Creation of a New Delivery Model

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• Creation of a New Delivery Model
• Jenny Redman-Schell, PT, MHA

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Learning Objectives

• Understand New Delivery Model
• Identify key components of the transformation
• Articulate improvements from the pilot site
• Understanding spread plan and overall insights

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Is a comprehensive, community-owned healthcare
system focused on achieving measurable, better
value for our customers. Our mission is to
improve the health of our communities.
Appleton Medical Center 160-Bed Acute
Care Medical Center
Theda Clark Medical Center 260-Bed Acute
Care Medical Center
New London Family Medical Center 25-Bed Acute
Care Medical Center
Riverside Medical Center 25-Bed Acute
Care Medical Center
Orthopedics Plus The New Standard for Quick, High
Quality Orthopedic Services In The Fox Cities
ThedaCare Physicians Employing Over 125
Physicians At 22 Locations
ThedaCare at Home Home Health, Hospice, DME,
Respiratory Therapy, Infusion, Pharmacy Services
ThedaCare at Work Occupational and Employee
Health Services, Employee Assistance Program
Ingenuity First Offers Innovative Solutions to
Employers For Health Care Costs
The Heritage/ Peabody Manor Continuing Care
Campus for Older Adults
Fox Cities Community Clinic A Free Clinic
Jointly Owned With St. Elizabeth Hospital
ThedaCare Behavioral Health Inpt and Outpt
Mental Health, Substance Abuse Services
Gold Cross Ambulance Service Jointly Owned
With Affinity Health Systems
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Mission the reason we are together
ThedaCares mission is to improve the health of
our communities
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Visiona picture of the ideal state to be achieved
To always set and deliver the highest standard
of health care performance in measurable and
visible ways so our customers are confident they
are making the right decision in choosing us.
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Strategy
The sum of all the things we do differently from
our competitors that create a unique value in the
eyes of the customer.
We will become a vibrant, growing health care
destination by providing a measurably better
value to our customers
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7/2/09 Ver. 4
TRUE NORTH METRICS
Safety/Quality - Preventable Mortality -
Medication Errors
Customer Satisfaction
- Access - Turnaround Time - Quality of Time
Financial Stewardship
People

• - OSHA Recordable Injuries
• Turnover (voluntary total)
• HAT Scores

- Operating Margin - Productivity
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MethodologyThedaCare Improvement System

• Value Stream Analysis
• Continuous Daily Improvement
• Leader Standard Work
• PDSA Template

Results
RESPECT FOR PEOPLE PDSA THINKING
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Respect for People

• No Layoff Policy
• Reassignment Process
• Learning to See
• Learning Environment Information flows freely
• Practice 5 Whys v. 5 Whos
• Use Data to Make Decisions
• No Blame
• No excuses Focus on Process not People
• People A3

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PDSA Thinking
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Value Stream Analysis

• Value Stream Analysis was completed for office
  visit
• Value Defined by Customer
• What Flows is the Patient
• Analysis of Value-Adding Steps
• Design Future State to Remove Waste and Maximize
  Flow
• 12-18 months of RIEs, Projects, and JDIs
• The What is known but not the How

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New Delivery Model Value Stream Initial State
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Future State Map
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Patient Experience
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Target State

• Customer Delighters
• Service Quality
• Convenient
• Access on-demand
• User-friendly
• Operates on-time
• Leaving with and understanding a plan of care
• Quality of time spent with patients
• Lab results before end of visit
• Clinical Quality Excellent/Far-exceeding
  industry trends

• Business Delighters
• Differentiated from all market competition
• - locally nationally
• Cost and productivity improvements of 5 to 10
  year over year

Critical Operational Success Factors
Org Structure Flow Cells
Access On Demand
Lab TAT/ Same Visit Ancillary Results
Pre- Registration
Alignment of Incentives, Policies,
Expectations Phys Comp
Role of MA
Standard Work Content Seq Timing Outcome Scripti
ng
Encounter TAT
Customer Service
Running on-Time Managing Flow Escalation
Plan of Care
Real-time Problem Solving
Leadership Model Coaching Managing to
Metrics Being in the Work Knowing the Business
Visual Tracking
Provider Staff Culture
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Continuous Daily Improvement

• Visual Management
• Staff Involvement in Problem Solving
• Maintenance and Improvement of Processes
• Answers are in the Work

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Key Components of the Work

• Transformation began in a pilot clinic
• Commitment document
• Understanding of baseline data and timings
• Risk assessment
• Cultural change plan
• 5S (sort, straighten, scrub, standardize,
  sustain) of exam/supply rooms
• Leadership daily standard work
• Epic training assessment

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Commitment Document

• Sections commitment to patients, commitment of
  providers, staff, administration, and clinic
• Written in the form of a compact gives and gets
• Tool is utilized often and gives framework for
  all process re-design

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New Delivery ModelKimberly Clinic
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New Delivery ModelKimberly Clinic
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New Delivery Model Kimberly Clinic
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Patient Feedback

• Quality of care along with friendly and helpful
  staff are the core drivers of patient delight
• New delivery model helps to reinforce the
  positive perceptions patients have of their
  clinic
• Rational benefits associated with new delivery
  model were time savings and quality of care
• New delivery model sets ThedaCare apart form
  other clinics

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Spread Plan

• Studied the work completed at pilot site
• Attempted to learn from others spread is hard!
• Developed plan for two VVS - divisional and site
  specific
• Divisional VVS completed foundational work that
  was common to all sites
• Task forces OD/HR, Education, IT, Lab
• Site specific VVS were developed with Physician
  leads Practice administrators
• Wave 1 six clinic sites

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New Delivery Model Wave 1Neenah Lab TAT
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New Delivery Model Wave 1IM Provider Sat
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New Delivery Model-Wave 1 Clintonville Service
Factor
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New Delivery Model - Wave 1New London DM
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Spread to Wave 2

• Completed Wave 1 review PDSA cycle
• Decision that spread plan was successful!
• Have greater physician engagement in work
• Added more clarity and action items to both
  divisional and site specific VVS
• Wave 2 includes seven clinic sites
• Currently in divisional VVS phase

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Overall Insights

• Hard work expect the icky ness phase
• Pilot site to learn from was extremely beneficial
• Need to have provider engagement leadership
• We have a spread plan that works
• Leadership standard work cant be underestimated
• Need to prioritize work so this transformation is
  not just an add on

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Jenny Redman-Schell [phone] jenny.redmansch
ell_at_thedacare.org