CI Journey Cleveland Clinic CI ¢â‚¬¢Vis, PCP ¢â‚¬¢Vis, Ortho Pre-Admit $ ¢â‚¬¢Lab ¢â‚¬¢PT ¢â‚¬¢Radiology ¢â‚¬¢Vis,

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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

    Press Comm

    Press

    Green

    Tester

    Comm

    Lathe

    Final

    Tester

    Bearing

    Press Palletize

    Epoxy Coater Winder

    Fuser Trickle 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 /

    Procedure Inpatient

    Outpatient

    Followup

    Back to

    Referrer

    Surgery /

    Procedure Inpatient

    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

    Outpatient Other

    Treatment

    Outpatient

    Followup

    Back to

    Referrer Outpatient

    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

  • FasTrac TM

    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

    V a

    lu e

    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