HealthCare Model for the 21 st Century
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1 HealthCare Model for the 21 st Century Institute for Healthcare Improvement National Forum CCHS Mission Care for the sick Dr. Frank E. Bunts Dr. George W. Crile Investigate their problems Educate those who serve Dr. William E. Lower Dr. John Phillips
2 Professional Staff 3,500 3,000 # 2,500 2,000 1,500 1, Caregivers 45,000 40,000 # 35,000 30,000 25,
3 Cleveland Clinic NEO Family Health Centers Brunswick CCHS NEO Hospitals
4 2.5 Average Severity Cleveland Clinic UCLA Mayo Mass Gen John Hopkins
5 Cleveland Clinic Florida Cleveland Clinic Lou Ruvo Center for Brain Health
6 Cleveland Clinic Canada Sheikh Khalifa Medical City
7 Cleveland Clinic Abu Dhabi 6.4 Million Patients FHC FHC R.E. Jacobs Health Center Elyria Family Health Center FHC Lorain Family Health And Surgery Center FHC Lou Ruvo Center for Brain Health Las Vegas, Nevada FHC Westlake Family Health Center H Fairview Hospital FHC H Lakewood Hospital FHC Lakewood Family Health Center FHC H Lutheran Hospital FHC Independence Family Health Center Strongsville Family Health and Surgery Center Brunswick Family Health Center Euclid Hospital Cleveland Clinic H H Marymount Hospital FHC Wooster Family Health Center H H S.T.J. Health Center Hillcrest Hospital H South Pointe Hospital H Medina Hospital Ashtabula County Medical Center Cleveland Clinic FHC Toronto Willoughby Hills Family Health Center HC FHC FHC Solon Family Health Center FHC Chagrin Falls Family Health Center FHC Beachwood Family Health and Surgery Center FHC Twinsburg Family Health Center H Cleveland Clinic Florida
8 Transport Team Hospital Transfers 25,000 20,000 # 15,000 10,000 5,
9 "There are decades where nothing happens; and there are weeks where decades happen." Lenin Engagement An "engaged employee" is one who is fully involved in, and enthusiastic about their work, and thus will act in a way that furthers their organization's interests. Wikipedia
10 Physician Engagement % tile Organization Structure Not for Profit Group Practice Physician Leadership Salaried Annual Professional Review 1 Year Contract
11 Organization of Care Delivery Profession Oriented - Division of Surgery Patient Oriented - Heart and Vascular Institute
12 Heart & Vascular Institute Cardiac Surgery Cardiology Vascular Surgery Vascular Medicine Miller Pavilion
13 Communication CEO Meetings - Weekly Institute Staff - Weekly Admin Departments - Monthly Institute Chair Dinners - Monthly Hospital - Monthly Community - Quarterly Connections - Quarterly Staff Meetings - Quarterly Institute Scorecard - Executive Forums Communication Intranet sites
14 Communication Social Media Communications Weekly e-newsletters
15 Transparency Physician HCAHPS Scores
16 Professional Staff Leadership Roles # Leading in Healthcare Course N=397 #
17 Cleveland Clinic Academy Staff Attendees # CC Experience
18 Caregiver Engagement %ile
19 HCAHPS Before & After Course Completion Pre Post 30 %ile Domain Explain Listen Respect Doctor Communication Mayo Mass Gen Johns Hopkins UCLA CC 50th
20 Patient Satisfaction %ile 60 Rank Execution Quality Access Value Cost Continuous Improvement
21 Executing to Meet Our Goals Quality
22 University Hospital Consortium Quality Rank th th th th Rank Patient Safety Indicators # Per Month
23 Heart Failure Readmissions 30 % 25 22% < 20% All Cause Readmissions % % %
24 12.0 Post-Op VTE # per 1,000 pts % 9.4% Hospital Acquired Infections 35 #
25 Executing to Meet Our Goals Access Emergency Departments Door to Doctor # 30 Minutes minutes minutes
26 Nurse on Call 200, Women s Health Institute Speed of Answer 70 Move to Appt. Center 50 # Seconds
27 Same Day Visits 1250 # thousands MyChart 1,800,000 1,400,000 1,000, ,000 Auto Enrollment Oct.15 th 200,
28 Executing to Meet Our Goals Lower Cost Choose Wisely Cost Campaign Cost Education Practice Change $28,437 Q1 Saving
29 Lab Tests Avoided # 14,000 12,000 10,000 8,0008 Thousands 6,0006 4,0004 2,0002 5,388 12,082 $1.2 Million Feb Apr Jun 2012 Aug Oct Dec Prostatectomy All Cases 8,000 $ per Case 7,000 6,000 5,000 23% 4,
30 Weight Management Weight Watchers Curves Shape Up & Go Fitness Centers Yoga Farmer s Markets 415,000 LBS Lost Vending Machines GO! Foods
31 Q1 04 Q2 04 Q3 04 Q4 04 Q1 05 Q2 05 Q3 05 Q4 05 Q1 06 Q2 06 Q3 06 Q4 06 Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09 Q1 10 Q2 10 Q3 10 Q4 10 Q1 11 Q2 11 Q3 11 Q4 11 Q1 12 Q2 12 Q3 12 Q4 12** Chronic Disease Enrollment 60 59% 57 % Employee Health Plan PMPM Costs 420 $ % 2.0%
32 Economics Inflection Point Cleveland Clinic Integrated Care Model Retail Venues Home Community - Based Organizations Care System CC Clinic Post-Acute (other) Independent Physician Offices Skilled Nursing Facilities Rehab Ambulatory D&T Hospitals Emergency
33 Joint Commission Patient Centered Medical Home Patient Centered Medical Home 91% Caregiver satisfaction 12% Provider explanation 12% Desired appointments 9% Time spent with provider 8% Confidence in provider
34 Care Path Development Cycle Guides in development 69 Guides complete 22 Paths complete 4 Paths in EMR 3 > 750 Caregivers Total Knee Blood Utilization #
35 Headache ED Pilot 70% 60% 50% 40% 30% 20% 10% 0% Opiates Prescribed Baseline 63% Pilot 5% The Change Curve Shock Right actions and clear change communications can reduce the emotional impact of changes Acceptance Morale & Productivity Exploring Emotion Initiation of change Time
36 ALL AMERICANS DESERVE WORLD CLASS CARE No one cares how much you know, until they know how much you care. Theodore Roosevelt
37
38 Care Paths Reduce variation Standardization >1000 engaged caregivers Process & role redesign Appropriateness criteria Culture change Mobile App iphone and Droid Access CC physicians Referrals Transfers
39 Premature Mortality Medical Access 10% Behavior 40% Obesity Sedentary Life Smoking Genetics 30% Environment 5% Social 15% U.S. News 2013 Honor Roll 1 Johns Hopkins Mass General Mayo Clinic CLEVELAND CLINIC UCLA
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