leading change by using metrics to focus on … · leading change by using metrics to focus on...
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Leading Change by Using Metrics to Focus on Patient-Centered Service
Vanderbilt University Medical Center
Dr. Stephan Russ
Paul Schmitz
Vanderbilt University Medical Center
2
• 200+ Pediatric Beds
• Leapfrog Recognition
• Level IV Neonatal ICU
• 13,000+ Admissions Annually
• Patient Care/Research Biomedical Information
• 800+ Beds Adult Care
• Level I Trauma Center
• Comprehensive Burn/Life Flight
• Magnet Designed Institution
• 50,000+ Admissions Annually
Vanderbilt Medical Group:
• 1.5+ Million Visits Annually
• 1,200+ Faculty Physicians
• 125+ Outpatient Settings
Shift in Care Delivery
Episodic
• Volume-driven
• Care Fragmentation
• Fee-for-service
• Duplicative testing
• Poor sharing of patient data
Population-Based
• Value-driven
• Care Coordination
• Personalized medicine
• Clinical integration
• Control physiologic indicators among groups
TODAY
FUTURE
Building the Core Key Insights
Understand capacity & potential value/impact of work
Building the Core Key Insights
Learn system drivers & levers
Building the Core Key Insights
Measurement systems must support strategic direction
Building the Core Key Insights
Execute frameworks with meaningful context & measurable performance
Building the Core Key Insights
Promote spread/sustainability & support accountability
Building the Core Key Insights
Involve providers from beginning & make work visible
Building the Core Key Insights
Access must be part of plan
Building the Core Key Insights
Arrange access with flexibility
Building the Core Key Insights
Understand capacity & potential value/impact of work
Learn system drivers & levers
Measurement systems must support strategic direction
Execute frameworks with meaningful context & measurable performance
Promote spread/sustainability & support accountability
Access must be part of plan
Arrange access with flexibility
Involve providers from beginning & make work visible
Balancing Act Knowledge
Game Changers Culture change
Dialogue
Leadership Commitment
Waves of Integration
Never Ending
Written Agreements
Capacity Mgt. Toolkit - Data
Data Transparency
Culture Change Key Ingredients
• Leadership focus and chair support of organizational goals critical
• Specific goals and data transparency effect positive change
• Be deliberate in scheduling changes
• Show positive performance trends
Knowledge is Power
• Investment significantly offset by growth
• Review/handoffs significantly impacted coordination issues
• Co-located clinical teams off-site work well
• Access/growth significantly improved
• All statistics reflect positive impact
What Have We Learned? Critical Success Factors
Promotion, Marketing is Critical: •Stakeholders at every level •Leadership commitment Care
Strong Organizational Understanding: •Effective capacity management •Changes in one area affect other areas •Dedicated multidisciplinary team/resources
Keep it Fresh: •Listen for new ideas •Experiment with analysis •This is a journey
No “Gold Standard,” Still Learning: •Visible progress in performance –Transparency is key •Commitment to real-time learning
✓
✓
✓
✓
Culture Change Catalyst
Physician Involvement & Leadership - Access Center - Transfer Center - Patient Experience
Our steps moving forward
Access
Predictive Modeling
Strategic resources
2012 Environment Limited Understanding
19
A Starting Point Measurement became foundation
Engagement
Alignment
Measurement
Patients, Referrings, Providers
Systems & Processes
Transparent reporting
No Access Measurement
Standardization Challenges
Silo Challenges Ad Hoc Reporting
Before
• Email, fax, phone, pre-arranged agreements • No management, tracking or controlling
Something we did have Centralized Template Management
24
After
• Web-based application accessed on campus • Requests are tracked, managed and archived • Better control over capacity changes
(reductions, deletes)
Centralized Template Management Quality Assurance
• Cadence Certified Template Specialist – Increased Advanced Hyperspace functionality
- One-Clicks - Questionnaires - Pools
Brian Wood “CCTS”
What Did We Do? Produced something
Listened
Partnered
Collaborated
Grew
Proprietary to Vanderbilt University Medical Center
New Patient Wait Time
Total Change Rate
Unique Provider Count
Completed to Budget
Template Unavailable
Rate
Adjusted Template Utilization
The BIG six
Current v. Proposed Cancel Reasons
Current Proposed PATIENT REQUEST PATIENT: REQUEST
PATIENT NEEDS EARLIER APPOINTMENT PATIENT: DECEASED
PATIENT DISSATISFIED WITH WAIT TIME PATIENT: WEATHER
PATIENT ARRIVED TOO LATE PATIENT: FINANCIAL
PATIENT DECEASED PATIENT: MEDICAL NECESSITY
PATIENT OFF STUDY CLINIC: REQUEST
PATIENT IN HOSPITAL CLINIC: SCHEDULING ERROR
PATIENT PREP INSTRUCTIONS NOT FOLLOWED CLINIC: WEATHER
AUTOMATED REMINDER REQUEST CLINIC: INTERNAL DISASTER
RESCHEDULED TO WAIT LIST APPT PROVIDER: REQUEST
SELF PAY NO DEPOSIT PROVIDER: WEATHER
PRECERT NOT APPROVED PROVIDER: PATIENT ARRIVED TOO LATE
INCLEMENT WEATHER
CLINIC REQUEST
ROOM/EQUIPMENT NOT AVAILABLE
SCHEDULING ERROR
TEMPLATE REASSIGNED
PROVIDER REQUEST
REFERRING REQUEST APPT SCHEDULED
OTHER
Capacity Management Transparency to Everyone
Major Group (SOM) Subgroup (SOM) Scheduling Department
Provider
Provider Summary Rosedale, Jeff
Rosedale, Jeff Rosedale, Jeff
Access Scorecard – Keep it Fresh
Current 7 Metrics
New 12 Metrics
31
Provider Time Away
*data mock up
Can We Forecast ?
33
May % June % Jul % Aug % Sept % Oct %
Total Slots 27,756 27,425 25,552 Total Slots 28,354 25,937 25,045
Unavailable Slots 6,335 22.8% 5,812 21.2% 5,764 22.6% Unavailable Slots 4,540 16.0% 4,933 19.0% 3,122 12.5%
Adjusted Capacity 21,421 77.2% 21,613 78.8% 19,788 77.4% Adjusted Available Capacity 23,576 83.1% 20,941 80.7% 21,463 85.7%
No Shows 1,228 1,375 1,235 Historic Adjusted Utilization 57.1% 57.1% 57.1%
Actual Visits 10,720 11,085 10,252 Projected Visits 12,191 10,686 10,984
Budgeted Visits 11,543 12,415 9,964 Budgeted Visits 11,765 10,916 10,026
Variance (823) (1,330) 288 Projected Variance 426 (230) 958
Adjusted Utilization 55.8% 57.7% 58.1% Actual Booked 14,756 9,232 4,526
May % June % Jul %
Scheduled Appointments 19,162 19,868 17,979 1284
Actual Visits 10,720 55.9% 11,085 55.8% 10,252 57.0% 573 44.6%
No Shows 1,228 6.4% 1,375 6.9% 1,235 6.9% 566
Reschedule 3,917 20.4% 5,156 26.0% 4,433 24.7% 1139 61.6% 5,888 67%
Cancel 4,816 25.1% 3,874 19.5% 3,531 19.6% 1850 8,795
Clinic & Provider Cancels 1,401 7.3% 1,320 6.6% 1,282 7.1% 1147 5,453
(8) 435
As of Aug 29th
Past 3 Months
HistoricalProjectedNew Patient Wait Time
Patient Movement - Past 3 Months
Patient Needed to Meet 62%
Variance
Next 0-15 Days
Current New Patients Scheduled
Current New Patients Scheduled Within 15 Days
Expected New Patients to be booked - next 15 days
Total New Patients Within 15 days
Total New Patients
Prior Three Months
Capacity Management
Projected Budget/Visits - Next 3 MonthsRolling - Past 3 Months
Projected Three Months
0
7500
15000
22500
30000
May June Jul
TemplatedCapacity
AvailableCapacity
Budgeted Visits
Actual Visits
0
7,500
15,000
22,500
30,000
Aug Sept Oct
Total Slots
AdjustedAvailable
Capacity
Budgeted Visits
Projected Visits
Talculator Template Example
Slots Target = 500 550 654 817 820
Variables = Budget 10% No Show 84% Available
(8 weeks away) 80%
Utilization Slots
Visits Target = 500 500 500 500 500
Budget Slots
Needed
Budget & No Shows
Budget & No Show & Unavailable
Budget & No Show &
Unavailable & Utilization
Provider Template
Data conversations stimulate change
Current Needed Variance
Weekly Slots 61 62 -1
Rough ride, nonetheless we learn and progress
• 72,000+ Data inquires
• ~650 Advanced scheduling implementations
• Adjusted Template Utilization from 56% - 68%
• More engagement across organization
– Access measures are Senior Leadership goals
– Report directly to Vice Chair for Health Affairs