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Joint Commission International Med Health Cairo 12-13 March 2014 1 Ashraf Ismail, MD, MPH, CPHQ Managing Director, Middle East Region Joint Commission International How Sourcing Excellence Can Rationalize Hospital Costs Slide 2 Joint Commission International Service Excellence Ability of the provider to consistently meet and manage patient expectations 2 Slide 3 Joint Commission International Key Elements of Service Excellence According to Robert Johnson (Institute of Customer Service), service excellence has four key elements: Delivering the Promise (of quality healthcare) Providing a personal touch Going the extra mile Resolving problems well 3 Slide 4 Joint Commission International Reducing the Drivers of Dissatisfaction, & Providing Exceptional Healthcare In order to achieve key elements of service excellence, healthcare institutions, in particular, must be concerned with reducing the drivers of dissatisfaction, and providing exceptional healthcare. According to the federal Agency for Healthcare Research and Quality (AHRQ) exceptional healthcare is defined as doing the right thing, at the right time, for the right person, and having the best quality result [outcome] 4 Slide 5 Joint Commission International What are the drivers of Patient Dissatisfaction 5 Slide 6 Joint Commission International Evidence of Quality Problems Several types of quality problems in health care have been documented: Variation in services Underuse of services Overuse of services Misuse of services Disparities in quality 6 Slide 7 Joint Commission International Waste And Variation In Health Care According to the Institute of Medicine, 30 to 40 cents of every dollar spent on health care is for costs associated with: Overuse, misuse, underuse, Duplication, System failure, Unnecessary repetition, Poor communication, and Inefficiency, all of which can be described as waste. 7 Slide 8 Joint Commission International 8 Slide 9 9 The proportion of waste in health care has been estimated in a range from 30% to 60%. Slide 10 Joint Commission International Poor Quality/ Waste In HealthCare 10 Poor Quality/ Waste In Healthcare Failure to provide effective treatments Overuse of certain treatments and underuse of others, Use of ineffective tests or service Misdiagnosis and poor coordination and communication. Inefficiency Slide 11 Joint Commission International 11 Poor Quality/ Waste In Healthcare Duplicate Or Repeat Testing/ProceduresDelays In Care,Failures of care coordinationInefficient Use Of Clinician Time, Improper Documentation/Record Keeping, Iatrogenesis, AndPatient Injuries Poor Quality/ Waste In Healthcare Slide 12 Joint Commission International Waste Can Includebut Is Not Limited To Waiting; Barriers To Flow; Handoff Breakdowns; Errors And Mistakes; Correcting, Revising, Or Reevaluating; Inaccurate Information; Inaccessible Information; Shortage Or Lack Of Tools Or Equipment; Incorrect Or Inappropriate Equipment; Inefficient Motions, Unnecessary Movement; Inaccessible Tools Or Supplies; And Inflexible Processes (Inability To Quickly Improvise). 12 Slide 13 Joint Commission International What is the Most Cost Effective Way For Providing Exceptional Healthcare? Does Improving Quality Save Money? 13 Slide 14 Joint Commission International Quality Can Be Improved By 14IIM Lean, Six Sigma Accreditation Safe Health Design Evidence Based Medicine Effective Utilization Management Slide 15 Joint Commission International How Lean Works for Health Care 15 Slide 16 Joint Commission International Lean in Health Care Lean is a compilation of world-class practices that can improve a health care organization through an evidence-based methodology. Lean health care strives to be patient-centric and to always serve the patient It is not always easy to implement in health care Barriers include Natural Human Desire To Cling To The Familiar, Fear Of Change, A Lack Of Understanding Of How Lean Works 16 Slide 17 Joint Commission International The Case for Lean in Health Care Lean practices help a health care organization run as a successful business, focusing on achieving a positive return on investment (ROI) by eliminating, or at least minimizing, non-value-added activities. Conti.. 17 Slide 18 Joint Commission International Practices might include the following: Improving employee retention Reducing adverse events Reducing re-admission rate Reducing length of stay Better leveraging available resources Improving employee and physician satisfaction and physician/nurse relations Increasing nurses direct patient care time, which will result in improved patient perception of care 18 The Case for Lean in Health Care Slide 19 Joint Commission International Results of 175 Rapid Process Improvement Weeks at A Medical Center in United States Published by IHI 19 Slide 20 Joint Commission International Joint Commission International Standards 20 Lean Thinking Principles directly or indirectly facilitate their compliance with many of the Joint Commission International standards Standard QPS.5 The data analysis process includes at least one determination per year of the impact of hospital wide priority improvements on cost and efficiency Standard QPS.5 The data analysis process includes at least one determination per year of the impact of hospital wide priority improvements on cost and efficiency Standard FMS.9 The hospital establishes and implements a program to ensure that all utility systems operate effectively and efficiently Standard FMS.9 The hospital establishes and implements a program to ensure that all utility systems operate effectively and efficiently Slide 21 Joint Commission International Potential Return on Investment Joint Commission International Accreditation Potential Return on Investment Improved care fewer complications Better reputation -- increased number of new patients More satisfied staff better retention and lower recruitment and training costs More efficient, cost effective work processes Better preventive maintenance program longer life of biomedical equipment Better safety management, and risk reduction reduced liability exposure Greater clarity to leadership structure and quality oversight Special recognition from payment sources and insurance companies Slide 22 Joint Commission International Impact of Safe Health Design 22 Slide 23 Joint Commission International Standards-based design incorporates elements of the JCI standards into the built environment 23 Slide 24 Joint Commission International Evidence-based Design Features And Effects 24 Evidence Based Design Principles Have Shown Return On Investment In Many Ways All reducing operational cost!! Slide 25 Joint Commission International Engaging patients and their families in care decisions and management of their conditions leads to better outcomes and can reduce costs Introducing evidence-based concepts into policies, regulations Identify opportunities to reduce overused and misused Services, Take action Measure performance, Reports should be shared 25 You cant manage what you dont Measure, You cant manage what you dont Measure, Slide 26 Joint Commission International 26 Slide 27 Joint Commission International Quality improvement programs often do save money Effective quality improvement strategies require continued nurturing Despite challenges, hospitals should be committed to improving patient care and make steady progress 27 Better Outcomes For Patients And Meaningful Cost Savings For The Health Care System Slide 28 Joint Commission International Dr. Ashraf Ismail, MD,MPH,CPHQ Managing Director, Middle East Region