LEAN Community Care Coordination

Transcription

1 LEAN Community Care Coordination May 2013 to December 2013 Waterloo Wellington CCAC Lynda van Dreumel, Project Manager Dana Khan, Director Client Services Patricia DiRuzza, Manager Client Services

2 Why did WWCCAC embark on a LEAN project? Standards of Care Initial Team Contact Initial RAI HC Changes in Business Process CCM: September 2012 Document Management System: February 2013 Pooled TA Model: February 2013 Anecdotal Reports of Inefficiencies 2

3 Purpose of LEAN Project: Develop Lean Recommendations Understand sources of inefficiencies Implement Lean Recommendations Improve Standards of Care 3

4 Guiding Principle: Person Centered Approach 4

5 Guiding Principle: LEAN Approach Process People Tools Patient Needs 5

6 Guiding Principle: Defining Value Value Add (VA) Meets a patient need, defined by patient Has a positive impact on patient health Done right the first time Business Value Add (BVA) Required by law Policy or mandated activities Non Value Add (NVA) Consumes resources without enhancing value Any form of Waste 6

7 Project Methods Phase 1: Review Available Metrics 72 hour Initial Team Contact Time to Initial RAI HC Completion (Lock) Phase 2: Time Study CC and TA Time Studies Prioritization of Issues based on Activity Time Phase 3: Focus Groups Process Mapping and Role Mapping Documentation of VA, BVA, NVA tasks Prioritization and Development of Solutions Phase 4: Implementation 7

8 Phase 1: Review Available Metrics 8

9 Initial Team Contact Task Volumes Ave TAT = 6.74 d Feb 1 Apr 30, 2013 (n=1359) 9 Complete In Progress Incomplete Requires CC Action 9

10 Percentage of Initial RAI HC Completed within Standard of Care 40 % On Time (Feb 1 Apr 30) % On Time (Feb 1 Apr 30) 0 Community Independence Chronic Complex

11 Average Days to Initial RAI HC Lock Feb 1 Apr 30 Target 5 0 Community Independence Chronic Complex

12 Phase 2: Time Study 12

13 Time Study Details Time Study Duration: 2 to 3 weeks Method: Tool: Why: Self tracking on a daily basis Shadowing to validate data Manual Tracking Tool developed by small group of CC s and TA s Data for Value Assignment Method to prioritize recommendations (using time weighting) 13

14 14

15 Care Coordinator Results 40% 38% 22% Direct Time = 22% VA (also some VA in other categories) 15

16 Team Assistant Results Provider Reports 28% Manual Tasks & Triage Tool 18% Core Home Care process 16% Miscellaneous 15% LTC & SSR 9% Other Reports 5% Telephone or in person 4% Electronic 2% Redistributed 1% Faxing 1% CSSA'S 0% 16

17 Phase 3: Focus Groups 17

18 Activities in Focus Groups Lean Overview of LEAN Value Assignment to all Indirect Tasks Use of LEAN Tools: Value Stream Mapping Fishbone Analysis 5 Whys/Root Cause Analysis 18

19 Value Analysis Comparison CC Care Coordinator CC CC Value Add Business Value Add Non Value Add 19

20 Value Analysis Comparison CC TA TA 31 CC TA CC Value Add Business Value Add Non Value Add 20

21 Key Inefficiencies Identified Time spent clarifying information Time spent checking and correcting information Data quality and data insufficiency Variation in TA and CC process across teams/sites Inefficient hand offs 21

22 Examples of Recommendations 22

23 Removing an Inefficient Hand Off 23

24 Resource Leveling 24

25 Single Minute Exchange of Dies 25

26 Recommendations to Address Errors and Variation in Process: Education refresh sessions: Entering Frequencies in CHRIS Dashboard Shortcuts ( Search function for E&S) Standardization of Work: New PSPR ADP Process Discharge Wizard and Service Updates 26

27 Other Recommendations to Streamline Processes: Leveraging Technology: MiFi for all visiting Care Coordinators Development of E Forms for LTC 27

28 Phase 4: Implementation 28

29 How did WWCCAC implement the recommendations? Based on Impact and Ease of Implementation Prioritize Assign Lead CSMs assigned a recommendation PM provided planning support PM tracked progress in implementation 3,6,12 months PM Tracking 29

30 1600 Opportunity Score (Time*NVA) Lower Impact with Greater Effort Lowest Impact with Greatest Effort Benefit * Ease Item 8 Highest Impact with Least Effort Item 6 Item 7 Item 9 Items 4 and 5 Quickest Wins with Least Effort

31 Current Status Recommendations were assigned 3 month, 6 months or 12 months timelines for implementation All but 3 recommendations have been implemented or are in Pilot phase of implementation Remaining 3 recommendations submitted as proposed new projects 31

32 Results: Revisit the Data 32

33 Initial Team Contact Task Volumes Ave TAT = 8.0 d Complete In Progress 600 Incomplete Ave TAT = 6.74 d 90 Feb 1 Apr 30, 2013 (n=1359) Aug 1 Nov 30, 2013 (n=1475) Requires CC Action 33

34 60 Percentage of Initial RAI HC Completed within Standard of Care % On Time (Feb 1 Apr 30) % On Time (Sep 1 to Nov 30) 0 Community Independence Chronic Complex

35 Average Time to Initial RAI HC Lock Feb 1 Apr 30 Sep 1 Nov 30 Target 5 0 Community Independence Chronic Complex

36 Next Steps for WWCCAC Issue Comments Manual Tasks: Review, Refresh, Revise Business case submitted for separate project. Documentation Standards Business case submitted for separate project. APR/CSR Upload/HPG Inbounding Many identified inefficiencies could be addressed by technology 36

37 Lessons Learned 37

38 Narrow your scope Lessons Learned Smaller scope = focused solution = quick implementation Resist the temptation to solve all the problems at once! Experienced facilitators needed Skill is required to keep group on track and focused on solutions Focus group volunteers have self selected ensure your group reflects the entire organization 38

39 Lessons Learned Timeliness of implementation A lag between recommendations and implementation can affect confidence in the process Group may underestimate degree of change required LEAN is contagious! Be prepared for an influx of Lean project requests Lean will change the way people view issues, talk about problems and suggest solutions Cultural change from the bottom up! 39

40 Questions? 40

41 Supplementary Slides 41

42 DOWNTIME WWCCAC examples Defects / Rework Inappropriate nursing supplies sent to client s home. Overproduction Waiting Non utilized brainpower Intake received appended documents that are not necessary to determine CCC eligibility. Placement team waiting on confirmation of Medically Stability to complete bed matching. Numerous ideas are lost or overlooked only to be rediscovered later. Transportation Inventory Motion Extra Processing CC s driving out to clients home, back to office and out to another client is same area. Multiple versions of the same documents. TA spends time navigating through multiple screens in CHRIS to get to required field. TA records same information on 4 different forms 42

43 Care Coordinator Results 40% 22% 38% All Activity Chronic Complex Community Independence 22% Direct Time with Client (face to face) 23% 20% 38% Indirect Time 39% 45% 40% ALL OTHER ACTIVITIES NOT RELATED TO THE HOME VISIT 39% 35% 43

44 Time Study: Care Coordinators Indirect Task activities: Chronic Complex & Community Independence Chronic/Complex Community Independence 44

45 TA Time Spent: CC vs. CI/SS Four Categories with CC vs CI/SS differences. No difference in all other categories Category % All LTC & SSR Misc (Mtg,Train) MT and TT Provider Reports 45

46 Care Coordinator Value Assignment VA, BVA, NVA assigned for All Indirect Time All Value Chronic Complex Community Independence 55% VA 56% 55% 22% BVA 21% 21% 23% NVA 23% 23% 46

47 Team Assistant Value Assignment VA 31% VA, NVA, BVA assigned for all tasks NVA 52% BVA 17% All Value Chronic Community Complex Independence 31% VA 33% 29% 17% BVA 15% 19% 52% NVA 52% 52% 47