Transition Planning Presented by the Nursing Institute for - - PowerPoint PPT Presentation

Transition Planning

Presented by the Nursing Institute for Healthcare Design

Continuing Education Information

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Transition Planning Session Overview

Erin Clark, RN MS EDAC

Session Agenda

Event Agenda (4 hours total) Topic Details Forum Time Introduction Overview of session, housekeeping items, etc Podium 10 mins Transition Planning Project Planning/Organization readiness Podium 30 mins Operations Game Podium 30 mins Interactive Session #1 Workflow/Process Redesign Breakout Session Break Out 45 mins Break (15 minutes) Activation/Implementation Coordination of Building Readiness Panel 60 mins Training Simulations Interactive Session #2 Training Planning Simulation Preparation Break Out 45 mins Closing Remarks Final Q&A Closing Announcements Podium 5 mins

Pam Redden, Pamela Redden, MS BSN RN EDAC Kelly Guzman, RN, MS Josh Halon, Josh Halon, RN MSN EDAC

Transition and Activation Planning: The Kick off

Organizational Readiness

• Leadership Council/Executive Steering
• Organizational Charts
• Evaluate your starting point
• Communications

Activation Steering Committee

• Align

lignment

• Definition: An arrangement of groups in relation to one another
• Linking of organizational goals and efforts. Requires common

understanding of purposes and goals, setting of priorities, and accomplishment through consistency between department and plans.

• Vison and Guiding Principles
• Focus on Day 1
• Roles
• les and Res

esponsib ibil ilit ities

• Decisions!
• Monitor Start up task list
• Priorities and work-plan schedule
• Resourcing
• Mee

eetin ing fr frequency and mem embership ip

Resources and challenges when getting started

• Identify Committee Members
• Typically Department

Managers/Champions

• Identify a Co-Chair(s) for each

committee

• Establish Meeting Cadence and Norms
• Generate Buy-in from Stakeholders
• Why is their role important

Executive Team Patient Care Support Services IT/Telecom/ Equipment Marketing/ Communication/ Education Transition Committee

Activation Organization

Activation Organization

Imaging Center Activation Organization

Operational Methodology

Operational Workstreams

• Map and validate

policies & procedures

• Identify gaps
• Identify opportunities

to improve or streamline

• Identify opportunities

for innovation

• Lists existing used

technology

• Identifies gaps in

technology

• Detail helps to

develop project plan and budget

Project Plan & Budget

• Map infrastructure to

‘operate’ program, including streamlining & process improvements

• Map integration of all

programs within the project

• Collates infrastructure

and workstreams to determine personnel, equipment, workflow, scheduling, training and tracking needs

• Develops program

budgets to meet needs and aligns them to

• verall project budget
• Includes legal &

regulatory requirements

Transition Plan & Operational Readiness

• Organizes processes

and schedules to fit out and prepare finished space for

• perationalizing

program

• Plans for check-in,

testing, calibration and asset tagging of FF&E, portable devices and supplies

• Organizes human

resource activities for staffing program/space

• Organizes and

prepares support services

• Organizes trial process

runs

• Organizes orientation

& training requirements

Tools: Future State Process Mapping

a Description Person Responsible Date Business Operations

• Contracts – (Payors & Others)
• Credentialing (Rich/Payors)
• HR
• Legal entity
• Operating Budgets
• Purchasing
• Regulatory compliance
• Revenue cycle

Rich/Shonu Rich-MSRDP Elizabeth Steinhour Rich/Shonu Susie Susie/Pam TBD Athena/UHS. Rich/Rick 60 days-UTHS Tax ID Clinical Care

• Patient experience
• Policies and Procedures
• Shared Services
• Staffing
• Workflows

DIH Pam Rich/Pam Pam/Shonu Steve /DIH Communication

• Patient portal
• Website
• Written materials/ patient education
• Marketing/(public education )

School of Communications TBD Steve/Rick Beto/Shonu/Seton Facility

• Equipment and Furniture
• Facility Ops (mail, housekeeping, parking, security)
• Wayfinding/construction

Pam Ricardo John/Daniel IT

• EHR
• Equipment
• Technology (RTLS, phones, tablets, etc.)

Rick/Seth Orientation & Training

• Competencies
• Onboarding/orientation
• Scenario training

Pam/Clinical Admin Director, Consultant NM Patient Access Model

• Call Center
• Financial Counseling
• Intake
• Scheduling

Rick Quality & Outcomes

• Accreditation
• Clinical Outcomes
• PROs

Pam Steve Elizabeth T.

Task chart

Project Planning- Change Management Communication

• Develop Communication Plan

– Audience Analysis – Develop Communication Goals – Timeline

• Establish Communication Cadence
• Communication Tools

– Project Metrics – Project Timeline – Monthly Project Updates

Communication

• Communications Committee
• Inspiring a shared vision
• Internal Communications
• Community
• Public
• Physicians
• Organizations
• Media
• Events

Communication

• Communication Tools

– Budget-- Get one! – Support Staff – Themes – “Scripts” for Receptionists – Pictures, pictures, pictures – “Friday Footnotes” – Websites

Communication

• Use their language!
• Nurse Manager vs Clinical Manager
• Unit Secretary vs Unit Clerk vs Unit Coordinator
• A rose is a rose…

– The “War Room” vs. “Change Headquarters” – “Innovations and Opportunities” – W.A.D.I.T.W. – E.T.D.T.

Communication

–

Organizational culture and “hot topics”

–

Ex: Hand washing/infection control, Falls, etc.

–

Important institutional initiatives

–

Patient Experience

–

Involving physicians

• Concerns:

–

Find out what they are thinking.

–

Take five minutes and make a list of concerns

Transition Planning: Resources & Special Considerations

Transition or Activation Planning?

Topics for Review

• Transition Goals
• Transition Timeline/Schedule

– Coordination with facility construction

• Transition Budget & Project Resources
• New facility staff- hiring
• Change Management

Transition Goals- Sample

• Comprehensive transition plans
• Define roles and responsibilities
• Develop new facility operations

plans

• Orient and train staff
• Fit-up the building
• Successful regulatory visit
• Safe move/activation on Day 1
• perations

2019 2021

Jun Sep Dec Mar Jun Sep Dec Mar Jun

Go/No-Go

Sep 1

Building Turnover

Nov 23

Regulatory Week

Apr 26

Patient Occupancy

Jun 1

DR #1

Mar 4

DR #2

Apr 1

DR #3

Apr 22 Jun 1 - Sep 1

Assessment

Aug 1 - Oct 1

Task List

Jan 1 - Jan 1

Operations Planning/Workflow Planning

Oct 1 - May 1

Transition Committees

Jan 1 - Jan 1

Regulatory Planning

Feb 1 - May 1

Fit-up

Oct 1 - Feb 1

Transition Budget

Jan 1 - May 1

Orientation and Training

Jun 1 - Mar 1

Policies and Procedures

Aug 1 - Apr 1

Move Materials

Jun 1 - Aug 1

Post-Move

Jan 1 - Aug 1

Dress Rehearsal Scenario Development and Validation

Apr 1 - Apr 23

Dress Rehearsal Logistics

Transition Timeline/Schedule- 24 months

Coordination with Facility Construction

• Track construction milestones

– Substantial completion – Staff & Stock – IT Schedule – Equipment Installation Schedule

• Review Building Readiness Go/No-Go

– Certification of Required systems – Commissioning activities

Transition Budget: Breakdown Estimates

• 2-4% of Total Co

Constructio ion Project Budget

• 8-10% Contingency -

Transit itio ion Budget

• 30% hourly burden rate

adjustment for backfill of personnel for training

• $1 per square foot for

relocation and consolidation support

Transition Budget: Breakdown Estimates

• 50% Education and Training
• 20-25% Fit-Up
• Pre-turnover cost – 10-12%
• Move costs-8-11%
• Close out – ~5%

Training 50% Fit-up 23% Pre- turnover 12% Move 10% Close out 5% Training Fit-up Pre-turnover Move Close out

Transition Resources

• Adm

Adminis istrativ ive- Executive & Physician Sponsors

• Transition Tea

eam- Clinical, Facilities, IT, Procurement

• Dep

Department Dir Directors/Managers- New facility planning

• Or

Orie ientation & & Training – Trainers (Educators, Train the Trainer-Department), Admin Support

New Facility Staff-Hiring

• Validate time required based on complexity and difficult to

fill positions.

• Key tasks:

– Mapping competencies to positions – Labor relations- review of contracts and notice requirements – Communications to staff/potential candidates

• Hiring fairs

– Integrating staff – new & existing

• Timeframes

– Orientation & Training – Work in existing facility prior to opening

Transition Planning = Change Management

• No magic bullet or just one way!
• There is a LOT of new stuff:

– Building – Technology – Sounds – Equipment/Furniture – Workflow/Operations – People – Loss

• Create a climate of change
• What works with your culture?

Don’t assume everyone wants to go to the new facility!

Change Management Factors Strategies, Models, Assessment Tools, References

• Organizational competing priorities- What

else is going on?

• Integrity- Can your team execute change

successfully?

• Commitment- Successful projects have

executive support

• Effort/Duration - Ideally, no one’s workload

should increase more than 10%.

• Change fatigue- How much change is too

much?

• Timing of training- Ensure the new stuff

“sticks”

Change Management Models

Owner vs. Consultants Perspective

How do you see it? The Lens of Owner and Consultant

• Can’t we just move that wall?

➢ No, we can't go back and change the design now.

• That change will impact the budget/schedule? Really?

➢ Under construction? Our mantra is "no change orders“. ➢ And that will be an “add service”

• That’s not the way we do it

➢ We think about how to make the process easier for them.

How do you see it? The Lens of Owner and Consultant

• What day did you say we are moving? ( that doesn’t

seem like a good day) ➢ Yes, this is really happening. ➢ We remember what it was like to be in their shoes.

• Who made that decision? (I wasn’t at the last meeting)

➢ I wish they would just decide already!

• I didn’t know it was going to look like that

➢ Given the chance, most staff will attempt to work the way they always have ----- you can't fit old processes into new space

QUESTIONS?

Bottleneck Game

Teri Oelrich, MBA BSN

Game Purpose & Rules

• Have fun while realizing the impact of everyday
• ccurrences on operations, space needs, cost of

construction and staffing!

• Each Team will be given $5 Million Dollars
• Pick one person from your table to come to the front table.
• Winning Team either… Gets home or after 20 Mins has the

most money left!

Emergency Department

Emergency Visits % of Visits by Type Walk-in- Triage Triage to Bay Work Up/Exam: RN & MD Imp. Orders Lab Turn Xray Turn MD Revisit Trx Time D/C or Bed Turn Trx Bay to D/C Room Turn

Thru- Put

Emergent 24,000 30% 2 10 30 20 20 30 10 40 30 180 20 17 800 25 13,800 8

1,412

Urgent 32,000 40% 3 15 20 10 20 20 10 20 20 120 15 19 500 25 10,025 21

1,684

Non-Urgent 24,000 30% 4 20 15 5 15 20 10 10 15 90 15 14 400 25 6,250 26

1,714

Total 80,000 100% 50 30,075 55

1,600 Treatment Bays Scenario X 50.0 Baseline 50.0 Emergency Department Total Square Footage Scenario X 30075 Baseline 30075 Costs Scenario X

#########

Baseline

#########

Operational Assumptions DGSF Benchmark Sq Ft: Trx Bay & Seats Seats in Waiting Room Trx Bay 50 50

• 10.0

20.0 30.0 40.0 50.0 60.0 Scenario X Baseline

Treatment Bays

30,075 30,075

5,000 10,000 15,000 20,000 25,000 30,000 35,000 Scenario X Baseline

Emergency Department Square Feet

$15,037,500 $15,037,500

$- $2,000,000 $4,000,000 $6,000,000 $8,000,000 $10,000,000 $12,000,000 $14,000,000 $16,000,000 Scenario X Baseline

Estimated Construction Costs

ED Gaming Tool: Baseline Example

80,000 Visits = 50 Stations, ~30,000 Sq. Ft. & ~$15 Million in Construction Costs

ED Gaming Tool: Change to Operations Example

Emergency Department

Emergency Visits % of Visits by Type Walk-in- Triage Triage to Bay Work Up/Exam: RN & MD Imp. Orders Lab Turn Xray Turn MD Revisit Trx Time D/C or Bed Turn Trx Bay to D/C Room Turn

Thru- Put

Emergent 24,000 30% 2 20 35 20 25 40 10 40 30 200 25 19 800 25 15,575 15

1,263

Urgent 32,000 40% 3 25 25 10 25 30 10 20 20 140 20 23 500 25 12,300 32

1,391

Non-Urgent 24,000 30% 4 30 20 5 20 30 10 10 15 110 20 17 400 25 7,700 36

1,412

Total 80,000 100% 59 35,575 83

1,356 Treatment Bays Scenario X 59.0 Baseline 50.0 Emergency Department Total Square Footage Scenario X 35575 Baseline 30075 Costs Scenario X

#########

Baseline

#########

Operational Assumptions DGSF Benchmark Sq Ft: Trx Bay & Seats Seats in Waiting Room Trx Bay 59

50

44.0 46.0 48.0 50.0 52.0 54.0 56.0 58.0 60.0 Scenario X Baseline

Treatment Bays

35,575 30,075

27,000 28,000 29,000 30,000 31,000 32,000 33,000 34,000 35,000 36,000 Scenario X Baseline

Emergency Department Square Feet

$17,787,500 $15,037,500

$13,500,000 $14,000,000 $14,500,000 $15,000,000 $15,500,000 $16,000,000 $16,500,000 $17,000,000 $17,500,000 $18,000,000 Scenario X Baseline

Estimated Construction Costs

Operation Changes:

• Add 10 mins from Triage to Trx Bay
• Add 5 Mins to Work-up
• Add 5 mins to Lab Turnaround
• Add 10 mins to X-Ray Time
• Add 5 Mins to Turn Room after Patient Leaves…

Adds ~5,000 Square Feet Adds 9 Treatment Bays Adds ~$3 Million Dollars

Example - Occupancy Bottleneck ED Bays Full - On Divert No Turn - pass the dice! Each Pt Diverted = ~$3,000 loss in Revenue x 10 Pts per hour = $30,000

Example - Life Preserver Card

• Operational Improvement ahead –
• HAVE YOUR TABLE BE YOUR LIFE- LINE
• Name the Operational Improvement!

Let’s Play

Bottleneck Cards

Lifesaver Cards

L

Cash Spent

L L L B B L B L B B B B B B B L L B B L L B L B

ED

L L L L L B B B B B B B B B L B B B B L B B B B L B B B L B B B B B B L B B B B L B B B B B B B B B L B L L L B B B B L B B B B B B B B B L B B B L B L L L

Break Out Session #1

Operations Planning/Workflow Redesign

Objectives

• Create an efficient process within the

design

• Consider all the variables for each

process step

• Consider the 7 flows of healthcare and

the 7 wastes

Instructions

• Each table will be a group
• Review materials

– Maps – Worksheet – Supporting Materials

• Identify “roles”
• Facilitators will guide you

through the process

Transition Planning Panel

Break Out Session #2

Training Planning Simulation Planning

Thank you!

Facilitators Sponsors