transforming office roles …the lean approach katial, md lynn klima, cnp amy middleton lisa morris,...
TRANSCRIPT
Transforming Office Roles …THE LEAN approach
Lynn Klima RN, MSN, CNPDirector of Clinical Improvement
• IHA – Who Are We?• Transformation – The Beginning PCMH Building the Care Team
• Thinking of the Work in a New Way LEAN
The Transformation Story
• 150 Physicians• 37 APN/PA• 30 Sites• 250,000 Active Patients• 22,000 New Patients in 2008• 488,000 Patient Visits in 2008• 2,652 Deliveries• 700 Employees
What is IHA?
5 divisions including Internal Medicine, Family Medicine, Pediatrics, OB/GYN, and Surgery
After Hours
Ancillary Services – CT, General Ultrasound, General Radiology
Specialty Services – Maternal and Fetal Medicine, Pediatric and Adult Neurology, Dermatologic Surgery, General Surgery
Hospitalist Services at SJMH and Chelsea for adult patients
What is IHA?
IHA’s Network of Care
Leadership Structure and Committees
IHA
endeavors through its evolved and participatory structure to bring all its resources to meet the
needs of our patients and the community.
Inspired by our MissionIntegrated Health Associates (IHA) exists to meet community needs
through the provision of personalized, high quality health and medical services
to our patients in a manner which results in high levels of patient satisfaction with clinical quality, services, accessibility and value.
Driven by our ValuesCommitment
Advocacy Respect
Efficiency Service
PATIENTS AND COMMUNITY
FAMILY MEDICINE OFFICES Ann Arbor Family Practice
Brighton Family Care Specialists IHA Family Practice
Milan Family Medicine Okey Family Practice Pinckney Family Care
INTERNAL MEDICINE OFFICESChelsea Internal Medicine
AIIM-Cherry Hill AIIM-Commonwealth
Huron Valley Neurology IHA Plymouth Internal Medicine
IHA Hospitalists AIIM-Pauline
OB/GYN OFFICESAnn Arbor OB/GYN Associates –
Ypsilanti/Milan/Plymouth Associates in Gynecology &
Obstetrics – Brighton/Ypsilanti/Chelsea
Canton Obstetrics and Gynecology IHA Maternal-Fetal Medicine
IHA Menon, Miller & Midwives IHA WestArbor OB/Gyn
Walker Gyn. of IHA
PEDIATRIC OFFICESChelsea Pediatrics
Child Health Associates-Ann Arbor Child Health Associates-Plymouth
Huron Valley Neurology IHA Livingston Pediatrics
Pediatric Healthcare Associates-Canton
Pediatric Healthcare Associates-Ypsilanti
Primary Pediatrics
SURGICAL OFFICESCanton Obstetrics & Gynecology?
Chelsea Surgical Associates IHA Dermatologic Surgery
Associates
FAMILY MEDICINE OPERATING TEAM
Bob Breakey, MD - Chair Michael Bruderly, MD
Karen Edwards Cindy Elliott
Zoë Foster, MD Janet Hubert, MD Mike Jasbeck, MD
Marty Murray Monty Okey, MD
Melissa Sokol-Keith, MD Mark Zawisa, MD
INTERNAL MEDICINE OPERATING TEAM
Karl Brenner, MD Peter Dews, MD Mary Durfee, MD
Cindy Elliott Michael Friedlander, MD
Joyce Leon, MD Mark Lindley, MD - Chair
Evan Padgitt, CNP Art Tai, MD
Dave Winston, MD Steve Yarows, MD
OB/GYN OPERATING TEAMCheryl Bachman, CNM
Wes Beemer, MD – Chair David Bryant, MD
Cindy Elliott Jody Jones, MD Kris Miller, MD
Bryan Popp, MD Joanne Vicari, MD Karen Walker, MD
PEDIATRIC OPERATING TEAMNancy Anastasi, MD
Ginny Bareham, CNP Susan Bass
Karen Brenner, MD Cindy Elliott
John Gardner, MD Beth Hall, MD
Kim Meisenhelder, MD Marty Murray
Lisa Profera, MD Nancy Spangler, MD - Chair
Elizabeth Stone, MD Howard Weinblatt, MD
Mary Westhoff, MD
SURGICAL OPERATION TEAM(part of OB/Gyn Ops Team)
Renee Bayer Wes Beemer, MD – Chair
Cindy Elliott Jody Jones, MD
Jennifer Kulick, MD Mel Larson Bruce Maki
Karen Walker, MD
COMMITTEES AND SUBCOMMITTEES
CLINICAL QUALITY IMPROVEMENT COMMITTEE
Wes Beemer, MD Robert Breakey, MD
Amy Cooke, MD Mary Durfee, MD –Chair
Cindy Elliott Nancy Griffith
Olav Jaren, MD, PhD Lynn Klima
Jennifer Kulick, MD Lynn Lewis, CNP Mark Lindley, MD
Lee McDonagh, RD, CDE Pary Reza, MD
Nancy Spangler, MD Sandy Talbott, CNP
Steve Thiry, MD
CLINICAL RESEARCH COMMITTEE
Will Chamness, MD Jeff Dimaya Cindy Elliott
Olav Jaren, MD, PhD Mark Lindley, MD
Gayle Moyer, MD – Chair Sharon O’Leary, MD
Melissa Sokol-Keith, MD Lowell Sprague
Steve Yarows, MD
COMPENSATION COMMITTEE Wes Beemer, MD Bob Breakey, MD Karl Brenner, MD
Bill Fileti Dawn Johnson
Mike Kucera, MD – Chair Ted Merkel, MD Lowell Sprague
Art Tai, MD
APN/PA COMPENSATION SUB-COMMITTEE
Wes Beemer, MD Craig Brockman, CNP
Cindy Elliott Bill Fileti
Dawn Johnson Mike Kucera, MD
Jodi Lambert, CNP Linda MacEllven
Pat Reckling, CNP Nancy Sebby, CNP
Diane Weid, CNP – Chair
COMPLIANCE ADVISORY COMMITTEE Cindy Elliott
Jackie Gandol Chris Holda
Brad Judge, MD Linda MacEllven
Marty Murray Lena Payne
Joanne Vicari Block, MD Carol Ways, MD – Chair
David Winston, MD
FINANCE COMMITTEE Bob Adams, MD
Raj Deenadayalu, MD Bill Fileti
Mike Friedlander, MD Jim Marley, MD – Chair
Marty Murray Melissa Sokol-Keith, MD
Lowell Sprague Neal Weinberg, MD
Francie Youssef, MD
HEALTH PROMOTION Mira Agrawal, MD Lynn Klima, CNP
Ginny Johnson, MD Jay Lodwick, PA-C
Amy Middleton Pary Reza, MD
Nancy Sebby, CNP Steve Thiry, MD – Chair
Marti Walsh, MD Melissa Zarow, DO
Vicki Zilke, CNP
HUMAN RESOURCES COMMITTEE
Renee Armstead, MD Yuvelle Eaton-McFarland, MD
Cindy Elliott Bill Fileti
John Gardner, MD Joyce Leon, MD Linda MacEllven Gayle Moyer, MD Alberto Nacif, MD
Karen Walker, MD – Chair
LEADERSHIP DEVELOPMENT COMMITTEE
Wes Beemer, MD Bob Breakey, MD – Chair
Mary Durfee, MD Bill Fileti
Michael Kucera, MD Mark Lindley, MD
Nancy Spangler, MD
IHA GOVERNING BOARD (IGB)
Wes Beemer, MD Bob Breakey, MD – Chair
Mary Durfee, MD Bill Fileti
Julie Gargan Kozma, CNP Mike Kucera, MD Mark Lindley, MD Jim Marley, MD
Gayle Moyer, MD Melissa Sokol-Keith, MD
Nancy Spangler, MD Steve Thiry, MD
Neal Weinberg, MD
MARKETING COMMITTEESue Archer, MD
Nancy Anastasi, MD Cheryl Bachman, CNM
Mike Bruderly, MD Cindy Elliott
Bill Fileti Julie Gargan Kozma, CNP
Bridget Long, MD Kristin McFadden, DO
Amy Middleton Lisa Profera, MD – Chair
MEDICAL INFORMATICS
COMMITTEE Matthew Bressie, MD
Chris Holda Janet Hubert, MD Chris Kottke, MD Joyce Leon, MD
Marty Murray Mike O’Donnell
Evan Padgitt, CNP Sandy Talbott, CNP Neal Weinberg, MD
Mark Zawisa, MD - Chair
MULTI-SPECIALTY EXPANSION Robert Breakey, MD
Mary Durfee, MD Cindy Elliott
Bill Fileti Mike Friedlander, MD - Chair
Maria Heck, DO Jennifer Kulick, MD
Rajiv Deenadayalu, MD Peter Meyers, DO
Lowell Sprague Brian Woodruff, MD
NOMINATING COMMITTEE
Rossana DeGrood, MD - Chair Mary Durfee, MD
Bill Fileti Madelyn McMurtrie, CNP
Monty Okey, MD Steven Popper, MD
PATIENT SERVICE COMMITTEE
Roger Chen, MD Pam Davies, MD – Chair
Joanne Dommer-Kind, CNP Mary Durfee, MD Kathy Kise, CNP Linda MacEllven
Kimberly Meisenhelder, MD Darcey Owings, CNP
Pat Reckling, CNP Brian Woodruff, MD
PUBLIC POLICY COMMITTEECindy Elliott
Delores Garcia, MD Maria Heck, DO
Chris Holda Jody Jones, MD – Chair Madelyn McMurtrie, CNP
Pary Reza, MD Karen Selle
RETIREMENT PLANNING
COMMITTEE Jim Alford, MD
Virginia Bareham, CNP Osamah El-Aroud, MD
Bill Fileti John Gardner, MD Jay Lodwick, PA-C Linda MacEllven Ted Merkel, MD
Kelly O’Connor, MD Monty Okey, MD
Jim Sansone, MD – Chair Lisa Sprague, MD
Lowell Sprague Liz Stone, MD
David Winston, MD
RISK MANAGEMENT COMMITTEE
Wes Beemer, MD - Chair Cindy Elliott
Bill Fileti Ginny Johnson, MD
Julie Gargan Kozma, CNP Allison Kreske, MD Mark Lindley, MD Ken Owings, MD Carol Ways, MD
WEB SITE COMMITTEE
Cindy Elliott Pat Gordon, MD
Chris Holda Vaishali Katial, MD Lynn Klima, CNP Amy Middleton Lisa Morris, MD
Theresa Poppe, MD Brian Woodruff, MD - Chair
Steven Yarows, MD Carla Zahuranec, MD
Mark Zawisa, MD
IHA MANAGEMENT TEAM
Jackie Gandol Chris Holda Lynn Klima Amy Middleton Director of Business Director of Technology & Director of Clinical Director of Marketing Services Information Services Improvement Marty Murray Linda MacEllven Vice President - Director of Human Administrative Services Resources & Customer Service Cindy Elliott Lowell Sprague Chief Operating Officer (COO) CFO
Bill Fileti President & CEO
Identifying a Process Improvement Tool
• LEAN– Familiarity to all participants
– IHA pilots» Registry function, Test Tracking, Learning
Collaborative
– Local experts• Margie Hagene - LEAN
Value Stream Workshop
Understanding how things currently operate. This is the foundation for the future state
Value Stream Scope
Designing a lean flow through the application of MQS principles
Current State Drawing
Implementation Plan
Determine the Value Stream to be improved
The goal of mapping! Implementation of Improved Plan
Future State Drawing
Developing a detailed plan of implementation to support objectives (what, who, when)
Scoping
Workshop Day 1
WorkshopDay 2
WorkshopDay 3
Post Workshop
30,60,90 Day Reviews
Stan
dard
ize
for
late
r im
prov
emen
t
Leadership Involvement
Value Stream Mapping
Objective
To develop a Care Management model forChronic disease and preventive care with
clear IHA role definition and clear sequence of patient contact.
Taking Small Bites…..
• One population: adult chronic illness• Participants
• Division Head• Division Director• Human Resources• 1-2 providers• Role Representatives• Director of Quality Improvement• Chief Operating Officer
Identifying Teams
Three DAYS, THREE MAPS (and a lot of EXCEDRIN later)
• Clinic Map
• Office information map
• Telephone triage map
• 18 Different ROLES
Current State Map
Our Future State
Establishing Pilots
• Four offices to pilot• 1 provider pilot champion per office
– IHA Family Medicine– Ann Arbor Family Practice– Brighton Family Care– Commonwealth Internal Medicine
Focusing the work
• Medical Assistant Role: – Changes to medical practice assistant
• RN/LPN office role• Office RN Care Manager
Focusing the work
• Revising job descriptions- 3 clinical office roles for supporting the patient and provider
• Establishing the appropriate tools for training the staff (current and future)
• Developing the training materials• Developing competency materials to support the
changes/ongoing training
Variations of the Pilot
• Family Care Team approach championed by Dr. Peter Anderson in his book: “Liberating the Family Physician”.
• No additional resources/FTE’s associated with the pilot.• Budget neutral• Working within the scope of practice• Medication reconciliation and complexity of the patient
drive the scope of the work. • 1 provider/ 2 support staff
Planned Care: Implementing the Model
Care Mapping Diabetes
Health Changes Action Plan
Planned Care Follow-Up
Quality Measures
– Increasing Provider productivitygross margin/ visitvisits/month
-Increasing accuracy and completeness of documentation
% “plan in hand”% medication reconciliation accuracy
-Improve overall quality of careDiabetes/Adult Prevention Metrics
Quality Metrics
• Provider Satisfaction• (30-60-90)
• Amount of time able to spend with patients• Quality of Care you are able to provide• The amount of time spent working outside of the
office on office work• Staff are reliable to carry out orders
Quality Metrics
• Staff Satisfaction• My job makes good use of my skills and abilities• I feel empowered to go the extra mile when serving
our patients• At the end of the day, I feel less stressed and
better supported
Quality Metrics
• Patient Satisfaction• How prepared did you feel today coming in for your
visit?• How prepared did you feel to carry out your
plan/goals from the visit?• Were you happy with the time you spent with the
provider?
Maintaining the momentum
• Keeping the group meeting• Bi-monthly touch base calls with pilots• Regular updates at key leadership
meetings• Ongoing collaboration with I.T. for
infrastructure development.• Outcomes reporting• Integration into Healthstream
Our Future State… next steps
Completion of the pilot (late fall 2010)Definitive staffing model
Reporting of outcomes/pilot to leadership groupsImplementation of the new job roles/revised job descriptions
Role out to other divisions in the organization
Future:MBA reception role
Reception/billing specialistSupport team members: APN, Dietician, SW
It’s kind of fun to do the impossible!
Walt Disney