1 Viral Load Suppression Lean Six Sigma Green Belt Project Shawntrell Miles Jordan Health
2 About Jordan Health Federally Qualified Health Center located in Rochester, New York. Accreditation by the Joint Commission. We provide comprehensive community-based healthcare of the highest quality with dignity and respect, regardless of ability to pay. Patients present with disproportionately high rates of unemployment, poverty, low literacy, and drug use. Serves approximately 30,000 patients per year across 10 different sites. Prevention and Primary Care department. Serving approximately 170 HIV patients per year at 2 specific sites. Partnership with New York State Health Department AIDS Institute.
3 Jordan Health HIV Care Cascade August 2015 Jordan HIV Primary Care Cases Cases with any VL within one year Cases with continuous care through the year (2 or more VL) 132 177 170 75% of infected Virally Supressed (within the last year) 143 81% of infected
Who is Jordan? 4
Who is Jordan? 5
6 Lean Six Sigma Green Belt Project Viral Load Suppression Problem statement: The amount of time it takes a newly diagnosed HIV infected patient or a new patient to Jordan Health with an unsuppressed HIV infection takes an average of 132 days to reach viral load suppression.
7 Definitions of the DMAIC Process Define Measure Analyze Improve Control DEFINE the project, opportunity (or problem statement), benefits and broad resource requirements (see LSS Charter). Include high level current state assessment, challenges and a Measurement plan which identifies what needs to be measured to validate a current state baseline and how it will be achieved MEASURE confirms and details the current state presented in DEFINE. Provides a baseline of metrics in Measurement Plan; validates the Measurement system; any mapping of processes; determines unacceptable performance; estimates process capability; identifies key drivers influencing performance ANALYZE the baseline data and document current performance. Benchmark key performance measures; identify value/non-value processes and other waste; identify root cause of variations that might impact the Key Performance Indicators (KPIs) IMPROVE quantifies the impact of the drivers (Improvement project goals); determines how to intervene to improve performance; looks for opportunities to reduce variation (control process); assess risks and failure modes; validate final solution and lock down specification; execute Improve Plan. CONTROL ensures the ongoing compliance to the new specification. Document and set up monitoring infrastructure/systems; implement statistical sampling if needed; re-asses process capability; verify benefits & savings; iterate where necessary; celebrate on completion!
8 Define SIPOC PROCESS: Viral Load Suppression CUSTOMER OUTPUTS PROCESS INPUTS SUPPLIERS List the primary customers (internal and external) for the process List the key products, services or outcomes of the process List the key steps in the process List the key information, materials, parts, supplies, etc. required for the process List the key suppliers of the inputs - both internal and external Patients Viral suppression Assessing barriers Willingness of patient Patient List the secondary customers (residual) for the process Clinical Providers Lower community Viral Load Providing medication Medication Doctors/ Nurse List the key defects or undesirable outcomes of the process Ensuring access to medication Mental Health Assessment/Treatment Care Managers Education Health Literacy Assessment/ Education Nurse What are the controllable process parameters? Providing medication Helping to overcome barriers Care Managers Losing patients to care Providing education Treatment Adherence Counselors Peer Educators Patient remains not suppressed. What are the uncontrollable process parameters? Patient willingness Substance Use Assessment/ Treatment Nurse 8
9 Define PROJECT: Main Customers Viral load suppression- Voice of the Customer What do you need to know from these customers? Reactive Sources Proactive Sources Plan Patients What encourages or discourages them from being suppressed? Consumer advisory Council Interviews/Focus groups/surveys Find out what works for patients that are currently meeting their suppression goals What barriers are they experiencing? What resources are lacking? Define barriers Support Staff What methods have they tried? Case Conferences Interview Establish best practices Clinicians What is the clinical process? Utilization of support staff Interview
10 Measure Analysis of staff hours spent on suppression efforts per patient per month. Staffing Hours per Patient per Month Treament Adherence Coordinator 4 Peer Educator 2 Care Coordinators 4 RN 1 Quality Manager 1 Total Hours 12 10
11 Measure Project Opportunity (Goals) Improvement Indicators Baseline Goal Units Patients Virally Suppressed 79% 90% Percentile Staff hours spent on unsuppressed patients 264 hours 100 hours Hours per month Cycle time for suppression 132 days 60 days days 11
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13 Analyze STAKEHOLDER ANALYSIS PLAN Stakeholder Power Interest Attitude Activity Rationale for Rating AA H L clinical staff is very influential, but this staff member is resistant to change Action Plan utilize clinical knowledge and abilities, encourage buy in Date Last Revised 2/23/2015 SG L L very resistant to change keep morale up and clearly communicate change, encourage buy in 2/23/2015 LP, EW H H new staff, eager to engage keep them involved and use their excitement to encourage others 2/23/2015 13
14 Analyze 14
15 Improve Plans for Improvement Create a form letter and checklist to improve the quality of records received with vital labs from other agencies. RN will use the checklist to make sure the record is as complete as possible prior to the first visit. Treatment adherence coordinator will perform an assessment at the intake to identify immediate barriers and to create a plan to address needs.
16 Results to date May 1, 2015- November 30, 2015 14 New Patients to our clinics Transfers in= 9 4 suppressed 3 recently started on meds 1 suppressed in 19 days 1 suppressed in 90 days Newly diagnosed= 5 1 incarcerated prior to starting meds 2 recently started on meds 1 not on meds yet due to parents insurance 1 suppressed in 82 days
17 We are testing out these new processes and it will be a couple more months before we obtain enough data to determine our outcomes. The three patients that have achieved suppression, did so in an average of 64 days! We will continue to improve our process and develop a control phase. Stay tuned
18 Thank you! Shawntrell Miles 585-423-2857 smiles@jordanhealth.org