Owning and Developing Your Practice Through Alignment
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1 Owning and Developing Your Practice Through Alignment David Mantz Director, Respiratory Care, Sleep Disorders Center and The Tammy Walker Cancer Center Salina Regional Health Center Salina Kansas
2 Alignment 1. the act of aligning or state of being aligned; especially : the proper positioning or state of adjustment of parts (as of a mechanical or electronic device) in relation to each other 2. the forming in line 3. an arrangement of groups or forces in relation to one another
3 Strategies for Success
4 Define and Accept Reality David Walker Former Comptroller General now CEO of Peter G. Peterson Foundation I.O.U.S.A. Photo from Wikipedia
5 US National Debt 12% increase in 2008 = 63.8 trillion Per household: other = $2,172 Civil servant retirement = $15,851 Military retirement = $29,694 Social Security = $160,126 Medicare = $244,288 Total debt/household = $546,668 USAToday May 29-31, 2009
6 Current Status Healthcare Financial News Harvard Study: Medical Expenses account for 62% of all personal bankruptcies 78% of the filers had some form of health insurance American Hospital Association Study Mean income of 400 hospitals studied was zero Reuters Study of Cancer Patients 25% deferring therapy due to financial reasons
7 Bank Robber USA Today Trillion Spent on Healthcare in % 30% 25% 20% 15% 10% 5% 0% Hospital Care Physician Services Prescription Drugs Private Insurance Nursing Home Care Equipment Dental Home health Research Non-durable Durable Medical Equipment
8 M. Scot Peck Quote The truth is that our finest moments are most likely to occur when we are feeling deeply uncomfortable, unhappy of unfulfilled. For it is only in such moments, propelled by our discomfort, that we are likely to step out of our ruts and start searching for different ways or truer answers.
9 What Does This Mean to Us? Change will continue at an increasing rate Everything will be questioned The Good News We can be successful as a profession with a strategic plan We have a lot to offer We have a creative nature MacGyver
10 Basic Alignment
11 Some Questions to Consider How do we become irreplaceable? Jim Collins Good to Great First Who Then What Right people in the right places What are Hospital Administrators Thinking? How do we add 20 million patients with no payment increase? How do we reduce costs and maintain quality? What are your hospital s goals? What are your department s goals? Are they aligned with the organization? Why do we need to align with them?
12 Aligning Department Goals with Organizational Goals Salina Regional Health Center Org Goal #1 To achieve excellence in patient care with outstanding people using best practices (Quality) What does Quality look like? Respiratory Care Department Goal: To manage severe respiratory distress with noninvasive ventilation and prevent intubation and mechanical ventilation
13 # of Patients PDCA Report BIPAP TO PREVENT INTUBATION Leader s Name: David Mantz Committee Reported to: Respiratory Care February 2010 PLAN: 1. What was the BASELINE? (show in graph/table); 2. What is the TARGET? 75% Success rate 3 What are the BARRIERS to reaching the target? (describe below) Baseline: See Chart for each unit s baseline Target: 75% Success Rate in Preventing Intubation Barriers: Getting an order to adjust the BiPAP for a suggested Vt. DO: 4. What did you DO last reporting period (month, 90-days, etc.) to improve? -Reported patients that required BiPAP in the shift Report -Promoted the use of BiPAP therapy -Started looking at how many vent patients we had in comparison to BiPAP Patients CHECK: 5. What is the ACTUAL current performance? (show in graph/table) BiPAP to prevent intubation Total # of Vent Patients Total # of Bipap Patients Successfully stayed off Vent Comfort Measures Only Changed to DNR 0 September 36% October 43% November 61% December 74% January 67% February 80% % = Percent of non-inutbated patients for that month (CMO and DNR not included in percentage) DO: 6. If target was not achieved, what will you DO next reporting period to improve? ACT: 7. If target was achieved, what will you do next reporting period to hold the improvement? Target is unknown, Next month will: Encourage use of BiPAP post extubation prior to re-intubation Continue to get BiPAP to Prevent Intubation into the shift reports Continue to encourage use of BiPAP, and ask for orders that set parameters for the estimated Vt; not a set IPAP and EPAP Evaluate which vent patients may have benefited from the BiPAP
14 Aligning Department Goals with Organizational Goals Salina Regional Health Center Org Goal #1 To achieve excellence in patient care with outstanding people using best practices (Quality) Department Goal: To convert 50% of all aerosol therapy to metered dose inhalers with valved holding chambers
15 in thousands PDCA Report MDI CONVERSION Leader s Name: David Mantz Committee Reported to: Respiratory Care February 2010 PLAN: 1. What was the BASELINE? (show in graph/table); 2. What is the TARGET? 50% of therapy MDI s; 3 What are the BARRIERS to reaching the target? (describe below) Baseline: See Chart for each unit s baseline Target: To consistently improve each month above previous month Barriers: Other medications; Mucomyst, Pulmicort DO: 4. What did you DO last reporting period (month, 90-days, etc.) to improve? -Established Baselines -Encouraged Team Leaders to manage and promote MDI conversions CHECK: 5. What is the ACTUAL current performance? (show in graph/table) MDI Conversion MN TX MDI TX 0 August 09, 22% September 09, 21% October 09, 24% November 09, 26% December 09, 26% January 10, 26.5% February 10, 39% %=percentage of MDI therapy DO: 6. If target was not achieved, what will you DO next reporting period to improve? improvement? ACT: 7. If target was achieved, what will you do next reporting period to hold the Target is not met, Next month will: Identify and speak to doctors that do not want therapy converted Continue to encourage all staff to convert MDI s Continue to have Team Leaders manage and promote MDI conversions Change wording in the policy so it is more clear regarding spacers with face masks; if you have an appropriate fit with a face mask it may be used
16 Aligning Department Goals with Organizational Goals Salina Regional Health Center Org Goal #1 To achieve excellence in patient care with outstanding people using best practices (Quality) Department Goal: To enroll 20% of all protocol eligible patients in an evidence based therapist driven protocol
17 # of Patients PDCA Report 20% OF ALL ELIGIBLE PATIENTS ARE ENROLLED IN THE APPROPRIATE PROTOCOLS Leader s Name: David Mantz Committee Reported to: Respiratory Care February 2010 PLAN: 1. What was the BASELINE? (show in graph/table); 2. What is the TARGET? 20% Protocol Usage; 3 What are the BARRIERS to reaching the target? Baseline: See Chart for each unit s baseline Target: To consistently improve each month above previous month Barriers: We do not have a report built for diagnosis, enabling us to calculate our percentage of protocol usage DO: 4. What did you DO last reporting period (month, 90-days, etc.) to improve? -Promoted protocol use to Doctors -Encouraged Therapists to promote protocol usage -Met with the hospitalists and adjusted the weaning protocol CHECK: 5. What is the ACTUAL current performance? (show in graph/table) Protocols Total # of Vents (non CABG) Vent Weaning Weaning w as successful Asthma in the ED Eval & Treat 10 Bronchiolitis BiPAP in ED September October November December January February DO: 6. If target was not achieved, what will you DO next reporting period to improve? ACT: 7. If target was achieved, what will you do next reporting period to hold the improvement? Target is unknown, Next month will: Check into the diagnosis report Continue to get protocols into the shift reports Continue to encourage use of protocols Weaning protocol will go back to critical care committee for approval Educate Staff on Critical Care Committee
18 Why Focus on Quality Care? 5. CMS Pay for Performance 4. No pay for Never Happens 3. Public Access to Your Facility Performance 2. To Secure our Place on the Clinical Team 1. Because our Patients Deserve the Best
19 How to Focus on Quality Treat Your Patients One at a Time Patients Deserve Your Full Attention Batch Therapy is Demeaning to our Profession Utilize Technology and Expand Your Practice Measure, Demonstrate and Articulate We must do things that matter We must measure the benefits We must show our value We must be able to articulate our value to others We must be aligned with our organization
20 How to Focus on Quality Be Accountable and Own Your Practice Nurses calling and PRN Develop Clinical Leaders Evidence Based Care Be Active to Develop a Strategic Plan Collaborate With Other Clinical Team Members Engage Your Senior Leaders Sell Your Plan With Alignment Show How We Add Value (not just performing tasks)
21 What About Financial How do our goals improve financial value? Put your MacGyver hats on! Good looks may not be enough! Find something to fix and fix it! But how? You have to have help You have to have relationships You must work hard You might have to take some risks Lets look at financial losses and fixes
22 Net Revenue by Product Line Product Line # of cases LOS Total Cost Charges Balance Total Receipts Net 0.01 Cardiovascular IP Surgical ,371,334 9,538, ,341 3,583, , Cardiovascular IP Medical ,085,157 2,668, , , , Respiratory IP Surgical , ,635 41, ,788 45, Respiratory IP Medical ,132,364 4,462, ,254 1,567, , Respiratory Outpatient ,305 1,347, , , ,407
23 Net Revenue by DRG Diagnosis Related Group # of cases LOS Total Cost Charges Reimbursement Net/Pat 313 Chest Pain , , , Respiratory Infection w/cc ,978 47, COPD w/o cc , COPD w/cc ,401 90, COPD w/mcc ,710 65,
24 Aligning Department Goals with Organizational Goals Salina Regional Health Center Org Goal #2 To provide each patient with an experience that surpasses their expectations (patient satisfaction) How do you measure patient satisfaction? Respiratory Care Department Goal: To provide each patient with an exceptional experience (How)
25 How to Focus on Patient Satisfaction Make your care personal Take Responsibility for the patient s experience Explain your procedures Answer questions (accurately! Be knowledgeable) Be Collaborators (teamwork) Rounding Show That You Really CARE...How?
26 What Do Your Patients Want? Press Ganey 1999: What matters most to patients are the.. Attitude Interactive skills Caring behaviors of their caregivers Press Ganey 2010: What your patients want the most is: A knowledgeable and caring provider
27 Superior Alignment
28 Take Home Thoughts for Alignment Know Your Organization s Goals Be Engaged Be Accountable Collaborate and Add value Change before you have to All can be done best if we focus on our patient
29 Stay Open to New Ideas
30 References CBSNews.com (search David Walker) Peter G. Peterson Foundation (I.O.U.S.A) abcnews.go.com USAToday May 2009 Press Ganey & 2010
31 Thank you! I appreciate the opportunity to spend this time with you today! David Mantz, BA, RRT-NPS Respiratory Care Director Salina Regional Health Center Salina, KS dmantz@srhc.com
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