Presentation is loading. Please wait.

Presentation is loading. Please wait.

The Phoenix Project Integrating Effective Disease Management Into Primary Care Using Lean Six-Sigma Tools John Oujiri, MD Cynthia Ferrara, MS St. Marys/Duluth.

Similar presentations

Presentation on theme: "The Phoenix Project Integrating Effective Disease Management Into Primary Care Using Lean Six-Sigma Tools John Oujiri, MD Cynthia Ferrara, MS St. Marys/Duluth."— Presentation transcript:

1 The Phoenix Project Integrating Effective Disease Management Into Primary Care Using Lean Six-Sigma Tools John Oujiri, MD Cynthia Ferrara, MS St. Marys/Duluth Clinic Health System

2 Integrated health system Main Campus in Duluth,MN with three neighborhood sites 16 regional clinics throughout northeast MN and northwest WI 400+ physicians St. Marys/Duluth Clinic Health System (SMDC)

3 SMDC clinics are located over 25,000 square miles and serve a population of nearly half a million people 18.7 people per square mile 11.4% of population below poverty level (2004)

4 Develop a standard set of workflows for delivering evidence-based care that provides a consistent clinical experience for patients and a consistent process for care teams. Differentiate our organization to payers, employer groups, and government agencies. Goal of Phoenix Project

5 Phoenix Lean Process Road Map 8.Control Phase On-going Sustain and Continuous Improvement 7.Staged Implementation Pilot Sites 1-3 Feb 08-July 08 6.Report to Sponsors November Midway Report and Feedback August Sponsor Update Frequent 3.Weekly Action Meetings Start: June Day Breakthrough Work-out June Pre-Launch Planning May 2007

6 Cross-functional teams from pilot sites (3) assembled to apply lean design concepts to core processes and systems in four-day event. Empowered to develop solutions/actions. Core Breakthrough Team Members: Staff and physicians from pilot sites and key leadership. 4-Day Breakthrough Work-Out

7 Value Stream Mapping Demonstrates waste, gaps and major constraints in care delivery Identifies value-added steps needed Captures the current reality Defines value from customer perspective Forms the basis for an implementation plan

8 Major Red Flags Identified Lack of consistency across clinics in key sub-processes, roles and workflows Under-utilization of EPIC (Electronic Health Record) capabilities and a variety of individual physician solutions rather than a system solution Daily mountains of rework by the most constrained resources in Primary Care Information Gaps at several critical points in the delivery of Primary Care. Waste identified during encounter and rooming process due to lack of any pre-visit planning Significant Patient Activation opportunity

9 Four guiding principles developed to help move from the current process to an effective and efficient model of care delivery. Do the right thing. Do it right

10 Phoenix Guiding Principles Practice to the full scope of licensure & abilities Automate work That No Human Should Do Create and implement a Common Way of Doing Things across the Duluth Clinic system Design Centralization into our process wherever it makes sense

11 Lean Strategies Applied Visual Management Use of simple signals and signs in EPIC Standardization Work gets done so that the outcomes are more predictable Mistake Proofing Building error prevention into the design of the process Constraints Analysis / Bottleneck Reduction Improving flow by designing to overcome resource constraints. Move work forward Automation T aking routine tracking tasks out of the hands of people and into EPIC


13 Elements of the New Design: Pre-Visit Planning Centralized, pre-visit planning takes place for every scheduled visit –Standard process, questions and protocols –Labs ordered per protocol –Health Maintenance alerts Initial Med Review takes place before patient appointment

14 Lab First tasks are completed prior to rooming A standardized rooming process (i.e. socks/shoes off for diabetic visits, BP measurement, depression screening) Med Review by CA at rooming Load and pend Best Practice Alerts for physician order approval Elements of the New Design: Check-in and Rooming

15 Information needed for the encounter has already been prepped for provider Provider will: –Reconcile med list –Update Problem List –Make a follow-up appt plan with each visit –Enter future orders –Support patients behavior change efforts –Enter patient instructions Elements of the New Design: Physician/Credentialed Practitioner

16 Health risk, knowledge and activation assessment RN Coaching Model –Disease coaching and care coordination is a value- added service that payers have been willing to reimburse –Motivational Interviewing skills Use of enhanced take-home patient instructions Creation of a Disease Management Care Plan EPIC / MyHealth online tools allow patients to access their medical record, review labs, etc Elements of the New Design: Patient Activation

17 100% of patients are directed to check out Every patient receives an After Visit Summary –Communicates what occurred during the visit Includes instructions and updated Med List Next appointment scheduled Future labs ordered, per provider and protocol Elements of the New Design: Check-Out

18 Appears to be more complexity in the front end of process These additional up front process tasks represent Prevention of process rework and delays on the day of encounter Process Steps and Perceived Complexity

19 Process % of patients with: Completed pre-visit planning Health Maintenance alerts satisfied Lab orders complete Medication list reviewed RN coaching appointment (per selection criteria) After Visit Summary, Med list and next appt scheduled Control Phase Key Performance Metrics *Balanced Scorecard/Strategy Map Measures

20 Clinical * Optimal Diabetes Management: 25% Customer Service * Achieve 10% increase in overall patient satisfaction Financial: Physician and Staff Productivity * RVUs/Provider FTE * Direct Operating Margin * Encounters per Support Staff FTE

21 Feedback to Care Teams Routine reporting feedback loop Data is provided at physician,clinic and system level for all SMDC clinics Incorporates evidence-based guidelines in assessing quality performance Process and outcome measurement, evaluation and management Data is transparent within the health system

22 Diabetes Optimal Management % of Patients Meeting All 7 Measures** Phoenix Project Pilot Site 1 June 07-July 08 n=556 Implementation Feb 08 (*) Includes: A1C in last 6 monthsBlood Pressure <130/80 A1C <7%Tobacco Free LDL in last 12 monthsAnti-platelet use in patients over 40 y/o LDL <100 mg/dL.

23 DC-Clinic C Diabetes Management June 2007 – June 2008 n=981 Feedback to Physicians and Staff: Physician Level

24 Implementation Feb 08

25 Phoenix Project: Impact on Disease Management Integration of population-based disease management into routine care Decrease in missed opportunities for lab work and increased % of patients up-to-date (A1C, LDL, etc) Future appointments and labs scheduled before patient leaves the clinic, whenever possible Improved patient engagement in self-management –RN Coach: Alert fires within EHR for patients meeting criteria for referral –Patients receive After Visit Summary that clearly communicates what occurred during their visit, including instructions and next steps Prepared proactive care team –Lab results available at time of appt increase effectiveness of pt visit Intentional and focused efforts to enhance disease management has led to health plan collaboration and improved reimbursement structure

26 Ongoing Challenges Change Management –There is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things. Machiavelli, The Prince, 1513 Physician Engagement Clinical Inertia Unexplained Variance Reluctance in system to hold individuals accountable for implementation and results, i.e. culture of consequences No Net New –Ensuring that efficiencies gained allow for value added activities without increase in resources Value must be defined by external customer (patients and families) rather than internal (staff, physician, payers)

27 Lessons Learned Implementing lean thinking in a traditional health care culture is not for the faint of heart (IHI) Communication is essential Do not underestimate the response to change in status quo The vocal, unhappy minority cannot steer the ship Senior leadership support is invaluable Involve patients in planning process Not a quick fix –Improvement to metrics will take time –Will require sustained commitment Clear definition of roles and responsibilities will help project move forward You get what you expect and you deserve what you tolerate

28 Questions ?

29 Bibliography Averbeck B. Bringing evidence-based best practices into practice. Health Management Technology November Averbeck, Beth and Beth Waterman. (2007, May 17). Embedding Reliability in Ambulatory Care: The Care Model Process. Presented at the 2007 ICSI/IHI Colloquium at Minneapolis, Minnesota. Bodenheimer T., et al.: Improving primary care for patients with chronic illness. JAMA 288: ,October 9, Bodenheimer T., et al.: Improving primary care for patients with chronic illness. Part Two: The chronic care model. JAMA 288: ,October 16, Dorr D., et al.: Disease management: Implementing a multi-disease chronic care model in primary care using people and technology. Disease Management 9:1-15, February 1, Going Lean in Health Care. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; (Available on Norman, Gary, Kaczmarski, Phil, and Pexton, Carolyn. (2003, November 26). Integrating Six Sigma with Lean & Work-Out in Pexton, Carolyn. (2003, May 13). Framing the Need to Improve Health Care Using Six Sigma Methodologies. Selna, March. (2006, May 11). EHR-based Disease Management, Success & Challenges at Geisinger Health System. Presented at the 2006 Disease Management Colloquium at Philadelphia, Pennsylvania. Solberg L.,et al.: Challenges of Change: A qualitative study of chronic care model implementation. Annals of Family Medicine 4: , July-August Wagner E,et al.: Improving chronic illness care: Translating evidence into action. Health Affairs 20;64-78, November/December 2001.

Download ppt "The Phoenix Project Integrating Effective Disease Management Into Primary Care Using Lean Six-Sigma Tools John Oujiri, MD Cynthia Ferrara, MS St. Marys/Duluth."

Similar presentations

Ads by Google