the nyp operating calendar - ehcca.com · department total 2 3095433 4/17/2004 4/18/2004 1 2519800...

Annual Kick-off MeetingGoals & Objectives StartReport card Review

Ops/Business Planning ReviewFinalize Joint Budget

Operating Plans/Budget/Capital Complete

Report card ReviewFinalize Volume Targets

Strategic Planning Multi-yr

January

FebruaryApril

May

June

September

August

July

November

December

October

MarchOrganization/Talent ReviewReport card Review

Strategic Planning Update (3 yrs)Budget Kick-offOrganization/Talent Review Follow-up

Executive Mgt Meeting

Report card Review





2004 Budget Goals

Expected Profits $10 millionLOS Reduction .5 dayVolume Growth ~2,500 casesCase Mix 1.82Capital Investment $209 millionExpense Reductions $44 million

Initiatives

Joint Budget Planning & ReviewPerformance Review Complete

Budget PrepStrategic Planning Start-upFinal Internal Audit Plan

Employee SurveyUpdate of Multi-yr FinancialRisk Assessment & Audit Planning

1

The NYP Operating Calendar

NewYork-Presbyterian’s Big Bang Approach to Implementing “Six Sigma”

The Power of the PartnershipThe Power of the PartnershipPerformance ExcellencePerformance Excellence

Driving a Culture of Performance Excellence

Cardiac ServicesInpatient Medical Mgmt 6+ service lines

Radiology

Supply Chain

Bed Capacity

• 700 individuals

• 128 teams

• 100 CFs, 20 BBs, 80 GBs

• 65+ projects

• 5 campuses

• $29M in 2004 and $59M in 2005

Performance Improvement

Six SigmaCAP & Work-OutTM Leadership & Management Systems

Performance Excellence

Hip Fracture LOS Reduction

Case Study

Benefit Type:

NYP Focus Area:Bed CapacityCardiac ServicesIP Medical ManagementSupply ChainRadiology

Increased Revenue Efficiency Throughput Service Excellence Satisfaction (patient, MD, and/or staff) Cost Savings

DMAIC with CAP WorkOutTM with CAP CAP Only

Project Type:

NYP Sponsor: Andria CastellanosNYP Process Owner: Louis Bigliani, MD &

David Helfet, MDBlack Belt: Matt ChisholmMaster Black Belt: Beverly LamppGreen Belt(s): John Novotny, MD, Gail Ryder, Lorraine Kemp, RN, Lorraine Baker, RNOther Team Members: William Macaulay, MD,Catherine Compito, MD, Dean Lorich, MD, Rita Hamburgh, PT, Sharon Zisserman, Charles Walters, Karen Schlachter, James Butler,RN, Marie Finn,RN

Related Projects: None

NYP Campus Location:CPMCCHONYNYWCTAPWestchester

Case Study: Hip Fracture LOS Reduction

Best Practice ReviewLowest Variation

Best Practice ReviewLowest Median

Significance of Practice Patterns

P = 0.070

Mood Median Test: LOS versus Procedure MD

Mood median test for LOS

Chi-Square = 2.46 DF = 6 P = 0.872

Procedure MD

Procedure M

D

Procedure MD

Discharge Disposition

Discharge Day

Procedure Day

Hospital Campus

Discharge Unit

Major Diagnostic Testing

Discharge Service

Significant X’s Improvement Strategy

MD Education & Feedback

Additional PRI RNs; Increase SNF Selections

Pilot Weekend Discharges at Allen Pavilion

Refine Priority Ranking of Hip Fracture Cases

Review Best Practices

Cluster Patients; RN Training

No Action Required

No Action Required

Control Mechanism

Monthly MD Scorecard

Periodic Audit by SW Mang

Review Results of 4 Week Pilot

Modify Intake Form / TSI LOS Rpt

Service Line

TSI Rpt on Vol by Discharge Unit

None

None

Driving Quality Improvement by Improving and Monitoring Physician Practice Patterns

2 68

(2)43ORIF W/O COMPLICATIONS/COMORBIDITIES211

3 69ORIF W/ COMPLICATIONS/COMORBIDITIES210

3 69HEMIARTHROPLASTY; PARTIAL HIP209DEPARTMENT ALOS4 610ORIF W/ COMPLICATIONS/COMORBIDITIES210229845210479318MD #5

(4)106


(2)64ORIF W/ COMPLICATIONS/COMORBIDITIES210447004810480771MD #49 1625



5 611HEMIARTHROPLASTY; PARTIAL HIP209146916210474746MD #3(2)1210

(2)64ORIF W/ COMPLICATIONS/COMORBIDITIES210476283510477322

0 66HEMIARTHROPLASTY; PARTIAL HIP209283639010480167MD #213 1225

(2)64ORIF W/ COMPLICATIONS/COMORBIDITIES210175380110478804


MD #1

VARIANCETARGETACTUALDRG DESCRIPTIONDRGMRNENCTR

NUMBERPROCEDURE

MD

April 2004Monthly MD Scorecard

2 Department Total

1 4/18/20044/17/200430954331 4/23/20044/22/20042519800

7 4/13/20044/6/20041616901

1 4/23/20044/22/200430962924 4/17/20044/13/20043089075

2 3/30/20043/28/20043090835

1 3/28/20043/27/20043088653-3/24/20043/24/20043086552

2 4/16/20044/14/20042757704

1 4/3/20044/2/200419476472 4/2/20043/31/20041150633

4 3/19/20043/15/20042254753

2 4/16/20044/14/200416398732 4/14/20044/12/20041237525

1 3/31/20043/30/20041003659

2 4/22/20044/20/200430958923 4/9/20044/6/20043093859

7 3/25/20043/18/200417186362 3/29/20043/27/20043090792

1 4/1/20043/31/20043078448

3 4/2/20043/30/200422663951 3/30/20043/29/20042066699

Pre Op LOS

Proc Date

Admit DateMRN

DischargeUnit Vol % Vol LOS

G02W 4 18% 8G05C 3 14% 17G08C 12 55% 8G08N 3 14% 7

Dept Total 22 100% 9

Pre Operative Length of Stay Discharge Unit Distribution

April 2004

69% discharged fromdesignated units

Cases with long preoperative LOS to be investigated prior to monthly meeting with orthopedic attendings

Examining Lurking Variables Impacting LOS

Who What When

Finalize action triggers and responsesCampus Specific Teams By mid-June

Tom Sedgwick & Matt Chisholm Implement weekend discharge pilot Based on recruitment of weekend PRI nurse

Obtain physician “buy-in” regarding the need for changes in practice patterns

Train Service Line support staff in the development of control reports

Matt Chisholm & Laura Forese, MD Throughout month of June

By mid-JuneMatt Chisholm & Rich Fenton

Action Plan for LOS Reduction: Service Line Collaboration and Accountability

Metric Target Values Measurement Definition

Measurement Method

Upper/Lower Spec Limits

Control Method

Frequency of data

collection

Responsibility (Who Will Measure)

Alert Flags Action

Y' Total LOS

DRG 209 = 6 DRG 210 = 6 DRG 211 = 4

Discharge Date less Admission

Date TSI Reporting

209 = 8 / 3 210 = 9 / 3 211 = 8 / 3 I-MR Chart Monthly

Service Line Support Staff

Lack of Downward

Trend Isolate x's

Critical X

Procedure MD

DRG 209 = 6 DRG 210 = 6 DRG 211 = 4

Discharge Date less Admission

Date TSI Reporting

209 = 8 / 3 210 = 9 / 3 211 = 8 / 3 Dashboard Monthly

Service Line Support Staff

LOS Above Target

Alert Chair/ Chief

Critical X

Discharge Day

Weekend Discharge above 20%

Discharge Day of Week

Qualitative Pilot Results Lower Limit TBD TBD Post Pilot TBD Post Pilot TBD Post Pilot

TBD Post Pilot

TBD Post Pilot

Critical X

Procedure Day

Procedure w/I 24 Hrs of Admission

Procedure Date less Admission

Date TSI Reporting Upper Limit TBD Dashboard MonthlyService Line Support Staff

Pre Op LOS above USL

Alert Ortho OR Eff Comm

Critical X

Discharge Unit

All medically appropriate cases

Unit Discharging Patient TSI Reporting

Lower % Limit TBD Dashboard Monthly

Service Line Support Staff % below LSL

Alert Admitting/Nursing

Service Line Collaboration and Accountability

11.1

6.88.3 7.6

6.8 5.7

02468

101214161820

DRG 209 DRG 210 DRG 211

Before After

REDUCED LOS FOR ALL DRGREDUCED LOS FOR ALL DRG’’s SINCE JUNE 2004s SINCE JUNE 2004

CUMC(Milstein & Allen Pavilions)

Day

s

10.9

6.3

13.4

8.8

6.9 5.3

02468

101214161820

DRG 209 DRG 210 DRG 211

Before After

WCMC

Results

• Organization Structure• Projects• People

A Case Study: NewYork-Presbyterian’s Big Bang Approach to Implementing “Six Sigma”

Getting Started:Current Organization Structure

Program Adminsitrator

Green Belts

Black Belts (30)

Chief Quality Officer

PI Steering Committee(PISC)

Change Facilitators (~100)

Master Change Facilitators (2)

Chief Learning Officer

CAP/WO Steering Committee

•Project and People Selection and Training done independently for SS and CAP/WO

Getting Started: Six Sigma Project Funnel

New project idea generated

Idea Request Form completed in e-Project

Ideas reviewed againstcriteria and sorted

Is idea appropriatefor Six Sigma?

Office of Project Management prepares Summary Report

for PISC

Idea forwarded to COLE

Is project approved?

1 or more BBs and1 or more GBs assigned

Status reports enteredinto e-Project upon

completion of each step

PISC scores and prioritizes ideas

Project ideaplaced on list

for futureconsideration

Summary Reportpresented monthly to

PISC

N

N

Y

Y

New intra-departmental project ideagenerated

VP prioritizesand approves

idea

Getting Started: Project Selection Criteria

Systems and structures to support the change; control measures in place

Sustainability

Time the project will take to completeTime to Complete

Increased revenue, decreased cost, cost avoidance, implementation support

Financial Benefits

Technological change needed, organizational acceptance, project span/scope (across multiple campuses)

Ease of Implementation

Outstanding clinical care, caring environment & facility aesthetics

Patient Satisfaction

Home/work life balance, collegial respect, rewarding career

Staff Satisfaction

Competence of nursing staff, availability of facility-based specialist, access to the OR, ease of scheduling, state of the art equipment

Physician Satisfaction

Department of HealthRegulatory and Safety

Improved patient outcomes, reduced infection rates & appropriate utilization of ancillary services.

Clinical Excellence

ExampleCriteriaWave 1 October ‘03 - August ‘04

• Radiology• Supply Chain• Impatient Medical Management• Bed Capacity• Cardiac Services

Wave 2 August ‘04 - June ‘05

• Operational Benchmarking• Perioperative Services• Support Services• Finance• Ambulatory Services• Quality Outcomes

Getting Started: Wave 1 Performance Improvement Leadership

Process Area Sponsor Leader Finance CUMC WCMC CHONY TAP Westchester Resource HRBed Jackie Cathy Maria Hussein Brenda Cathy Tina Ruth Willie Diane

Capacity Mucaria Johnson Stang Tahan Sauer Cullen Stimpson Mendelowitz Manzano David

Cardiac Graham Marie Christina Bernadette Abby John Tina Maura Rick FranServices Gulian Weissman Grimley Miesner Jacobson Canning Stimpson Lehr D'Aquila Corridon

Inpatient Medical Andria Charlie Gerlayn Kathy Greg Charlie Charlie Ginny Steve DoretteManagement Castellanos Thompson Cannella Nickerson, M.D. Kerr, M.D. Schlein, M.D. Cain, M.D. Susman, M.D. Corwin, M.D. Norris

Radiology Bill Lalli Tina Paul Rich Bernadette Lorraine Doug Cynthia JoanneGreene Omar Liu Schwabacher Fenton O'Brien Kemp McGrath Sparer Olson

Supply Brian Marc Farida N/A N/A N/A N/A N/A Bob N/AChain Alsford Cottle Cheddie Kelly, M.D.

# of teams# of team members

# of NYP led BB teams

BedCapacity

CardiacServices

Inpatient MedicalManagement

Radiology

SupplyChain

4

9

96

Total 99 553* 26

836

15

160

90

22

10

16 0

5

126

81

* Totals include individuals working on more than one team

Getting Started: Six Sigma Teams

Getting Started: Training Organization

CQO CLO

Black Belts/Greenbelts Change Facilitators (CAP/WO)

Jan '04 April '04 July '04 Oct '04 Total Target

TrainingProjects

MBBs

BBs

GBs

0

10

41

10 20

81

20

0 0

30

120

4

36

160

4030 40

160

40

40

160

36

4 2

Getting Started: People

Getting Started: Selection Process

Position posted

Screened by HR

Interviewed by Director

Scored and ranked

Interviewed by panel of VPs

Recommendations forward to Senior Management

Offers made

• Strong track record of high performance with

• Proven analytical and statistical problem solving skills

• Leadership and project management skills

• Strong sense of organization’s values• Excellent communication skills• High degree of customer sensitivity• Long term commitment to

organization

• Leader of teams • Mentor• Apply methodology• Introduce methodology and tools

to others• Act as both technical and cultural

change agent• Reduce defects and/or process

variation

Selection CriteriaRole

Getting Started: Black Belt Role and Selection Criteria

Issues of Current Design

No central contact point for process improvement ideas

Extra steps to coordinate projects that are not clearly SS or WO

Possibility of overlap with similar projects being done by multiple teams using both SS and WO

Overlap of training for SS and CAP/WO. Conflicts for individuals that are scheduled to become both CFs and GBs.

Long Term Design ConceptsI. Projects

• Single point of contact for selection/assignment• Selection principally done locally• Tracking centralized

II. People

• Centralized training• BB’s managed locally• Selection done through organizational talent review

III. Oversight

• Dr. Berman’s senior management team

Project Administrator

Service Line Ldr Service Line BBs

Function Ldr Function BBs

COO COO BBs

MBBs

Service Line CFs

Function CFs

COO CFs

MCFs

Quality Leader

Chief Quality Officer

Training Administrator

Training BBs

Training MBBs

Training CFs

Training MCFs

Training & OD Leader

Chief Learning Officer

Dr. Berman's Small Staff

Long Term SS/CAP/WO Org Structure

Projects Training

New SS Project Idea is

generated

Area Manager & BB(s)1

approve project and assure project alignment to Hospital Big Ys and/or

NYP 25

BB places approved project into eproject & is responsible for

mentoring GB

Key:

• For BB Project-- Identical Process except MBB & COO’s/Service Line Directors approve & review projects

• BBs report-out to MBBs, COOs, Service Line Directors & Quality Leader– group session for BBs

BBs & Area Mgrs2

hold Project Reviews with the

GBs to keep projects on-track

Completed projects

signed-off by BB & Area

Mgrs1

Project closed in eproject

Service Line Managers, Functional Managers and/or COOs report

project status at quarterly CEC Meetings

1

Annual Kick-off MeetingGoals & Objectives StartReport card Review

Ops/Business Planning ReviewFinalize Joint Budget

Operating Plans/Budget/Capital Complete

Final Internal Audit PlanReport card ReviewFinalize Volume Targets

Strategic Planning Multi-yr

January

FebruaryApril

May

June

September

August

July

November

December

October

March

The NYPH Operating CalendarOrganization/Talent ReviewReport card Review

Employee SurveyUpdate of Multi-yr Financial

Strategic Planning Update (3 yrs)Budget Kick-offOrganization/Talent Review Follow-up


Report card ReviewRisk Assessment/Internal Audit Planning





Strategic GrowthPerformance ImprovementPeople DevelopmentInformation TechnologyInnovation

Initiatives

Joint Budget Planning & ReviewPerformance Review Complete

Budget PrepStrategic Planning Start-up

Benefit Dollars are rolled up to Central Quality for tracking

purposes (via eproject)

Project Selection Migrates to a Local Level in Long Term Org Structure

Challenges

I. Momentum/Capacity

II. Cross Campus Best Practice

III. Communication

IV. Involvement and buy in of Physicians

V. Placement of Black Belts after two-year commitment

VI. Training Space

NewYork-Presbyterian Hospital Success Will Be:

SizePhilanthropyAcademic StrengthEmployer of ChoiceFinancial Track RecordHealthcare SystemService Excellence and Patient-Centered CulturePerformance Improvement Metrics and ToolsQuality Signature and Patient Safety

Questions?

the nyp operating calendar - ehcca.com · department total 2 3095433 4/17/2004 4/18/2004 1 2519800...

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