Operational Quality Improvement Operational Quality Improvement - - PDF document

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Operational Quality Improvement Operational Quality Improvement - - PDF document

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09/18/2012 Caroline LeGarde, Administrator, Johns Hopkins Department of Dermatology September 14, 2012 Operational Quality Improvement Operational Quality Improvement Designing Safe and Efficient Systems and Spaces Operational Quality Improvement

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Operational Quality Improvement

Caroline LeGarde, Administrator, Johns Hopkins Department of Dermatology September 14, 2012

Operational Quality Improvement

Designing Safe and Efficient Systems and Spaces

Operational Quality Improvement Initiatives

  • Dashboard for Safety & Quality
  • Access Initiative
  • Safety & Teamwork – SAQ Results & Tools

y

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Overview of Department

  • Leadership Team and Faculty

– Chairman & Administrator: Dr. Sewon Kang, Caroline LeGarde – Physician Advisor/Safety Officer: Dr. Janis Taube

  • 6 of 16 faculty members joined in early FY10,

new management team hired in FY10‐11  FY12 = “Stabilization” year  FY12 = Stabilization year

  • Process changes & safety/teamwork focus

 Culture change taking root

09/18/2012 3

FY12/13 Safety Initiatives & Dashboard

  • Safe: Phototherapy adverse events, Specimen

labeling errors

  • Effective: Hand hygiene
  • Timely: Days to next new appointment, Results

reporting (biopsy result explained to patient & d d) documented)

  • Patient‐centered: Access center
  • Efficient: Dermatopathology TAT

09/18/2012 4

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Safe: Phototherapy adverse events

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Safe: Phototherapy adverse events

FY12 

09/18/2012 6

New phototx LPN New UVA1 box

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Teamwork & Communication

Treatment Nurse Physician Assess & prescribe Administer & report

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Follow‐up

l Protocol Consistency: Phototherapy “Pathway”

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Timely: Days to next new appointment

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FY12 

No‐shows: Why they are so Bad

  • Delays in treatment, lack of continuity

y , y

  • Pushes back other appointments, must book

further out than necessary

  • Volume variability –

difficult to schedule

09/18/2012 10

difficult to schedule

  • Lost revenue, poor use
  • f staff & doctor time
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No‐shows: The Old Strategy

  • Reduce days to next appointment

Reduce days to next appointment

  • Appointment letter
  • Automatic Televox phone call 5 days before
  • Day before phone call from staff
  • Day‐of phone call to reschedule if no‐show

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Day of phone call to reschedule if no show No‐shows: The Old Strategy Results

09/18/2012 12

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No‐show Policy: the New Strategy

09/18/2012 13

No‐shows: The New Strategy Results

Prep., Comm’n

Go Live!

09/18/2012 14

to Stake‐ holders

Live!

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No‐shows: The New Strategy Results

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No‐show Policy: Implementation G d i ti & i

  • Good communication & no surprises

 one month notice to stakeholders Reminders: (1) time of scheduling, (2) appt. letter, (3) 2‐day prior phone calls , (4) signs in clinic new separate phone line option to cancel new separate phone line option to cancel

  • Consistent application

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Sustained results of NSF

Prep., Comm’n to Stake‐ holders

FY12 

Go Live!

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No‐show Policy: Results to Date

  • Suddenly patients care!

Suddenly patients care!

  • Sooner appointments opening frequently
  • Higher show rate = 4 extra pts. / day
  • Started with one hospital‐based adult

clinic, rolled out to Pediatric Dermatology clinic

09/18/2012 18

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Patient‐centered: Access Initiative Access Challenge = Multiple phone numbers Access Challenge Multiple phone numbers

  • One doctor → one scheduler
  • Weak back‐up plan or cross coverage
  • Difficult to monitor quality or accuracy
  • Difficult to roll out new protocols

09/18/2012 19

Access Services

410‐955‐5933

How to make a Derm. appointment: 2009

JHOC PedsDerm GSS Bayview Melanoma

Immuno.

Access Services

Mohs Surg. 410‐955‐2049 410‐847‐3767 410‐550‐0503 410‐550‐0315 410‐550‐0724 410‐955‐2992 410‐614‐1022 410‐614‐6204 410‐614‐6686 410‐955‐1588 410‐955‐1573 410‐502‐2082 410‐955‐3865 410 955 8662

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410‐955‐8662 410‐955‐3397 410‐955‐1570 410‐502‐6778 410‐614‐0255 410‐955‐2163

20+ Phone Numbers!

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410‐955‐5933

How to make a Derm. appointment: 2011

JHOC PedsDerm GSS Bayview Melanoma

Immuno.

Access Services

Mohs Surg. 410 955 5933 410‐955‐1573 410‐955‐2049 410‐847‐3767 410‐550‐0503 410‐614‐1022 410‐955‐1588

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410‐955‐2992

8 Phone Numbers

410‐955‐1588

How to make a Derm. appointment: 2012

410‐955‐5933 JHOC PedsDerm GSS Bayview

Immuno.

Access Services

Mohs Surg. 410‐955‐1573 410‐955‐2049 410‐847‐3767 410‐550‐0503

Co‐located

JHOC, PedsDerm, GSS, Bayview, Immuno. & Melanoma

410‐955‐5933

09/18/2012 22

410‐955‐2992

1 Phone Number

(or the number you already have)

410‐955‐1573 410‐955‐2049 410‐847‐3767 410‐550‐0503 410‐955‐2992

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Roll‐out Plan for Access Initiative

  • Hired manager and 6 incremental FTEs –

will be 12 agents total

  • Moved one division at a time

Partnered with faculty for every change Standardized all phone trees (with patient input)

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Standardized all phone trees (with patient input)

Clarified & simplified protocols Monitored metrics

Thank you for calling the Johns Hopkins Department of Dermatology GSS Appointment # 410‐847‐3767

To Make an Appt. To Change or Cancel an Appt. For Prescription Refills

For Lab or Biopsy Results or to speak to a Nurse For Our Fax number and Address

To Hear These Options Again

1 2 3 4 5 9

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Patient‐centered: Access Initiative

  • Focus on accurate and timely scheduling

with service excellence (metrics!)

  • Ongoing education for staff about Derm.

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Access Metrics

  • Pick carefully what to measure

Pick carefully what to measure

  • Transparency + Consistency = Trust
  • Reinforce the right things and

tie back to patient safety = Engagement

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Access Metrics

  • Pick carefully what to measure
  • Transparency + Consistency = Trust

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The New Access Challenges

  • Capacity! “Hopkins Family”, international,

Executive Health, readmission prevention

  • Retraining our patients – resetting

expectations

  • Message flow

09/18/2012 29

Message flow

  • QA/QC
  • Retaining staff – critical impact of turnover

SAQ: Climbing out of the Danger Zone

  • Focus on teamwork & safety

09/18/2012 30

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SAQ Results – Teamwork & Safety

Clinic Staff  24% higher vs 2009‐10

  • Med. Staff  13% higher vs 2009‐10

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Clinic Staff  23% higher vs 2009‐10

  • Med. Staff  40% higher vs 2009‐10

0.7 0.8 0.9 1

Most Improved Units in Teamwork Climate

0.1 0.2 0.3 0.4 0.5 0.6

Armstrong Institute for Patient Safety and Quality 32

2009 TW Climate 2011 TW Climate

*only includes units with data in both years

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0.7 0.8 0.9 1

Most Improved Units in Safety Climate

0.1 0.2 0.3 0.4 0.5 0.6

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2009 Safety Climate 2011 Safety Climate

Dermatology Results – Medical Staff

40 13 33 20 40 36 21

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Dermatology Results – Clinic Staff

23 24 16 27 16 33 36

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Teamwork & Safety Tools

  • Effective (unified) leadership

– Clinic manager + Medical Director + RN

  • Consistent communication

– Safety & Service “S&S” meetings, newsletters – Manager daily memos to all

Scripting

  • Scripting

– “Safety, safety, safety” – “In response to staff/resident/faculty feedback…” – Gallup survey Q12 language

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Creating Spaces for Teamwork

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Teamwork Spaces – the “Pod Bridge”

09/18/2012 38

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Teamwork Spaces – the “Pod Bridge”

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Teamwork & Safety = Learning Together

09/18/2012 40

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Our Newest Tool: Mini‐RCA

  • Same format as traditional RCA
  • Multi‐disciplinary – involve

staff, residents, faculty

  • Gather facts

Discuss processes & systems

  • Discuss processes & systems
  • Implement change

09/18/2012 41

Example: Mini‐RCA

  • 4/24/12 (Tues PM) Dr. X +

resident performed punch biopsy

  • 1 week later, Dr. X noted that results had

not been received, pending path report

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not in EPR

  • Specimen not received by Pathology
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FY12/13 Safety Initiatives & Dashboard

  • Safe: Phototherapy adverse events, Specimen

labeling errors

  • Effective: Hand hygiene
  • Timely: Days to next new appointment, Results

reporting (biopsy result explained to patient & d d) documented)

  • Patient‐centered: Access center
  • Efficient: Dermatopathology TAT

09/18/2012 47

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