Operational Quality Improvement Operational Quality Improvement - PDF document

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 Initiatives • Dashboard for Safety & Quality • Access Initiative • Safety & Teamwork – SAQ Results & Tools y 09/18/2012 2 1

09/18/2012 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 documented) d) • Patient ‐ centered : Access center • Efficient : Dermatopathology TAT 09/18/2012 4 2

09/18/2012 Safe : Phototherapy adverse events 5 09/18/2012 Safe : Phototherapy adverse events FY12  New UVA1 New box phototx LPN 09/18/2012 6 3

09/18/2012 Teamwork & Communication Physician Treatment Nurse Assess & prescribe Administer & report Follow ‐ up 09/18/2012 7 Protocol l Consistency: Phototherapy “Pathway” 09/18/2012 8 4

09/18/2012 Timely : Days to next new appointment FY12  09/18/2012 9 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 difficult to schedule • Lost revenue, poor use of staff & doctor time 09/18/2012 10 5

09/18/2012 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 Day of phone call to reschedule if no show 09/18/2012 11 No ‐ shows: The Old Strategy Results 09/18/2012 12 6

09/18/2012 No ‐ show Policy: the New Strategy 09/18/2012 13 No ‐ shows: The New Strategy Results Prep., Go Comm’n Live! Live! to Stake ‐ holders 09/18/2012 14 7

09/18/2012 No ‐ shows: The New Strategy Results 09/18/2012 15 No ‐ show Policy: Implementation • Good communication & no surprises G d i ti & i  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 09/18/2012 16 8

09/18/2012 Sustained results of NSF Prep., Comm’n to Stake ‐ holders Go Live! FY12  09/18/2012 17 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 9

09/18/2012 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 How to make a Derm. appointment: 2009 410 ‐ 955 ‐ 5933 Access Services Access Services 410 ‐ 955 ‐ 1588 Mohs Surg. JHOC PedsDerm GSS Bayview Melanoma Immuno. 410 ‐ 955 ‐ 1573 410 ‐ 955 ‐ 2049 410 ‐ 847 ‐ 3767 410 ‐ 550 ‐ 0503 410 ‐ 614 ‐ 1022 410 ‐ 502 ‐ 2082 410 ‐ 550 ‐ 0315 410 ‐ 614 ‐ 6204 410 ‐ 550 ‐ 0724 410 ‐ 955 ‐ 2992 410 ‐ 955 ‐ 3865 410 ‐ 614 ‐ 6686 410 955 8662 410 ‐ 955 ‐ 8662 410 ‐ 955 ‐ 3397 410 ‐ 955 ‐ 1570 20+ Phone Numbers! 410 ‐ 502 ‐ 6778 410 ‐ 614 ‐ 0255 410 ‐ 955 ‐ 2163 09/18/2012 20 10

09/18/2012 How to make a Derm. appointment: 2011 410 955 5933 410 ‐ 955 ‐ 5933 Access Services 410 ‐ 955 ‐ 1588 Mohs Surg. JHOC PedsDerm GSS Bayview Melanoma Immuno. 410 ‐ 955 ‐ 1573 410 ‐ 955 ‐ 2049 410 ‐ 847 ‐ 3767 410 ‐ 550 ‐ 0503 410 ‐ 614 ‐ 1022 410 ‐ 955 ‐ 2992 8 Phone Numbers 09/18/2012 21 How to make a Derm. appointment: 2012 410 ‐ 955 ‐ 1588 Mohs Surg. 410 ‐ 955 ‐ 5933 410 ‐ 955 ‐ 5933 Co ‐ located Access Services JHOC PedsDerm GSS Bayview JHOC, PedsDerm, GSS, Bayview, Immuno. & Melanoma Immuno. 410 ‐ 955 ‐ 1573 410 ‐ 955 ‐ 2049 410 ‐ 847 ‐ 3767 410 ‐ 550 ‐ 0503 410 ‐ 955 ‐ 2992 410 ‐ 955 ‐ 1573 410 ‐ 955 ‐ 2049 410 ‐ 847 ‐ 3767 410 ‐ 550 ‐ 0503 410 ‐ 955 ‐ 2992 1 Phone Number (or the number you already have) 09/18/2012 22 11

09/18/2012 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) Standardized all phone trees (with patient input)  Clarified & simplified protocols  Monitored metrics 09/18/2012 23 Thank you for calling the Johns Hopkins GSS Department of Appointment # Dermatology 410 ‐ 847 ‐ 3767 1 2 3 4 5 9 To To Hear For To For For Our Change or These Lab or Biopsy Make an Prescription Fax number Cancel an Results or to Options and Address Appt. Refills speak to a Nurse Appt. Again 24 12

09/18/2012 Patient ‐ centered : Access Initiative • Focus on accurate and timely scheduling with service excellence (metrics!) • Ongoing education for staff about Derm. 09/18/2012 25 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 09/18/2012 26 13

09/18/2012 09/18/2012 27 Access Metrics • Pick carefully what to measure • Transparency + Consistency = Trust 09/18/2012 28 14

09/18/2012 The New Access Challenges • Capacity! “Hopkins Family”, international, Executive Health, readmission prevention • Retraining our patients – resetting expectations • Message flow Message flow • QA/QC • Retaining staff – critical impact of turnover 09/18/2012 29 SAQ: Climbing out of the Danger Zone • Focus on teamwork & safety 09/18/2012 30 15

09/18/2012 SAQ Results – Teamwork & Safety Clinic Staff  24% higher vs 2009 ‐ 10 Med. Staff  13% higher vs 2009 ‐ 10 Clinic Staff  23% higher vs 2009 ‐ 10 Med. Staff  40% higher vs 2009 ‐ 10 09/18/2012 31 Most Improved Units in Teamwork Climate 1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 *only includes units with data in both years Armstrong Institute for Patient Safety 32 2009 TW Climate 2011 TW Climate and Quality 16

09/18/2012 Most Improved Units in Safety Climate 1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 33 2009 Safety Climate 2011 Safety Climate Dermatology Results – Medical Staff 40 13 36 33 20 40 21 34 17

09/18/2012 Dermatology Results – Clinic Staff 36 23 24 33 16 27 16 35 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 09/18/2012 36 18

09/18/2012 Creating Spaces for Teamwork 09/18/2012 37 Teamwork Spaces – the “Pod Bridge” 09/18/2012 38 19

09/18/2012 Teamwork Spaces – the “Pod Bridge” 09/18/2012 39 Teamwork & Safety = Learning Together 09/18/2012 40 20

09/18/2012 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 not in EPR • Specimen not received by Pathology 09/18/2012 42 21

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09/18/2012 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 documented) d) • Patient ‐ centered : Access center • Efficient : Dermatopathology TAT 09/18/2012 47 24