TCPI Project Pathway: Session 5 of 8 Streamlining Clinical and Office Work – Milestone # 22 (27for primary care)

About the TCPI Milestones 22 Milestones for specialty practices 27 Milestones for primary care Scores on each milestone determine Phase completion For example, to complete Phase 1, as score of 3 is necessary on milestone 13 (setting an aim). Other phases require various scores for other milestones.

Milestone Classes Review Scoring and Strategies for Meeting Them (numbers in parentheses indicate milestone numbers for primary care) Each Milestone-Group Class will be held live 3 times: Quality Improvement Strategies and Action –milestones 14, 15, 16 (19, 20, and 21) (already held- recording available) Improvement Goals – milestones 1, 2, 3, 13 (1, 2, 3, 18) Staff Engagement: Teamwork and Joy – milestones 6 and 19 (6 and 24) Identifying Patient Risk and Using Best Practices – milestones 7, 11 (8, 9, 10, 16) Streamlining Clinical and Office Work – milestone 22 (27) Coordinated Care – milestones 8, 9, 10 (11, 12, 13, 14) Person and Family-Centered Care – milestones 4, 5, 12, 17 (4, 5, 7, 15, 17and 22 for primary care) Business Strategies – milestones 18, 20, 21 (23, 25, 26)

Today’s Objectives Review scoring for streamlining clinical and office work milestones: 22 (27 for primary care) Outline strategies for meeting each of these milestones Review relevance of milestones’ scores to phases Open discussion

Milestone 22 (27 for primary care): Practice has a formal approach to understanding its work processes and increasing the value of all processing steps. (A score of 3 is needed to complete Phase 4.)

Your Transformation Workplan – Practice Plan Tab

Strategies for Meeting Milestone 22 (27) Change Package – 3.4.1 Train staff in lean approaches and the concept of value Consider hiring or training internal experts in process improvement Use lean principles across the organization, such a defining waste and identifying value through the patient’s eyes Use process mapping to document workflows and identify value-add and non-value steps Convene regularly to discuss and improve workflows to optimize use of the EHR

What are my key processes? Patient Scheduled Appt – Patient Checked Out Same Day Appt Request – Patient Checked Out Patient Admitted in ED – Patient Scheduled Patient Seen – Pateint Discharged Others?

Process Mapping Helps Examine value to identify wastes and non-value added activities

Process Mapping Example with Swimlanes: PA Office Visit

Practical Process Mapping

What is Lean? What are Lean Principles? Business and problem solving philosophy based on providing value through continuous improvement The customer/patient comes first Identify Value-added versus non-value added steps in a process Improves Processes by Eliminating Waste

8 Types of Waste - DOWNTIME Defects Overproduction Waiting Not utilizing talent Transportation Inventory excess Motion Excess processing

Strategies (continued) Change package 3.4.2 – Eliminating Waste Use just in time inventory approaches Standardize exam room set up and supplies Optimize staffing on a daily basis to assure minimal down time of staff and space Centralized stock formulaic ordering with multisite facilities Establish pull production principles Put supplies in kits when frequently needed together Use spaghetti diagrams to track movement through the practice Cross train staff Standardize workflow across care teams and site where possible

Strategies from Change Package 3. 4 Strategies from Change Package 3.4.2 (continued) – Maximizing Provider Value Integrate behavioral health Incent effective team-based care Reduce exam room interruptions Eliminate phones from exam rooms; knock if needed Use technology where possible to reduce effort required by staff Define use case for exam rooms (e.g. nurse visit) Use standardized approaches for scheduling Optimize exam room workflow Translate productivity statistics to lost revenue to make the case to staff Use pagers for all staff to eliminate exam room interruptions Create a compensation model that does not create barriers to change Use protocols for non-licensed staff Expand number of support staff per provider; evaluate the model regularly Move from relative value unit-based compensation to relative value units plus performance metrics Optimize number of exam rooms per provider Use productivity measures that include non-visit related care Develop a walk-in care model Adjust schedules to account for no show

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Coming Next Week: Coordinated Care Specialty milestones: 8, 9, 10 Primary care milestones: 11, 12, 13, and 14