Hospital Performance Improvement and Data Webinar 5-14-13

PowerHealth Solutions Proprietary. All Rights Reserved © PowerHealth Solutions 2010

Gail RobbinsDirector, Business Transformation

and DevelopmentMay 14, 2013

OnDemand Customer Spotlight:

Does Your Data Speak to You?Using Data to Support

Hospital Performance ImprovementGail Robbins

Jordan Hospital

Introduction

Who am I? How did I get here? Why should you care?

Value-based Business Model

4 common capabilities needed:

People and Culture Business Intelligence Performance Improvement Contract and Risk Management

Jordan Health System Vision and Strategic Plan

Advancing the Health of

our Communities

Better Healthcare

Better Health

Better Value

Performance Improvement

Agenda

Little bit of Lean

Examples of performance improvement activities

• Patient Flow

• Patient Satisfaction

• Resource Management

What is Lean?

Not a technique – it’s a philosophy of continuous improvement (Kaizen).

A systematic approach to identifying and eliminating waste through continual improvement

Takes long-term perspective and perseverance Core idea: maximize customer value while minimizing waste

LEAN is a “WAY OF DOING BUSINESS”, a way of thinking and acting designed to

ADD VALUE FOR OUR CUSTOMERS through the ELIMINATION OF WASTE.

Kaizen – Japanese for “Good Change”

Current State Map

Future State Vision

Action PlanImplement

Evaluate

Identify the

Customer

85% of the reasons for failures to meet customer needs are related to deficiencies in systems and processes….rather than the fault of the employee. W.E Deming

Sustaining the Improvements Requires Cultural Transformation

• Do the Standard Work

• Surface and solve problems

• Improve the Standard Work

Staff

• Observe, Measure, Analyze, Action

• Coach the front line

• Support, lead improvement

Management • Align to strategy

• System and structures

• Gemba and coaching

• Steward changes

Executive

Performance Improvement, Decision Support, Human Resources, Information Technology, Facilities

Behaviors, habits and standard work for staff and leadership MUST change to ensure daily continued improvement

Observe, Measure, Analyze, Action

Metrics and problem solving tools that are aligned with new standard work are clearly displayed and routinely communicated with staff

Measure performance of the new standard work (History)– How are we performing over time?– How are we performing compared to goal?

Gather data on why standard work is not followed (Pareto)– What is our biggest problem?– 80/20 rule for prioritization

Address barriers to standard work (Problem solving)

VISUAL MANAGEMENT

Dashboard Features

Goal is to create a feedback system that results in concrete improvement activities

• Metrics - clearly communicated and understood - lead to action

K.I.S.S. • Limited number of KPIs• Automated and dynamic• As close to real-time as possible

– Pitch = how often performance is measured– Lean organizations strive to reduce pitch duration– Opportunity for improvement is greatest when problems are

addressed at the time of occurrence

Example of Visual Management

Emergency Department DashboardMeasure Metric Goal Average Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13

Number of Patients COUNT 2,519 2,886 2,665 2,891 2,709 2,501 1,462

LWBS Cases COUNT 0 36 41 23 54 46 44 9

% LWBS PERCENT 2.0% 1.4% 1.4% 0.9% 1.9% 1.7% 1.8% 0.6%

Arrival To Bed MINUTES 15 21 21 19 22 23 21 18

In Bed To EDMD MINUTES 15 28 29 26 29 28 32 23

ADMISSIONSArrival to Admit MINUTES 240 470 423 431 479 577 481 391 Arrival to EDMD MINUTES 30 47 48 43 49 49 52 39

EDMD To Dispo Admit MINUTES 120 163 156 163 158 157 177 166

Hospitalist Request to Admit Request MINUTES 45 124 114 115 124 178 106 86

Admit Request to Bed Assignment MINUTES 5 11 14 12 8 8 12 9

Bed Assignment to Depart ED MINUTES 40 149 106 118 153 230 157 114

Number of Admissions COUNT 0 545 630 577 614 629 524 296

Number placed in ED Hold Bed COUNT 0 340 251 285 418 473 391 222

% Admissions in ED Hold Bed PERCENT 0 62% 40% 49% 68% 75% 75% 75%

Admit to Depart ED Hold MINUTES 30 150 115 117 145 228 143 83

DEPART HOMEArrival to Depart ED MINUTES 180 234 226 226 233 241 252 226 Arrival to EDMD MINUTES 30 47 48 43 49 49 52 39

EDMD to Disposition Home MINUTES 120 144 139 138 141 149 151 145

Disposition Home to Depart ED MINUTES 30 30 27 28 30 31 37 32

At or below target < 150% of target > 150% of Target

Problem Identified

Target Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-130

100

200

300

400

500

600

700

120 156 156 163 157 177 166

45

114 114 115 178 106

86 40

106 106 118

230

157

114

Arrival to EDMD EDMD To Dispo AdmitHospitalist Request to Admit Request Admit Request to Bed AssignmentBed Assignment to Depart ED

Min

utes

7.3 hrs 7.5 hrs 8.2 hrs

10.4 hrs

8.4 hrs

6.9 hrs

4 hours

It takes too long to admit a patient from the ED

More Specific Problems identified

Target Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-130

50

100

150

200

250

300

350

400

450

45 114 114 115

178 106 86 5

14 14 12

8

12 9

40

106 106 118

230

157

114

Hospitalist Request to Admit Request Admit Request to Bed AssignmentBed Assignment to Depart ED

Min

utes 3.9 hrs 3.9 hrs 4.1 hrs

6.9 hrs

4.6 hrs

3.5 hrs

90 min

1.Hospitalist time to process admission is too long2.Admitted patients wait too long for an available inpatient bed.

Drill down by Hospitalist and Hour of Day

Drill Down to Patient Level – Query Options

Drill Down to Patient Level – Sample Metric

Hospitalist Request to Admit RequestFrom 10/11/2012 to 10/11/2012

Patient IDNursing

Unit Admission SourceArrival Date

Start Metric

End Metric

Time Elapsed

Patients: 19 Avg: 114.7

AJ0806097135 MOU1 ADMITTED FROM EMERGENCY ROOM 10/11/12 15:26 20:15 289

AJ0806096848 3 South ADMITTED FROM EMERGENCY ROOM 10/11/12 15:12 20:00 288

AJ0806097168 2 East ADMITTED FROM EMERGENCY ROOM 10/11/12 15:41 20:24 283


AJ0806093761 CCC ADMITTED FROM EMERGENCY ROOM 10/11/12 11:38 14:35 177










AJ0806091807 CCC ADMITTED FROM EMERGENCY ROOM 10/11/12 08:24 09:06 42





Problem Analysis and RecommendationProblems Variation in how EDMDs communicate admission disposition

to hospitalist Variation in how Hospitalist processes patient admission

Countermeasure: Create standard work for EDMD - must speak (vs text or

email) with Hospitalist before putting patient on Hospitalist Tracker

Modify Hospitalist schedule to meet peak demand times High performing hospitalist to mentor colleagues to improve

TAT

Drill Down on Delays in Discharges

NURSING UNIT

DATE

Patient Last NameTime of

Discharge Patient

Condition

Late D/C Order

(after 12P)Nursing

Doc

Case Mgmt

ReviewFacil ity

Bed Ride HomePT

Clearance Echo Stress TestOther

Testing

Daily Log

Reason Patient Left After 2PMWaiting for

Discharges After 2PM

Reasons for Discharge Delay – 3 South

0%

10%

20%

30%

40%

50%

60%

70%

80%

10 day sample, 26 discharges

Reasons for Discharge Delay – 2 East

Ride Home

Nursing Doc

Facility Bed

Other Testi

ng

Patient Condition

Late D/C

Ord

er (after 1

2P)

Case Mgmt R

eview

PT ClearanceEch

o

Stress

Test0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

9 day sample, 20 discharges

SYSTEM SCORECARD

Indicator Name And PathAIM Period Target

Current Month

Prior Month

2 Months Prior QTD

Communication with Doctors 01/31/2013 80.0% 76.1% 80.5% 71.8% 76.1%

Communication with Nurses 01/31/2013 79% 71% 67% 73% 71%

Responsiveness of Hospital Staff 01/31/2013 66% 61% 60% 51% 61%

Hospital Environment 01/31/2013 63% 56% 45% 49% 56%

Pain Management 01/31/2013 72% 75% 75% 59% 75%

Medications 01/31/2013 63% 54% 64% 71% 54%

Discharge Info 01/31/2013 86% 79% 86% 79% 79%

Likelihood to Recommend 01/31/2013 74% 64% 60% 63% 64%

Overall Rating 01/31/2013 70% 58% 58% 56% 58%

Understanding Your Care 01/31/2013 55% 49% 48% 48% 49%

HCAHPS

Performance

Drill Down by Question

Question%

Aways Target Never Sometimes Usually AlwaysNumber Surveys

YTD % Always

Nurses explain in way you understand 62% 79% 0 1 8 14 90 66%

Nurses listen carefully to you 71% 79% 0 1 6 16 89 68%

Nurses treat with courtesy/respect 81% 79% 0 1 4 18 89 82%

Total 71% 79% 0 3 22 64 89 72%

Last Updated Date: 3/10/2013 12:49 AM

Communication with Nurses

# of Responses

Drill Down by Nursing Unit

Question%

Aways Target Never Sometimes Usually AlwaysNumber Surveys

YTD % Always

3 East 70% 79% 0 1 7 19 27 72%

3 South 48% 79% 0 2 10 11 23 59%

Ob 78% 79% 0 0 2 7 9 85%

Total 62% 79% 0 1 8 14 90 66%

Last Updated Date: 3/10/2013 12:49 AM

Communication with Nurses

# of Responses

Time from DO to Room ready for next patient is

too long

The Problem

Problem: In the last two pay periods, CT Scan FTEs have been over budget based on their flexible budget.

Evidence: Bi-weekly FTE Tracker

Theory: Staff is working too much overtime.

Variance

Pay Ending # % # # %

6-Oct-12 1,006 1,028 (22) -2.1% 0.60 0.64 0.04 7.56 8.09 0.53 6.6% 7.4 0.6 0.16 2% 6 15 1.0% 9

20-Oct-12 H 957 1,028 (71) -6.9% 0.69 0.64 (0.05) 8.20 7.87 (0.33) -4.2% 7.2 0.6 1.00 14% 9 15 1.6% 6

3-Nov-12 973 1,028 (55) -5.4% 0.65 0.64 (0.01) 7.93 7.94 0.01 0.1% 7.3 0.6 0.63 9% 9 15 1.5% 6

17-Nov-12 H 974 1,028 (54) -5.3% 0.67 0.64 (0.03) 8.10 7.94 (0.16) -2.0% 7.2 0.6 0.90 13% 22 15 3.8% (7)

1-Dec-12 H 926 1,028 (102) -9.9% 0.68 0.64 (0.04) 7.86 7.72 (0.14) -1.8% 7.1 0.6 0.76 11% 11 15 1.9% 4

15-Dec-12 935 1,028 (93) -9.0% 0.67 0.64 (0.03) 7.83 7.77 (0.06) -0.8% 7.2 0.6 0.63 9% 9 15 1.6% 6

29-Dec-12 H 1,006 1,028 (22) -2.1% 0.66 0.64 (0.02) 8.32 8.09 (0.23) -2.8% 7.0 0.6 1.32 19% 47 15 8.4% (32)

12-Jan-13 H 1,007 1,028 (21) -2.0% 0.63 0.64 0.01 7.87 8.09 0.22 2.7% 7.2 0.6 0.67 9% 27 15 4.7% (12)

26-Jan-13 901 1,028 (127) -12.4% 0.74 0.64 (0.10) 8.29 7.61 (0.68) -8.9% 7.3 0.6 0.99 14% 51 15 8.7% -36

9-Feb-13 926 1,028 (102) -9.9% 0.74 0.64 (0.10) 8.55 7.72 (0.83) -10.8% 7.2 0.6 1.35 19% 26 15 4.5% -11

23-Feb-13 H 1,039 1,028 11 1.1% 0.60 0.64 0.04 7.82 8.24 0.42 5.1% 7.0 0.5 0.82 12% 8 15 1.4% 7

9-Mar-13 944 1,028 (84) -8.2% 0.69 0.64 (0.05) 8.15 7.81 (0.34) -4.4% 7.3 0.6 0.85 12% 14 15 2.4% 1

953 1,028 (76) -7.3% 0.69 0.64 (0.05) 8.20 7.85 (0.36) -4.6% 7.2 0.6 1.00 14% 25 15 4.3% (10)

11,594 12,336 (742) -6.0% 0.67 0.64 (0.03) 8.04 7.91 (0.13) -1.7% 7.2 0.6 0.84 12% 239 180 3.5% (59)

Var

Rolling 4

FT13 YTD

Worked Hrs per

Stat

Non Prod FTEs

Non Prod

%

Actual Budget

OT as a % of

Worked

Worked Hours and FTEs Overtime Hours

ActualFY13

Budget Actual ActualFLEX

BUDGETWorked

FTEsH=

Ho

lida

y Volume Paid Hours/Stat Paid FTEsVariance

FY13 Budget

Variance

Current Condition and Data Analysis

Looked at volume and staffing by hour of the day

…and found we had excess staffing between 10A and 5P

Action to Improve

Modify staffing schedule – or flex staffing - to better meet demand• Net change: take 3 hrs, or 12.5% off schedule per week

Reduce 1 tech between 3 and 5pm and from

11p-12a

Add 1 tech @

7am

Results

Too soon to tell as staffing changes have not been finalized but…….staffing in CT Scan is coming back into line with target

Variance

Pay Ending # % # # %

6-Oct-12 1,006 1,028 (22) -2.1% 0.60 0.64 0.04 7.56 8.09 0.53 6.6% 7.4 0.6 0.16 2% 6 15 1.0% 9

20-Oct-12 H 957 1,028 (71) -6.9% 0.69 0.64 (0.05) 8.20 7.87 (0.33) -4.2% 7.2 0.6 1.00 14% 9 15 1.6% 6

3-Nov-12 973 1,028 (55) -5.4% 0.65 0.64 (0.01) 7.93 7.94 0.01 0.1% 7.3 0.6 0.63 9% 9 15 1.5% 6

17-Nov-12 H 974 1,028 (54) -5.3% 0.67 0.64 (0.03) 8.10 7.94 (0.16) -2.0% 7.2 0.6 0.90 13% 22 15 3.8% (7)

1-Dec-12 H 926 1,028 (102) -9.9% 0.68 0.64 (0.04) 7.86 7.72 (0.14) -1.8% 7.1 0.6 0.76 11% 11 15 1.9% 4

15-Dec-12 935 1,028 (93) -9.0% 0.67 0.64 (0.03) 7.83 7.77 (0.06) -0.8% 7.2 0.6 0.63 9% 9 15 1.6% 6

29-Dec-12 H 1,006 1,028 (22) -2.1% 0.66 0.64 (0.02) 8.32 8.09 (0.23) -2.8% 7.0 0.6 1.32 19% 47 15 8.4% (32)

12-Jan-13 H 1,007 1,028 (21) -2.0% 0.63 0.64 0.01 7.87 8.09 0.22 2.7% 7.2 0.6 0.67 9% 27 15 4.7% (12)

26-Jan-13 901 1,028 (127) -12.4% 0.74 0.64 (0.10) 8.29 7.61 (0.68) -8.9% 7.3 0.6 0.99 14% 51 15 8.7% -36

9-Feb-13 926 1,028 (102) -9.9% 0.74 0.64 (0.10) 8.55 7.72 (0.83) -10.8% 7.2 0.6 1.35 19% 26 15 4.5% -11

23-Feb-13 H 1,039 1,028 11 1.1% 0.60 0.64 0.04 7.82 8.24 0.42 5.1% 7.0 0.5 0.82 12% 8 15 1.4% 7

9-Mar-13 944 1,028 (84) -8.2% 0.69 0.64 (0.05) 8.15 7.81 (0.34) -4.4% 7.3 0.6 0.85 12% 14 15 2.4% 1

Var

Worked Hrs per

Stat

Non Prod FTEs

Non Prod

%

Actual Budget

OT as a % of

Worked

Worked Hours and FTEs Overtime Hours

ActualFY13

Budget Actual ActualFLEX

BUDGETWorked

FTEsH=Ho

liday

Volume Paid Hours/Stat Paid FTEsVariance

FY13 Budget

Variance

Lessons Learned

Problems are gold The people doing the work are resident experts Observation is crucial

“You can observe a lot just by watching.”-Yogi

Berra

If you can’t measure it, you can’t improve it“However beautiful the strategy, you should occasionally look at the results”

-Winston Churchill

Clearly display metrics and problem solving activities and routinely discuss with staff

It’s a marathon, not a sprint

There are so many men who can figure costs, and so few who can measure

values. ~Author Unknown

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