susan moffatt-bruce, md, phd, facs chief quality and ...€¦ · engaging healthcare professionals...
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Engaging Healthcare Professionals in Operational Excellence
Susan Moffatt-Bruce, MD, PhD, FACS
Chief Quality and Patient Safety Officer
Associate Dean of Clinical Affairs, Quality and Patient Safety
Cheryl Dickerson, MS, MT, SSBB
Senior Lecturer, Fisher College of Business
Teamwork Problem solving
Leadership
Operational Excellence
Value
“The extent of workforce commitment, both emotional and
intellectual, to accomplishing the work, mission, and vision of
the organization.” - Baldrige Glossary, 2007
Engaged (31.5%)
Disengaged (51.0%)
Actively disengaged (17.5%)
- U.S. Workforce,Gallup, 2014
Healthcare’s Value Proposition
VALUE=
Health outcomes that matter to patients
____________________________________
Cost of delivering outcomes
VALUE is the only goal that can unite interests
Volume-driven to Value-driven Payment Transition
Volume-driven
Healthcare
Value-driven
Healthcare
Cost
Quality
Source: Center for Healthcare Quality and Payment Reform
HHS sets clear goals and timeline for shifting Medicare reimbursements from volume to value
“Whether you are a patient, a provider, a business, a health plan, or a taxpayer, it is in
our common interest to build a health care system that delivers better care, spends
health care dollars more wisely and results in healthier people.”
–Sylvia M. Burwell, Health and Human Services Secretary
“CLEVELAND - For a second year in a row, the
federal government is tying hospital performance
to payment, and nine local hospitals are paying
the price.”
Patient Journey
Let’s revisit what we know
The rules in health care are changing:
Consumer-driven market (consumerism)
Performance-based model (quality and value)
Reimbursement will decrease (revenues)
The U.S. has the highest healthcare costs in the world and lower
quality outcomes than many countries.
Creating Engagement
Clarity
Focus
Discipline
Connection
Control
Creativity
- Karen Martin,
The Outstanding Organization, 2012
Black (What are its characteristics?) Green (What do you do with it?)
Red (How could we do better?) Blue (How do these attributes apply
to engaging people in OpEx?)
Discuss: What can _______ teach us about engaging
people in Operational Excellence?
• Hard plastic
• Many colorful parts
• Parts are interchangeable
• Make happy faces
• Make sad faces
• Have a face making race
• Be intentional about building relationships
while we problem solve
• Everyone doesn’t start from the same place
Black (What are its characteristics?) Green (What do you do with it?)
Red (How could we do better?) Blue (How do these attributes apply
to engaging people in OpEx?)
Why do healthcare professionals engage?
If you’re not at the table…
…you’re on the menu.
- Michael Enzi
Moving from this…
…to this.
Operations Councils
Nurse Lead
Physician Lead
Administrative Lead
Process Improvement Facilitator Frontline MD’s and RN’s
Pharmacy, PT, OT, etc.
Case Management & Social work
Facilitator: Dedicated team member,
Lean and Six Sigma training
DATA ACCESS and support
21
Surgical First-Case Start: Delay Reasons
Surgeon Delays Staff Other Surgical ( flip room ) Anesthesia Delays All other
Quantity 60 24 23 20 4 0
Cum % 46% 64% 82% 97% 100% 100%
% of Total 46% 18% 18% 15% 3% 0%
0%
20%
40%
60%
80%
100%
120%
-
10
20
30
40
50
60
70
Cu
mu
lati
ve
Pe
rce
nt
Oc
cu
ren
ces
Late Start Delay Reasons Pareto Chart
April '13-June '13 Time Period:
ED “Post” Results*
6.3%
1.2%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
Pre-BCMA Post-BCMA982 medication administrations
observed 993 medication administrations
observed
p<0.001
Cardiac Monitoring Days
23
5.3
4.8
2.5
2.5 2.6
2.4 2.5 2.5 2.5 2.5 2.5 2.5 2.5
2.4 2.4
0.0
1.0
2.0
3.0
4.0
5.0
6.0
Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan
Avg
Day
s P
er
Pat
ien
t
Cardiac monitoring policy revision effective 12/17/2014
Rayo MF, et al. BMJ Qual Saf 2015
Personal Belief & Behavior
Department Culture & Strategy
for Improvement
Hospital and System
Culture & Strategy for Continuous
Improvement
Clinical Transformation:
Enabling the Learning Health System
Local
Learning
Health
System
Local
Learning
Health
System
Local
Learning
Health
System
Local Learning Health System
Preliminary estimates for 2013 show a further 9 percent decline in the rate of
hospital-acquired conditions (HACs) from 2012 to
2013, and a 17 percent decline, from 145 to 121 HACs per 1,000 discharges, from 2010 to
2013. A cumulative total of 1.3 million fewer HACs were
experienced by hospital patients over the 3 years
(2011, 2012, 2013) relative to the number of HACs that would have occurred if rates had
remained steady at the 2010 level. We estimate that approximately 50,000 fewer
patients died in the hospital as a result of the
reduction in HACs, and approximately $12 billion in health
care costs were saved from 2010 to 2013. Although the precise causes of the decline in patient harm are not fully understood, the increase
in safety has occurred during a period of concerted attention by
hospitals throughout the country to reduce adverse events, spurred in part by
Medicare payment incentives and catalyzed by the U.S.
Department of Health and Human Services (HHS) Partnership
for Patients initiative led by the Centers for Medicare & Medicaid Services (CMS).
AHRQ Draft of Preliminary 2016 Report
Thank You
Susan Moffatt-Bruce, MD, PhD, FACS
Chief Quality and Patient Safety Officer
Susan [email protected]
Cheryl Dickerson, MS, MT, SSBB
Senior Lecturer, Fisher College of Business