NMHS Work Systems and Processes

Karen E. Koch, PharmD, MSHA

Organizational PerformanceOrganizational Performance Administrator

Essence of QualityEssence of Quality• Every successful quality revolution has included participation of upper managementincluded participation of upper management.  We know of no exceptions.

• Joseph Juranp

• It is not enough to do your best; you mustIt is not enough to do your best; you must know what to do, and then do your best.

• W. Edwards Deming

NMHS’ Commitment to  the BaldrigeFramework

PI Framework – Approach‐Deploy‐Learn & Integrate

Work System & Process Design• Integrate ADLI with Evidence‐based Planning Process• Integrate ADLI with Evidence‐based Planning Process

Work System & Process Designy g• Focus on patient perspective

– Service Line Organization – NMMC Tupelo– Service Line Organization – NMMC Tupelo– Population‐Focus – NMHS

• Prevention & Wellness• Outpatient Care• Emergency Services• Acute Care• Post‐acute Care

• Harmonize with Collaborative Work Groups (CWGs)

Population‐focused Work Systems  & Collaborative Work GroupsCollaborative Work Groups

Collaborative Work Groups

Meet monthly  Collaboratively review

Identify and share besty

or quarterly review data/scorecards

share best practices

Perpetuate Share GoodPerpetuate Ideas for 

Excellence to 

Share Good Catch & Careline

other sites Learnings

Work System RequirementsWork System RequirementsCommunity Focus (prevention &  Clinical Enabling

‐ Patient & key stakeholders 

(pwellness) 

Clinical EnablingServices 

‐ Environmental Assessment‐ Relevant internal requirements Non‐clinical 

P i S i requirements ‐ Good Catch findings, CSF expectations

Enabling Services

Patient Settings: Outpatient, emergency, acute & post‐acutep

Work Process Requirements & Performance MeasuresPatient Care Setting ExampleCSFs Requirements  (Voice of the Customer) Measures

People Maintain training (provide me with competent care) Training hoursPeople Maintain training (provide me with competent care) Training hours

Service Employ AIDET (be nice to me) Patient satisfaction

Q lit R id t (d ’t k iti ) W it tiQuality Rapid assessment (don’t keep me waiting)Evidence‐based guidelines (provide me quality care)Safe environment (keep me safe)

Wait timesCore measuresFalls & infections

Finance Low cost and efficient (be low cost) Cost & productivityFinance  Low cost and efficient (be low cost) Cost & productivity

Growth Expand services &/or utilization (be available to me) Market share & penetration

Work System ImplementationT i l & l• Trial & scale up

• Training 85

Capability: Mean Hours of Training per FTE

• Clinical Educators

• Policies, Guidelines 55

70

Hou

rs Goo

d

Policies, Guidelines

& Protocols

H d i d d

40

55

FY08 FY09 FY10 FY11Mean hours per FTE

*

• Hard‐wired order 

sets & prompts

Mean hours per FTEASTD's bestTrendline (avg hrs/FTE)

Data Source: ASTD * Data not available

*Evidence‐based PlanningWork System ImplementationEvidence based Planning Process 

*90‐day Action Plansy

*Performance Scorecards

*Excel Process*Benchmarking‐ Identify role model behavior (internal/external)

Cost Control

• Patient Safety Focus– Just Culture & Good Catch

– Patient Safety Rounding

– Comprehensive Unit‐based Safety Program (CUSP)

• Transitions in Care• Co‐Management

NMHS Falls and Pressure Ulcer Prevention (FY)

0.08

0.1

0.12

0.4

0.6

Ulc

ers

days

* 10

0)

s days

* 10

0)

Goo

d

ood

0 02

0.04

0.06

0 08

0.2

0

Pres

sure

#

PUs/

patie

nt

Falls

# fa

lls/p

atie

nt d

Falls cost savings = $273,625PU cost savings = $617,700

Go

0

0.02

0.0FY10 FY11 FY12 YTD FY10 FY11 FY12 YTD

(#(#

Falls Pressure ulcers

(FY10 vs FY11)

NDNQI falls mean (0.35) PU peer reviewed best practice (0.108)Data Source: QMS

Ideas for Excellence & Clinical Process ImprovementImprovement

14

NMMC Respiratory Related Pressure Ulcers(RR PUs)

8101214

RR

PU

s

(RR PUs)

IFE Jun 2010: Skin asessment added to charting pathwayG

ood

0246

# of

R

IFE Apr 2011: Mole skin

0FY09 FY10 FY11 FY12 YTD

RR PUsData Source: Internal

Fall Prevention• Fall calendars• Post‐fall huddles toPost fall huddles to determine cause(s)– Mini‐Root Cause Analysis (RCAs)

• Unit‐based interventions• Hourly rounding

s

NMHS Central Line and Surgical Infection Prevention (CY) od

27

36

45

6

8

10

oced

ures

ntra

l lin

e da

ys Prevention (CY)

Cost savings =G

ood

Goo

9

18

27

2

4

6

SSI/#

of p

ro

AB

SI/1

000

cen

5 Lives savedCost savings =

Cost savings =$1.4 million/4 years

0009 10 11 12* 09 10 11 12*

CLA

ICU CLABSI (actual device-associated)SSI (actual procedure associated)* Jan-Jul SSI (actual procedure-associated)Expected per NHSN

Data Source: NHSN

NMHS Heart Failure Care Transition (30 day readmission rates)(30‐day readmission rates)

NMHS Heart Failure Care Transition,30-Day Readmission Rates

d

Care Transition began

50100150200250300

10%20%30%40%

atie

nt v

olum

e

mis

sion

rate

s

Goo

d

050

0%10%

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3

FY09 FY10 FY11 FY12

Pa

Rea

d

NMHS HF patient volume Care transition patient volumeNMHS HF readmissions Care transition HF readmissionsQuest 90th (8.9%; '12 8.0%) Data Source: Premier

Self Care College began

Supply Chain Management• Lean design warehouse: Hi h /l t• Lean‐design warehouse: High accuracy/low waste• Direct contracting

Minimal vendor/distributor costs– Minimal vendor/distributor costs

0 12%

0.16%

500 000

600,000

ed

NMHS Centralized Inventory Transactions

Goo

d

0.04%

0.08%

0.12%

300,000

400,000

500,000

Erro

r rat

e

Line

s pi

cke

Goo

d

0.00%200,0002007 2008 2009 2010 2011 2012

YTDLines picked Error rateData Source: Tecsys

• ADLI FrameworkPerformance Improvement

• ADLI Framework• Lean Culture

– Leaders & selected staff trainedLeaders & selected staff  trained at all entities

– Streamline & efficiency projects

( )• Root Cause Analysis (RCA)– Retrospective, safety focused

• Good Catch TeamMeetings• Good Catch Team Meetings– Daily mini‐RCAs– PI projects & interventions p j

Innovation: Walmart Clinic

C l b Cli i (2010)• Columbus Clinic (2010)– First in MS

Highest volume in United– Highest volume in United States (2012)

• Oxford Clinic (2011)( )– Second in MS

• 2011: Lean‐designedInnovation: Central Sterile Processing2011: Lean designed 29,000‐sq‐ft CSP Plant

• Robots & computerized psystems 

• One‐way flow‐ three separate areas–Decontamination– Prep & packaging– Prep & packaging– Sterilization

• First of its kind in United States 

Innovation: Central Sterile ProcessingNMHS CSP Efficiency: More Trays

24

25

115,000

120,000

ys

Processed with Fewer FTEs

Goo

d

Goo

d

23

24

105,000

110,000 FTEs

# of

tra y

22100,00006 07 08 09 10 11 12

YTDTotal trays processed by CSP FTEsTotal trays processed by CSP FTEs

Data Source: SPM, T-Doc & Human Resources

Innovation: Hybrid Operating Room

Enables cardiologists & cardiovascular surgeons to collaborate oncollaborate on cases

Innovation: HealthWorks!i hild ’• Interactive children’s 

health education center

S h l b d i l &• School‐based curriculum & community‐based programsprograms

• Served >78,000 in first three yearsthree years

• Improved diet & health knowledgeg

Panel Members & Contact InformationPanel Members & Contact Information• Steve Altmiller

– President, NMMC‐Tupelo• Lee Greer, MD

– Chief Quality & Safety Officerld• Donald Jones

– Administrator, NMMC Hamilton• Donna Pritchard• Donna Pritchard

– Chief Nursing Officer &  Service Line Administrator

Contact Information:  662‐377‐3193www.nmhs.net/Baldrige2012.php