1. UMHS Future State for the Ideal Patient Care Experience Presented by 2 nd year participants of the UMHS Healthcare Leadership Institute November 2006 This work is respectfully dedicated to the memory of our classmate, colleague and friend Thomas Carli, M.D.

2. Members: John Billi, MD Linda Larin Thomas Carli, MD Jeanne Rizzo Kathy Gold Marcy Waldinger Jeanne Kin Consultants: Judy Calhoun Dorene Markel Jim Ellis, MD David Pinsky, MD Lindsay Graham Heather Wurster Nadine Lewis Our “Change the World” members:

3. Crossing the Quality Chasm The IOM “Chasm” Report gives us a vision of where to go The IOM “Chasm” Report gives us a vision of where to go Lean Thinking gives us tools and methods to get there Lean Thinking gives us tools and methods to get there

4. The IOM “Chasm” Report gives us a vision of where to go The IOM “Chasm” Report gives us a vision of where to go Lean Thinking gives us tools and methods to get there Lean Thinking gives us tools and methods to get there Lean Thinking

5. “ Crossing the Quality Chasm” Six Aims Health care must be: Safe Effective Patient-centered Timely Efficient Equitable Source: Crossing the Quality Chasm: A New Health System for the 21st Century, Institute of Medicine, National Academy of Sciences, 2000.

6. “Crossing the Quality Chasm” Ten Rules For Care Care based on continuous healing relationships Customization based on patient needs and values The patient as source of control Shared knowledge and the free flow of information Evidence-based decision making Safety as a system property The need for transparency Anticipation of needs Continuous decrease in waste Cooperation among clinicians

7. UMHS Future State: The Ideal Patient Experience A. UMHS will create an advanced medical home for each patient that provides continuity of care, coordinates care across venues (inpatient, emergency care, outpatient, home care, procedures, non-UM) and promotes provider communication. The Advanced Medical Home: A Patient-Centered, Physician-Guided Model of Health Care. Policy Monograph of the American College of Physicians. January 22, 2006. pp. 1-21

8. UMHS Future State B. The patient will be the ultimate decision maker or source of control related to their care within medically appropriate options. This includes a free flow of information about the disease or illness; an assessment of the patients' options clearly articulated in a manner that they can understand; and the trusted clinician’s expert advice. The patient will make the decisions for their care to the degree they are most comfortable.

9. UMHS Future State C. UMHS will promote and utilize standardization to eliminate unjustified variability in all we do. This includes: eliminating inefficiencies, redundancy and waste; improving safety; providing greater consistency; and improving quality and appropriateness. C. UMHS will promote and utilize standardization to eliminate unjustified variability in all we do. This includes: eliminating inefficiencies, redundancy and waste; improving safety; providing greater consistency; and improving quality and appropriateness.

10. UMHS Future State D. Safety will be a system priority. This includes designing systems and processes that minimize the possibility of errors and supports and promotes safety initiatives throughout the Health System. D. Safety will be a system priority. This includes designing systems and processes that minimize the possibility of errors and supports and promotes safety initiatives throughout the Health System.

11. UMHS Future State E.We will create an environment of customer service for our patients and families. Every interaction with any faculty, health profession student and/or staff member will be one that exemplifies our caring and sensitivity with the goal to provide excellent customer service and a culture that reduces stress and promotes healing. E.We will create an environment of customer service for our patients and families. Every interaction with any faculty, health profession student and/or staff member will be one that exemplifies our caring and sensitivity with the goal to provide excellent customer service and a culture that reduces stress and promotes healing.

12. UMHS Future State F. Care will be coordinated around the medical needs of the patient in a manner that enhances their quality of life and future health. This also includes minimizing and managing handoffs, understanding the patients' goals, their lifestyle and making their health care work within that framework. F. Care will be coordinated around the medical needs of the patient in a manner that enhances their quality of life and future health. This also includes minimizing and managing handoffs, understanding the patients' goals, their lifestyle and making their health care work within that framework.

13. UMHS Future State G. We will provide facilities, amenities and aesthetics that promote health and well-being. This includes a clean, safe, and healing environment that is conducive to well-being. G. We will provide facilities, amenities and aesthetics that promote health and well-being. This includes a clean, safe, and healing environment that is conducive to well-being.

14. Points of Synergy/Convergence Ambulatory Care Operating Principles Ambulatory Care Operating Principles CVC: Transforming Cardiovascular Care CVC: Transforming Cardiovascular Care MVN CHOICES Program: ED & Throughput MVN CHOICES Program: ED & Throughput MVN Mission and Vision: UMHHC at Home: Creating Ideal Patient Transitions to Home MVN Mission and Vision: UMHHC at Home: Creating Ideal Patient Transitions to Home Children and Women’s Guiding Principles: Family Centered Care Children and Women’s Guiding Principles: Family Centered Care FGP/Ambulatory Care Integration and the Medical Management Center FGP/Ambulatory Care Integration and the Medical Management Center Service Excellence Initiative (Ellis, Childs) Service Excellence Initiative (Ellis, Childs) Michigan Quality System Michigan Quality System Ideal Employee Experience Ideal Employee Experience Criteria for selection of capital projects Criteria for selection of capital projects

15. Endorsements Health System Executive Group endorsed sharing across UMHS Health System Executive Group endorsed sharing across UMHS Endorsed by: Endorsed by: –Senior Leadership Council (Chairs and SMT) –CDA Group (CDAs, Amb Care Directors) –Faculty Group Practice Board

16. Next Steps Engagement, dialog, input, and endorsement from all UMHS leadership groups Engagement, dialog, input, and endorsement from all UMHS leadership groups Create an institutional awareness/common understanding of ideal patient experience Create an institutional awareness/common understanding of ideal patient experience –Clinical mission leaders direct initiatives to support the future state –Proposals are evaluated for their ability to move us toward future state –Ongoing moral support and necessary resources are provided to support initiatives that are aligned to support future state Ensure strong coordination with ideal employee/ provider experience Ensure strong coordination with ideal employee/ provider experience

17. Discussion and Feedback Do you endorse proposed future state? Do you endorse proposed future state? What improvements do you recommend? What improvements do you recommend? Your thoughts about next steps? Your thoughts about next steps? –What can we do to make this a reality? –What can you do to make this a reality? Other considerations or advice? Other considerations or advice?

18. References Crossing the Quality Chasm: A New Health System for the 21st Century Crossing the Quality Chasm: A New Health System for the 21st Century –newton.nap.edu/catalog/10027.html newton.nap.edu/catalog/10027.html Michigan Quality System Michigan Quality System –www.med.umich.edu/mqs www.med.umich.edu/mqs The Advanced Medical Home: A Patient- Centered, Physician-Guided Model of Health Care. Policy Monograph of the American College of Physicians. January 22, 2006. pp. 1-21. The Advanced Medical Home: A Patient- Centered, Physician-Guided Model of Health Care. Policy Monograph of the American College of Physicians. January 22, 2006. pp. 1-21. –www.acponline.org/hpp/adv_med.pdf www.acponline.org/hpp/adv_med.pdf