1. Moving ACP Provider Satisfaction to Tier 1

2. Objectives Provide a broad stroke understanding of LEAN approach to problem solving How to build a “Fishbone” diagram that identifies problems or issues with ACP Engagement Sharing ways to improve ACP Engagement Case study at NHRMC

3. Key Principles of LEAN Eliminate Waste Improve Efficiency Improve Quality Improve Customer Satisfaction Save $$$

4. Culture Change Not a top down approach Enables staff to redesign work when recognize its not necessary or if they can achieve a better outcome Less meetings, more coaching

6. 8 Kinds of Waste D O W N T I M E Defects Over-production Waiting Not Clear Transporting Inventory Motion Excess Processing

7. Value Stream Mapping Observe current state Identify value and non-added value activities Observe work where its being done Map out process

9. Process for building the Fishbone Distribute sticky notes to all participants Ask a specific question Allow all participants to write one item on each sticky note and call time in 3 to 4 minutes Going around the room, each person shares one note Anyone else who wrote something similar shares their note and these go together in one category – name the category Go around the room until everyone’s notes are read

10. ACP Provider Engagement Invited all of the PA’s and NP’s to attend initial session regarding ACP Engagement Asked the question: What would you change that would make you feel the best about you and your job at the end of the day?

12. Responses The relationship with my MD. Positive feedback and respect. The relationship I have with my patients/families Direct link to a resource person at CHS Respected by my physicians Viewed as a provider

13. Describe things you would like to see changed NHRMC Physician Group does not provide recognition. No announcements to the community (this has already been fixed) Not sure who my employer is? CHS vs. NHRMC vs Administrator often with differing expectations Not sure who to contact for certain problems/issues Mixed communication/Receiving inaccurate information Not being included in the physicians’ lounge at NHRMC First name only on name badge. Does not acknowledge my role Desire regular team meetings with effective next steps. Seems nothing ever changes when we make suggestions. Want to operate at highest scope of my credentials with appropriate support Recognition and thank you from the physicians Sometimes I am an employee/sometimes I am a colleague

14. Response Categories Office Flow Documentation Issues Costs and Resources Scheduling Follow up with Patients EPIC Issues Prioritization Communication Appreciation

15. Communication Created the ACP Leadership Council Meets monthly 8 Team Members Representation on the Physician Leadership Council and on MD committees for EPIC and Quality

16. 16 Governance Structure PNLC Administrative Council PNLC Quality Subcommittee PNLC Epic Subcommitte e Co-led Governance and Committee Structure Co-Leaders: VACANT (Charlotte PNLC) Dan Goodwin (Charlotte PNLC) Co-Leaders: Amy Messier, M.D. (PNLC Member) Dan Goodwin (PNLC Member) Co-Leaders: Amy Messier, M.D. Melissa Davis (PNLC Member) ACP Leadership Council Co-Leaders: Megan Whitley, PA (PNLC Member) Kathy Gresham (Administrative)

17. Initiatives LEAN Training for Leadership ACP Site Visit book streamlined Input on Quality Matrix Optimization of EPIC strategies Review of Incident to billing Ideas for NP and PA week

18. Appreciation Rounding in the PA and NP Lounge Identifying low hanging fruit changes “Sweat the little stuff” PA and NP Week Congratulations Cake Popcorn Snack/Cheese Tray Cake Pops Ice Cream

19. Next Steps LEAN project to further develop the scope of the Leadership team and to develop a communication plan ACP meetings within each specialty group with Physicians to discuss process improvement Continue monthly leadership meetings Socials outside of office/hospital time

20. Questions Communication Respect Recognition