How We Successfully Integrated our Multi-site Health System Laboratory Organization in a Budget Constrained

World

Michelle Barthel, System Director of Lab Services

Objectives • Provide overview of Regional Health

• Discuss System Integration Journey

• Share Results

• Provide Lessons Learned

Regional Health is the Largest Health Care System in Western South Dakota

Regional Health is community based health care. We are in more than 20 communities, 2 states and 32 specialty areas of medicine. Regional Health: 5 Hospitals 25 Clinic Locations 1 assisted living facility 2 care centers 6 urgent cares 7 specialty treatment centers

Regional Health Laboratories

• Five hospital laboratories • 25 clinic laboratories • 1.75M tests annually

2015 Laboratory Consolidation Goals

• Quality and Safety • Financial Stewardship

– Increase revenue through outreach growth – Decrease expenses through consolidation and standardization

• Provider and Caregiver Engagement – Decrease annual turnover to <20% – Improve provider and caregiver engagement scores

• Patient and Family Experience – Improve patient experience scores to >=75th percentile

• Community Stewardship – Increase laboratory access

SWOT W S

O T

Strengths •Advanced platform •Large testing menu •New CEO advocates innovation and growth •Capacity for growth

Weaknesses •Limited resources •Budget constraints •Low employee engagement •High turnover rate •Difficult to recruit •Low patient experience scores •Lack of standardization •8 EMRs/difficult to obtain metrics

Opportunities •Gain Executive support •Standardize and consolidate •Expand patient access •Improve quality •Improve engagement and retention

Threats •Resistance to service line by market presidents •Low percentage of commercial payers •Increasing competition •Non-competitive Pricing •MLS/MLT shortage •Declining reimbursement

SWOT Analysis: Weaknesses • Negative culture/ low engagement • 41% turnover rate (several openings for

MLS/MLT positions) • Low patient experience scores- 58th percentile • Each lab reported to a different market

president/ processes not standardized or efficient

• Quality and process issues • 8 EMRs/lack of good data and metrics • Limited resources/budget constraints

Where to begin?

What is the root cause of major weaknesses?

– People issues • Culture • Engagement/turnover • Patient Experience

– Quality issues • Process

Next Steps • Gain executive support and trust

• Establish effective leadership team

• Begin teambuilding and strategic planning

Executive Support

• Established monthly meetings with president in each market

• Gained trust by adding value and support to each individuals area

• Regular updates and transparency

Establish an Effective Team

Skillset needed for leadership support: – People development and focused – Quality and process focused – Service focused – System thinkers – Innovative

Teambuilding

• Gain trust • Set expectations • System planning • Share expertise • Create efficiencies

Strategic Planning- New Team • Establish Vision

• Identify Breakthrough Objectives

– Gap Analysis – Impact Analysis

• Annual Objectives/Metrics

Original Vision

• Regional Health’s vision: We aspire to be the best health care system in America

• RH Laboratories’ vision: We aspire to be the best laboratory system in America

Revised Vision

• To be the trusted leader in service excellence and innovative quality solutions.

Determine Breakthrough Objectives

– Using affinity diagram and $100 test of potential

Ideal State

Gap Analysis Improve Recruitment

8.

Implement Lean

Improve Patient Experience

Obtain ISO Certification

Expand Outreach

Improve Caregiver Development

Improve quality and reduce errors

Expand Testing Menu

Impact Analysis Improve Recruitment

Implement Lean

Improve Patient Experience Obtain ISO

Certification

Expand Outreach

Improve Caregiver Development

Improve quality and reduce errors

Expand Testing Menu

Annual Objectives

• Focus on development opportunities for laboratory

caregivers Metrics: – Turnover rate – Patient experience scores

• Focus on Implement Lean processes into all laboratories Metrics: – # of people trained on Lean processes – # of Lean processes implemented

Improve Development Opportunities: Strategies

– Develop career path • Leadership and system support roles • Develop system education coordinator and trainers • Improve continuing education and training • Succession planning • Development plans for all caregivers • Mentorship program

– Perform stay interviews

• Identify and address issues early – Improve hiring process

• Behavioral based interviews • Job shadowing on shift prior to offer • Standardize onboarding

Leadership • Supervisor • Manager • Sr. Director

Pre-Analytic: • Lab Assistant I • Lab Assistant II • Sr. Lab Assistant Technical:

• MLT • MT/MLS • Sr. MT/MLS

Client Services: • Office Assistant

System Support Staff: • Educational Specialist • Quality Specialist • POC Coordinator • Technical Specialist • IT Specialist

Laboratory Career Path

Implement Lean/Improve Quality: Strategies

– Develop system lean team – Provide lean training for all – Perform Value Stream Analysis – Perform Quick Win Waste Walks in every lab – Standardize equipment and processes – Reorganize testing

Standardization of Equipment and Processes

• Chemistry and hematology • Autoverification • Supplies • Competencies • Patient experience • Accreditation • Inspections

Reorganization of Testing

• Microbiology • Blood bank • Fertility • Respiratory PCR • Consolidation of laboratories • Waived testing and lab assistants in

remote locations

Communication and Implementation

Participation of all roles in system Executive team meetings and presentations Board presentations Interdisciplinary team meetings

Annual Results Review • Staff Development Results 9 Certifications and promotions 4 pursuing MLT degree 3 pursuing MLS degree

• Turnover Rate

– Baseline= 41%; Target= <20% – FY17 = 24% – FY 18 YTD = 22%

• Patient Experience Score

– Baseline= 58th percentile; Target=>75th percentile – FY17 = 92nd percentile – FY 18 = 95th percentile

Annual Results Review • Percent of people trained in lean concepts

– Baseline= 33%; Target= 100% – FY17 Results= 100%

• Number of lean initiatives implemented – Baseline= 0; Target= 10 – FY17 Results= 10

• FTE reduction of 12.76 • Cost savings of = $2.8M

Accomplishments Pe

ople

• Restructured leadership

team

• Implemented better hiring practices

• Implemented Laboratory Career ladder

• Created new system roles

• Gained executive and provider support

• Obtained certifications and training.

Tech

nolo

gy

• Implemented new chemistry and hematology instruments

• Implemented automation line

• Implemented auto-verification

• Standardized EMR and LIS

Proc

ess

• Implemented zone

coverage phlebotomy and new morning draw process

• Increased access • Standardized and

centralized onboarding

• Centralized billing

• Centralized microbiology • Blood bank efficiencies

Lessons Learned

• Too many competing goals • Too many ineffective meetings • Continued focus needed • Start somewhere even if conditions aren’t

perfect • Don’t forget to celebrate successes

Recap of Keys to Success

• Executive and provider support • Effective leadership team • Strategic planning/focus

– Focus on people – Focus on quality

References Cowley, Michael and Domb, Ellen. (1997). Beyond Strategic Vision Effective Corporate Action with Hoshin Planning. New York. Routledge.

Smart, Geoffrey and Street, Randy. (2008). Who: The A Method for Hiring. New York.

Questions & Answers

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Michelle Barthel, MT, MHA System Director of Laboratory Services Regional Health 605-755-8094 mbarthel@regionalhealth.org