Sentara: Performance Improvement

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Sentara Performance Improvement
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Reinventing

• Reinventing was created in 1995 to
• Reduce annual costs by gt 50 M
• Help integrate Sentara
• Grow the business
• 14 Internal consultants.
• Masters Degrees, experienced, Black Belts .
• 2 Nurses, 4 Management Engineers, 3 Finance,
• 1 EdD, 2 Performance Management, 2 Ancillary
  Mgrs
• Purpose has evolved to
• Reduce Costs
• Redesign processes to exploit technology and new
  facilities (innovation)

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Reinventing Focus

• Run the Benchmarking Productivity Models
• 10-12 major performance improvement projects each
  year
• Major project teams are cross divisional
• All team members work on multiple projects
• Lead and support
• Collaborate with each other, other support
  departments and operations
• 1 consultant assigned to each hospital
• Q (Quality of idea) X A (Acceptance) E
  (Effectiveness)
• GE formula for Six Sigma success

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Organizational Structure
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Performance Improvement Processes

• Operational benchmarking
• Productivity
• Innovation/technology
• Reengineering, simulations, modeling
• Process Redesign
• Improvement projects
• Operational performance improvements
• Clinical performance improvements
• Outsourcing
• Six Sigma
• DMAIC
• DMADV
• Lean production
• Work outs

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1995-2002 Major Projects

• Project Annual savings
• Lab Redesign 7.0 M
• Supply Standardization/Management 4.5 M
• Registration/Coding 3.2 M
• LOS Reductions 5.2 M
• Denial Reductions 1.0 M
• SHM Improvements 10.1 M
• SMG/TMG Integration 9.6 M
• Clinical Engineering Outsourcing .8 M
• Dietary Outsourcing 1.5 M
• Transcription Outsourcing .5M
• Hospitals Benchmarking Improvements 28.6 M
• Total 72.0 M

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Benchmarking Productivity Driven Performance
Improvements
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Improvement Process
Data Reviewed for Top Opportunities Teams formed
Preliminary Assessment by team to COO Work Group
Report on How to get the savings COO work group
Results Hardwired to Budget
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Results

• Year 1 reduced costs by 12 M
• Year 2 reduced costs by approx 10 M
• Year 3 reduced costs by 7 M
• Success Environmental Services, Transcription,
  Pharmacy, Radiation Oncology, Supplies
• Misses Nursing, Medical Records, Patient
  Accounting
• Lessons learned
• Need productivity standards
• Need to benchmark FTEs not just dollars

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Why change the focus on improvement
engage an outside consultant?
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Outstanding Issues to Deal With

• Increasing pension liability
• Rising medical malpractice costs
• Increasing costs of technology
• Drug Eluting Stents
• Implants
• Rhythm Devices
• Expanding application of Implant Technology
• Physician support
• Changes in reimbursement
• Shortages of key clinical care givers
• Cyclical nature of health insurance profitability
• 900 M investment in new facilities technology
  over 5 years

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Two Pronged Approach to Improvement

• Call to action with management group
• 530 quality ideas submitted
• Several ideas already being implemented
• Engaged outside consultant
• System wide review
• 220 additional ideas
• Productivity standards
• Create process to prioritize and select projects
• Prioritized combined list of 750 ideas
• Teams and hospitals committed to achieve savings

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Year One Process

• Hospitals productivity savings/improvement ideas
• Each hospital assigned a Black Belt to help
  implement changes
• Departmental productivity improvements
• Other identified improvement ideas
• First phase of the changes is in 2004 budget
• Productivity system being modified to produce
  bi-weekly reports
• Hospital teams are reporting results to COO
  workgroup
• Performance improvement ideas
• Seven system-wide teams are working on
  improvement projects
• Each team has a Black Belt to help implement
  changes
• Progress is being monitored by Operations
  Committee

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Year Two Process

• Hospitals
• Black Belts will help redesign processes to
  realize savings
• Major initiatives include
• Redesign of Nursing Model
• Redesign of Medical Care management
• Other Departments who have biggest gap to
  standards
• Cost center simplification and workload unit
  standardization
• System-wide teams
• Black Belts will help teams implement complex
  projects
• Progress will continue to be monitored by
  Operations Committee

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Productivity Standard Implementation
2004
25
Reduction of Gap Actual to Standard
2005
35
2006
40
Reduction of Gap Actual to Standard
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Completed projects as of 9/3/03 Summary of
teams presentations

• Team Estimated Value
• Ancillaries 1,260K
• VPMA 550K
• Nursing 1,300K
• SMG/WCMG 300K
• SHM/MCC 15,900K
• Supplies 700K
• Corporate 7,671K
• Total annualized savings for 2004 27,681K
• (plus one time savings of 270K)
• There is some duplication between teams and
  hospitals completed projects (estimated to be
  less than 10)

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Completed projects as of 9/3/03 Summary of
hospitals presentations

• Hospital Estimated Value
• SNGH 4,575K
• SVBGH 1,636K
• SWCH 4,154K
• SBH 395K
• SCH 1,533K
• SLH 807K
• Total annualized savings for 2004 13,100K
• (plus one time 2003 savings of 380K)
• There is some duplication between teams and
  hospitals completed projects (estimated to be
  less than 10)

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Summary of productivity approach

• Lessons learned
• Correcting model/standards has been a huge task
• Messengers do get shot
• Providing support/help is essential to momentum
• Overall
• Results year to date exceed expectations.
• Much accomplished before/during outside
  consultants assessment.
• Perception is the fear factor provided
  motivation.
• Progress is being made and momentum maintained
• 40M in savings identified (more each month)
• Additional savings from productivity changes in
  budgets
• Many significant improvements (DMAIC/DMADV) will
  be needed to get to 2005 and 2006 standards

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Why change the focus on Improvement adopt a Six
Sigma approach/culture?
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2002 Six Sigma Activities

• Internal consultants needed updated tools.
• Training provided by Juran Institute in 2002.
• 41 Green Belts trained/certified by Juran
  Institute
• 19 improvement specialists
• 20 operational leaders, 2 physician leaders
• 8 project teams (2 clinical , 6 operational
  projects)
• 21 of the green belts became Black Belts
• Trained/certified by Juran Institute
• 19 improvement specialists
• 2 operational leaders

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Six Sigma Projects (2002)

• DMAIC
• Ventilator management in GICU (SNGH)
• Reduce LOS by 1 day saving .5M to 1M per year
• Glucose management of cardiac surgery patients
  (SNGH)
• 73 improvement of glucose levels within desired
  range
• Lab specimen throughput (Reference Lab)
• Increased STAT TAT from 48 to 63
• Radiology report availability (SWCH)
• Increased reports meeting expectations from 63
  to 96
• Central scheduling (SSH)
• Improved speed to answer by 44
• Medical care management authorization process
  (SNGH)
• Reduced inappropriate admissions

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Six Sigma Projects (2002 cont.)

• DMAIC
• Staffing resource improvements (SLC)
• Reduced annual agency expenditures by 289K (18)
• OR throughput (SCH)
• Improved first cases starting time from 24 to
  43
• Improved processes at SCH
• Reduced ED throughput time from
• Fast track 123 to 85 minutes
• Treated and released from 224 to 187 minutes
• Reduced time to schedule radiology appt from 7
  days to 1 day
• Reduced radiology time for registration complete
  to report signed from 14 hours to 3 hours
• Reduced average patient registration time from 20
  to 15 minutes

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Radiology Results
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Registration Results

• Reduced registration cycle time from 20 to 15
  minutes
• Reduced staff by 10 by matching staffing to
  demand.
• Revised schedule based on patient arrival
  patterns
• Patients arrive 29 minutes (avg) before scheduled
  appointment
• 25 patients arrive 10 minutes or less before
  appointment
• Improved wait time from registration to procedure
  from 34 Min to 8 Min.
• 93 agreed that todays visit met expectations
• Reduced delays in registration
• 50 of delays due to the patient forgetting their
  script
• Standardized script and increased faxing of
  scripts

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Registration Process Controls
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Six Sigma Projects (2002 cont.)

• DMADV
• Redesigned processes to exploit RIS/PACS
• Redesigned processes to optimize new facilities

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2003 Six Sigma Activities

• Black Belts/Green Belts continue to apply
  concepts
• SCH Imaging, Registration, Scheduling, ED
• SWCH Registration, Scheduling
• Seven system-wide performance improvement teams
• Several other projects
• 32 managers selected for 2003 Green Belt
  training
• Training/certification provided by Juran
  Institute
• Six project teams (2 clinical, 4 operational)
• Working with internal Black Belts

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Six Sigma projects (2003)

• DMAIC
• SWCH CHF Reduce of patients not achieving
  expected LOS from 44 to 29.
• SNGH Medical Records Increase of midnight
  paper results on chart by 0630 from 61 to 95.
• SNGH Cardiac Surgery DRGs Reduce of patient
  days greater than expected by 50.
• SHM Claims Reduce pended claims from 10.5 to
  5.25.
• SMHM Reduce worked hrs per inpatient case from
  4.0 to 3.0
• SH HR recruitment Reduce RN fill time from 76.5
  to 61.2 days

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2004 Priority Projects (Six Sigma, etc)

• Hospitals productivity improvements
• System-wide performance improvement teams
• ED throughput
• Six Sigma projects (replicate 2002, identify new
  projects)
• Radiology throughput (exploiting PACs/RIS/Voice)
• OR throughput (exploiting surgery/mats mgmnt
  system)
• Physician order entry (exploiting CPOE)
• Pre-reg reg process (exploiting patient
  tracking)
• Patient flow in redesigned hospitals
• Outsourcing support processes

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Summary

• Performance improvements is a multi-dimensional
  challenge which requires multiple approaches.
• Benchmarking is a key ingredient for success.
• Productivity standards are critical to achieving
  and holding the gains.
• Six Sigma (and other performance improvement
  tools) are necessary to
• Identify problems, causes and solutions for gaps
  to benchmark/productivity standards
• Exploit new technology or new facility designs
• All the above are irrelevant without the right
  team.
• All the above are irrelevant without operational
  ownership.