Redesigning Specialty Practices from a Balanced Systems Perspective. 7 th International Summit of Office Redesign Institute for Healthcare Improvement March 20, 2006 9:30-12:30 Marjorie Godfrey, Carolyn Kerrigan, Barbara Rieseberg Dartmouth-Hitchcock Medical Center.
7th International Summit of Office Redesign
Institute for Healthcare Improvement
March 20, 2006
Marjorie Godfrey, Carolyn Kerrigan, Barbara Rieseberg
Dartmouth-Hitchcock Medical Center
9:30-9:45 Welcome & Introductions MG
9:45-9:55An Overview of Plastic Surgery CK
9:55-10:15 The Facts BR
10:15-11:25 How to discover “The Facts” MG
The 5 Ps
11:25-12:25 The “Rest” of the Story CK & BR
Huddles, SMAs & SBITRs
12:25-12:30 Summary & Evaluation MG
Partner with our customers to improve form and function for better living
6 surgeons 2 residents Perspective
4 nurses 2 LNAs
4.3 physician FTEs seeing ‘all comers’
2.0 resident FTEs
.50 FTE nurse practitioner
…..underutilized, limited to wound specialty care
5.6 nurse FTEs – 4.60 RNs; 1.0 LPN
…..work not requiring their license/ training
3.7 secretarial FTEs – diversified work
…..appointments, surgeries, academic support, etc
“If you want to build a ship, don’t drum up the men to go to the forest to gather wood, saw it, and nail the planks together…
Instead, teach them the desire for the sea.”
-Antoine de Saint-Exupfery; French WWII Pilot
The “Place” where patients, families and health care teams meet.
Acute care well?
A “Generic” Clinical Microsystem model
Satisfaction of need, monitoring, assessment of outputs
Plan for care
Beneficiary knowledge, including knowledge of life
while not in direct contact with the health care system
Use the Assess, Diagnose & Treat Your Specialty Practice Workbook to diagnose the strengths of your microsystem and to start identifying improvement opportunities.
PATIENTS … well?
Involving the patient & family in the process
Involving the microsystem players in the processCaring for Patients & Growing Microsystems
Specialty Practice well?
“There are no inferior jobs in any organization. No matter what the assigned task, if it is done well and with dignity, it contributes to the function of everything around it and should be valued accordingly by all.”
Dr. Charles H. Mayo
“The doctors often tell us that they couldn’t do their work without us. Our custodial staff receives a lot of positive feedback. It makes us feel like equal members of the team.”
Know Your Core and Supporting Processes work without us. Our custodial staff receives a lot of positive feedback. It makes us feel like equal members of the team.”
Aim: Practice “Assessing Your Specialty Practice” with a case study.
“Our hunch is that changes are likely to last longer when they can be incorporated into the structures and habits of the way we work”
Discipline: Focused Projects work without us. Our custodial staff receives a lot of positive feedback. It makes us feel like equal members of the team.”
Think out of the bowl! work without us. Our custodial staff receives a lot of positive feedback. It makes us feel like equal members of the team.”
http://www.claypaky.it/common/press/art_cirque.htm work without us. Our custodial staff receives a lot of positive feedback. It makes us feel like equal members of the team.”Choreography
Detailed mock up of patient flow
Detailed mock up of provider flow
Changing role of RNsImprovement Ideas:
Secretarial scheduling/patient information information
Patient self-report of medical history using electronic survey tool
Space utilization and décor for group room
Modification of Patient Satisfaction SurveyImprovement Ideas (cont’d):
45 min information
90 -120 min
To: Carolyn Kerrigan, MD, Elyse E. Pringle
Subject: Recent BRITE Appointment
Date: Wed, 24 Sep 2003
Hello - Thank you very much for making my recent visit with you and the staff so welcoming, informative, and worthwhile. I felt very comfortable in the group setting and think it is an excellent format for providing information and attention to women who have individual needs but shared concerns.
Thank you again…
Surgeon booked in 1 room information
Surgeon booked in 2 rooms
% Booked information