Johnston Memorial Hospital Value Optimization System Box 9 Insights After Year 5 October 2016
Nikki Vanburen, RN, MSN, MBA Chief Nursing Officer Johnston Memorial Hospital Abingdon, VA John Jeter, CPA, CGMA, MBA, FABC Assistant VP, Chief Financial Officer / Assistant Administrator Mountain States Health Alliance Northeast Market Abingdon, VA
One of 13 Facilities of Mountain States Health Alliance since 2009 Located in Historic Abingdon Virginia Population 55,000 Founded over 100 years ago 116 Bed Acute Care Facility 850 Team Members Services Include: - Acute Care - Family Birth Center - Cardiac/Heart Care - Surgical Services - Oncology Services
Transformation TPOC November 2 3, 2011 - The Steering Committee was formed TPOC A3 Completed January 3, 2012 - The first VSA MedSurg Value Stream Analysis
Results!
Leaning Through Organizational Distraction Look around, look around at how Lucky we are to be alive right now! The Schuyler Sisters, Hamilton
MSHA Senior Leadership Transition MSHA Leadership Team (November 2011) Marvin Eichorn Senior VP CFO, MSHA Ann Fleming Senior VP, Virginia Operations John Schario Senior Vice President Consumer Health Services MSHA Steve Kilgore President and CEO Blue Ridge Medical Management Corporation
MSHA Senior Leadership Transition MSHA Leadership Team (October 2016) Marvin Eichorn Senior VP CFO, MSHA Steve Kilgore President and CEO Blue Ridge Medical Management Corporation
MSHA Organizational Restructuring Before July 2014 VA Division TN Division
MSHA Organizational Restructuring After July 2014 NW NE WC SE
JMH Senior Leadership Transition Chief Executive Officer Chief Operating Officer Chief Medical Officer Chief Nursing Officer Chief Financial Officer Director of Human Resources 2012 2013 2014 2015 2016 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 JMH Leadership Team (November 2011) Sean McMurray, CEO John Jeter, CFO Steve Givens, COO Karen Pennington, CNO Stephen Toadvine, MD, CMO Jackie Phipps, Director of Human Resources
JMH Senior Leadership Transition Chief Executive Officer Chief Operating Officer Chief Medical Officer Chief Nursing Officer Chief Financial Officer Director of Human Resources 2012 2013 2014 2015 2016 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 JMH Leadership Team (October 2016) John Jeter, CFO Jackie Phipps, Director of Human Resources
JMH New Facility and Service Lines July, 2011 The New JMH Built JMH achieves Leadership in Energy and Environmental Design (LEED) GOLD certification September, 2013 Introduce Orthopedic Hospitalist Program November, 2013 Initiate Vascular Surgery Program July, 2014 Launch first 24/7 Interventional Cardiac Cath Lab in Southwest Virginia August, 2014 Implement Pulmonology Critical Care Services July, 2015 Start Infectious Disease Service Line August, 2015 Begin Endocrinology Program
On March 31, 2015, Wellmont Health System and Mountain States Health Alliance have agreed to exclusively explore the creation of a new, integrated and locally governed health system designed to be among the best in the nation and address the serious health issues that affect our region.
Struggles in Physician Engagement Let Us Burn the Witches to Save Them
If you want to engage your physicians, fix their problems - John Toussaint, MD
We don t need four days to do this Can I direct deposit these savings we re supposed to get? What s in it for me? I m sorry, but we don t have anyone available to participate in this event. I can t afford to lose any wrvus by taking a week off
Physician Engagement
Physician Accountability and its Impact on the Rest of the Team vs
Reducing Sepsis Mortality Using Lean to support a physician s passion and vision Screening for sepsis at triage Identification of patients with sepsis Physician sepsis order set utilization Pre project 2013 0% 20-30 / month 0% Post project (2016 Results) 100% 90-100 / month 97% Mortality LOS (O/E) Cost/case Pre project 2013 17% 0.86 $12 K Post project (2016 Results) 6.40% 0.79 * $8.9 K ** * 1.2 day variation / patient ** $1 M savings
Joint Replacement Bundled Payment Initiative Yielding to the influence of a key physician to achieve transformational change
ER Rapid Patient Management (RPM) Giving physicians enough time to get there RPM was implemented in February 2015, since that time we have conducted two (May 2015 and September 2016) Rapid Improvement Events to continue to improve the process.
Observation Length of Stay Leveraging corporate physician leadership to improve engagement
Strategic Deployment of Lean I see waste From Stragedy to Strategy
MSHA Strategic Planning Process Core Strategies I. Transform the delivery of care/from a fee-for-service model to a population health management model using evidence based practices designed towards improving cost and quality. II. III. Achieve smart growth. Aggressively pursue and achieve operational cost efficiencies and manage fixed costs in alignment with market volume reduction. Support Strategies IV. Enhance organizational infrastructure to support current needs and realize future vision. V. Enhance relationships to support value-based business model. VI. Build technology infrastructure to support current needs and realize future vision.
MSHA Strategic Pillars Pillar Pillar Statements People Attract and retain the best talent needed to meet the healthcare needs of our region Quality Financial Deliver measurably excellent care that consistently leads to the best patient outcomes Achieve stable financial viability by managing costs effectively and improving revenue stream Service Growth Create an excellent experience every time for our patients/ families, physicians, co-workers and community Be provider of choice through targeted and focused efforts resulting in additional market capture Innovation Lead positive change and create value in an evolving delivery system through agility and entrepreneurialship
MSHA Team Member Incentive Plan EBITDA Patient Communication EBC & Patient Safety ED Performance Population Health 1. RN Communication 2. Physician Communication 3. Communication w/meds 4. Discharge Instructions 1. EBC 2. Sepsis Mgmt. Bundle (NEW) 3. CAUTI 4. CLABSI 5. VAP 6. MRSA 7. C-Diff. 1. Patient Satisfaction 2. Door to Admit (IP) 3. Door to Discharge (OP) 4. Door to Provider 5. LWBS 1. Readmissions 2. Sepsis Mortality Index 3. Transitions of Care (NEW) When I left the hospital, I had a good understanding of the things I am responsible for in managing my health? Weighting 25% Weighting 20% Weighting 25% Weighting 20% Weighting 10%
JMH Strategic Planning Lookback and Selection
JMH X-Matrix Deployment to Organize Work and Select Value Streams
Continuing to Reassess our Process Re-examine Value Stream Useful Life ü From 12-15 months to 6-9 months Move from a Department Based Value Streams to Process and Disease Path Based Value Streams ü From Med/Surg and Emergency Room to CHF/COPD/Pneumonia and Patient Flow
JMH Process Owner Turnover Med Surg/Inpatient Services/Patient Flow Process Owners Process Owner Date in Role Jennifer Harris X 2/2012 6/2012 Tonya Moser X 7/2012 4/2013 Sherry Shepard X 5/2013 10/2013 Stephanie Cook X 11/2013-10/2014 Teresa McGrady 11/2014 10/2015 Melissa Whited 11/2015 - Present
JMH Value Optimization System (VOS) Core Team Member Development Core Team Member Vicki Ward Jillian Anderson Kim Godbey Tim Trent Cheryl Rasnake Brandon Barnett Next Role Regional Lab Director Physician Integration Manager Medical Oncology Nurse Manager Internal VOS Sensei Director of Guest Relations Senior Planning Analyst Since it s inception the JMH VOS Team has had a total of 10 Team Members. 2 have left MSHA, 2 currently still in VOS and 6 have advanced to another role.
A3s for Alignment, Action, and Accountability Growth and Innovation Pillars Patient Experience
Results! 14 VSA s MedSurg/Inpatient (5 Passes) Emergency Department (2 Passes) Perioperative Services (2 Passes) Oncology Services (2 Passes) Elective Joint Replacement (1 Pass) Outpatient Services (1 Pass) Cardiopulmonary Services (1 Pass) 78 RIE s Projects, JDI s 4 2P s Departmental Daily Improvement Boards Metric Initial Present Improvement IP LOS (days) Obs LOS (hours) IP Cost/Stay Obs Cost/Stay ED Visits Admissions # Team Members Market Share 4.23 Jan 2012 37 Jan 2014 $3973 July 2012 $294 Jun 2014 42,434 FY13 7,310 FY13 822 FY13 34% Nov 2011 3.45 Aug 2016 20.4 Aug 2016 $3350 FY16 $229 FY16 41,030 FY16 YTD July 8,409 FY16 849 FY16 47.7% Q4 2015 Updated Aug 30 2016
I see waste
Live Long and Prosper Team Member Education & Development VOS Orientation for all New Team Members
Live Long and Prosper Shitsuke Sustainment Through Discipline Executive Leadership Engagement at all levels: Daily- Improvement Weekly- Wall Walks at VOS Mission Control Monthly- Department Managers Meeting Quarterly- TPOC Reviews Annually- Strategic Plan connection to VOS Methodology
Leadership Discipline Results HOME Board and Multidisciplinary Rounding - The team developed Standard Work for preparation, structure of the conversation and active/passive participants of the MDR process with connection to the HOME Board for transparency - Leadership Rounding promoting ownership and engagement - Continued reduction and management of length of stay resulting in increased capacity, reducing the % of admitted patients held in the Emergency Department