Kunnacherry MBU & NBN Care Mgmt. Physician involvement at the Executive Steering Committee, Clinical Steering Committee and Activation Team levels; Quality integrated across all teams ACTIVATION LEADERSHIP TEAM Room Mgmt. PSO Move Coord. Emergency Mgmt. Transit Center Legal / Regulatory

Pavilion for Women Activation Team Structure

Michael Belfort, MD Wycke Baker, MD Manisha Gandhi, MD Liz Bolds, RN Emily Weber, RN Stephanie Martin, MD David Zepeda, MD Jessica Ohlemacher, MD Kirsten Benjamin, RN Steve Welty, MD Bart Putterman, MD Carol Forsberg, RN Nancy Hurst, RN Elaine Whaley, RN Sandy McElligott Patti Heale, RN Brian Kirshon, MD Michael Speer, MD Edwina Popek, MD Cris Daskevich Gary Dildy, MD Judy Swanson, RN Chanda Cashen Ed Yosowitz, MD Clinical Steering Committee Surgical Svcs ICU
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42 31.5 33 28 28

5 10 15 20 25 30 35 40 45

Baseline (F eb '12) Improve (Mar '12) Improve (Apr '12) Control (May '12) Nov '12

Median C ycle Time (Minutes) Improvement Stages

Median R esolution Time for Urgent C alls (minutes)

G

  • al

Actual

33%

Outpatient Flow Redesign

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70 3

20 40 60 80 Baseline Current

3rd Next Available for Annual Exams (days)

Outpatient Access Improvement

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Medical Practice (August ‘13) 90.9% Texas Children’s Pavilion for Women Overall 91.1%

Process Improvement: Positive Impact on Patient Satisfaction

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Admit Assess/ Triage Labor & Delivery Mother Baby Care Launch Family

Growth Management Requires Physicians

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Inpatient Flow Redesign

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HCAHPS Recommend Hospital:

91.9% (98th percentile)

HCAHPS Rate Hospital 0-10:

86.1% (96th percentile)

Inpatient Pavilion for Women (August 2013): 90.3%

Process Improvement: Positive Impact on Patient Satisfaction

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Focus on Quality and Safety

0.00% 0.50% 1.00% 1.50% 2.00% 2.50% 3.00% 3.50% 50 100 150 200 250 300 350 400 450 500 Number of Deliveries Per Month

PFW Obstetric Adverse Event Rate

Monthly Delivery Volume OBAE Rate Linear (Monthly Delivery Volume) Linear (OBAE Rate)

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100%

hand hygiene compliance since April 2013

0.80%

early, elective delivery less than 39 weeks of gestation

ZERO

adult central line associated blood stream infections, and surgical site infection for vaginal hysterectomies

98.9%

administration of antenatal steroids to women who deliver between 24 – 32 weeks of gestation

Physician are Foundational

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RESULTS

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43%

Outpatient Visits

Patient Access Improved

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SLIDE 65 Page 64 200 400 600 800 1,000 1,200 1,400 1,600 1,800 2,000 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Woodlands Northwest West Sugar Land Methodist

190%

Visits in First Year

MFM Community Expansion

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43% 137%

OB Ultrasounds Fetal ECHOs

Upstream Diagnosis Grows Downstream Volume

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March 26, 2012: Pavilion inpatient areas

  • pen for deliveries
  • 50
100 150 200 250 300 350 400 450 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Deliveries Births

31%

Pavilion Opening Unprecedented Delivery Volumes

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20 40 60 80 100 120 0% 5% 10% 15% 20% 25% 30% 35% Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Admissions Rate Actual Admissions Actual Rate

FY11: 627 admissions FY12: 828 admissions

NICU/CVICU Admissions Not Diluted: 23% of Annual Births

1180 NICU admissions in FY13

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96 patients admitted to ICU in Year 1

2 4 6 8 10 12 14 April May June July Aug Sept Oct Nov Dec Jan Feb March GYN Onc GYN Post Partum OB

Women’s ICU Admissions

High-Risk Focus Supports Maternal ICU

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150 200 250 300 350 400 450 500 550 Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep

FY13 Delivery Forecast

FY10 Actual FY11 Actual FY12 Actual FY13 Actual/Projected w/historical Delivery Ceiling (15/d)

Reaching Capacity in Year 2: > 4900 deliveries

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Willowbrook West Houston San Jacinto Texas Medical Center The Woodlands The Vintage

Projected 2013 Deliveries Managed with Community-based Hospital Partners

~10,000

Right Care, Right Place, Right Time

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3

in First Year

Ground Breaking In-Utero Advances

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Laser Heart Spina Bifida FETO

X X X X X X X X X X Children’s Hospital Honor Role top 5 offer in

Fetal Intervention Procedures Offered

Children’s Hospital Honor Roll

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Now Delivering Miracles

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A New Model of Care

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  • Enchantment starts with listening
  • Leverage your strengths and expertise
  • Partnerships and collaborations are key
  • Entrance by an “outsider” dramatically changes the

market dynamics

  • Flexibility is key to evolving to on-going market demands
  • Stay true to your mission and vision – the rest will work

itself out

Prescriptions for Success

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  • “Leadership = Vision + Structure + People, with people being by

far the most important component.” – Mark A. Wallace

  • Stay true to your values – the rest will follow
  • Listen – again, and again, and again…
  • Communicate, communicate, communicate
  • What is best today, may not be in 6 months or 2 years - keep an
  • pen mind, admit your mistakes and adapt quickly
  • True paradigm shifts do not occur overnight. They will be

difficult and they will be challenged. Take nothing for granted and expect the unexpected.

  • Surround yourself with top talent and support them in every

way that you can

Leadership Lessons Learned

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Cris Daskevich, FACHE, MHA/MBA Senior Vice President Texas Children’s Hospital ccdaskev@texaschildrens.org John McKeever, MBA Executive Vice President Gelb Consulting, An Endeavor Management Company 800-846-4051 office jmckeever@endeavormgmt.com Diane Osan, FAIA, ACHA Chief Visionary Officer FKP Architects, Inc. 713-821-9290 dosan@fkp.com

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