AAMC’s Lean Journey

Presented by Mary Margaret Jackson, CPHQ

Chief Quality and Risk Officer

The Situation: Where We Are

• The future of Abbeville Area Medical Center as an independent community health system is threatened.

• Neither the status quo nor incremental changes in quality, cost, and the patient experience will be sufficient.

• AAMC's survival requires a shared disciplined approach to innovative improvement that will transform the way we do business.

• The success of the transformation will ultimately depend on the participation of all team members, volunteers, and physicians.

The Goal: Where We Need to Be

• AAMC will improve the value of our patient and family experience through higher quality, lower cost, and improved safety.

• We will eliminate waste from processes. • We will instill a culture of continuous

improvement. • Whenever possible, we will double the

good and half the bad. • We will focus on what is important!

Why are we implementing Lean?

• For several years, we have focused on improving our quality, finances, and the patient/family experience. To date, we have made only incremental changes in these measures. That is not acceptable.

• AAMC needs to make swift, breakthrough improvements to ensure its survival as an independent community health system.

What will Lean do for

AAMC?

• Lean is not another “program” or a short-term cost reduction plan.

• It is a ground-breaking initiative that utilizes Lean thinking to eliminate waste from processes and instill a culture of continuous improvement.

• It is a break-through change intended to transform the way we care for patients and their families.

• In short, it is the way we will operate and do business.

Who Will be Involved in Lean?

• EVERYONE!!!• All team members, physicians, and volunteers will

be involved.• Our success depends on everyone’s

participation.• We are even branching out to the community for

involvement. CPHQ1. Quality Leadership and StructureB. Leadership

3. Engage Stakeholders

•The Duke Endowment, in partnership with the South Carolina Hospital Association (SCHA) and the North Carolina Hospital Association (NCHA), awarded AAMC an innovative, opportunity to establish the Carolinas Rural Hospital Lean Culture Transformation Collaborative. •In year one, the grant funding was awarded to 4 hospitals in SC to improve operational, quality and financial performance, patient care, customer service and health outcomes of small, rural hospitals in South Carolina and North Carolina by implementing a lean operating system and culture.•AAMC has been paired with Newberry hospital to work through the Lean process for the past three years. CPHQ1. Quality Leadership and StructureB. Structure

3. Assist in selecting and using performance improvement approaches (e.g., PDCA, Six Sigma, Lean thinking)

Grant Funding

How will Lean work?

• Based on our goals, we will select departments or units on which to focus. For each of these focus departments, we will put together teams of about 4 to 6 team members, one-third of whom will be from the focus department, one-third will be from areas that interact with the focus department, and one-third will be those not involved with the department but who can provide a fresh perspective on the situation.

• Over a three-day + period, the team will partake in a Value Stream Analysis which will result in Rapid Improvement Events, RIEs, Projects, and Just Do Its.

How Many Teams Will We Have?

• During the third year on our Lean journey, we anticipated working in four Value Streams and conducting several Rapid Improvement Events in each, involving at least 41% of our full time and part time work force.

 I If Lean Eliminates Waste, Will

it lead to Layoffs?

• NO! Lean includes a redeployment policy, meaning that jobs will not be eliminated as part of a Lean project.

• In addition, we created a Lean Department, which created career developing opportunities.

• Lean will create opportunities. Those who serve on teams will have a chance to develop new skills.

• We have developed manager/leadership skills.CPHQB. Implementation and Evaluation

Establish teams and roles

CertificationsGreen/Bronze Certification:•Mary Margaret Jackson, Cindy Hill, Sharon Norryce, Charlotte Campbell (September 2013)•Carl Monson (November 2013)•Latressa Kennedy & Sherry Hall (March 2014)•Erin Stillinger & Sarah Rudder (Feb 2015)•Alberta Watt & Ernest Shock (July 2015)

CertificationsSilver Certification•Mary Margaret Jackson & Carl Monson (July 2014)•Erin Stillinger & Charlotte Campbell (Oct 2014)CPHQ3. Performance Measurement and Process ImprovementC. Education and Training

2. Provide training on performance/quality improvement, program development, and evaluation concepts.

TPOCTransformational Plan of Care

for AAMC was firstdeveloped October 4, 2012.

Reviewed quarterly, just completed our 9th review on

August 5, 2015

How have the Focus

Departments Been Chosen?• Senior Leadership assessed every department in the

hospital to identify the units in which rapid improvement would have the biggest impact throughout AAMC.

• The decision process included evaluating all opportunities for improvement.

• The four focus departments chosen are ED, Revenue Cycle (RVC), Health Related Home Care (HRHC) and Physician’s Practice.

CPHQ1. Quality Leadership and StructureA. Leadership

1. Support organizational commitment to quality

Mission Control Board is where we discuss the TPOC

• For the first two years AAMC executive leadership met at the Mission Control Board every week, recently we have gone to every 2 weeks.

• The meeting lasts for about 30 minutes and we have agendas that cover all of our topics

CPHQ1. Quality Leadership and StructureA. Leadership

1. Support organizational commitment to quality

Value Streams

• A VSA is 3 day event where a team of people who work in an area undertake a value stream mapping exercise as a way to see those activities that are either valued by the patient or are simply necessary to get through the internal processes that exist.

RIE’s

RIE (Rapid Improvement Event):

A 4.5 day process utilizing a team based methodology to apply the lean tools for seeing waste and

making immediate improvement. Used for Implementing Change.

Where do we go from here?

Added Value Stream in Inpatient

• Evaluate & Implement Swing Bed Charlotte Campbell

• Develop ED Business Plan Erin Stillinger

• Improve HRHC Admits and Recerts Tempie Gilmer

• Implement 340b Program for Outpatients Cynthia Glover

• Develop Comprehensive Plan To Increase Market Share – Tele-Health and Behavior Health Gregg Holtzclaw

• Physician Quality Reporting System

Dr. Chris Oxendine

Project Action Plan Value Stream ID:

Status KeyPostponed

Not StartedCompleted

On Track

BehindX Problem

Purpose of Project Owner Comp. Date

July

Aug

Sept

Oct

Nov

Dec

Jan

Feb.

Mar

Apr

May

June Overall Status Initial A3 Due Date

Reduce Readmissions MMJMarch 31, 2014 May 15, 2014 March

2015reviewed 9/1/14

Readmission rates for CHF, pneumonia, hip and knee to any hospital; Returns to the ED within 72 hours; percentage of non-emergent ED visits by HOP pts

Stay current with HOP requirements MMJJanuary 15, 2015

June 2015review 11/29/14

# of active HOP pts

Decide on how to roll out MedHost ES June 30, 2015 reviewed 12/3/14

Work to improve and maintain HCAHPS scores

ES March 15, 2015 review 8/29/14All 10 domains of HCAHPS

To determine follow-up care for indigent patients

Dr. Oxendine (Joe)

12/1/2014 5/30/15 review 11/09/14 -

Contract review by 12/31; implemented by 1/31/15

Ernest S.11/1/2014 1/31/15

4/15/15 5/15/15review 9/09/14

Assess annual competency and new hire orientation process for chosen

depts. Alice 4/30/2015

Paul Barrett Reported to QMC 3/15/2015

Laura Baughman 3/15/2015

Vonne Bullock Behind 3/15/2015

Debra Capdevilla On hold 3/15/2015

Rene Clamp On Track 3/15/2015

Meg Davis 3/15/2015

James Day Behind 3/15/2015

Jeff Garrett 3/15/2015

Cynthia Glover Reported to QMC 3/15/2015

Sherry Hall Behind 3/15/2015

Cindy Hill On Track 3/15/2015

Gregg Holtzclaw 3/15/2015

Mike Mattison 3/15/2015

Julie Moore On Track 3/15/2015

Danna Norman On Track 3/15/2015

Rhonda Riley On Track 3/15/2015

Judy Rudder Behind 3/15/2015

Tina Skinner Reported to QMC 3/15/2015

Tim Stewart Behind 3/15/2015

Terri Timmerman 3/15/2015

Kristie Warner 3/15/2015

Alberta Watt 3/15/2015

Janice White Reported to QMC 3/15/2015

Charlotte Campbell On Track

Erin Stillinger On Track

Tempie Gilmer On Track

Cynthia Glover On Track

Gregg Holtzclaw On Track

Dr. Chris Oxendine

2015Mary Margaret Jackson (MMJ), Alice Rigney (AR)

RVC, ED, HRHC, FMA, InPt

Date:

Next Review:

S-Bar

1 2

Description of metrics being tracked 8 9

A3 Status

6/30/2015

Exec SponsorProcess Owner

Tim Wren: RVC, Ernest Shock: ED & InPt, Joe Melikant: FMA

Competency Assessment

7Project Description

Care Transitions- BOOST

ED EMR Implementation

HCAHPS

6543

Planned Date (Shade): Complete:

HOP

Sleep studies

Indigent Care Plan

TAT

Informed consents

Patient Information Updated Prior to Each VisitHCAHPS

Sleep studies

Accessing Foundation funds

Linen

Reg and Pre-reg

Fax report requests

6S shop

Supply room in MSEH services to Physician Office

Reportable measures for quality

Reallocation of lab charges/supplies.

Brightree implementation

Reg MDI Organizing and labeling surgical supplies and supply room

Competency of Radiology staff

Scanning

IVIG

Payroll entryCapture Services Performed at Physician PracticesED Mobile Devices

Physician Quality Reporting System

Evaluate & Implement Swing Bed Develop ED Business PlanImprove HRHC Admits & RecertsImplement 340b Program for OutpatientsDevelop Comprehensive Plan to Increase Market Share - Tele-Health & Behavior Health

Questions??