Recipe for Sustainability Ginger A Wirth, DCS Brent Walker, DCS - - PowerPoint PPT Presentation

Recipe for Sustainability

Ginger A Wirth, DCS Brent Walker, DCS Alliance Operating Unit

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Is this scenario familiar?

Identified the problem/goal Gathered your team Created a plan Tested processes Evaluate results Modified/altered procedures Achieved goal/target Celebrations happened Targets stayed good……..

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Until…..

Next initiative gets added to the team (focus gets diverted)

• Nobody is watching prior processes
• Focus and resources are shifted to new goal
• Team goes back to “what is easy and familiar”

Somehow you are back to baseline and you are underperforming Everyone wonders what happened? Nay-sayers “I told you that wouldn’t work!” Initiative becomes the latest “flavor of the month”

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Recipe for sustainability

Determine your flavor of “cookie”

• set your process goal

Gather ingredients

• Select your team

Set up your “test kitchen”

• Make “small batches of dough”
• Follow the PDSA model to trial processes

Evaluate your product/taste results

• Decide what needs adjusting-make modifications as

necessary

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Sustainability

Sustainability is one of the most challenging aspects of any process redesign. Redesign by nature is continuous Sustainability is the ability to maintain. Requires consistency of practice, adaptability, and communication.

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Sustainability

Three key elements of sustainability

• Standard work
• Maintenance
• Continuous

Improvement

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Standard Work

Clearly document new processes Eliminate variation Education is key Training new team members is essential Monitor performance and reeducate as necessary

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Maintenance

Keep your “Champion/head chef” in place Monitor your results regularly-

• Don’t take your foot off the gas

Continue to report progress to the team Continual maintenance of your processes ensure that the improved practices become embedded in the culture and processes of your department and organization

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Continuous Improvement

Monitor and report your data/results Provide feedback to team members and leaders Accountability must be maintained for all Continue to share the wins and celebrate successes Make changes as necessary, understanding that most processes and goals are dynamic and never static

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Winning the “Blue Ribbon” over and over

Core ingredients have to remain constant

• You cannot replace salt for sugar

You have to be willing to make incremental improvements on the recipe

• May need to add ingredients
• Someone may have an allergy (gluten,

nuts, etc.)

Do not keep your recipe a “secret”

• Make sure all new team members are

educated

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Case Study: Lake City Medical Center

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Lake City Medical Center: Patient/Day

65.0 75.0 85.0 95.0 105.0 115.0 125.0

Start

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Lake City Medical Center: LWBS + LPT + AMA

0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0%

Start

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Lake City Medical Center: ER Throughput

40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200 210 220 14-Jul Aug Sept Oct Nov Dec 15-Jan Feb March April May June July August Sept Oct Nov Dec 16-Jan Feb March April May June July August Sept Oct Nov Dec Jan-17 Feb March April May June July August Sept Oct Nov greet to adm dispo DC LOS ESI 4/5 LOS

Star t

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Lake City Medical Center: Door to Doc

2 4 6 8 10 12 14 16 18

Start

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50 55 60 65 70 75 80 85 90 95

Lake City Medical Center: Press Ganey

Start

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Seasons of Change

Year 1 Year 2 Year 3 ER Staff Loss of ER RN Director Travel Nurses Multiple Openings Loss of Director Quality Interim ‘Brand New’ ER RN Director No Locums Lots of Turnover Full Time RN Director New ER Managers Stable ER Staff Hospital Staffing Changes New CEO New CNO Loss DAC, new DAC Loss Reg. Director New Floor RN Director New CNO New Lab Director Loss of Rad. Director Loss DAC, new DAC New Reg. Director Interim QI Director New QI Director New Rad. Director Loss DAC, new DAC Physical Plant Changes ER Construction ER Capacity Doubled New 3rd Floor new ICU Second CT Scan Joint Initiatives Chest Pain Accreditation Stroke / Sepsis Stroke Accreditation Sepsis Accreditation

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Results

ER Volume Lost Business (LPT, LPMSE, AMA) Admission Percentage 2014 numbers 27611 (Total ER Visits) 1262 (Total 2016) 16% 2015 (compared to 2014) 32188 (Gross Increase 4577 or 15%) 483 (62% Reduction) 16% 2016 (compared to 2015) 38329 (Gross Increase 6730 or 17%) 418 (13% Reduction) 17% Projected 2017 (compared to 2016) 42162 (Gross Increase 3833 or 10%) 333 (20% Reduction) 17%

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Revenue Change Revenue Increase 2014 to 2015 $4,508,800 Revenue Increase 2015 to 2016 $6,257,750 Revenue Increase 2016 to 2017 (est.) $3,588,025 Total Increased Revenue in Three Years $14,354,575

Financial Estimates

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Nieman Marcus $250 cookie recipe

THE ORIGINAL "NEIMAN MARCUS" COOKIE RECIPE 1 c. soft butter 1 c. sugar 1 c. brown sugar 2 eggs 1 tsp. vanilla 2 c. flour 2 1/2 c. blended oatmeal (plain uncooked) 1/2 tsp. salt 1 tsp. baking soda 1 tsp. baking powder 12 oz. chocolate chips 9 oz. grated Hershey bar 1 1/2 c. chopped nuts Cream butter, sugar and brown sugar. Add eggs and vanilla. Mix flour, oatmeal, salt, baking soda and baking powder. Add chips, Hershey bar and nuts. Roll into small balls and place 2 inches apart on lightly greased of "Pam" sprayed cookie sheets. Bake for 6 minutes at 375

• degrees. Do not overcook or cookies will be dry. Keep cookies small, they are very rich!

Makes approximately 5 dozen.

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Thank you!!!

Thank you

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Contributors

“It’s a Southern Thing” http://facebook.com/itsasouthernthing Implementing and sustaining transformational change in health care: lessons learnt about clinical process redesign-Katherine M McGrath, Denise M Bennett, David I Ben-Tovim, Steven C Boyages, Nigel J Lyons and Tony J O’Connell. MJA 2008; 188: S32–S35 Dr Michael White, SMD Lake City Medical Center Cooks.com http://www.cooks.com/recipe/e639g9hj/the-

• riginal-neiman-marcus-cookie-recipe.html

Edible Art Bakery www.edibleartnc.com