webinar: transforming operational throughput – the journey toward value-based care
DESCRIPTION
At the 2014 Children’s Hospital Association Annual Leadership Conference, Huron Healthcare and Texas Children’s Hospital (TCH) presented an educational session on the journey toward value-based care. In the presentation, Huron Healthcare managing director, Larry Burnett, TCH Senior Vice President, Tabitha Rice, and TCH Assistant Vice President of nursing, Jackie Ward, shared valuable insights from their work together at TCH. Focusing on insights and results from TCH’s engagement with Huron Healthcare, the presentation includes: • Opportunities and results at TCH in areas including care management, care progression, patient placement, and care variation. • Keys to driving results, successful change, and integrated care delivery • Steps for a sustainable approachTRANSCRIPT
ANNUAL LEADERSHIP CONFERENCEOctober 12-14, 2014 • Palm Desert, California
Texas Children’s Hospital
Transforming Operational Throughput – The Journey Toward Value-Based Care
2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Agenda
• Learning Objectives• Background: A Changing Industry, About TCH• Opportunities and Challenges at TCH• Where We Began • Work to Date/Results: Care Management, Care
Progression, Patient Placement, and Care Variation• Strategies for Improvement • Lessons Learned• Next Steps• A Sustainable Approach/Conclusion
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2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Learning Objectives
• Identify strategies to enhance integrated care across the delivery system
• Learn specific initiatives to drive improvement in throughput efficiencies
• Understand outcomes from a financial, clinical, and operational perspective
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2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Background: A Changing Industry
Dynamics in health care are driving unprecedented change:
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Bottom Line: A Challenging Fiscal Environment
• Shifting from volume-based to value-based purchasing
• Shifting from experience-based to evidence-based care delivery
• Focusing on eliminating waste
2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Background: About Texas Children’s Hospital
• 503-bed not-for-profit hospital and academic medical center in Houston, TX
• Part of a 650-bed system• Mission to create a healthier
future for children and women throughout the global community by leading in patient care, education and research
• Consistently ranked among the top children’s hospitals in the nation
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2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Opportunities and Challenges at TCH
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Care Management
Patient Placement
Care Progression
Care Variation
2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Where We Began• Transactional approach to care management
– Operational inefficiencies in utilization management– Lack of integration of care management functions– Under-resourced, both in terms of people and tools
• Need for care progression– Above average severity-adjusted Length of Stay (LOS), compared to
risk-adjusted benchmarks– Lack of consistent, coordinated interdisciplinary rounds– Spending significant hours on census alerts and unable to
accommodate outside transfers
• Inadequate or insufficient tools to support patient placement – Inefficient bed turnaround, including environmental services support– Delays in placing patients from the ED and PACU
• Challenges in care variation– Payers shifting to DRG-based payment structure– Lack of consistency in utilization of evidence-based standards
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2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Work to Date: Care Management • Restructured Care Management department and recommended case
loads in line with national Care Management standard• Engaged over 20 Care Managers in weekly Clinical High Risk meetings
to collaboratively resolve barriers to efficient patient flow, efficient care, transitions to the next level of care and hospital reimbursement
• Redefined roles and responsibilities of department personnel, including utilization review, discharge/transition planning, avoidable day documentation, interaction with multidisciplinary team and utilization management
• Initiated a Care Management Medical Director to provide physician leadership and expertise related to Care Management practice
• Initiated an Access Care Manager role to increase the number of patients who are screened for appropriate status and level of care at the time of admission
• Implemented Morrisey, a Care Management software tool fordischarge planning, utilization review and other work flowmanagement
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2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Results: Care Management
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• Prioritizing patient load• Proactively anticipating and planning for discharge• Facilitating interdepartmental communication• Managing high-risk patients• Improving utilization management • Engaging physicians
2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Work to Date: Care Progression
• Established 11 daily multidisciplinary Care Progression Rounds (CPR) across 35 services to proactively plan for patient’s discharge with the care team and the patient/family
• Conducted over 1,500 CPRs (and counting) since project start with participation by over 500 physicians, nurses, and supporting care team members
• Created Epic Care Progression Rounds flow sheet to facilitate timely and efficient documentation of anticipated discharge dates and barriers to discharge (i.e., education, prescriptions, transportation)
• Increased effectiveness of Care Progression Rounds by leveraging a new Quality Review process and garnering timely feedback from participants
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2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Results: Care Progression
• Improving interdisciplinary communication and collaboration
• Improving patient and family involvement • Improving ability to proactively anticipate and
communicate discharge dates• Increasing patient, staff and physician satisfaction
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2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Work to Date: Patient Placement• Redesigned patient placement department and recommended caseloads to
support responsibilities that include bed assignment, level of care assessment prior to admission, and timely interaction with nursing units, nursing supervisors and physician advisors
• Centralized patient placement process, which allows resource nurses to spend more time assisting with patient care, reduces avoidable patient delays, and maximizes the space/beds available – including a process for nursing units to provide placement input to inform placement decisions
• Created a patient placement matrix to assist in identifying the appropriate unit for each patient based on services required
• Initiated Level of Care Reviews at admission, reducing denials and ensuring beds are available for the patients that need them most
• Upgraded to TeleTracking XT™ platform, which streamlines communication between the nursing units, Bed Management, EVS, and Patient Escort and improves our ability to proactively place patients in the right bed
• Trained over 600 TCH nurses, unit clerks, EVS, and Patient Escort staff on the TeleTracking system
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2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Results: Patient Placement
• Improved ability to ensure patients are placed into the right bed at the right time
• Instituted new process for census management• Consistent “Bed Turnaround Time” below 50 min
– Efficient housekeeping responses to high priority requests
• Use of PatientONTRAC Summary and Detail reports by clinical leadership to:– Drive staff performance– Share successes – Review areas of opportunity
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2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Work to Date: Care Variation• Worked with physicians, nurses, and ancillary providers in
select DRGs to:– Streamline care– Reduce variation– Enhance existing evidence-based standards of care
• Used lean methodology and processes as the structure to perform this work
• Developed future state vision of care processes for Diabetes and Pneumonia patients at TCH that align care with IOM dimensions of quality and safety
• Developed Pneumonia multidisciplinary care pathway to be integrated into Care Progression Rounds
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2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Results: Care Variation
• Developed interdisciplinary Care Pathway for patient care
• Implemented vision for Diabetes Center of Excellence
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2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Organizational Results⬇38% reduction in acute care red census alert
hours⬇8% reduction in hospital readmissions⬇Reduction in capacity-related transfer denials ⬆Significant improvement in admission, transfer
and discharge physician and nursing metrics• Significant improvements in Length of Stay (LOS)
⬇18 hour decrease in average LOS⬇13% decrease in severity-adjusted patient LOS
• Capacity to serve + 2,296 more inpatients per year
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2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Results: Severity Adjusted LOS
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2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Strategies for Improvement
• TCH partnered with Huron to expand solutions that ensure care is:✔Clinically appropriate✔Delivered efficiently✔According to evidence-based standards
• Focused on throughput initiatives to:⬆ Improve efficiency of patient flow⬆ Improve care delivery⬆Change satisfaction system-wide
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2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Lessons Learned
• Key to driving results:– Utilizing a team-oriented, process-and data-driven
approach, supplemented by enabling technologies– Bringing all team members together to work on necessary
components
• Key to driving successful change:– Proper structure and methodology– Leadership, data, devoted resources, communication and
implementation
• Key to integrated care delivery:– Physician/nurse partnership
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2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Next Steps
– Formal Patient Flow meetings – Clinical High Risk meetings, focusing
on patients with outlier LOS– Focus on specific patient populations
where variation is high– Extending the Care Management
model beyond hospital walls
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Continuing to build upon Huron engagement:
2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
A Sustainable Approach
• Huron’s tools and processes have enabled TCH to build on recent improvements
• TCH and Huron worked to create a sustainable solution
- TCH has seen additional improvements since the engagement and continues on a positive trajectory
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2014 ANNUAL LEADERSHIP CONFERENCE AND MEETING OF THE MEMBERSHIP
Contact InformationPresentations
www.childrenshospitals.net
Larry Burnett, RN, MSN
Managing Director, Huron Healthcare
Phone: (480) 892-2511
Email: [email protected]
Tabitha Rice, MBA
Senior Vice President, Texas Children’s Hospital
Email: [email protected]
Jackie Ward, MSN, RN
Assistant Vice President of Nursing, Texas Children’s Hospital
Email: [email protected]