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Doing More with Less:
How One Health System Improved Patient Experience
with an Efficient, Cost-Effective Operating Model
Discussion Guide
Introductions
North Shore-LIJ Health System:
At a Glance
Establishment of Need
Unique Challenges
Lessons Learned & Outcomes: Doing More with Less
Questions & Answers
2
About Our Speakers
Roe Long, RN, BSN, MBA: Vice President, Ambulatory Services at North
Shore-LIJ Health System
Leads Transformation and Operations for the Physician and Ambulatory Network
Services
25+ years of management experience in healthcare operations for hospitals and
medical groups
3
Rebecca Flink, RN, BSN, MHA: Senior Operations Planner, Hammes
Company
Led the design, development and implementation of operations of 150+ capital
projects for 20 years with a regional health system
Helped clinicians recognize specific need and identify operational model of care
and flow
Dave Connolly: Vice President & Architect, Hammes Company
Development and management of major healthcare project assignments nationally
Led the visioning session and development of prototype models for NS-LIJ
engagement
North Shore-LIJ Health System:
Establishing Needs
4
North Shore-LIJ Health System: At A Glance
5
– 16 award-winning hospitals (5
tertiary, 7 community, 3
specialty, 1 affiliate)
– 400 ambulatory physician
practices
– Long Island, Manhattan,
Queens and Staten Island –
service area with a population
of 7 million
Nation’s third largest non-profit, secular healthcare system
Nation’s sixth largest physician group practice – North Shore-LIJ
Medical Group
North Shore-LIJ Health System – Great Neck,
New York
A Comprehensive Strategy
6
Key planning elements:
Ambulatory Network Planning
Strategic Facility Planning
Key implementation elements:
Buy-in
Operationalize
Facility development
Establishment of Need
7
Develop the Ambulatory Network Plan
– Then apply tools / toolkit to implement
Deploy consistent, cost-effective approach
to ambulatory service deployments
Consolidate practices to build a consistent
operational model
Standardized practices:
– Benchmarks
– Kit of parts
– Prototyping
Build consensus internally with champions
Our Approach:
Visioning, Prototyping & Standardization
8
Preliminary Visioning Session
9
What Message Do We Send To Our Patients?
What Message Do We Send To
Our Staff?
What Message Do We Send To Our Physicians?
What Are Our ‘Big Ideas’?
Highest Quality Care
Actualize and EmpowerOur Staff
We Support Our Physicians
Value Our Patients
Guiding Principles
10
Form Follows Function Follow
Flow (Follows Funds)
Efficient Use of:Spaces
ProcessesSystems
Create Flexible Planning Tool Replicated As
Needed
“90/Rule”90% of What a
Care-Giver Needs is Within
5 Seconds of Where They
Need It
Patient Flow
11
GREETER / CONCIERGE
Welcome
Patient Information
Packet
MonitorWaiting
List of Daily Patients
Oversee (future)
Electronic Kiosk
Provide for Patient
Comforts / Questions
PATIENT / FAMILY LOUNGE
Appropriate Seating
Positive Distractions
Private Cell Booths
PATIENT SERVICE CENTER
“IN”
Insurance Verification
Collect Co-Pay
Insurance Consultation
EMR Updates• Demographics• Insurance
AdditionalCo-Pay
NextAppointment
Referrals
INTAKE
Weight / Height
Meds Check
Allergies
Vitals
PATIENT SERVICE CENTER“OUT”
EXAM
Consult Exam
Enter
Exit
ClinicalSummary
EKGAdditional Test
Referral
Prescription
Clinical Summary
Staffing Model
12
Off-SiteServices
4-6 Providers
Centralize Appointment SchedulingBilling Services (Future)
Surgery Scheduling (Future)
12.5 FTE’s(Does Not Include
Site Manager)
23.0 FTE’s(Does Not Include
Site Manager)
Provider Pod 2
Biller 1 FTEWithout EMR – Input ChargesWith EMR – Charges Go Direct
Medical Record 1 FTEWithout EMR - Pull / Org. Charts
for Patient DayWith EMR – Scan Paperwork
MA 1 FTEMD / PA
Provider 12-3 Exams
Biller 1 FTEWithout EMR – Input ChargesWith EMR – Charges Go Direct
Medical Record 1 FTEWithout EMR - Pull / Org. Charts
for Patient DayWith EMR – Scan Paperwork
Practice Manager# of Sites
Based on Size
MA 1 FTEMD / PA
Provider 22-3 Exams
MA 1 FTEMD / PA
Provider 32-3 Exams
MA 1 FTEMS / PA
Provider 42-3 Exams
MA 1 FTEMD / PA
Provider 52-3 Exams
MA 1 FTEMD / PA
Provider 62-3 Exams
4-6 Providers
MA 1 FTEMD / PA
Provider 12-3 Exams
MA 1 FTEMD / PA
Provider 22-3 Exams
MA 1 FTEMD / PA
Provider 32-3 Exams
MA 1 FTEMD / PA
Provider 42-3 Exams
MA 1 FTEMD / PA
Provider 52-3 Exams
MA 1 FTEMD / PA
Provider 62-3 Exams
ClinicalStaff Coordinator
1 FTE (RN)
Provider Pod Receptionist /
Greeter
Pod 1 1.5 FTEPod 2 .5
Additional FTE
Check Out Receptionist 2 FTESchedule Next Appointment
Referral ScheduleAnswer Phone Calls for Pod
Cross Function With MA
Check Out Receptionist 2 FTESchedule Next Appointment
Referral ScheduleAnswer Phone Calls for Pod
Cross Function With MA
Provider Pod 1
Unique Challenges
13
Unique Challenges
Urban setting
– Building new sites not feasible
– Inventory of ambulatory locations not
always designed for healthcare setting
Differences in markets
– Manhattan vs. Suffolk
– How do you differentiate yourself?
Managing expectations
– Differences across practices - tied to
geography, senior leadership and providers
– Physicians expecting perfection - versus following
the process of the Visioning Session
14
Lessons Learned & Outcomes
15
Lessons Learned & Outcomes
Buy-in and team consensus critical
– Visioning Session for new practices to
lead staff and physicians to design their
own future
– They will recognize challenges and need for
change – we will supply the toolkit
Lower-cost provider
– Value-based reimbursement future
– Must drive down expense yet remain productive and
efficient with a best practice patient experience
Prototype model
– Different for every health system – where you are and who you are
– Derived from culture, level of physician integration, market characteristics
and unique operational considerations
16
Questions & Answers
17
Please direct all inquires to:
webinars@hammesco.com
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