Get exclusive access to the latest innovations, techniques, research and best practices to improve quality and efficiency at the

Engineering Lean and Six Sigma Conference 2015, held in collaboration with the Lean Educator Conference.

Sept. 30 – Oct. 2 | The Westin Atlanta Perimeter North | Atlanta

www.iienet.org/leansixsigma

Topic

1. Introduction

2. QPI Program Results

3. Overview of QPI Program

4. QPI Wins

5. Overall System Results

6. Questions & Answers

Implementing a Robust Quality & Process Improvement (QPI)Transformation Program to

Improve Quality & Reduce Cost

2

Who Are We?

Jennifer Lingenfelter

Executive Director, Project Management Office • Leads large system-wide strategic performance

improvement projects • Implemented lean principles in the United States,

Europe and the Middle East • Certified Lean Six Sigma Black Belt

• Leads large system-wide strategic performance improvement projects

• Industrial Engineer • National Malcolm Baldrige Examiner • Certified Lean Six Sigma Black Belt

Executive Director, Project Management Office

Michael O‘Toole

3

Piedmont Healthcare is a five hospital system

serving Atlanta and surrounding communities.

Our Mission: Healthcare marked by compassion and sustainable excellence in a progressive environment, guided by physicians, delivered by exceptional professionals, and inspired by the communities we serve.

Quick Stats: • 11,000 Employees

• 1,100+ Physicians in the Piedmont Clinic

• 400+ Employed Physicians

• 600+ Non-Employed

• 200+ Total Groups

• 5 Hospitals

• 1 Tertiary Acute Care Hospital

• 4 Community Hospitals

• 1,104 Licensed Beds

About Piedmont Healthcare

• 250+ locations

• 9 Urgent Care Locations

• 6 Outpatient Centers

• Heart and Transplant Institutes

• Piedmont Wellstar HealthPlan served ~40,000 employees, families, and Medicare beneficiaries in its first year

4

QPI Program Results: Saving Lives and Money!

108 Certified

Black Belts

Certified Black Belts Certified Green Belts

36 Lives saved in

one project

Lives Saved

$7M in 2

years

17:1 ROI

Cost Savings

40 Certified

Green Belts

5

Quality & Process Improvement Program Overview

6

QPI Program: A Best of Breed Approach

Quality & Process Improvement Program

Six Sigma

Inter-mountain

Healthcare

Baldrige Performance

Excellence

Program

Lean IHI Model for

Improvement- PDSA

More value for customers with fewer

resource- $200M benefits in 7 years

Dr. Brent James – Advance Training Program:

Reduced Variable costs by $150M

Deep Vein Thrombosis (Blood Clot) rate fell by 65% leading to a $760K cost savings

Led to a 75% reduction in blood stream

infection rate in ICU at Yale- New Haven Medical Center

7

Always Safe

Respect, Challenge & Develop Our People

Living the Piedmont Promise with Every Patient

A Better Way, Every Day

QPI Program

8

• All Leaders assigned to a QPI Coach • Expectations of Leaders in QPI Training:

– Complete Capstone Improvement Project – Attend class (8 modules) – Complete all pre-work and homework – Complete Capstone Improvement Project – Pass Final Exam

QPI: Defined Certification Requirements

• Attendance at Training and project team meetings (50%) • Team Member evaluations (20%) • Results (15%) • Exam (15%)

Black Belt:

Green Belt:

9

Quality & Process Improvement Program Sample Wins

10

Clostridium Difficile (C. diff)

High Clostridium

Difficile infection rate

See:

1. Identify the problem and set goal(s)

2.Understand what is currently happening

3. Determine cause(s) problem

Solve:

4. Conceptualize future state

5. Realize future state through experimentation and interventions

Share:

6. Follow up and Share lessons learned

Share

Reduced the utilization of IV antimicrobials by

over 10%

Reduced the C. diff rate by 27%

Prevented 36 healthcare facility associated C. diff

infections at PAH

Problem Methodology Results

11

Increased First Case On-time Starts

Surgery Cases do not predictably start “On -time”

See:

1. Identify the problem and set goal(s)

2.Understand what is currently happening

3. Determine cause(s) problem

Solve:

4. Conceptualize future state

5. Realize future state through experimentation and interventions

Share:

6. Follow up and Share lessons learned

On-time first case start rate increase from 47% to 77%

A 64% improvement

Problem Methodology Results

12

Reminder Phone Calls (Reduction in no-show rate)

High transplant evaluation No-

Show rates

Savings of ~$836K

Decreased No-Show rate from 21% to 16%

100% Reminder phone calls made

Problem Methodology Results See:

1. Identify the problem and set goal(s)

2.Understand what is currently happening

3. Determine cause(s) problem

Solve: 4. Conceptualize future state

5. Realize future state through experimentation and

interventions

Share: 6. Follow up and Share lessons

learned

13

Overall System Results from Quality & Process Improvement Program

14

Quality I Safety I Service

LEAPFROG MEASURESPAH PFH PMH PNH PHH PAH PFH PMH PNH PHH

ICU Physician Staffing 15.00 15.00 5.00 15.00 15.00 100.00 15.00 5.00 50.00 100.00

HAC 4: Pressure Ulcer - Stages III and IV* 0.114 0.229 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000

Computerized Prescriber Order Entry (CPOE) Systems 5.00 5.00 5.00 5.00 5.00 100.00 100.00 100.00 100.00 100.00

CLABSI SIR (ICU Only)** 1.33 1.24 N/A 0.52 0.94 0.68 0.00 0.00 0.00 0.00

CAUTI SIR (ICU Only)** 2.37 0.56 0.50 0.38 2.48 0.00 0.00 0.00 0.00 3.23

HAC 5: Falls and Trauma* 0.570 0.114 1.368 0.000 0.000 0.000 0.000 0.000 0.000 0.000

HAC 2: Air Embolism* 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000

HAC 1: Foreign Object Left in After Surgery* 0.057 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000

SCIP-VTE-2 Anti-Blood Clot Med Post-Surgery*** 92% 98% 94% 96% 96% 100.00% 100.00% 100.00% 100.00% 100.00%

SSI: Colon SIR** 0.99 0.55 0.00 2.11 1.03 1.68 0.00 0.00 0.00 0.00

SP 9: Nursing Workforce 71.43 95.24 100.00 90.48 100.00 100.00 100.00 100.00 100.00 100.00

SP 19: Hand Hygiene 30.00 27.00 30.00 30.00 30.00 30.00 30.00 30.00 30.00 30.00

PSI 15: Accidental Puncture or Laceration* 2.350 1.990 1.680 1.950 2.470 3.846 3.695 5.682 0.000 3.304

SCIP-INF-9 Pts w/ Urinary Cath Removed on POD1-2*** 93% 89% 97% 92% 99% 100.00% 98.33% 100.00% 96.00% 92.31%

SCIP-INF-1: Antibiotics 1 Hr Before Surgery*** 96% 98% 100% 98% 99% 98.11% 100.00% 100.00% 100.00% 100.00%

PSI 14: Postoperative Wound Dehiscence* 0.270 0.420 0.690 0.630 0.520 0.000 0.000 0.000 0.000 0.000

SP 2: Culture Measurement for Performance 20.00 20.00 20.00 20.00 20.00 20.00 20.00 20.00 20.00 20.00

SP 3: Teamwork Training and Skill Building 36.00 36.00 36.00 36.00 32.00 40.00 40.00 40.00 40.00 40.00

SP 23: Prevention of Ventilator Assoc. Complications 18.33 16.67 20.00 20.00 18.33 20.00 20.00 20.00 20.00 20.00

SP 17: Medication Reconciliation 30.33 32.67 30.33 30.33 28.00 35.00 35.00 35.00 35.00 35.00

SP 4: Identification and Mitigation of Risks/Hazards 76.36 98.18 109.09 98.18 98.18 120.00 120.00 120.00 120.00 120.00

PSI 12: Postoperative PE/DVT* 10.270 4.990 6.080 3.270 2.750 2.466 9.852 0.000 0.000 0.000

SP 1: Leadership Structures and Systems 111.43 111.43 120.00 111.43 111.43 120.00 120.00 120.00 120.00 120.00

PSI 6: Iatrogenic Pneumothorax* 0.590 0.360 0.320 0.350 0.210 1.214 0.000 0.000 3.788 1.133

SCIP-INF-3 Prophylactic Antibiotics D/C Within 24 Hr*** 98% 98% 100% 95% 98% 96.15% 97.10% 100.00% 100.00% 95.83%

SCIP-INF-2 Prophylactic Antibiotics for Surg Pts*** 96% 100% 99% 100% 100% 96.15% 100.00% 100.00% 100.00% 100.00%

PSI 11: Postoperative Respiratory Failure* 12.210 12.000 16.040 9.320 12.940 7.653 0.000 0.000 0.000 14.599

PSI 4: Death among surgical IPs w/ treatable CCs* 110.810 95.120 N/A 111.730 110.570 193.548 0.000 0.000 0.000 0.000

OVERALL SCORE 2.1811 2.7746 2.8400 2.8856 2.8117 3.2662 3.6646 3.8281 3.9198 3.4695

LETTER GRADE D C C C C A A A A A

Fall 2014 Survey (as submitted) Current Month (Last Reported)

LEAPFROG MEASURESPAH PFH PMH PNH PHH PAH PFH PMH PNH PHH

ICU Physician Staffing 15.00 15.00 5.00 15.00 15.00 100.00 15.00 5.00 50.00 100.00

HAC 4: Pressure Ulcer - Stages III and IV* 0.114 0.229 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000

Computerized Prescriber Order Entry (CPOE) Systems 5.00 5.00 5.00 5.00 5.00 100.00 100.00 100.00 100.00 100.00

CLABSI SIR (ICU Only)** 1.33 1.24 N/A 0.52 0.94 0.68 0.00 0.00 0.00 0.00

CAUTI SIR (ICU Only)** 2.37 0.56 0.50 0.38 2.48 0.00 0.00 0.00 0.00 3.23

HAC 5: Falls and Trauma* 0.570 0.114 1.368 0.000 0.000 0.000 0.000 0.000 0.000 0.000

HAC 2: Air Embolism* 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000

HAC 1: Foreign Object Left in After Surgery* 0.057 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000

SCIP-VTE-2 Anti-Blood Clot Med Post-Surgery*** 92% 98% 94% 96% 96% 100.00% 100.00% 100.00% 100.00% 100.00%

SSI: Colon SIR** 0.99 0.55 0.00 2.11 1.03 1.68 0.00 0.00 0.00 0.00

SP 9: Nursing Workforce 71.43 95.24 100.00 90.48 100.00 100.00 100.00 100.00 100.00 100.00

SP 19: Hand Hygiene 30.00 27.00 30.00 30.00 30.00 30.00 30.00 30.00 30.00 30.00

PSI 15: Accidental Puncture or Laceration* 2.350 1.990 1.680 1.950 2.470 3.846 3.695 5.682 0.000 3.304

SCIP-INF-9 Pts w/ Urinary Cath Removed on POD1-2*** 93% 89% 97% 92% 99% 100.00% 98.33% 100.00% 96.00% 92.31%

SCIP-INF-1: Antibiotics 1 Hr Before Surgery*** 96% 98% 100% 98% 99% 98.11% 100.00% 100.00% 100.00% 100.00%

PSI 14: Postoperative Wound Dehiscence* 0.270 0.420 0.690 0.630 0.520 0.000 0.000 0.000 0.000 0.000

SP 2: Culture Measurement for Performance 20.00 20.00 20.00 20.00 20.00 20.00 20.00 20.00 20.00 20.00

SP 3: Teamwork Training and Skill Building 36.00 36.00 36.00 36.00 32.00 40.00 40.00 40.00 40.00 40.00

SP 23: Prevention of Ventilator Assoc. Complications 18.33 16.67 20.00 20.00 18.33 20.00 20.00 20.00 20.00 20.00

SP 17: Medication Reconciliation 30.33 32.67 30.33 30.33 28.00 35.00 35.00 35.00 35.00 35.00

SP 4: Identification and Mitigation of Risks/Hazards 76.36 98.18 109.09 98.18 98.18 120.00 120.00 120.00 120.00 120.00

PSI 12: Postoperative PE/DVT* 10.270 4.990 6.080 3.270 2.750 2.466 9.852 0.000 0.000 0.000

SP 1: Leadership Structures and Systems 111.43 111.43 120.00 111.43 111.43 120.00 120.00 120.00 120.00 120.00

PSI 6: Iatrogenic Pneumothorax* 0.590 0.360 0.320 0.350 0.210 1.214 0.000 0.000 3.788 1.133

SCIP-INF-3 Prophylactic Antibiotics D/C Within 24 Hr*** 98% 98% 100% 95% 98% 96.15% 97.10% 100.00% 100.00% 95.83%

SCIP-INF-2 Prophylactic Antibiotics for Surg Pts*** 96% 100% 99% 100% 100% 96.15% 100.00% 100.00% 100.00% 100.00%

PSI 11: Postoperative Respiratory Failure* 12.210 12.000 16.040 9.320 12.940 7.653 0.000 0.000 0.000 14.599

PSI 4: Death among surgical IPs w/ treatable CCs* 110.810 95.120 N/A 111.730 110.570 193.548 0.000 0.000 0.000 0.000

OVERALL SCORE 2.1811 2.7746 2.8400 2.8856 2.8117 3.2662 3.6646 3.8281 3.9198 3.4695

LETTER GRADE D C C C C A A A A A

Fall 2014 Survey (as submitted) Current Month (Last Reported)

LEAPFROG MEASURESPAH PFH PMH PNH PHH PAH PFH PMH PNH PHH

ICU Physician Staffing 15.00 15.00 5.00 15.00 15.00 100.00 15.00 5.00 50.00 100.00

HAC 4: Pressure Ulcer - Stages III and IV* 0.114 0.229 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000

Computerized Prescriber Order Entry (CPOE) Systems 5.00 5.00 5.00 5.00 5.00 100.00 100.00 100.00 100.00 100.00

CLABSI SIR (ICU Only)** 1.33 1.24 N/A 0.52 0.94 0.68 0.00 0.00 0.00 0.00

CAUTI SIR (ICU Only)** 2.37 0.56 0.50 0.38 2.48 0.00 0.00 0.00 0.00 3.23

HAC 5: Falls and Trauma* 0.570 0.114 1.368 0.000 0.000 0.000 0.000 0.000 0.000 0.000

HAC 2: Air Embolism* 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000

HAC 1: Foreign Object Left in After Surgery* 0.057 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000

SCIP-VTE-2 Anti-Blood Clot Med Post-Surgery*** 92% 98% 94% 96% 96% 100.00% 100.00% 100.00% 100.00% 100.00%

SSI: Colon SIR** 0.99 0.55 0.00 2.11 1.03 1.68 0.00 0.00 0.00 0.00

SP 9: Nursing Workforce 71.43 95.24 100.00 90.48 100.00 100.00 100.00 100.00 100.00 100.00

SP 19: Hand Hygiene 30.00 27.00 30.00 30.00 30.00 30.00 30.00 30.00 30.00 30.00

PSI 15: Accidental Puncture or Laceration* 2.350 1.990 1.680 1.950 2.470 3.846 3.695 5.682 0.000 3.304

SCIP-INF-9 Pts w/ Urinary Cath Removed on POD1-2*** 93% 89% 97% 92% 99% 100.00% 98.33% 100.00% 96.00% 92.31%

SCIP-INF-1: Antibiotics 1 Hr Before Surgery*** 96% 98% 100% 98% 99% 98.11% 100.00% 100.00% 100.00% 100.00%

PSI 14: Postoperative Wound Dehiscence* 0.270 0.420 0.690 0.630 0.520 0.000 0.000 0.000 0.000 0.000

SP 2: Culture Measurement for Performance 20.00 20.00 20.00 20.00 20.00 20.00 20.00 20.00 20.00 20.00

SP 3: Teamwork Training and Skill Building 36.00 36.00 36.00 36.00 32.00 40.00 40.00 40.00 40.00 40.00

SP 23: Prevention of Ventilator Assoc. Complications 18.33 16.67 20.00 20.00 18.33 20.00 20.00 20.00 20.00 20.00

SP 17: Medication Reconciliation 30.33 32.67 30.33 30.33 28.00 35.00 35.00 35.00 35.00 35.00

SP 4: Identification and Mitigation of Risks/Hazards 76.36 98.18 109.09 98.18 98.18 120.00 120.00 120.00 120.00 120.00

PSI 12: Postoperative PE/DVT* 10.270 4.990 6.080 3.270 2.750 2.466 9.852 0.000 0.000 0.000

SP 1: Leadership Structures and Systems 111.43 111.43 120.00 111.43 111.43 120.00 120.00 120.00 120.00 120.00

PSI 6: Iatrogenic Pneumothorax* 0.590 0.360 0.320 0.350 0.210 1.214 0.000 0.000 3.788 1.133

SCIP-INF-3 Prophylactic Antibiotics D/C Within 24 Hr*** 98% 98% 100% 95% 98% 96.15% 97.10% 100.00% 100.00% 95.83%

SCIP-INF-2 Prophylactic Antibiotics for Surg Pts*** 96% 100% 99% 100% 100% 96.15% 100.00% 100.00% 100.00% 100.00%

PSI 11: Postoperative Respiratory Failure* 12.210 12.000 16.040 9.320 12.940 7.653 0.000 0.000 0.000 14.599

PSI 4: Death among surgical IPs w/ treatable CCs* 110.810 95.120 N/A 111.730 110.570 193.548 0.000 0.000 0.000 0.000

OVERALL SCORE 2.1811 2.7746 2.8400 2.8856 2.8117 3.2662 3.6646 3.8281 3.9198 3.4695

LETTER GRADE D C C C C A A A A A

Fall 2014 Survey (as submitted) Current Month (Last Reported)

15

0.4

0.35

0.32

0.33

0.34

0.35

0.36

0.37

0.38

0.39

0.4

0.41

FY2014 FY2015

SERIOUS SAFETY EVENT Serious Safety Event

13%

Quality I Safety I Service

16

ED Pt Satisfaction MD Pt SatisfactionInpatient Patient

Satisfaction

FY2014 65% 80% 69%

FY2015 65% 82% 70%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

SATISFACTION RATES FY2014 FY2015

2%

Quality I Safety I Service

1%

17

[VALUE]

71.20%

[VALUE]

Engagement

Piedmont Healthcare Engagement

FY2013 FY2014 FY2015

12.3%

Talent

18

Growth

[VALUE] [VALUE]

144913

FY2013 FY2014 FY2015

Adjusted Admits

4%

19

$5,000

$620,000

$0

$100,000

$200,000

$300,000

$400,000

$500,000

$600,000

$700,000

Operating Income and Margin

PIEDMONT HEALTHCARE INCOME AND MARGIN

FY2014 FY2015

Stewardship

124%

*Not True Dollar Values 20

In a time of drastic change, it is the learners who inherit the

future. The learned find themselves equipped to live

in a world that no longer exists.

Eric J. Hoffer

21

Want to Know More?

• Who: Michael O’Toole & Jennifer Lingenfelter

• What: Learning Objectives – Discover how to successfully implement a Quality & Process

Improvement transformation program to drive improvements in Quality, Service, Safety, & Financial metrics

– Describe pitfalls to avoid / lessons learned when implementing a Quality and Process Improvement program

• When: October 1st - 11:05- 11:50 AM

22

Questions?