value stream mapping # 2 report discharge process (july …...value stream mapping # 2 report...
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Value Stream Mapping # 2 Report – Discharge Process (July 2017)
Presented at the JCC Meeting, November 14, 2017
by Regina Gomez, Director of Quality and
Jennifer Carton-Wade, Assistant Hospital Administrator
The Team
Gemba Sub-Teams
We broke into teams in order to observe:
• Case conferences
• Discharge huddles
• Resident care conferences
• Interdisciplinary resident care teams
• Individual members of the care team
Going to the Gemba
Processes Observation SummaryProcesses Observed Residents RN MD MSW Rehab
Case conference (initial)
4 10 12 8 6
Discharge assessment 2 5
Counseling plan 1 5 8 1
Medication pass 2 4
Therapy 1 5 3
Psychosocial support 1 6 1 2
Home evaluation 8 2
Patient education 2 6 5 1
Pack belongings 2
TOTAL: 113 8 26 29 35 15
105 hours of observation, 113 processes observed!
Education – lean overview and value stream mapping
Mapping the Current StateHot pink stickies for waiting
Yellow stickies for observations and wastesPink stickies for process steps
Blue stickies for ideas
Current State Data SummaryUnit: PMS S2
TimeCare
PlanningDC
ProcessCare
PlanningDC
Process
LT 1,490 46,750 2,925 75,460
LT in days 1 day 32 days 2 days 52 days
CT 50 490 45 500
WAIT 1,440 46,260 2,880 74,960
VA 50 465 22 380
NVA 1,1440 46,285 2,903 75,080
VA % 3.4% 1% 1% .5%
Summary of current state issues • No clear signal/notification of discharge date
• Home not ready (home eval not scheduled soon enough)
• Durable medical equipment (DME) delays
• Resident participation in discharge meeting
• Lack of a comprehensive discharge plan of care
• Non-standard discharge care plan meeting
• Multiple forms of discharge documentation
• No standard work for linkage/continued care referrals
Idea Generation
Idea Generation Reporting
Future State Mapmutual goals
care coordination
care transitions
resident empowerment
fostering confidence
health and wellness
Lean Concepts to Reflect in the Future State
Future State Data Summary
Current PMS Current S2Future
“Short Stay”
Care Planning
DC Process
Care Planning
DC Process
DC Process Only
LT 1,490 46,750 2,925 75,460 17,550
LT in days 1 day 32 days 2 days 52 days 12.2
CT 50 490 45 500 270
WAIT 1,440 46,260 2,880 74,960 17,280
VA 50 465 22 380 265
NVA 1,1440 46,285 2,903 75,080 17,305
VA % 3.4% 1% 1% .5% 1.4%
Total time for discharge post identification of DC date:
12.2 days in the future vs 32-52 days currently
Our Vision of the Future• Length of stay for short stay residents will drop from 84
to 54 days (a reduction of 36%)
• Lead time from identification of discharge to actual
discharge will drop from a range of 32-52 to 12.2 days
while maintaining time for treatment and care and
maintaining a safe and supportive environment
• Characteristics of the future state include:
Resident developing self-confidence for self-care
Enabling health and wellness of the resident post-
discharge
Fully integrating linkages to community resources
for the betterment of resident outcomes post-
discharge
Problem Statement
The number of residents discharged from Laguna Honda has
been declining over the past 3 fiscal years. Availability of
housing for the population served is increasingly more limited in
San Francisco. There is a need to focus on discharge planning
processes of residents who are able to return to their prior living
situation where housing is not a barrier to discharge.
Targets and Goals
By the end of FY 17-18,
1. Increase by 25% the number of residents (who
are short stay and have a home) discharged
back to the community within 60 days of
admission.
2. Reduce average LOS by 30% by improving
internal and external discharge planning care
coordination processes and reducing wait times
between processes. (Average LOS for S2 from
263 to 184 days, PM from 77 to 54 days)
Implementation Plan
Next Steps:
Just Do Its - 4
Kaizens - 3
Questions & Answers
Thank you.