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Update on Effectiveness and Efficiency

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Presentation on theme: "Update on Effectiveness and Efficiency"— Presentation transcript:

1 Update on Effectiveness and Efficiency
Randy Harmatz March 2016

2 2015 Quality and Accountability Performance Scorecard Ranking
As you recall, in early October we recevied the news just before the BQC that our rating in the Q&A study dropped from 4 to 3 stars. We were very disappointed and took the time to analyze where we lost ground * 102 Academic Medical Centers, lower is better

3 2015 Quality and Accountability Performance Areas of Opportunity
Efficiency Measures Length of Stay Direct Cost . As we discussed at the last meeting, we shared that while we maintained a solid performance in the traditional quality metrics, (mortality and safety), we did not perform well in the areas of effiency and effectivenss …In addition, there was a change in the methodology which weighted more heavily these areas where have not performed as well As we will discuss in great detail, LOS directly impacts almost every other E&E measure….and it also impact most directly patient satisfaction. Patients waiting for long periods of time in our ED are less likely to feel we met their needs. To address LOS means we have to identify all the pieces and part of our system that delay timely discharge. Effectiveness Measures 30 Day Readmission Rate ED Time to Admission ED Time to Discharge * 102 Academic Medical Centers, lower is better

4 Call to Action Must improve outcomes while accommodating growth
Strategic meetings convened Hospital and Faculty Leaders Key Focus: Length of Stay and Patient Satisfaction Processes that are not connected but need to be Once we framed the problem we began to understand how to approach the solution Must improve outcomes while acomodating growth..”being full” is not an excuse Dr G convened meetings with hospital and faculty leaders to take action… Inter-related : Example here : Team doesn’t have a case manager, it delays post acute placement and results in a longer LOS and possibly patient dissatisfaction Another example if we don’t address end of life early higher lOS and more family distress identify the the “pieces of improving the effieincy and effectiveness puzzle

5 Patient Satisfaction LOS Reduction
Geo- Centricity Case Management Observation Unit Care Redesign Discharge Placement Palliative Care Patient Satisfaction LOS Reduction Hospice Community Engagement Voice of the Patient Identified pieces of the puzzle Review with you the plans for improvement that we well underway while we wont see improvement overnigt, by putting the right processes in place we will see sustained improvement Discharge Appointments

6 Geo- Centricity Case Management Observation Unit Care Redesign Discharge Placement Palliative Care Patient Satisfaction LOS Reduction Hospice Community Engagement Voice of the Patient Discharge Appointments

7 Case Management Revise case management structure and process
Implement pro-active discharge planning Ensure sufficient personnel and the right skillset mix Train Physician Advisors Engage patients/families First, we must address deficencies in case management An effective CM program is integral to managing LOS. Partner with physicians and assist with details Trained MDs to work with faculty

8 Geo- Centricity Observation Unit Care Redesign Discharge Placement Palliative Care Patient Satisfaction LOS Reduction Hospice Community Engagement Voice of the Patient Discharge Appointments

9 Observation Unit Cohort short-stay patients in central location
Set expectations Protocolize care Shared focus on rapid evaluation and treatment Access to resources Easy identification Same mental model Currently observations are all over the hospital. Pt dissatisfier, should improve pt flow and satisfaction.

10 Geo- centricity Care Redesign Discharge Placement Palliative Care Patient Satisfaction LOS Reduction Hospice Community Engagement Voice of the Patient Discharge Appointments

11 Geo-centricity Implement dedicated service- specific units
A focused team to improve care and efficiency Improve communication Good examples: neuro ICU Pilot on 74/75 (positive results) Patients with chronic conditions have a “home” Unit Supplies, equipment can be standradized..

12 Care Redesign Discharge Placement Palliative Care Patient Satisfaction LOS Reduction Hospice Community Engagement Voice of the Patient Discharge Appointments

13 Care Redesign Improve care processes to achieve appropriate utilization: imaging, lab, drugs, blood products, etc. Expand use evidence-based protocols Expand availability of diagnostic tests and therapeutic services (nights/weekends) Care Redesign Ultimate goal is to insure the best outcomes for our patients we need to make sure we are good stewards of resources. Supply chain

14 Discharge Placement Palliative Care Patient Satisfaction LOS Reduction Hospice Community Engagement Voice of the Patient Discharge Appointments

15 Palliative Care Expand availability of palliative care services
Earlier transition to the next level of care Engage patients/families/care givers in goal setting Palliative Care Reduces overuse of care Manage what you have (chronic condition) E.g. Liver tx pat, assessed, not eligible for tx. (article with an example)

16 Discharge Placement Patient Satisfaction LOS Reduction Hospice Community Engagement Voice of the Patient Discharge Appointments

17 Discharge Placement Address barriers to placement
External (payors) Internal (early communication) Increase use of UF Health Homecare New strategic partners (Select) Engage patients/families

18 Patient Satisfaction LOS Reduction Hospice Community Engagement Voice of the Patient Discharge Appointments

19 Discharge Appointments
Implement standardized process for timely follow-up appointments at the time of discharge Ensure continuity of care Expand market share Leverage technology/EPIC Discharge Appointments Monitor FUP compliance with appointments

20 Patient Satisfaction LOS Reduction Hospice Community Engagement Voice of the Patient

21 Hospice Expand “Hospice in Place”
Facilitate better utilization of local hospice agencies Expand resources for “end of life” planning End of life support to pt/family Continue to educate patient/family, physicians and health team ADVANCED DIRECTIVE – churches/senior center

22 Patient Satisfaction LOS Reduction Community Engagement Voice of the Patient

23 Community Engagement Community Engagement Expand successful community partnerships to improve care across the continuum Facilitate resources for safety net patients Address social determinants of health

24 Patient Satisfaction LOS Reduction Voice of the Patient

25 Voice of the Patient Patient/family an active member of the care team
Expand patient surveying in all settings Engage patients in all levels of care redesign (wayfinding, technology, etc.) AVS redesign Nothing about me witout me

26 Geo- Centricity Case Management Observation Unit Care Redesign Discharge Placement Palliative Care Patient Satisfaction LOS Reduction Hospice Community Engagement Voice of the Patient Discharge Appointments

27 The Perfect Patient Experience

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