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

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