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Metric Driven Strategy for EHR Continuous Improvement

Session #36, February 12, 2019

Brian Kay, Vice President Continuous Improvement

Nicole Klaus, Director EHR Optimization and Strategy

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Brian Kay, MS

Has no real or apparent conflicts of interest to report.

Nicole Klaus, RN, MBA, MPA

Has no real or apparent conflicts of interest to report.

Conflict of Interest

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• Learning Objectives

• About Us

• Rogers Improvement System

• Managing for Daily Improvement

• Application of Agile Methods

• Lessons Learned

Agenda

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• Identify the strategic benefits of employing daily

and monthly review of EHR performance metrics

in project identification

• Evaluate the challenges and opportunities to

overcome them when using data to make

decisions on continuous improvement objectives

• Select metrics that align with the organization’s

vision and strategy

Learning Objectives

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Rogers Behavioral Health:

About Rogers – Who We Are

• Established in 1907 as Rogers Memorial Hospital, Wisconsin’s largest private, unaffiliated, not-for-profit psychiatric and addiction services hospital.

• Psychiatrist-driven, evidence-based models of care by multidisciplinary teams that also include general medicine physicians, psychologists and other psychiatric clinicians.

• Robust service continuum for the right intensity of care at the right time:– Inpatient hospitalization– Residential treatment centers– Partial hospitalization (PHP)– Intensive outpatient (IOP)

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Six Rogers Memorial Hospital Wisconsin locations:

– Oconomowoc• Inpatient hospital

• 8 residential centers

• PHP and IOPs

– West Allis • Inpatient hospital

• PHPs and IOPs

– Brown Deer • Inpatient hospital

• PHPs and IOPs

– Madison

• PHPs and IOPs

– Kenosha

• PHPs and IOPs

– Appleton

• PHPs and IOPs

Rogers Behavioral Health:

About Rogers – Who We Are

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Regional Rogers Behavioral Health network of specialty clinics

(PHPs and IOPs):

• Tampa Bay

• Nashville

• Chicago

• Minneapolis

• Philadelphia

• St. Paul

• San Francisco Bay Area

• Miami

• San Diego

Rogers Behavioral Health:

About Rogers – Who We Are

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• Intensive, multimodal treatment in structured therapeutic settings under supervision of board-certified psychiatrists.– On-site access to experts in psychiatric

subspecialties and psychology for additional clinical consultation.

• Individualized treatment plans, flexed to accommodate typical and atypical fluctuations/shifts in response and comorbidities.

• Length of stay calibrated to achieve optimal therapeutic impact and to sustain and build upon treatment gains post discharge.

Rogers Behavioral Health:

About Rogers – What We Do

Specialized continuums of care:

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Intake Employee

ExperienceDepression Practice

Management

VSST

EST

TPOC

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Managing for Daily Improvement (MDI) is

focused on transforming to a leadership

culture that:

• Creates, accommodates, and sustains a

culture of continuous improvement.

• Facilitates a data driven, action oriented,

engaged & empowered lean organization.

• Are we having a ‘good’ or ‘bad’ day?

• What would ‘better’ not ‘perfection’ look like?

• If you have an idea for ‘better’, how would you

implement it? How would sustain it? How

would you improve it?

MDI is about People

What is MDI?

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What is MDI

• A series of repeatable processes designed to…

– Connect everyone to what is important

– Help leaders at all levels spot normal from abnormal conditions

– Identify and proactively address issues that impede our success

– Develop leaders as coaches

– Resolve our “gaps” through team-driven problem solving and A3’s

– Sustain breakthroughs from team improvements

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Standardized Work - Method

The best known way TODAY

Standard Work will

Sustain the gains

A3 Thinking (PDCA) drives

Continuous Improvement

STD WORKP

erfo

rmance

Time

STD WORKP

erfo

rmance

Time

Standard Work is intended to drive change. The more

frequent the change the faster the improvement.

Continually Higher

Performance is an

indication of a healthy

organization

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Tier 1 Readiness Huddle

• Key Features:

– Safety issues are proactively addressed (focus on preventing harm)

– Check Methods, Equipment, Supplies, and Staff’s (MESS) readiness for the day’s work

– Understand the day’s work plan / schedule (volume, special needs for patients, etc)

• Leader Standard Work:

– Front-line leader performs SMESS checks

– Leaders perform tiered huddles (unit level to one up) to escalate issues

– Higher-level leaders confirm / coach / support performance of these tasks

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• Follow standard work

• Escalate if SW cannot be

followed

• Check MESS

• Run Tier 1 huddle

• Track and maintain area

performance

• Respond to andon and track

abnormalities

• Confirm standard work

• Do daily PDCA

• Run Tier 2 huddle & plan for the day

• Monitor unit performance

• Perform gemba rounds

• Confirm & coach team leads & supv’s

on LSW

• Resolve escalated problems

• Perform root cause problem solving• Perform gemba rounds and walks

• Perform check-act on weekly/monthly

performance

• Coach managers on LSW

• Lead cross-department problem solving • Ensure that DMS is followed and

improved

• Perform gemba walks

• Ensure that big issues are resolved

• Model coaching and problem solving

• Perform gemba walks

• Engage leaders in achieving goals

• Model coaching and problem solving

• Understand and develop capabilities

Team Lead

(Charge

RN)

Managers &

Supervisors

Directors

COO

CEO

Staff

Tiering Communication

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Journey from Reaction to Optimization

• Transition from hyrbrid system to system wide electronic system

• Grew from a department of 5 to a department of 33

• Electronic record development was based on issue management and tickets

• Partnered with Rogers Improvement System to implement MDI

Our Story

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Deciding What to Measure

• Project decisions are made based on potential to have influence on strategic anchors

– Clinical Effectiveness

– Patient Experience

– Healthy Culture

– Responsible Growth

– Outreach

• Metrics were chosen based on the impact projects would have on these actions

Deciding How Often to Measure

• Daily

– Functional teams huddle daily to prioritize daily tasks

• Bi-Weekly huddles

– Leadership council meets weekly to review project risks and barriers

• Monthly

– Leadership reviews progress with executive team to determine needs

MDI in the Technology World

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• Leadership Council

– Staff nominated by leadership

– Empowered to own meeting and own metrics

– Subcommittees

• User Experience

• Policy and Compliance

• Finance

• Culture

• Scorecard is reviewed and decisions are made based on problematic areas

Empowering Employees

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Before

• Electronic Health Record compliance 82%

• Solutions Compliance 71.10%

• Medication barcode scanning rate 88%

• Service Level Agreement Violations 7.14%

• Time in Medical Record 17 min per patient

• Nursing time in medical record 5 min per

patient

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• Electronic Health Record compliance increased from 82% to 91%

• Medication barcode scanning rate increased from an average of 88% to 95%

• Service Level Agreement violations decreased to 2.3%

• Time in the EMAR per patient for staff decreased from 17.45 to 15.81 minutes

– Nursing Partial Hospitalization and Intensive Outpatient level of care time per patient hit targets for the last three months due to a targeted implementation

Outcomes Achieved

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• Ensuring data accuracy – regain confidence from end users in data

• Finding the right data for the right problem – finding the best strategic match

• Scheduling and attending the daily huddles – adding value to meetings

• Don’t let progress get in the way of perfection – start meeting instead of waiting for the perfect set up

Challenges and Barriers

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• Align metrics selected by strategic initiatives. There are so many metrics to pick from, using the relationship to the vision of your organization will have more of an impact on your objectives

• Set a time limit for daily check ins. Everyone is already busy, and it becomes too easy to get into the weeds

• Leadership should remove barriers identified in huddles right away to maintain focus

• Transfer responsibility of reporting to employees to encourage engagement and ownership

• Tiered reviews - We can target users daily to impact those who are struggling while making system improvements to enhance overall use

Recommendations

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• Initial Phases

– Position based huddles

– Changes driven by end user feedback

– Leadership council

• Phase 2 (in progress)

– Workstream huddles

– Creation of user councils

– Partnership with clinical and revenue leadership

– Continued leadership council (representation each workstream)

– Formal training next week

Next Steps

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Brian Kay

Brian.kay@rogershospital.org

Nicole Klaus

nklaus@rogershospital.org

Please remember to complete the online survey

Questions