Welcome to Orlando Enhanced Learning Session Patient Access and Wait Times Using Lean Methodology to Improve Patient Access in the Ambulatory Setting CHOC Children’s Hospital Orange, CA Using Lean Methodology to Improve Patient Access in the Ambulatory Setting Kathy Kolodge, RN, MHA Executive Director, Ambulatory Care Services Carmen Namenek, BA Project Manager, Ambulatory Administration Gina Cadogan, Manager, Patient Access Center About CHOC Children’s • Established in 1964 • 279 bed – main hospital in Orange • 54 bed hospital within a hospital in Mission Viejo • Four Centers of Excellence – Heart Institute – Neuroscience Institute – Orthopaedic Institute – Hyundai Cancer Institute Our Mission: To nurture, advance and protect the health and well-being of children. Our Vision: To be the leading destination for children’s health by providing exceptional and innovative care. CHOC Children’s Ambulatory Care Services • 5 Primary Care Community Clinics – 22,000 capitated members – 70,000 annual visits • 2 Mobile Health Clinics for Asthma care • Specialty Health Care Centers – 11 locations – 29 specialties – 140,000 clinic visits Organizations Will Be Shifting Care Models From Volume Based to Value Based Value-Driven Health Care • Superior outcomes based on evidence-based treatment • High quality, low cost • Encourages care coordination • Right care, right place, right time • Patient centered • Rewards health and prevention Cost Volume-Driven Health Care Value-Driven Health Care Quality 7 Ambulatory Care Strategy Success Hinges on Key Factors • Value Based Care: Patient-centered, evidence-based care that is incentivized to reward health and prevention (eg, superior quality at lower costs) • Care Re-Design: Development of efficient longitudinal care pathways that emphasize integration and prevention at lower costs (eg, medical home and collaborative care model) • Consumer Expectations: Changing expectations about access and convenience to pediatric subspecialty expertise • Integrated Ambulatory Care Networks: Strategic cornerstone for capturing market share, tertiary services and reducing gaps Why Redesign? • Patient/Family Satisfaction consistently less than optimal ranking in the lower percentile compared to peers. • Long waits for appointments with average next available 3rd appointment to specialty greater than 30 days. • Patient Cycle time averaging 106 minutes in specialty; 60 minutes in primary; Multidisciplinary clinics up to 250 minutes. • Ambulatory Care Center at capacity- unable to add additional providers or sessions Lean/ Six Sigma Lean Six Sigma merges the two disciplines of Lean and Six Sigma to eliminate steps that don’t have value, from a process using Lean tools & methodologies. • Lean – Lean focuses on eliminating waste from processes and increasing process speed by focusing on what customers actually consider quality, and working back from that. • Six Sigma – Six Sigma aims to eliminate process variation and make process improvements based on the customer definition of quality, and by measuring process performance and process change effects • KAIZEN - Means “Continuous Improvement” from the Japanese words KAI=change, ZEN=good Purpose of Kaizen • Achieve Rapid Design in Short Time Frame • Ability to Think Outside the Box • Develop Clearly Defined Blueprint • Deliverables at the End and Continuous Key Performance Indicator (KPI) Tracking Stakeholder Analysis Owner Responsible CHOC/CMF Champions Matt Niedswiecki Mitch Katz, MD CHOC, Outpatient Operations Kathy Kolodge Physicians:: Susan Clark, MD Mary Zupanc, MD Loan Hsieh, MD Anthony Chang, MD Anchalle Yuengsrigul, MD Subject Matter Experts Operations: Lisa Johnson Director Tinoosh Eftekharian –Mgr Dini Baker –Mgr Sarah Flores –Mgr De Meya Brewer–Mgr Gina Cadogan – Mgr, PAC Sandra Schultz, Mgr Customer Service Grace Leroy, Parent Carmen Namenek, Project Manager Dan Price, Dir Quality Support Administration: Hale Kuhlman Beth Rowett IT: Jason Fischer Karen Jones Buffy Schnurbusch Front Line Leaders: Becky Jenny, Charge Nurse Tammy Gulli, Access Supervisor Theresa Furtado, Charge Nurse Sandy De Los Rios, LVN Supervisor Michelle Beck, GI Supervisor CMF Project Charter CHOC outpatient specialty services has the desire to be positioned as a dominant fixture within the Southern California specialty services market. In order to achieve this goal the CHOC ambulatory care delivery system must accomplish the following: • Create a high quality, value driven delivery model that can be replicated in other specialties and settings. • Create an excellent place for a patient to receive care, for a provider to practice medicine, and for an associate to work. • Ensure the delivery model can sustain growth as defined by indicators such as providers, sessions, clinics, visits and financial resources. Priority Focus Areas Module 1 ENHANCING ACCESS Module 2 STREAMLINING REGISTRATION Module 3 IMPROVING PATIENT FLOW Module 4 ENSURING A COMPLETE DISCHARGE Module 5 MANAGING THE “IN BETWEEN VISIT” NEEDS Timeline May 2012 • Ambulatory Kaizen Event • Launch Project FY13 – Quarters 1 &2 • Launch Module One • Yellow Belt Training • Virtual Fax Go Live • Launch Module Two • Lean Enterprise Solution Beta Testing • Flow Facilitator Pilot FY13 – Quarters 3 & 4 • Patient Access Center Redesign • Kaizen Reunion • Registration Conversations Changed • Launch Module 3 • Pre/Post Clinic Huddles implemented FY14 – Quarters 1 &2 • Kiosk Project Launched • iRound Project • Green Belt Training • CA to MA transition • Division Phone Tree standardization Accountability Patient Access Center (PAC) • The Patient Access Center (PAC) is responsible for intake, authorizations, scheduling, appointment follow up and registration services for specialty care divisions. • Supporting 14 Specialties with more than 100 providers at 5 locations • Currently manage over 80,000 visits per year • The department’s vision is aligned with CHOC Children’s in improving the CHOC Experience for patients, families, providers and associates. • For many families, PAC is their first encounter with CHOC and Ambulatory Care Services. LEAN - Voice of the Customer Exercise We learned what families want from an access perspective CHOC Ambulatory Care Clinic Customer Persona Matrix Low (1) Med (5) Low Med Level of Impact High Low Med High (9) Goals Customer Segments Patient Family Access to appointments Patient Make visits convenient (needs of entire family) Access to appointments Effective and complete communication Standardization of appointments 9 9 9 9 9 9 9 9 5 9 9 Efficiency in scheduling Appointment coordination for one child and all children High 5 9 9 Is there a better way to get from here to there?...Yes! From 22 Phone Numbers • 8 Scheduling Phone Numbers • 14 Divisions Phone Numbers From 36 Fax Numbers • 8 PAC Fax Numbers • 14 Division fax number • 14 Clinic fax numbers To a centralized Phone # 1-888-770-2462 (1-888-770-CHOC) To a centralized Fax # 1-855-246-2329 (1-855-CHOC FAX) Before Redesign - Division-Based Teams After Redesign - Process-Based Teams Deployment Strategies • Stakeholder analysis • • • • • • Staffing model - Value Stream Map Training, skill validation and auditing Update current scheduling guidelines Revised Policy and Procedures Communication, Communication, Communication! Developed a Scorecard Measuring and Evaluating the Scheduling Process Key Performance Indicators (KPI) Team 1: Scheduling Abandoned Call Rate <8% Grade of Service >70% (The percentage of calls answered within 50 seconds Team 2: New Patient Coordination # of Days from Referral to Appointment Made Team 3: Pre-Registration (authorization and eligibility) Denial Rate <7% Team 4: Orders (authorization and coordination) # of days from order to completion Goal <15 days Team 5: Call and Confirm No Show Rate <10% Fill Rate >95% Grade of Service 90% % 84% 80% 85% 85 5% 85% 85% 8 83% GOS Goal >70% 77% 70% 60% 71% 66% 66% % 65% Added Physician Concierge Service which increased call volume. Enhanced services with existing resources. 56% % 50% 44% 40% Re-Design March 20, 2013 30% 20% 10% 0% July 2012 February 2013 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Abandon Call Rate 16% 14% 14% Added Physician Concierge Service which increased call volume. Enhanced services with existing resources. 12% 10% 10% 8% Abandon Rate <8% 9% % 8% 6% 8% Re-Design March 20, 2013 5% 4% 4% 2% 3% 3% 3% 3% 3% Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 0% July 2012 February 2013 Mar-13 Apr-13 May-13 Jun-13 Dec-13 Jan-14 Denial Rates 12% 10% 10% Denial Rate Goal <7% 8% 6% 6.30% 6.30% 5.50% 5.80% 5.10% 5.40% 5.00% 5.10% 4% 4.00% 4.00% 3.00% 2% 0% FY12 AVG FY13 YTD AVG Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Defect Opportunities 1. 2. 3. 4. 5. 6. 7. Abandon Call Rate (Goal <8%) Grade of Service (Goal >70%) PCP Referring Right Provider Right Location Return to Clinic order January 2014 Defects Per Opportunity (DPO) Number of Units x Number of opportunities/unit 2 defects = 0.009 DPO it x 7 opportunities/unit t iti / it 30 units Defects/Million Opportunities (DPMO) 0.009 x 1,000,000 = 9,000 DPMO 99% YIELD and 3.9 SIGMA Next Steps • Module 1 ENHANCING ACCESS – Clinical Team in PAC – Expansion of Physician Concierge Team • Module 2 STREAMLINING REGISTRATION – Person Management Training – Kiosk Upgrade • Module 3 IMPROVING PATIENT FLOW – CA to MA transition – Flow Facilitator Role • Module 4 ENSURING A COMPLETE DISCHARGE – Template Management • Module 5 MANAGING THE “IN BETWEEN VISIT” NEEDS – Care Coordination – Patient Portal Thank You! Presentations www.childrenshospitals.net/ Presenters Contact Information Kathy Kolodge, 714-509-8578 [email protected] Carmen Namenek, 714-509-4897 [email protected] Gina Cadogan, 714-509-4818 [email protected]