e8 helga avila - use of lean tools in operationalizing integrated care principles

Use of LeanTools in

OperationalizingIntegrated Care

Principles

Quality ForumPresentation

ByHelga Avila

Manager Process Improvement

February 27, 2013

MoH KRA 3

• Implement an integrated model of primary and community care to more effectively meet the needs of British Columbians, especially frail seniors and patients with chronic and mental health and substance use conditions.

VIHA Guiding Principles

• Comprehensive Services Across

the Care Continuum• Person/Patient Focus• Geographic Coverage and Population Served• Standardized Care Delivery through Inter-

Professional Teams• Quality Improvement

VIHA Guiding Principles

• Information Systems• Organizational Culture and

Leadership• Physician Integration• Governance Structure• Financial Management

Complexity of Need Triangle

Source: Kaiser and MOHS HCC Care Management Strategy

Level 1Well Population

No Risk but may have socioeconomic risk factors

Level 2 Supported Self Care & Management

Low Risk

Level 3Chronic Disease

Management CareHigh Risk

Level 4 Complex Care

High Risk Complex

Complexit y of N

eed

Individual Based

Population Based

↓ Disability & Complication

↓ Disability & Complication

Maintain Health & ↓ incidence of

disease

Maintain Health & ↓ incidence of

disease

Support respectful end

of life

Support respectful end

of life

Stay HealthyStay Healthy

Goals of Care

Care Managem

ent

Cultural Foundations

Source: Southcentral Foundation Nuka Model

• 1999 –redefined Vision, Mission, Key Points, Operational Principles

– Mission: Working together with the Native Community to achieve wellness through health and related services

– Vision: A Native Community that enjoys physical, mental, emotional and spiritual wellness

• Since –continual principle driven design

Organization

Source: Southcentral Foundation Nuka Model

Cornerstones

Source: Southcentral Foundation Nuka Model

Decision Making ModelDecision Making Model100

Patient/Family

“Control”

The “System”0

Low Acuity High

1. Control - who makes the final decision influencing outcome?2. Influences - family, friends, co-workers, religion, values, money3. Real opportunity to influence health costs/outcomes – influence

on the choices made - behavioural change4. Current model - tests, diagnosis, treatment (meds or procedures)

Source: Southcentral Foundation Nuka Model

• Healthcare has several ‘platforms’

• ICU/ER/OR – high tech, linear, mechanical• Procedures – linear, mechanical• Consultative – time limited, acute issue focused• Longitudinal relationship over time – chronic conditions,

outpatient, residential, behavioral health, primary care

• One size does not fit all – first two are product, manufacturing efforts –second two are service and knowledge efforts primarily

Reality

Source: Southcentral Foundation Nuka Model

• Health is a longitudinal journey

• Across decades• In a social, religious, family context• Highly influenced by values, beliefs, habits, and many

‘outside’ voices.• Office visits -brief, reactive stop-gaps

• Hospitalizations -brief, intense interruptions

• MUST fix basic, underlying primary care platform first or nothing else will work well

Reality

Source: Southcentral Foundation Nuka Model

• If the goal is population health over time• The major variables we can affect relate to

chronic conditions, habits, choices, optimizing impact of treatments

• Then…the backbone MUST be effective, longitudinal, personal coaching, teaching, supporting, coordinating relationship

• Office visits, procedures, hospitalization become episodes of care only

Rethinking the basic platform

Source: Southcentral Foundation Nuka Model

Evidence-Based Health System

Consultants

HospitalServices

SocialServicesIndividual/Family

Medical Home/Care Team

CommunityResources

PublicHealth

Note: The “Medical Home” is

likely not the “primary care”

that we currently have. Source: Southcentral Foundation Nuka Model

• Defining the purpose – relationship over time• Understanding complexity science -principles• Moving from product to service as the

fundamental base of entire system• Optimized primary care with redefined entire

system on that ‘new’ backbone/platform• Customer driven design –reallocation of power

and control at every level• Optimizing messy human relationships

The SCF Nuka Model

Source: Southcentral Foundation Nuka Model

Parallel Work Flow Redesign

Integrated Care Team

Medicationrefill

Chronic disease Monitoring

Management of study /test results Info

Undiagnosed orChanging new

Consumer concern

Preventivemed

Intervention

In clinicPoint of care

testing

Chronic DiseaseCompliance

Barriers

Acute MentalHealth

Concern

BehaviouralHealth

Consultant

CertifiedMedical

Assistant

ClinicalPharmacist

PCPProvider

DieticianCase

Manager

Source: Southcentral Foundation Nuka Model

Voice of the Customer – ‘Deep listening

• Multiple geographic advisory councils• Focus Groups• Comment cards• Customer Satisfaction surveys• SCF internet• Annual Gathering• Individual in depth interviews

•Elder Council •Listening Conference•Governing board•Staff Interactions•Service agreements•Individual complaints•Relatives and friends of staff•Customer Service staff

Source: Southcentral Foundation Nuka Model

Current State Mapping

• Integrated Health Network• Adult Mental Health• Child Youth & family• Senior’s Health• Diabetes Education• Heart Health

Patient Journey Mapping

• Patients and Caregivers• Complex• Multi-diagnosis

Future State Mapping

• Registering and Intake• Assessing• Initiating• Optimizing• Transitioning

Thank-you!Helga Avila, Manager Process Improvement

Vancouver Island Health Authority