from conception to birth: engaging physicians and families ... · pdf filefrom conception to...

Children’s Hospital Association

Annual Conference 2013

From Conception to Birth:

Engaging

Physicians and

Families as

Partners

AGENDA

• Introduction

• Engaging Physicians and Families

• Fostering Collaboration

• Continuous Engagement

• Results

• Q & A

INTRODUCTION

Texas

Children’s

Hospital:

Who We Are

Vision 2010: Excellence to Eminence

http://www.nri.texaschildrens.org/uploadedImages/About_NRI/NRI_Exterior_large.jpg

Pavilion for Women

Houston Market

Texas Children’s and

SLEH sign a contract

to construct adjoining

buildings and operate

under joint

administration. This

arrangement continues

for 35 years.

1950s

The partnership

provides community

with unique

resources and

immediate access

to high-risk

obstetrics experts

and >40 pediatric

subspecialties in

one location.

2006

St. Luke’s notified Texas Children’s of intent to get

out of OB services. Texas Children’s and St. Luke’s

enter a management agreement for obstetrics

service line

1980 – 1990s

Texas Children’s and

St. Luke’s separate in

1987. Texas Children’s

continued to grow and

has become one of the

largest freestanding

children’s hospitals

in the nation.

Pavilion for Women provides

comprehensive care with

centers of excellence in

specialties including:

• Maternal Fetal Medicine

• Infertility

• Fetal Intervention & Surgery

• Fetal Cardiology

• Reproductive Genetics

• Perinatal Nutrition

• Neonatology

• Reproductive Mental Health

• Gynecology

Today

We Had No Choice

Our Initial Vision

Improve neonatal

outcomes by taking care

of women prior to and

during their pregnancy

Executing the Vision

Changing the Model of Care

ENGAGING

PHYSICIANS &

FAMILIES

The Red Zone

• Culture Changes

• New Market Entry

• Partnership Formation

• Competitive Response

• Operational Challenges

• A New Facility

Today’s

Business Model

Future

Business Model

Transformation Required

Patient Experience Management

Source: Gelb/APQC/Beryl Institute Benchmarking Study

Source: Gelb Benchmarking Study

Physician Experience Management

Customer Enchantment

Functional

Recognize Needs

Emotional

Engagement Process

Primary Experience Stewards

Key Touchpoints

Awareness

• Physician

Liaisons

• Faculty/Staff

Need

• Front Desk Staff

• Faculty/Medical

Staff

Scheduling

• Faculty/Medical

Staff

• Support Staff

Transition

• Faculty/Medical Staff

• Support Staff

Treatment

• Faculty/Medical

Staff

• Support Staff

Experience Map

Video / Audio Recordings

Physical

Environment

Communications

1.

Interview

Transcripts

2.

From Data…

3.

4.

…to Insights

Detailed Findings

Day in the Life

Touchpoint

Assessment

Handle with Care

OB - Driven

Segmenting Patients

In Control Support Seekers

Want OB leadership,

not pediatrics

Concerned about lack

of adult care focus at

Texas Children’s

Feel existing OB

nursing team highly

skilled and capable

Physician Partners

Convenience and

access in the Texas

Medical Center can be

challenging

Change in Perspective

Selling the Vision

FOSTERING

COLLABORATION

It’s not the building…

Guiding Principles

Create a significant architectural landmark

Fit into existing TCH campus

Provide flexibility for change over time

Respond to physician and staff needs

Support cutting edge patient care and services

Provide the ultimate customer experience

Inclusion

Transparency

Why is Input Critical?

Physician Experience Management

Family Experience

Management

Program Components

• LDRs (Not LDRPs)

• Emergency C-Section ORs (On same floor as LDRs)

• Scheduled C-Section & GYN / Fetal Intervention ORs (On dedicated floor)

• Assessment / Triage Center

• Women’s Specialty Unit

• Mother Baby Unit

• NICU (Level 2 & 3)

• Family Fertility Center with IVF Lab

• Women’s Radiology Suite

• Maternal and Fetal Center

• Concierge Services

• Patient Support Services

• Education / Conference Center

• Physician Offices / Clinics

• Support / Logistic Services

• Milk Bank

• Lab / Blood Bank

• Cord Bank

• Psychological / Social Support Center

Sharp Mary Birch Hoag Hospital

University of Iowa

University of Nebraska

Adult

facilities

Pediatric

facilities

Vanderbilt

Prentice

Benchmarking

LDR

NICU

LDR

NICU

Horizontal Travel

Distance:

615’

Vertical Travel

Distance:

225’

LDR

NICU

Organizational Concepts

Test Fits

STACKING: 3,500 Births Growth Concepts

STACKING: 5,000 Births Growth Concepts

Interiors

Translating Feedback into

Customer Experience

+

The “Stork” Cart

+

Initial Design

Concept

Refining the Design

February May

Assessment

Stork Cart Parking

Designed Parking into Patient Rooms

Labor and Delivery

Stork Cart Parking


Mother Baby/Ante Partum

Stork Cart Parking


Family Launch Zone

Launch Zone

CONTINUOUS

ENGAGEMENT

Our New Vision

Lead the

advancement of

healthcare for

women and

newborns through

innovation and

excellence in

patient care,

education and

research.

Shared Leadership Model

Executive Steering

Committee

Clinical Support

Services

Sarah Maytum

Liz Bolds

Patty Eng

Business Operations

Joann Lee

Christina Kadavil-

Kunnacherry

Inpatient Clinical

Services

Carol Forsberg

Emily Weber

Ashley Miller

Facilities Preparation

Jill Pearsall

Rick McFee

Ted Gillis

Renee Williams

Outpatient Clinical

Services

Chanda Cashen

Jennifer Upshaw

Roula Zoghbi

Support Services

Bert Gumeringer

Jennifer Borders

Brian Murry

BCM OB/Gyn

Fetal Center

TCWS

REI/IVF

Triage

Women’s

Specialty

Unit

L&D

Epic

NICU

Ancillary Services

Milk Bank

RT

Food &

Nutrition

Pharmacy

Pathology

PT/OT

DI

Pt. Ed./

Childbirth

Ed

Guest

Services

Social Work

Pt & Fam Services

Volunteer

Services

Rec.

Therapy/

Child Life

Spiritual Care

HIM

Human

Resources

Finance

Operations

Cashier

EPIC/IRIS

Retail

Business

Services

Property

Accounting

Safety

IS/Telecom

Security

Facilities

Ops

Supply

Chain

Biomed

Facilities

Planning &

Developmnt

Supply

Chain

Safety

IS/Telecom

Security

Facilities

Ops

Food &

Nutrition

(Retail)

Biomed

Linda Aldred Myra Davis Susan MacDonald Bart Putterman, MD Wycke Baker, MD

Mary Jo Andre Pete Dawson Sandy McElligott Laura Shuford Cris Daskevich

Michael Belfort, MD Ed Yosowitz, MD Ben Melson Alec King Monju Monga, MD

Amber Tabora Mark Mullarkey Steve Welty, MD Randy Wright Marcia Katz, MD

James Versalovic, MD Mark Skolkin, MD

Psychosoc.

Support

Facilities and Support Team Coordinator

Activation Project Coordinator – Christina Kadavil-Kunnacherry

MBU

& NBN

Care Mgmt.

Physician involvement at the Executive Steering Committee, Clinical Steering Committee and Activation Team levels; Quality integrated across all teams

ACTIVATION LEADERSHIP TEAM

Room

Mgmt.

PSO

Move

Coord.

Emergency

Mgmt.

Transit

Center

Legal / Regulatory

Pavilion for Women Activation Team Structure

Michael Belfort, MD Wycke Baker, MD Manisha Gandhi, MD Liz Bolds, RN Emily Weber, RN

Stephanie Martin, MD David Zepeda, MD Jessica Ohlemacher, MD Kirsten Benjamin, RN Steve Welty, MD

Bart Putterman, MD Carol Forsberg, RN Nancy Hurst, RN Elaine Whaley, RN Sandy McElligott

Patti Heale, RN Brian Kirshon, MD Michael Speer, MD Edwina Popek, MD Cris Daskevich

Gary Dildy, MD Judy Swanson, RN Chanda Cashen Ed Yosowitz, MD

Clinical Steering

Committee

Surgical Svcs

ICU

42

31.5 3328 28

0

5

10

15

20

25

30

35

40

45

Baseline

(Feb '12)

Improve

(Mar '12)

Improve

(Apr '12)

Control

(May '12)

Nov '12

Med

ian

Cyc

le T

ime

(Min

ute

s)

Improvement Stages

Median Resolution Time for

Urgent Calls (minutes)

Goal Actual

33%

Outpatient Flow Redesign

70

30

20

40

60

80

Baseline Current

3rd Next Available for Annual Exams (days)

Outpatient Access Improvement

Medical Practice (August ‘13) 90.9%

Texas Children’s Pavilion for Women Overall

91.1%

Process Improvement:

Positive Impact on Patient Satisfaction

Admit

Assess/ Triage

Labor & Delivery

Mother Baby Care

Launch Family

Growth Management Requires

Physicians

Inpatient Flow Redesign

HCAHPS Recommend Hospital:

91.9% (98th percentile)

HCAHPS Rate Hospital 0-10:

86.1% (96th percentile)

Inpatient Pavilion for Women (August 2013):

90.3%

Process Improvement:

Positive Impact on Patient Satisfaction

Focus on Quality and Safety

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

0

50

100

150

200

250

300

350

400

450

500

Nu

mb

er

of

De

live

rie

s P

er

Mo

nth

PFW Obstetric Adverse Event Rate

Monthly Delivery Volume OBAE Rate Linear (Monthly Delivery Volume) Linear (OBAE Rate)

100%

hand hygiene compliance since

April 2013

0.80%

early, elective delivery less than 39 weeks of gestation

ZERO

adult central line associated blood stream infections, and surgical site

infection for vaginal hysterectomies

98.9%

administration of antenatal steroids to women who deliver

between 24 – 32 weeks of gestation

Physician are Foundational

RESULTS

43% Outpatient Visits

Patient

Access

Improved

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

Oct

-10

No

v-1

0

De

c-1

0

Jan

-11

Feb

-11

Mar

-11

Ap

r-1

1

May

-11

Jun

-11

Jul-

11

Au

g-1

1

Sep

-11

Oct

-11

No

v-1

1

De

c-1

1

Jan

-12

Feb

-12

Mar

-12

Ap

r-1

2

May

-12

Jun

-12

Jul-

12

Au

g-1

2

Sep

-12

Oct

-12

No

v-1

2

De

c-1

2

Jan

-13

Feb

-13

Woodlands Northwest West Sugar Land Methodist

190% Visits in First Year

MFM Community Expansion

43%

137% OB Ultrasounds

Fetal ECHOs

Upstream Diagnosis Grows

Downstream Volume

March 26, 2012:

Pavilion inpatient areas

open for deliveries

-

50

100

150

200

250

300

350

400

450

Oct

-10

Nov

-10

Dec

-10

Jan-

11

Feb-

11

Mar

-11

Apr

-11

May

-11

Jun-

11

Jul-1

1

Aug

-11

Sep-

11

Oct

-11

Nov

-11

Dec

-11

Jan-

12

Feb-

12

Mar

-12

Apr

-12

May

-12

Jun-

12

Jul-1

2

Aug

-12

Sep-

12

Oct

-12

Nov

-12

Dec

-12

Jan-

13

Feb-

13

Deliveries Births

31%

Pavilion Opening Unprecedented

Delivery Volumes

0

20

40

60

80

100

120

0%

5%

10%

15%

20%

25%

30%

35%

Oct

-10

No

v-1

0

De

c-1

0

Jan

-11

Feb

-11

Mar

-11

Ap

r-1

1

May

-11

Jun

-11

Jul-

11

Au

g-1

1

Sep

-11

Oct

-11

No

v-1

1

De

c-1

1

Jan

-12

Feb

-12

Mar

-12

Ap

r-1

2

May

-12

Jun

-12

Jul-

12

Au

g-1

2

Sep

-12

Oct

-12

No

v-1

2

De

c-1

2

Jan

-13

Feb

-13

Ad

mis

sio

ns

Rat

e

Actual Admissions Actual Rate

FY11: 627

admissions

FY12: 828

admissions

NICU/CVICU Admissions Not Diluted:

23% of Annual Births

1180 NICU admissions in FY13

96 patients admitted to ICU in Year 1

0

2

4

6

8

10

12

14

April May June July Aug Sept Oct Nov Dec Jan Feb March

GYN Onc

GYN

Post Partum

OB

Women’s ICU Admissions

High-Risk Focus Supports Maternal ICU

150

200

250

300

350

400

450

500

550

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep

FY13 Delivery Forecast

FY10 Actual FY11 Actual FY12 Actual FY13 Actual/Projected w/historical Delivery Ceiling (15/d)

Reaching Capacity in Year 2:

> 4900 deliveries

Willowbrook

West Houston

San Jacinto

Texas Medical Center

The Woodlands

The Vintage

Projected 2013 Deliveries Managed with

Community-based Hospital Partners

~10,000

Right Care, Right Place, Right Time

3 in First Year

Ground Breaking

In-Utero

Advances

How is the market changing?

Laser Heart SpinaBifida

FETO

X X

X

X X

X X X X

X

Children’s Hospital Honor Role top 5 offer in-utero procedures

Fetal Intervention Procedures Offered

Children’s Hospital Honor Roll

Now Delivering Miracles

A New Model of Care

• Enchantment starts with listening

• Leverage your strengths and expertise

• Partnerships and collaborations are key

• Entrance by an “outsider” dramatically changes the

market dynamics

• Flexibility is key to evolving to on-going market demands

• Stay true to your mission and vision – the rest will work

itself out

Prescriptions for Success

• “Leadership = Vision + Structure + People, with people being by far the most important component.” – Mark A. Wallace

• Stay true to your values – the rest will follow

• Listen – again, and again, and again…

• Communicate, communicate, communicate

• What is best today, may not be in 6 months or 2 years - keep an open mind, admit your mistakes and adapt quickly

• True paradigm shifts do not occur overnight. They will be difficult and they will be challenged. Take nothing for granted and expect the unexpected.

• Surround yourself with top talent and support them in every way that you can

Leadership Lessons Learned

Cris Daskevich, FACHE, MHA/MBA

Senior Vice President

Texas Children’s Hospital

[email protected]

John McKeever, MBA

Executive Vice President

Gelb Consulting, An Endeavor Management Company

800-846-4051 office

[email protected]

Diane Osan, FAIA, ACHA

Chief Visionary Officer

FKP Architects, Inc.

713-821-9290

[email protected]

Contact Us

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