Optimizing PACE Operations and Efficiencies OPOE Program September

Optimizing PACE Operations and Efficiencies (OPOE) Program September 16, 2015

Introduction § Introduction to OPOE § Learning Collaborative Members: – – – 2 Arch. Care, New York – Henriette Kole and team Bienvivir, Texas – Rosemary Castillo and team Midland Care Connection, Kansas – Karren Weichert and team New. Courtland LIFE, Pennsylvania – Mary Austin and team PACE Organization of Rhode Island – Joan Kwiatkowski and team

Agenda § Introduction to Optimizing PACE Operations and Efficiencies (OPOE) § Learning Collaborative and Introductions § Lean Six Sigma in Healthcare § Program Description and Milestones § Roles & Responsibilities § Case Study § Logistics § Questions & Discussion

NOVACES Team § Brian Mac. Claren – Liaison to NPA § Dr. Bahadir Inozu – Project Director § Marliese Bartz – Program Manager, Green Belt Instructor – Consultant for Bienvivir and Midland Care Connection § Ed Vasko – Consultant for Arch. Care, New Courtland LIFE, and PACE Organization of Rhode Island § Charles Mount, CAPT USN (Ret. ) – Project Advisor

What is Lean Six Sigma? § To your organization … – – Increased value delivered to the patient A methodology for continuous improvement A management philosophy A data-driven culture § To you … – A new way of thinking – A focused approach to problem-solving – Management and leadership skills development 5

Lean in Healthcare § Frank and Lillian Gilbreth (Cheaper by the Dozen) wrote numerous articles regarding efficiencies in healthcare – First to promote nurses handing instruments to surgeons, eliminating unnecessary motion § Henry Ford actively promoted patient focused care as more efficient – Examined nursing process to eliminate unneeded steps citing that more time is spent in motion, than caring for patients § A 2009 ASQ Hospital Study showed that 53% of the hospitals reported some level of lean deployment. Examples include: – Clinical deployment • Surgery/operating room (61 percent of hospitals) and emergency department (60 percent) – Ancillary/support services deployment • Admissions/discharge (43 percent) and radiology/imaging (43 percent) – Non-clinical/support deployment • Purchasing/supply (36 percent), information systems (24 percent) and administration (24 percent) 6

Exposure to Lean Six Sigma § What have you seen, learned about or experienced with: – Lean Six Sigma? – Process Improvement? – Continuous Quality Improvement? 7

PACE OPOE Collaborative Roles ESTIMATED WEEKLY TIME COMMITMENT ROLE Champion Green Belt (2 Per PACE Site) Team Member (Subject Matter Expert) • • • EVENT PARTICIPATION 12 hours during workshop 1 hour per week • Champion Training • Webinars (4) • Workshop Report-Outs • PACE Conferences 30 hours during workshop week Up to 8 hours per week • Green Belt Training • Improvement Workshop #1 (Shadow) • Improvement Workshop #2 (Co-lead) • PACE Conferences Up to 30 hours during workshop As needed post workshop • Improvement Workshops #1 or #2 • PACE Conferences (optional)

Role: PACE Champion § Opportunity Selection – Identify the highest priority improvement opportunities and allocate resources – Communicate the need for change with clear problem statements, metrics and goals § Workshop Execution – Ensure the team stays focused on problem resolution – Approve and communicate process improvement action plans – Remove obstacles and provide resources to support project activities § Participation – – 1. 5 day Champion training Report out sessions by project team (throughout) 4 PACE Collaborative webinars (including this one) Winter Summit

Champion Training § Description – Training on how to champion improvement projects, organization, staff performance and an overview of Green Belt training – Selection of projects for each site § Commitment – 1. 5 days § Audience – PACE Champions/Executives § Schedule – September 29 -30 in Alexandria, VA

Role: PACE Green Belt § Workshop Execution § Coaching from consultant to become a lead facilitator and pursue certification § On-site support of pre and post improvement workshop activities § Participation – – – – 4. 5 days of Green Belt training Improvement workshop planning Improvement workshops (3 ½ days each) Project Management of Improvement Action Plan 3 PACE Collaborative Webinars Winter Summit Planning Winter Summit

Green Belt Training § Description – Training and hands-on simulations in Lean and Six Sigma concepts to lead continuous improvement projects – Mentoring on Project Charter development – First step in pursuing PACE Green Belt certification § Commitment – 4. 5 days in central location § Audience – PACE Green Belt Candidates § Tentative Schedule – November 16 -20 in Alexandria, VA (TENTATIVE)

Green Belt Certification § Complete Green Belt training § Successfully co-lead two improvement workshops under the guidance of a NOVACES consultant § Document improvements achieved § Goal: Become the resident expert at respective PACE sites and continue leading future improvement workshops independently 13

Role: PACE Team Member § Workshop Execution – Involvement in workshop as a subject matter expert – Supporting implementation of improvement action items § Participation – – – Involvement in improvement workshop planning Improvement workshops (3 ½ days) Support of improvement action plan Selected Collaborative Webinars Winter Summit (Optional)

What Are Improvement Workshops? § A fast-paced and focused problem-solving event § Both action and team-oriented, that uses data to make rapid improvements to a process § A cross-functional team focuses on designing solutions to achieve well defined goals § Other common names are Kaizen and Rapid Improvement Event § Run as a single event, which typically lasts 5 days or less § Follow-Up Phase is designed to complete an action plan and sustain improvements 15

Improvement Workshops 1 & 2 § Commitment – – 3. 5 days for workshop at site location Weekly update calls/meetings with team (as determined) Bi-weekly mentoring calls (Green Belts only) Implementation of improvements (as needed) § Audience – PACE Green Belt Candidates and SME’s (Team) § Time-Frame – Staggered December 2015 thru March 2016

Case Study § University of Alberta Hospital (2012) § Situation: – Emergency Department experiencing longer than desired emergency department length of stay (ED-LOS) for patients – Goal for ED-LOS was 8 hrs. ≥ 60% of Patients but increasing to 90% by 2015 – Average ED-LOS was 17. 6 hrs. for Family Medicine & 16. 3 hrs. for General Internal Medicine § Rapid Improvement Workshops held to find opportunities for improvement

Case Study (continued) 18

Case Study (continued) § Changes to ED process were piloted with the following results GIM LOS dropped 43% 19 & FM dropped by 28%

Case Study (continued) n& y! o i t a ke nic s u i f m f Com t by sta en m e lv invo 20

PACE OPOE Collaborative Webinars § Description – Virtual sharing of experiences, lessons learned, challenges, and updates on sites’ progress § Commitment – Total of 4 one-hour webinars (including this one) – Participation in preparing and delivering short presentations § Audience – Champions, Green Belts, NPA Leaders

Scheduling § Sam K. will facilitate activities for the Collaborative – Champion training, Green Belt training, Webinars and Summit(s) § NOVACES will coordinate directly with PACE sites for the improvement workshops and project-specific activities

Questions & Discussion QUESTIONS? 23

Appendix