BUILDING YOUR REHAB CENSUS

Transcription

1 BUILDING YOUR REHAB CENSUS (or at least how we ve built ours) Rusty A. Moore, DO Southwest Regional Medical Director Neuroscience Clinical Program and Continuous Improvement Intermountain Healthcare My Dixie Regional Experience Some Misguided Attempts at Growth 1

2 What I Found: 2010: 9.5/16 = 59% occupancy rate; 263 served Skilled Nursing masquerade Barking up the wrong tree o Meeting Millar o Rotarians A storied tradition of adversarial physicians o The overly possessive physiatrist o The just plain crazy physiatrist o The lack of a physiatrist No access to case management o Conflicting loyalties Territorial therapists I also found extraordinary people doing extraordinary things. So Why Did It Seem Like Such a Secret? 2

3 So What Did We Try? Less than Successful Efforts: Educate referral sources o Staff meetings Hospitalists Social work/case management o Admission criteria o Decision Trees o Visit Vegas Advisory council o Never any actionable information Blame the Traitor So What Did We Try? More Successful Efforts: First, Fly the Plane o Give great rehab Willingness to do Hard Things o Improving our skillset (turnover, trachs, SCI) o Continuing to focus on team culture Reaching out to the rest of the continuum o Skilled Nursing Facilities and Home Health o Right patient, right bed, right time concept Listen to our customers Tell our story 3

4 Removing Barriers Such As: Access o Time pressure on case management to place patients o Earlier, simpler, more transparent decisions Face-to-face clarifications Lack of Exposure due to Location o You can t hate someone you know Crystal in the park o Physiatry up-front o Provider feedback Reporting outcomes to CV surgeons and Neurosurgery Stopping the Surprise readmissions Removing Barriers Continued: Reputation o Bowel Nazis Patient can t come until they poop o Nursing Home o Place for Nurses to Hide o Care limitations (trachs, IV abx, SCI, etc.) o Always send our patients back Physiatry ambiguity o I can t explain what I do to my kids (much less anyone else) Educate the masses via CME, staff meetings (hospital and SNFs) Topics could include: SCI management, TBI, neurogenic bladder, etc. Round with nurses and therapist on consults to educate in real-time Get involved with committees, med staff issues, and demonstrate a functional perspective 4

5 So Have We Really Changed Anything? 2017 (Q1-2): 12.8/16 = 80% occupancy rate, 162 served (highest YTD) Patients come directly from ICU o Recognized as best neuro observation and nursing care No longer called a nursing home (Most of the time) Trauma, neurosurgery, inpatient neurology consider us first choice Involvement with trauma and stroke patients from the time they arrive Case manager hugs 5

6 So How Do You Start? Honestly ask yourself a few questions: Do we have an accurate assessment of our reputation? Have we built bridges with our referral sources and our competition? Do people really know what we do? Do we give meaningful, timely feedback to referring providers and PCPs? Do we give appropriate expectations to patients, families and the acute teams in real time? Do people trust your screening decisions at face value? Does your doctor s unique skillset get any exposure upstream? Are you starting the screening/approval process as soon as it could be? 6

7 If you answered No to any of them: You Have Barriers: Do a 5 why analysis Determine Lead and Lag Measures for improvement Commit to daily improvement (and real-time tracking) Understand the difference between lead and lag metrics Involve the team (those that do the work understand how to make it better) Make it Visual Focus on one thing at a time (rapid cycle improvements) Celebrate success but be preoccupied with failure This is Really About Organizational Culture Bottom line: 7