UCSF Medical CenterMission BayOperations Planning

Clinical Affairs CommitteeMax Meng, MD, Chair

 Wednesday, June 27, 20124:30 – 6:00 p.m.

Room CL 222

Scott Soifer<Title>Brian HerriotDirectorMB Operations PlanningUCSF Medical Center

Building continues…

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Planning our journey

• This is an incredible opportunity to improve patient care at UCSF!

• We need your ideas and want to answer questions that are important to you

• You already know our overall scope, approach and MB Operations team structure

• Therefore, our format will be mostly Q&A• Lastly, we’d like to share physician-centric

operational items of interest and ask for your feedback

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Q & A

• Offices for physicians who are primarily working at the new campus? Most units have an office for the Medical Director and whomever is Attending at the time. The rest is hoteling space.

• Will there be an adult ER at Mission Bay, to accommodate adults associated with children at MBH? Current plan is for two Adult rooms in the ED.  

• Admission or transfer of adult patients’ criteria from MB? Who specifically will be admitted as an adult to the new MB hospital? The following slides indicated services moving to MB from Mt. Zion.

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Children's Inpatient

Outpt. Surgery/

Procedures NotesPediatric Gen Peds/Hosp. Primary Care @ MZ with other adult/pedi Primary CarePediatric Adolecent MZ MZ and MBPediatric Medical Specialties Al l - Cardiology, endocrine, GI/Liver, Genetics, Immunology, Pulmonol ogy, renal , Rheum, Hem/Onc/BMT

Pediatric Neurology Pediatric Surgical Specialties All - OHNS &(audiol & cochlear), OPH, Ortho ,NS, Uro, Plastics, Craniofac, Gen Surg.Pediatric Dermatology MZ MZ and MB - majority at MZPediatric DentalPCRCPediatric Rehab PH or MB inpt.No dedicated outpt. pedi rehab in the MB OPB. Final operational plan pendingPediatric Acute Care CenterPediatric Treatment CenterPediatric Outpatient DialysisPediatric ED

Women's Inpatient

Outpt. Surgery/

Procedures NotesObstetrics All of OB/Plaza level to MB

MZ Portions of OB/MZ to MBGeneral GYN MZ Portions of General GYN to MBSpecialty GYN UroGYN/FibroidsPrenatal DiagnosticsReproductive Endocrinology Serramonte OB/GYN

Moves to MB

Pending

Doesn't move to MB

Service not applicable in this setting

MZSerramonte

Outpt. Clinic

Outpt. Clinic

MZ

High Level Overview of Services Moving to MB

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As of 3/24/2012

High Level Overview of Services Moving to MB

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Cancer Inpatient

Outpt. Surgery/

Procedures NotesGIColorectal (benign & malig)GYN OncGUOrtho OncologyHead & NeckEndocrinologyBreastMelanomaDysplasiaThoracic PH PHMalignant Hem/BMT PH PHBrain Tumor (Neurosurgery) PH PH

Infusion MZ/PH Outpt. Infusion at MB for GI, GU, Colorectal, GYN Onc, Ortho, Endo crinology pts only Moves to MBPendingDoesn't move to MBService not applicable in this setting

PHPH

MZMZMZMZMZ

Outpt. Clinic

As of 3/24/2012

Q & A• Living donors for transplant? Will there be an adult ICU or

equivalent? There will be an Adult ICU.

• From an adult rheumatology standpoint, sometimes pregnant women develop critical illness related to autoimmune disease that requires hospitalization and daily monitoring by the rheumatology consult team. However, the rheumatology fellows already have heavy burdens on their time, making daily travel to MB challenging. I am eager to hear the thoughts of the Clinical Operations Planning Committee about coverage issues. I suppose one possibility would be for the MB Hospital to be covered by SFGH staff. However, I suspect many providers at SFGH are unfamiliar with APEX. Questionnaires regarding consults and coverage being prepared to go to Department Chairs. Is telemedicine an option for Rheumatology?

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Q & A• There is a frequent shuttle service directly between MB and

Parnassus, but for our fellows that sometimes need to go to multiple UCSF sites in a day (SFGH, VA, Laurel Heights, Parnassus), driving is a necessity. Will a parking permit for Parnassus cover parking at the new MB hospital? (Currently, the Parnassus Parking permit DOES cover parking at the MB Community Center, but does NOT cover parking at Mt. Zion.) For faculty, the A permits work at the cancer center buildings. Presumably they will still work at Mission Bay? To be discussed with the Campus Parking.

• Some of the cancer center clinical group will move, and some (at least for now) will remain at Mt Zion. Coordination of services will be critical, and understanding how to manage shared patients since patients will have to travel back and forth in order to see the various cancer practice physicians, and to access specific services. Yes.

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Q & A• I've stopped referring to my field as pediatric cardiology, in favor

of congenital cardiology, to reflect the large and increasing number of adult patients we see in clinic, as in-patients surrounding surgery done by "pediatric" cardiovascular surgeons, and surrounding interventional procedures in our cardiac catheterization lab.  Here at Parnassus we have variable support by an adult congenital service, and more frequently, by the adult general cardiology service.  At MB we will have little of this accessible in a useful manner.  So this falls into the consult issue brought up by others, but also in-patient admission and ICU management.  Because the needs of these diverse populations will be proportionate to the diversity of their underlying illnesses a general consideration of where adults will be cared for is probably insufficient.  Specifics are going to be extremely important.  The correct answer should probably not be that will be routinely transporting critically ill patients back and fourth between MB and Parnassus.  Adult Cardiology will have a clinic across the street. They will need to provide coverage for both the Cancer patients and the CHD patients. How this will be done will be decided by that Department.

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Q & A• I'd also be interested in hearing about the integration of IT at the

MB campus.  The future of clinical care is probably going to involve increasing reliance on mobile platforms.  How is MB preparing for this? MB IT Executive Steering Committee. I know we're barely into APEX but we have to have a proactive approach. The current APEX mobile platforms are cute and useful for browsing patient information, but insufficient for clinical care.  Have Seth Bokser come to another meeting to explain.

• Also, an increasing reliance on mobile platforms will require a fairly broad bandwidth.  Will MB have robust enough wireless services to accommodate this IT progression (including imaging, which is high-bit stuff)? Yes.

• Seems that the whole consult issue is going to be dependent on divisions & departments developing a plan and staffing. Who is going to ensure that all the relevant groups have thought about the issues in detail? Physician strategy group.

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Q & A• From the Emergency Department perspective: Staffing of the

Mission Bay ED is going to be problematic.  First of all, the desire of Children's Hospital leadership has increasingly been to have practitioners that have been trained in and focus primarily on pediatric care treat children. This will require that the ED be staffed with Pediatric EM trained physicians. However, adults will also be presenting to this ED thus there will be a need for physicians trained in adult/general EM as well. There are very few practitioners with these credentials available in the Bay Area thus the specter of double covering a low volume ED 24/7 exists. How will this be paid for? Is the Medical Center prepared to heavily subsidize this operation? 

We need to think of Direct Admit model for Cancer patients with the assumption being that all EM physicians can stabilize a patient for either admission to MB ICU or Parnassus.

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Operational topics of interest to physicians

•Intranet webpage dedicated to topics of interest to physicians. Considerations for content and design:

– MD office space in the hospital and OPB– Location of MD workstations – Dictation and consultation rooms– Nursing stations (for chart location)– Conference rooms and policies– Medical staff lounge locations– Call room location and allocation– Med room and clean/dirty utility locations– PPE locations– Crash cart locations– Access & badging, card reader locations– Communication (patient tracking board locations, Vocera design, …)– Rounding workflows

•What else interests you?

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Mission BayOperations Planning

Appendix

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An Unprecedented Opportunity

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Mission Bay Clinical Program: Phase 1

Mission BayNew specialty hospitals for children’s, women’s, and

cancer services

ParnassusRenewed campus focused on high-end adult surgical and medical services and

emergency medicine

Mount ZionRemaining the major outpatient hub with a

diagnostic and therapeutic focus, and women’s health

services

An Integrated Campus

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Mission Bay Hospital Planning TeamMark Laret

CEO

Ken JonesCOO

Kim ScurrExecutive Director

Operations Planning

Cindy Lima Executive Director

Mission Bay Project

MB IT EXEC STEERING COMMITTEEJean Burns

Core Infrastructure Telecommunications Application

Configuration Nurse Call Telemetry Time and

Attendance Telemedicine Audio/Visual Clinical Patient Experience OR Equipment

Integration Real time location Unified

communication and mobility Intercampus

Integration

MB FINANCE COMMITTEE

James Bennan

Operating Budget 2015

Expense Budget Staffing Model Review Labor Standards

Review New Program Review Transition Budget

CLINICAL OPERATIONS PLANNINGBrian Herriot

Jennifer Hood

Operational Readiness Patient Experience Process flows New Operations and

programs Process

Implementation Process redesign Workflow Staffing Requirements Transition Orientation/Education Policies/procedures Licensing/Regulatory Move Training Donor Tours/Opening

MB PHYSICIAN STRATEGY

Stacy AlexanderScott Soifer, MD

Peter Carroll, MD Elena Gates, MD

Program Refinement Volume projections Physician

Coverage/Consult Faculty Recruitment Department Service

Level Agreements Medical Model—

Ambulatory/ED

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Mission Bay Hospital Clinical Operations Planning Team

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Operations Planning: Integrated Scope of Work

MB clinical operations schedule

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Stra

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Ope

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Plan

ning

2012

Status Q1J F M

Q2A M J

Q4O N D

Q3J A S

2013Q1

J F MQ2

A M JQ4

O N DQ3

J A S

2014Q1

J F MQ2

A M JQ4

O N DQ3

J A S

2015Q1

J F M

5/1 Common Nursing Practices WF Design Complete3/1 Future State 6/30 Transition Planning Ends

Day in the Life

12/15 Licensing Visit2/1 Patient Move

10/1 11/1 1/1

Licensing go/no-go 12/1

1/15

1/15

1/31

11/1 Orientation & Training

9/1 Non-clinical Dept. Moves

12/1 Clinical Dept. Moves

Today

3/14 Deliver Equipment / Start BMS Install

8/20 Hospital Temporary Commissioning Network Go Live

5/1Workstation / RTLS, Voice Ready to Validate

12/1 Emergency Dept / PeriOp WF Design Complete5/1 Future State 8/1 PH/MZ Pilots

5/1Common Clinic Practices WF Design Complete7/1 Future State

5/1 Patient Flow (+admit/discharge), Lab & path, Imaging, Pharmacy WF Design Complete10/1 Future State 1/1 PH/MZ Pilots

9/30 Code Response, P Tube WF Design3/1 Future State 6/1 PH/MZ Pilots

1/1 Dept. Support Services WF Design8/1 Future State

6/1 Dept. Clinical Units/Practices WF Design8/1 Future State

9/30 Dept. Support Services WF Design1/1 Future State

12/14 Purchase Requisition

8/23 Data Center Go Live1/25 Purchase Requisition 6/3 Deliver Eqpt

1/10 EC Go Live 4/18 OPB Go Live

3/31 Requirements Approved 3/5 Purchase Requisition

5/29 Deliver Eqpt

6/17 EC Go Live 9/23 OPB Go Live 4/9 Hospital Permanent Network Go Live

Nurse Call Requirements Approved 11/9

7/16 Requirements Approved

10/30 Purchase Requisition

8/7 Deliver EC Equipment4/1 Deliver Hospital & OPB Time & Attendance Equipment

6/28 Requirements Approved 2/4 Purchase Requisition 6/9 Deliver Telemetry Equipment5/16 Requirements Approved 10/14 Purchase Requisition 6/2 Deliver RTLS Equipment

7/6 Req’ts Approved 11/5 EC Purchase Requisition 4/14 Deliver OPB& Hospital Workstation & Peripherals Equipment12/3 Hosp & OPB Purchase Requisition3/19 Deliver EC Equipment

6/11 Requirements Approved 9/29 Deliver Hospital Voice Equipment8/25 Deliver OPB Eqpt3/28 Purchase Requisition 7/22 Deliver EC Eqpt

9/1 Present FY15 Labor Cost budget and Transition budget to SLC

3/31 Build Case MB Labor Cost Estimates

5/2012 Begin to define and vet MB transition budget

6/30 Develop MB ED Medical Model

9/30 Quantify MD coverage re: ward config.9/30 Develop Adult ICU coverage model`

9/30 Resolve OB coverage needs at PH99/30 Facilitate access for community MD

12/31 Quantify scope/volume/mode of consult services

6/30 Define cross-campus programmatic interfaces

12/31 Determine evening/night coverage arrangement

Q4O N D

2011

Past Due or At Risk

· Outpatient surgery for Endocrine, Breast, Melanoma, Dysplasia pending.

· Consult and coverage framework now beginning to be documented

· Need decision on 23-hr stays at Mount Zion. Determine if Mount Zion is to be 100% outpatient.

· Additional Support Services work (e.g. loading dock plan, detailed materials & supplies paths of travel guidelines) will continue throughout 2012.

· Proposed MB fixed staffing model is not affordable; committee formed to challenge requests.

· Ask leadership to help manage IT expectations for MB facility given budget dollars allocated.

· IT staff availability given Apex deployment is a risk.

12/31 Finalize scope of services moving to MB1/31 Complete “Cancer to 1A” planning

10/28 Present summary to SLC12/7 Propose initial labor budgets; share “rules of the road”

1/31 Depts. prepare budgets

Hold Finance office hours 4/30

6/30 Facility Access / Materials WF Design Complete2/1 PH/MZ Pilots

12/5 Future State

6/1 Kick off project2/1 Build Ops planning team

8/31 Ready Room pilot

Completed: · Completed Phase 2 current state training· Completed Phase 2 current state workflows· CNP completed workstation assessment for

levels 3, 4, 5, 6· Drafted Ops communication plan, including

project site and intranet site approach· Closed out Phase 1 operations planning· Closed discussion on summ. vol projections

Completed: Hosted MB Periop & ED overview sessionsLaunched Phase 2 future state planningPrepared MB ancillary services coverage docChose preferred consult & coverage models for Telemedicine pilotDavid Radcliff consulted on ready roomCNP with Support Services: demo’ed nurse call & workflow monitor functions

Completed:· CNP: Finalize all workstation requirements-

location and model· Initial transition budget preparedNext up: · Periop & ED: future state WFs and gaps· Plan ready room pilot· Detailed planning for Telemedicine pilot· Challenge MB fixed staffing via committee

Next up: · On board Min Zhu, Ops planning project mgr· Launch ready room pilot· Prepare for Phase 2 stand & deliver· Orient Phase 3 interdisciplinary and

department specific team leads· Present MB transition budget plan to SLC· Develop user requirements for other MB IT

systems

Apr 2012 May 2012 Jun 2012 Jul 2012

Operations Planning Phase Transition Planning Phase

7/1 Current

7/1 Current

12/1 Current

2/1 Current

9/1 Current

Next up: · Improve ready room pilot and plan for

expansion· Host Phase 2 stand & deliver· Kick off Phase 3 interdisciplinary and

department specific workflow planning under revised methodology

Aug 2012

Clinical Operations Planning: Guiding Principles

• Plan workflow processes which place patients and families at the center of care

• Patient and staff safety are key considerations in all workflow practices

• Be responsible financial stewards by minimizing change to space and equipment program

• Challenge existing workflow processes to maximize efficiency and the quality of care

• Maximize use of new and existing technology and the new environment as it was designed when planning future workflow

• Embrace practices and workflow processes that promote “Quiet Hospital” and “Clean Facility” goals

• Plan workflow to provide effective communication within departments and throughout the hospital

• Incorporate infection control and prevention measures• Pilot new processes and technology at the Parnassus and Mt. Zion

campuses to the extent possible and evaluate outcomes prior to Mission Bay campus deployment

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