Productivity: New Care Team Model

Transcription

1 Productivity: New Care Team Model Hudson River HealthCare October 2006 Katherine Brieger, RD,CDE

2 Hudson River HealthCare

3 Hudson River: Harvesting Project Ideas for Spread Beacon 1998: Efficiency Orange 2002: Prevention Atrium 2005: Redesign Partnership 2005: Redesign Peekskill 2005: Innovation

4 Common Themes from the Projects Integrated Teams Consistent support staff with defined roles Work centered around the patient Planning of visits-chart review in advance Standing orders All tools readily available

5 Key Changes-Ranked Chart preparation/visit planning Team Huddles Technology for Communication Cross Training Don t t Move the Patient Implement EMR Standing Orders Prescription Refill Line

6 Planned Care Model

7 Panel To start identification of who is on the care team: patients and staff The panel of patients who usually see or choose a particular provider The group of office staff who generally work together for the care of: a panel of patients (including those patients who do visit the clinic infrequently)

8 It All Starts with a Team

9 Changes to improve the Design and Function of the Care Team Organize Care Teams Increase Clinician Support The clinician can be optimally productive only with optimal support Cross-functional team meets all of patient s s needs Example: The addition of health educator replaces costly provider time Couple Visits/Education for efficiency and revenue Example: OB Histories and Health Education

10 Shifting Work to Others Everyone can do many things for a patient Avoid narrow & unnecessary specialization Work should be done by the most appropriate level of staff Example: Nurse reviews patient self-management goal-setting instead of provider Example: Paper work done by MA s s and only signature or details by Provider Use protocols and guidelines

11 Changes to Improve Effective and Efficient Resource Use for the Population of Patients Exploit Technology Use technology to find new ways to accomplish work. Example: PDAs, EHR, Practice Mgt System Have all the tools you need Communicate directly and in real time Communicating directly and with urgency keeps everything on time Huddles, walkie talkies, EHR Organize the work around the patient, rather than organizing the patient around the work

12 Care Team Issues Number of Providers per Team Composition of Team Number of FTE Makeup of Team: Nurse, MA,PCP,Pat Rep, Social worker, Care Manager, other ideas Team Communication Issues Space Issues

13 Results: Team Composition 3 Providers 2 Nurses 2 MA 1 PCP 1 FTE SW 3 Pat Rep 1.5 Medical Records 0.5 Lab Total 11:3 2 Providers 2 Nurses 2 MA 1 PCP 1 FTE SW 2 Pat Rep 1 MR Total 9:2

14 HRHCare Steps in Adopting the New Care Team Model Selection of sites: Consideration of variations in productivity in relation to special populations Sites with more growth potential were selected Sites with adequate physical space

15 Staffing Determination Using the model of providers: staff selected sites were evaluated Some positions were moved to different tasks or titles A total of 8 new positions were needed for the new model. All new positions were for entry level staff: medical records, patient representative

16 Mini Learning Session Planned a three hour training for all sites Sites were asked to divide into teams Medical Director, COO, Director of Operations and HR were involved in the training Manual was designed by Medical Director- materials from the HDCs and IHI were pulled

17 Established Targets 20 patients per day per provider 7 hour day-excluding vacation and sick time CME and meetings were included in this time.

18 Team Leader Development Used Process Leader training model developed by W. Montalvo Modified the approach to meet HRHCare needs Held two training sessions-each each was two days in length Other sites were invited to attend as well as the Practice Managers

19 Team Leader Issues One of the sites attempted to use the Team Leader as a supervisor for the unit Delineation of supervisor duties was not made clear to staff Confusion resulted in this site Other sites, with Nursing supervision, have been able to utilize the model of team leaders

20 Training was held for all other staff: Patient Representatives LPN Clinical Assistants Patient Care Partner Providers Training focused on what was their role in the New Care Team

21 Follow Up CEO, Medical Director and HR scheduled follow up meetings at the sites Check in to see how things were going Twice a month conference calls with teams One hour conference in which teams are able to share issues, successes and PDSA cycles.

22 Measuring Results: Report Card is generated every pay period to reflect the outcomes of the New Care Team

23 Status Update: Some teams are more effective than others Team leadership is vital Staff turnover rates effect the outcomes Engagement in the change needs a cheerleader on site-without local strong leadership-model is not effective

24 What do we see for the future? Routine Group Visits: Group visit manual developed Incentives for all team members Continue with twice a month calls? Review leadership structure?