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