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Session #6 – Making Healthcare Waste Reduction and Patient Safety Actionable

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Poll Question

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Hotel Wi-Fi• HASummit14• PW: analytics

App Questions?• 3 app helpers• Raise hand with

mobile device• Walk to back

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Greg StockCEO, Thibodaux Regional Medical Center

Session #6 Making Healthcare Waste Reduction and Patient Safety Actionable

Mr. Stock has served for over 20 years as CEO of Thibodaux Regional Medical Center in Louisiana. He holds bachelors and masters degrees from Brigham Young University. He has served as CEO in three different HCA hospitals and in Northwest Hospital System in Arkansas. His career has been characterized by success stories of financial turnarounds, programmatic growth and growth in relationships with key stakeholders.

Dr. David A. Burton is the former Executive Chairman and CEO of Health Catalyst, and currently serves as a Senior Vice President, future product strategy. Before his first retirement, Dr. Burton served in a variety of executive positions in his 23-year career at Intermountain Healthcare, including founding Intermountain’s managed care plans and serving as a Senior Vice President and member of the Executive Committee. He holds an MD from Columbia University, did residency training in internal medicine at Massachusetts General Hospital and was board certified in Emergency Medicine.

David A. Burton, MD Former Chairman and CEO, Health Catalyst, Former Senior Executive, Intermountain Healthcare

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Poll Question #11) Which forms of waste do you feel have the greatest

opportunity for cost savings in your organization?

a) Ordering waste

b) Workflow waste

c) Defect waste

d) Unsure or not applicable

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Poll Question #22) How confident are you that your organization has a

good ability to identify waste opportunities?

a) Not at all confident

b) Somewhat confident

c) Moderately confident

d) Confident

e) Very confident

f) Unsure or not applicable

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Poll Question #33) How confident are you that your organization has the

ability to achieve cost savings through waste reduction?

a) Not at all confident

b) Somewhat confident

c) Moderately confident

d) Confident

e) Very confident

f) Unsure or not applicable

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Home(Patient Portal)

* To Invasive Care Processes

Clinic CareNon-recurrent

Clinic CareChronic Acute Medical

IP Med-SurgAcute Medical

IP ICU

Invasive Medical

Invasive Surgical

Diagnostic Work-up

Bedside care

Triage to Treatment Venue

Substance Preparation

Invasive* Subspecialist

Chronic Disease

Subspecialist

Screening & Preventive Symptoms

Procedure

Indications for Intervention

Diagnostic algorithms

Indications for Referral

Triage Criteria

Preventive, Diagnostic, Triage and Clinic Care, Algorithms; Referral & Intervention Indications (scientific flow)

Population Utilization

Knowledge Assets

Treatment and Monitoring Algorithms

Treatment and Monitoring Algorithms

Health Maintenance and Preventive Guidelines

Substance Selection

Substance Selection

Clinical Supply Chain Management

Admission Order SetsAdmission Order Sets

Supplementary Order Sets

Pre-Procedure Order Sets

Post-procedure Order Sets

Order sets and indications for selection of substances and clinical supplies (scientific-flow focus)

MD Per Case Knowledge

Assets

Post-procedure Care

Discharge

Bedside care practice guidelines, risk assessment and patient injury prevention protocols, bedside care procedures, transfer and discharge protocols

Standardized Follow-up

Post-acute care order setsIP (SNF, IRF)Home health

Hospice

Clinical ops procedure guidelines and patient injury prevention

Implementation of protocols based on MD orders and clinical operations-initiated activities (Lean/TPS workflow focus)

Clinical Ops Per Case Knowledge

Assets

Care Process Models

Value Stream Maps

The Anatomy of Healthcare Delivery

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Implementation of protocols based on MD orders and clinical operations-initiated activities (Lean/TPS workflow focus)

Clinical Ops Per Case Knowledge

Assets

Clinical OpsPer Case Utilization

Waste

Workflow Per Case

Waste

Clinical ops per case management

(individual patient focus)

Sample Metrics

Cost per caseNursing hours by unitOR minutesL&D minutesCycle timesCost per ancillary testEnvironmental services

Compliance with protocols for implementing care ordered

Population Health ManagementWaste reduction construct

PopulationUtilization

Waste

Per capita management

(population focus)

Sample Metrics

Admits/1000 membersIP days/1000 membersOP visits/1000 membersProcedures/1000 membersED visits/1000 membersReadmissions/1000 members

Compliance with value-based guidelines for diagnostic ordering, triage, referral and intervention

Per Capita Waste

Preventive, Diagnostic, Triage and Clinic Care, Algorithms; Referral & Intervention Indications

Population Utilization

Knowledge Assets

MD per case management

(individual patient focus)

MD Per Case Utilization

Waste

Sample Metrics

Cost/caseCost/procedureOR minutesL&D hoursOther LOS

Compliance with standard order sets, pharmaceutical, blood product and supply chain utilization

OrderingPer Case

Waste

Order sets, selection criteria (scientific-flow focus)

MD Per Case Knowledge

Assets

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Ordering Waste Workflow Waste Defect Waste

Ordering tests, care, substances and

supplies that do not add value

Variation in efficiency of delivering tests, care

and procedures ordered

Patient injuries incurred in delivering tests, care and procedures ordered

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Three forms of waste

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THIBODAUX REGIONAL MEDICAL CENTER

PURSUIT OF EXCELLENCEGreg Stock, CEO

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From Vision to RealityPatient Centered Excellence

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“Triple Aim”

Patient ExperienceClinical Quality Improvement

Cost-Effective Care

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Sustaining a High Level: Patient Experience

StatementsThibodau

x Regional

Terrebonne General Ochsner Our Lady

of LakeCleveland Clinic

East Jefferson

National Average

Nurses "Always" communicated well 87% 83% 75% 83% 83% 81% 78%

Doctors "Always" communicated well 89% 84% 79% 87% 82% 84% 81%

Patients "Always" received help as soon as they wanted 72% 65% 56% 63% 68% 59% 67%

Pain was "Always" well controlled 74% 73% 64% 75% 72% 72% 71%

Staff "Always" explained meds before giving it to them 68% 66% 59% 66% 66% 62% 64%

Room and bathroom were "Always" clean 79% 72% 60% 67% 78% 66% 73%

Area around room was "Always" quiet at night 78% 63% 60% 69% 57% 64% 60%

Patients reported YES, they were given information about their

recovery at home87% 85% 83% 87% 90% 84% 85%

Hospital rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest) 78% 69% 65% 75% 84% 73% 70%

Patients reported YES, they would definitely recommend the hospital 83% 69% 70% 76% 87% 76% 71%

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Performance Results

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Clinical Quality Improvement

51% Decrease in HAI’s since 2009 Zero VAP’s in 2013 & 2014

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Clinical Quality Improvement

58% below the national benchmark Patient acuity and severity of illness have increased steadily

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Thi-bo-

daux

Ter-re-

bonne

Ochsner

West Jef-fer-son

Our Lady of

the Lake

Baton Rouge

Teche Reg Grp Best Practice

2,000 2,500 3,000 3,500 4,000 4,500 5,000 5,500 6,000 6,500 7,000

4,370

5,600

6,119 6,535

6,341

4,837 4,886

6,033

5,028

Medicare Cost per Discharge (CMI ADJ) – 2013

Cost of Care

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No debt—Strong Cash Position

FY 2011 FY 2012 FY 2013 FY 2014 LA AVG NAT. AVG0

100

200

300

400

500436

501 492

430

48

172

DAYS CASH ON HAND

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Good News

“You are the low-cost provider”

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Bad News

“You are the low-cost provider”

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Employee Engagement Results

2001 2003 2005 2007 2009 20120%

20%

40%

60%

80%

100%

120%

93% 92% 97% 91% 91% 93%

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Productivity

TGMC vs. TRMC  FY 2013

Income Statements TGMC TRMC( in 000's or Thousands )  Net Revenue ( including Bad Debt ) $ 177,753 $ 152,021  

 Expenses  

 Salaries & Benefits $ 82,910 49.1% $ 66,319 43.6%Supplies & Materials $ 40,426 24.0% $ 33,006 21.7%

 If TGMC had TRMC %'s :  Salaries & Benefits $ 9,776 5.5%  Supplies & Materials $ 4,088 2.3%  

 Savings per year $ 13,865      

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Passion As A ValuePerformance From The Heart

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People can’t change

Awareness

Data

Knowledge

Beliefs

Values

Passion

Change

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Poll Question #4

4) How engaged is your medical staff in your healthcare transformation?

a) Not at all engaged

b) Somewhat engaged

c) Moderately engaged

d) Engaged

e) Very engaged

f) Unsure or not applicable

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Transforming an organization is the ultimate test of leadership. John P. Kotter, PhD

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Willie Nelson

What is the key to your success?“We play good music”

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The Future is Wellness

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Making waste reduction actionableDavid A. Burton, MD

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Population ordering waste reduction

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Sources of population ordering waste

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Population ordering waste reduction

Primary Care ordering variation within a population

Accessibility (emergency visits/1000 members) Diagnostics (laboratory tests, imaging studies)Compliance with value-based treatment and monitoring algorithms (office visits/1000 members, monitoring tests)

Therapeutics Substances (formulary compliance)Therapies (e.g., physical therapy)

Referrals to sub-specialists (compliance with indications for referral)

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Population ordering waste reductionCommunity Care dashboard

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Population ordering waste reduction

Admission ordering variation within a population. Triage to treatment venue based on objective clinical criteria (e.g., CURB-65 for Community Acquired Pneumonia)

Intervention variation within a populationAdditional diagnostic testing ordered by sub-specialist (lab test duplication; Dx studies) cath)

Compliance with indications for intervention for the applicable patient cohort

Facilitation of unbiased patient education regarding alternative treatment options for elective procedures

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Population ordering waste reductionNTSV C-Section rate with no induction attempt

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Per case ordering waste reduction (MD)

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Sources of per case ordering waste (MD)

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IP & OP per case ordering waste

Sources of ordering variation within a caseDiagnostics

Laboratory testsDiagnostic imaging studies

Therapeutics Therapies (e.g., respiratory, physical, et al) Substances (e.g., antibiotics, blood products)

Clinical supply chain (e.g., prosthetics, stents, synthetic bypass grafts, heart rhythm devices)Length of stay on a care unit

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Per case ordering waste

Approach and tools to wring out ordering wasteOrder sets. Evidence-based order sets for the Care Processes in the Pareto list to reduce variation in the ordering of simple diagnostic tests (lab, imaging)

Indications. Evidence-based indications and cost information to standardize utilization

Imaging tests (e.g., MRI, CT, US, nuclear scans) Substances (e.g., utilization criteria for blood, antibiotics, total parenteral nutrition)Major clinical supplies (e.g., joint prosthetics, cardiac and vascular stents, synthetic bypass grafts, heart rhythm devices, neurostimulators)

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Per case ordering wasteAppendectomy

Antibiotic order default changed on pre-op standing order set

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Per case ordering wasteAppendectomy

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Per case workflow waste reduction(clinical operations)

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Sources of per case workflow waste

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Workflow waste - surgical services

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Workflow waste – surgical services

reduce room turnover time

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IP per case waste reduction opportunityFacility perspective Per case ordering waste

Per case workflow waste

Per case defect waste

$144 MM~ 23%(100%)

Total IP per case waste

$57 MM*~ 9 %

(~40% of 23%)

$87 MM*~ 14 %

(~60% of 23%)

In Progress< 1** %* Preliminary Findings (work in progress)

** Extrapolated from OSHPD and CMS data

DRAFT

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Defect waste reduction

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• Ventilator-associated pneumonia (VAP)

• Adverse drug events (ADEs)

HAC cohorts/registries

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0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

% of Total Cost of Patient Injuries

% Total Cumulative %

Perc

ent T

otal

Cos

tPareto analysisCalifornia OSHPD data

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Pareto analysisRank-order list – CA OSHPD data

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Prevention processCLABSI flow diagram

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Defect waste reduction

CMS’s establishment of penalties weighted by measurement domain creates an incentive to choose CLABSI (#1) and CAUTI (#5) improvement initiatives (65% of total)

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Focus on workflow/defect waste

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Analytic Insights

AQuestions &

Answers

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Session Feedback Survey

1. On a scale of 1-5, how satisfied were you overall with this session?1) Not at all satisfied2) Somewhat satisfied3) Moderately satisfied4) Very satisfied5) Extremely satisfied

3. On a scale of 1-5, what level of interest would you have for additional, continued learning on this topic (articles, webinars, collaboration, training)?

1) No interest2) Some interest3) Moderate interest4) Very interested5) Extremely interested

2. What feedback or suggestions do you have?

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Upcoming Breakout Sessions

2:25 PM – 3:25 PM

9. Getting the Most Out of Your Data AnalystJohn Wadsworth, VP, Technical Operations Health Catalyst* This is a hands-on session

10. How to Make Analytics a Strategic, C-Level ImperativeJon Brown, VP and Associate CIO, Mission HealthGene Thomas, VP & CIO, Memorial Hospital Gulfport

11. Creating Physician EngagementBryan Oshiro, MD, CMO, Health CatalystChris D. Spahr, MD, Enterprise Quality Executive, CHW

12. User Group Kickoff & New Product RoadmapThomas D. Burton, SVP, Co-Founder, Health CatalystSteve Barlow, SVP & Co-Founder, Health CatalystHolly Rimmasch, Chief Clinical Officer, Health Catalyst* This is an interactive feedback session

Location

Grand Ballroom D

Grand Ballroom A

Savoy

Venezia