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CI Journey
Cleveland Clinic CI Summit
Darryl Greene
Lisa Yerian MD
Finance
Innovative Concept
Healthcare
Manufacturing
Founded in 1921
180 Acres – 50 Buildings
27 Institutes (Main Campus)
CC – Main Campus
CC – North East Ohio 9 Community Hospitals; 17 Family Health Centers
Las Vegas, NV Weston, FL
Toronto, Canada Abu Dhabi, UAE
CC – Beyond Ohio
CC – Integration
Electronic Medical
Record
Critical Care Transport Team
CC - Integration
CC- CULTURE
#
World Class Service CCHS Patient Experience
(2005 Messages)
0%
10%
20%
30%
40%
50%
60%
2001 2002 2003 2004 2005 2006
CCHS CCF
Overall Quality of Care, % Excellent
We appear to plateau;
how do we get even better?
How do we operationalize
and get tangible $’s?
Landscape / Tools
Who Can Be Involved in Improvement?
Event Chronic Illness Acute Wellness
Hematology Research Oncology Radiation Onc
Ancillary
Support
Administrative Physician /
Nurse
Environmental
Svcs
Patients
(4.6M)
Services
(18)
Care Givers
(34,000)
Who Can Be Involved in Improvement?
CC - Support Groups Medical Operations
• CI Department
• Business Intelligence
• Clinical Services Opns
Quality and Patient Safety
Patient Experience Office
Operations
• Supply Chain Mgt
• Patient Services
Finance
• Performance Mgt
• Enterprise Bus. Intel
Office of Leadership and Professional Development
Minster
PressComm
Press
Green
Tester
Comm
Lathe
Final
Tester
Bearing
PressPalletize
Epoxy Coater Winder
FuserTrickle ovenBalancer
Parts, Processes, Products
Manufacturing Line - Motor Vacuum Cleaner
Where Improvement Work Occurs?
Ongoing
Check
Ailments, Protocols, Processes, People
Care Delivery - Patient with Diabetes
Initial
Assessment
Diabetes
Diagnosis
Plan
of Care
Vascular
Problem ID
Surgery /
Procedure Inpatient
Outpatient
Followup
Back to
Referrer
Ongoing
Check
Ongoing
Check
Initial
Assessment
Initial
Assessment
Diabetes
Diagnosis
Diabetes
Diagnosis
Plan
of Care
Plan
of Care
Vascular
Problem ID
Vascular
Problem ID
Surgery /
ProcedureInpatient
Outpatient
Followup
Back to
Referrer
Surgery /
ProcedureInpatient
Outpatient
Followup
Back to
Referrer
Plan
of Care
Ongoing
Check
Vision
Problem ID
Plan
of Care
Plan
of Care
Ongoing
Check
Ongoing
Check
Vision
Problem ID
Vision
Problem ID
Outpatient Other
Treatment
Outpatient
Followup
Back to
Referrer
OutpatientOther
Treatment
Outpatient
Followup
Back to
ReferrerOutpatient
Other
Treatment
Outpatient
Followup
Back to
Referrer
Ongoing
Care
Treatment Path (s) Depends on
Complexity of Health Issue
Presented
Where Improvement Work Occurs?
Process Owner Unclear (pre- Institutes 2008)
Dept Internal Medicine
Cardiology Gastroenterology Rheumatology Endocrinology Pulmonology
Dept Surgery
Cardiac Colorectal Orthopaedic Endocrine Thoracic
Unique Differences
• Degree of Change: Industry / CC
• Service: Patient Care
• Culture: Patient Centric
• Structure: Distributed
• Incentives: Not Financial
“If you give me a large enough lever and a fulcrum on
which to place it, I shall move the world.” - Archimedes
Repeatable Cycle to Improve Performance
Measure /
Review
Performance
Improve Reward /
Recognize Set Goals
Culture to Sustain
Methodology Copyright Orion Advisory, LLC 1997-2009 Content Cleveland Clinic Confidential
Improvement Model
Review
Performance Improve
Reward /
Recognize Set Goals
Measure / Review
Performance Improve
Reward /
Recognize
Culture To Sustain
1
1 Plan, Scorecards, Dashboards
2
Business Review -
Deck/Forum 2
3
3 Problem Solving Tools
Project Management Tools
4
Rewards, APR, Evaluations 4
Methodology Copyright Orion Advisory, LLC 1997-2011
Cleveland Clinic Content Confidential
Tools / Practices of Model
FasTracTM
Lean
Ability to Act – Tools / Practices
Ability to Measure - Dashboards
Project Mgt
Six Sigma
Productivity
Business Mgt
CI Tools
CC - D. Greene, L. Yerian MD
Darryl Greene
Executive Director
CI Capability
Embed Team
Productivity
Management &
Business Mgt.
Practices
Program
Management
Office
Lisa Yerian, MD
Medical Director
CI Department
Applying CI In Healthcare
Generation 1 Generation 2 Generation 3
Pilots Pilots
Milestone Milestone
We are Here (at 6 Years)
CI Journey PLMI to Integrated Model
PI
• Bus Rvw &
FasTrac in
AP • Lean – AP
biopsy cell
• FasTrac in
FHC lab
• Bus Rvw at
All Levels
• Embedded
Resource
– Lean –
New Bldg
– Capacity
• Exposure &
Development
CI
PRA
0
5
10
15
20
25
30
35
40
45
50
2007 2008 2009 2010
2010 Goal = >25 minutes
Average Patient Wait Time
Q-Board – HemOnc Chemo Nursing
Service
Patient Wait Time
1st Goal < 30 minutes
Chemo Patient Wait Time
Business Review – HemOnc Dept.
Service
Avg Patient Wait Time – Treatment
Business Review – Cancer Institute
Service
Chemotherapy Wait Time
Quarterly Review – Enterprise
Service
Pat Exp – Would Recommend
2008 2009 2010 2007
CI Journey Cancer Institute
Cleveland Clinic (CI Breadth / Depth)
Access Clinic – Appt Days Wait
Outpatient Experience – Appt When
Wanted
Length of Stay
Financial Revenue / Operating Margin
Personnel Expense to Revenue
Service Line Net Income
Human Resources Productivity Wage Index
Patient Experience Recommend Hospital
Pain Management
Outpatient Experience
Ombuds Complaints per 1000 Visits
Key Measures Impacted
Historical CI Financial Benefit
2007 * 2008 2009 2010 2011 Est. Total
Multiple 3.07 2.61 3.47 1.81 1.88 2.55
ROI is Major Focus Enterprise Initiatives
* Note: 2008 CI authorized to add 9 unbudgeted FTE. Result is impact less than 3X.
3.07
2.61
3.47
1.81 1.88
-
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
2007 2008 2009 2010 2011 Est.
Target
3X
Target
1.5X
Time
Va
lue
Base
Camp
Gen 1 – Summary
• Sponsors and advocacy
• Time
• Acceptance
• Other Systems
• $’s
Change: Healthcare Tsunami
Creating Momentum?
Lessons Learned
• CEO Necessary / Not Sufficient
• WIIFM (not financial)
- Patients
- Time
- Value creation
• Navigate – Find the Arteries
- Sponsors - Cell by cell
- Patient Flow
• Build Upon Personal Journey (experience)
Sponsorship - Involvement
“What we have now works”
“What will I
become?”
“We have tried that before!”
“Am I doing it wrong now?”
“This isn’t manufacturing!”
“Too old to
learn this!”
“OK – I will get it over with,
Then go back to what I know!”
“Will my colleagues make fun?”
“Even if I fix this,
I can’t control them”
“We are too busy!”
Typical Path of Experience (Improvement Work)
Skeptical Overwhelm Hope and
Success
Accepted
Environment
New
Environment
Start Ongoing
Time
Experiencing
Improvement
Sponsorship
Applying CI In Healthcare
Generation 1 Generation 2 Generation 3
Milestone Milestone
Pilots Pilots
Focus - CC Service Lines
Digestive Disease Institute
Colorectal Surgery
Gastro-enterology
Nutrition
General Surgery (HPB
and Transplant)
Heart and Vascular Institute
Cardiology Cardiac Surgery
Vascular Surgery
Cardiac Imaging
CI Embed Leader
Embed
Institute
Central Team
Member
Central Team
Member
Institute Team
Member
CI Annual Plan
Gen 2 CI Department
Central Team
Prog. Mgt Office
Central Team
Mgt Eng / BMP
Inpatient
Rehab
Skilled Nursing
Facility
Home Care
Outpatient
Rehab
Family
Health
Center
Urgent
Care
Diagnostic /
Imaging
Center
Physician
Clinics
Home
Navigating the Arteries Pilot CI to Support Carepaths
Fitness
Center
Pharmacy
Grow Local
CI Skills Hospital
Days Pre-Window
Tota
l Paid
Costs
(000)
• Lab • Radiology • Vis, PCP • Vis, Ortho
Pre-Admit
$
• Lab • PT • Radiology • Vis, Ortho • Rx •Other
$$$
• Lab • PT • Vis, Ortho • Rx •Other
$$
• PT • Rx • Vis, PCP
$
IP Stay IP Recovery Recovery
Knee Replacement
Post-Window
Navigating the Arteries Pilot CI to Support Bundled Payments
• Measures / Processes
• Standards / Problem solving
• Technology
• Organization Structure
• Accountability
• Performance and Talent Mgt
• Skill sets and behaviors
• Leadership
• Training IMPACT
Navigating Arteries –
Integrating Systems
People System
Management System
Performance System
CI Journey at Cleveland Clinic Amazon.com
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