Venice Family Clinic QI Journey Despina Kayichian, MD Chief Medical Director

Objectives Identify some landmarks in our QI journey Share some tools we used Direction in 2016

PCMH Journey: Huddles 10/2014 Landmarks New COO 1/2013 VFC QI 2 years Initiativ 2013 QI Mgr 10/2013 QI Steering Cte 11/2013 UCLA Lean Academy 2014 New CMO 4/2014 PCMH Journey: Huddles 10/2014 QI Cte 5/2015

Some Tools… QI 101 QI Priorities Providers’ Dashboard Huddles/Patient Visit Planning (Azara DRVS) Learning Communities: CCI Innovation Catalyst Program; CCI SNAP (Safety Net Analytics Program)

QI 101… building the foundation for a data driven culture…

“I’ve got too much work to do to stop and listen to you” “The Tools Are Available” “The Tools Are Available”

QI 101…Lean Methodology Focus of process not people Learn Observation tools: TOS, Process mapping, Spaghetti Diagrams Identify waste 5 S Standard Work Root Cause Analysis Iterative PDCAs…Disseminate…Sustain

Goals of Lean Eliminate waste Maintain continuous flow Decrease variation Organize facilities, and supplier and customer interaction Satisfy customer/patient need perfectly “Level-load” production to match the rate of customer demand Patient involvement

Eight Wastes Defects Overproduction Waiting Not Utilizing Talent Lab needs to redraw tests due to incorrect order Registration paperwork having many redundant pages Provider waiting for patient to be roomed, and is not free to do other tasks Numerous ideas are “lost” only to be rediscovered later MD/Nurse time needlessly spent on clerical tasks instead of value-added tasks Transport Inventory Motion Extra-Processing Patients admitted are transferred to a unit with a similar level of care within hours of admission Expired supplies because of excess ordering Pharmacy tech spends time looking in multiple places for a particular med MA documents immunizations in multiple systems.

PDCA- Continuous Improvement Do Check Act Plan PDCA- Continuous Improvement The method by which we should be practicing continuous improvement in our daily work A tool to solve problems encountered while performing our daily work Plan Do Check Act Step 1 Clarify the Problem Step 2 Current State Step 3 Goals/Metrics Step 4 Analysis/ Root Cause Step 5 Plan & Implement Solutions Step 6 Evaluate Results Step 7 Standardize & Sustain

VFC QI Priorities

Providers’ Dashboard

Patient Visit Planning Care Team/Huddles/Checklists Patient Visit Planning (PVP)…challenges  solutions

Foundation for Success Patient Who (QI Team) Budget (Protected Time) IT (Azara DRVs) Know (Lean Academy)

Landmarks Budget New COO 1/2013 VFC QI Initiative 2013 QI Manager 10/2013 QI Steering Committee 11/2013 UCLA Lean Academy 2014 New CMO 4/2014 PCMH Journey: Huddles 10/2014 QI Committee 5/2015 Budget

QI Journey 2016 QI Workgroups tackling VFC QI Priorities; protected time for providers to participate. QI 101 to providers/front line staff Population management 2.0 Develop more QI champions/facilitators Learning communities My ultimate goal is to give back to the providers what was taken away from them in the post EHR era: to allow them to answer their patients’ concerns by looking into their eyes and not into the computer’s screen… Our organization’s goal is to have a robust quality foundation when we embark on the Alternative Payment Method journey…