1. ©2013 MFMER | slide-1 “Creating a Culture of Caring and Safety” Maribeth Braaten, Michelle Enos and Carie Roseboom STFM Conference on Practice Improvement November 22, 2013

2. ©2013 MFMER | slide-2 Objectives Demographics Locations Patient make-up Employee make-up Drivers Timeline Challenges Pulling it all Together

3. ©2013 MFMER | slide-3 Mayo Health System

4. ©2013 MFMER | slide-4 Demographics ECH - Employee and Community Health Patient Panel - 139,992 Employees MD - 130 NP/PA - 79 AHS - 621 Locations Baldwin (CPAM, FM, PCIM) NE Family Clinic (CPAM, FM, PCIM) NW Family Clinic (CPAM, FM, PCIM) Kasson Family Medicine Clinic (Residency) Mayo Express Care (four locations)

5. ©2013 MFMER | slide-5 Our World Baldwin Family Medicine Employees MD – 23 NP/PA 10 AHS-(support staff) 150 Patients – 30,556 Patients are made up of clinic employees and the community within about 50 mile radius. Challenge of out of “catchment area”

6. ©2013 MFMER | slide-6 Mayo Health System

7. ©2013 MFMER | slide-7 What Drives Us? Patient’s Expectations Provider choice Preferred Appointment Time Quality Time with Provider Known history Affordable Cost Baldwin Family Medicine Expectations Manageable Patient Panel Adequate time for patient care Adequate Space Consistently working to the highest scope of practice Manageable work day

8. ©2013 MFMER | slide-8 ECH Expectations Standardization Define Patient Population Right Patient, Right Time, Right Place Metrics More with Less “Work Smart” Best Patient Experience at the Most Appropriate Cost to the System CARE TEAM

9. ©2013 MFMER | slide-9 2013 Timeline

10. ©2013 MFMER | slide-10 30 Minute Appointment Evolution of the Care Team Standardized Rooming Pre-Orders PSC/PAC Inbound Calls Space/Creative Placement Extended Hours Commitments to Safety Challenges, Opportunities and Successes

11. ©2013 MFMER | slide-11 30 Minute Appointment Slot Restructuring of Provider’s Template 30 minute appointment slots NVC – Non-Visit Care Staggered Start AHS scheduling changes

12. ©2013 MFMER | slide-12 Evolution of the Care Team AIDET Commitment to Safety Staff Morale and Maintenance PDSA Cycles Ongoing Feedback and Modifications Patient Satisfaction Celebrations!

13. ©2013 MFMER | slide-13 Standardized Rooming Report Time versus Appointment Time Intake Meaningful Use Flow Forms Preventative Services Medication Reconciliation Consistent Service Throughout ECH

14. ©2013 MFMER | slide-14 Pre-Orders Fully Utilized Staff/Skills Ownership Timely Care and Service Enhanced Engagement Opportunities for meeting and improving metrics Increased patient satisfaction

15. ©2013 MFMER | slide-15 PSC/PAC Inbound Calls History Staffing Impact on current roles Patient Satisfaction Staff Satisfaction Data Challenges

16. ©2013 MFMER | slide-16 Preparing to Implement Transitioned to provider and “team” nursing Team Composition Lab Experiments November 2013-one team Spring 2014-six teamlets

17. ©2013 MFMER | slide-17 Space – Creative Placement Focus on Opportunities-not deficits Encourage ideas Ever Evolving Co-location Shared Space

18. ©2013 MFMER | slide-18 Commitment to Safety Multi-disciplinary Staff Involved and Engaged Initiative to Promote Safety Teamwork Optimal Patient Care PDSA Cycles

19. ©2013 MFMER | slide-19 Ways to Support Staff Treat each as an individual Transparency – knowing when Multi-generational staff All suggestions/input valued Have goal related reviews Help them succeed Let them live what they love

20. ©2013 MFMER | slide-20 Dealing with Hardships Honest, Appropriate and Timely Communication Knowing when to “Breath” and Take a Step Back Recognize Mistakes (learning opportunities) and when to Re-group Recognition and Celebration of Successes

21. ©2013 MFMER | slide-21

22. ©2013 MFMER | slide-22 Trudy Teddy

23. ©2013 MFMER | slide-23 “Nothing great in the world has ever been accomplished without passion”. Georg Wilhelm Friedrich Hegel

24. ©2013 MFMER | slide-24 Questions & Discussion