Reengineering Collaborative Model Overview

1
Reengineering CollaborativeModel Overview

• Patient Visit Redesign Collaborative
• Francis A. Zampiello, MD
• Director
• Quality Center, Bureau of Primary Health Care,
  HRSA
• United States Public Health Service
• Department of Health and Human Services

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The Institute of Medicine Challenge

• Between the health care we have and the care we
  could have lies not just a gap, chasm. To
  Fill that chasm requires we work together to
  redesign health care processes
• Crossing the Quality Chasm,
• A New Health System for the 21st Century
• IOM March, 2001

3
Our Collaborative Itinerary

• Destination
• History
• Approach
• Model
• Results
• What It Can Mean to a CAP Grantee
• Why it Works

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The Patient Redesign Collaborative
Destination

• An initiative to dramatically reduce cycle time
  for patient visits to the health center by
  redesigning the patient medical visit

5
The Patient Redesign Collaborative History

• Started by a small group who worked in and with
  health centers
• An innovative new learning model
• Proven reengineering strategies
  in both CHC private sectors
• Medical Economics Jan-June, 2000
• Unique Opportunities May, 2000
• Family Practice Management May 2000
• MGMA Update September, 1999

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Redesign Collaboratives To-Date

• Northeast May - October, 1998
• Midwest May - October, 1999
• Pacific West Sept. - January, 2000
• Southeast Jan. - June, 2000
• West Central May - Oct., 2000

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The Redesign Collaborative Approach

• A six month learning laboratory
• Multiple organizations
• Rigorous team selection process
• External facilitation and coaching
• Rapid test cycles
• Focused on results

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The Redesign Collaborative Model

• Phases of
• Redesign
• Timeline

Understanding
Track patient visits Map patient visits Read
reengineering literature Document
patterns Analyze the data
Pre-work
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The Redesign Collaborative Model

• Phases of
• Redesign
• Timeline

Redesigning
Understanding
Experiment on paper
Track patient visits Map patient visits Read
reengineering literature Document
patterns Analyze the data
Learning Session 1
Pre-work
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The Redesign Collaborative Model

• Phases of
• Redesign
• Timeline

Testing
Rapid Redesign Tests Controlled tests (PDSA
cycles) of the concept model
Redesigning
Experiment on paper
Learning Session 2
Understanding
Track patient visits Map patient visits Read
reengineering literature Document
patterns Analyze the data
Action Period 1
Learning Session 1
Pre-work
11
The Redesign Collaborative Model

• Phases of
• Redesign
• Timeline

Implementing
Trial Run Continuous testing of redesign model
Testing
Rapid Redesign Tests Controlled tests (PDSA
cycles) of the concept model
Action Period 2
Redesigning
Experiment on paper
Learning Session 2
Understanding
Track patient visits Map patient visits Read
reengineering literature Document
patterns Analyze the data
Action Period 1
Learning Session 1
Pre-work
12
The Redesign Collaborative Model

• Phases of
• Redesign
• Timeline

Diffusing
Moving the model to other clinical areas or other
sites
Implementing
Trial Run Continuous testing of redesign model
Learning Session 3
Testing
Rapid Redesign Tests Controlled tests (PDSA
cycles) of the concept model
Action Period 2
Redesigning
Learning Session 2
Experiment on paper
Understanding
Track patient visits Map patient visits Read
reengineering literature Document
patterns Analyze the data
Action Period 1
Learning Session 1
Pre-work
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12 Redesign Principles

• Dont Move the Patient
• Start All Visits on Time
• Create Broad Work Roles
• Exploit Technology
• Ruthlessly Eliminate Waste
• Match Capacity to Demand

• Increase Clinician Support
• Get All the Tools You Need
• Plan for the Expected
• Do Todays Work Today
• Organize Patient Care Teams
• Communicate Directly

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Results Cycle Time
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Results Cycle Time
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Results Productivity
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Results Productivity
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Results Value-Added Time
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Case Study CAPs Reengineering Potential

• 10,000 Additional Patients Served
• 19 More Uninsured With Primary Care Homes
• Move from 36 to 55 Access in Six Months
• Save 2.28 Million Dollars in 100 Access
  Costs !

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Why It Works

• Competitive selection process
• Strong CEO/ED commitment
• Aggressive external coaching and mentoring
• Creative learning sessions
• Clear performance goals
• Focused on results
• Structured, time-driven
  framework

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You Have a Ticket to Ride...

• With an overview of the 6 month Redesign
  itinerary, you now understand
• The Redesign Goal, History, Approach,
• Model and Results
• Broad redesign application
• CAP Grantees
• Welcome Aboard
• The Innovation Express!

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Reengineering CollaborativeModel Overview

• Patient Visit Redesign Collaborative
• Francis A. Zampiello, MD
• Director
• Quality Center, Bureau of Primary Health Care,
  HRSA
• United States Public Health Service
• Department of Health and Human Services
• For further information contact
  fzampiello_at_hrsa.gov