Leading change and delivering value based care
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Leading Change and Delivering Value- Based Care. It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change. Charles Darwin. Step 1: Create a Sense of Urgency. Step 2: Pull Together the Guiding Team.

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Leading change and delivering value based care
Leading Change and Delivering Value- Based Care

  • It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change.

  • Charles Darwin





Strategy is differentiation
Strategy is Differentiation

  • Southwest Airlines?

  • Starbucks?

  • Apple?

  • Banner Health System?

  • Your Physician Practice?






Banner pediatric care pathways
BANNER PEDIATRIC CAREPATHWAYS

  • DEFINE : CLINICAL PRACTICES

    • ASTHMA

    • BRONCHIOLITIS

    • FEVER

    • ABSCESS-CELLULITIS

    • UTI

    • GASTROENTERITIS

    • ALTE


Banner pediatric care pathways1
BANNER PEDIATRIC CARE PATHWAYS

  • DESIGN AND IMPLEMENT

    • ORDER SETS

    • MEANINGFUL MEASURES


  • 4 year boy with no significant PMH

  • presents with a gluteal abscess (5*6cm)

  • and fever to 101.

  • Questions:

  • When should he get an I/D?

  • Antibiotics?

  • Admission?

  • Labs?

  • Pain Control?


  • 5 yo with mild persistent Asthma presents with RR 30; exp wheeze; s.c retractions; prolonged expiratory phase, and oxygen sats of 93%. Afebrile; Nl mental status.

  • Questions:

    • How to standardize initial treatment/weaning?

    • Need for oxygen?

    • Use of Atrovent?

    • Use of Xopenex?

    • Use of MDI vs Nebulizer?

    • Need for Xrays


  • does a 6 week old non toxic child require an l.P.? wheeze; s.c retractions; prolonged expiratory phase, and oxygen sats of 93%. Afebrile; Nl mental status.

  • does a 8 week old with fever and bronchiolitis require a urine culture?

  • how about a 7 month old non toxic immunized child--does he/she need a blood cx?

  • a 3 week old with fever-- does he/she need a cxray?


Technical quality how do we measure its about misuse overuse and underuse
Technical Quality--- how do we measure? wheeze; s.c retractions; prolonged expiratory phase, and oxygen sats of 93%. Afebrile; Nl mental status.Its about Misuse, Overuse and Underuse

  • Asthma: % steroids; % xrays; % use of “asthma protocol”;

  • Bronchiolitis: % bronchodilaotors, % cxrays; % steroids;

  • Fever: % 0-28 days-blood/urine/csfcx; 29 days-3 mo: % blood cx; >= 6 month immunized child: % blood culture


2 access to services
#2: Access to Services wheeze; s.c retractions; prolonged expiratory phase, and oxygen sats of 93%. Afebrile; Nl mental status.

  • Operational Efficiency

    • ED: LWOT, Readmissions, Length of Stay, Door to Provider

    • Inpatient: Discharges before 11am


3 functional status
#3 FUNCTIONAL STATUS wheeze; s.c retractions; prolonged expiratory phase, and oxygen sats of 93%. Afebrile; Nl mental status.

  • How Functional are your Patients after they leave the Care Setting

    • Coordination of Care

      • Connection to other providers (home health, PCP’s, subspecialists)

      • Patient Education


4 community health
#4 COMMUNITY HEALTH wheeze; s.c retractions; prolonged expiratory phase, and oxygen sats of 93%. Afebrile; Nl mental status.

  • POPULATION HEALTH MANAGEMENT

    • Reducing admission rates?

    • Reducing readmission rates?

    • Reducing ED utilization rates?

    • Compliance to plan of care?


The value equation1
THE VALUE EQUATION wheeze; s.c retractions; prolonged expiratory phase, and oxygen sats of 93%. Afebrile; Nl mental status.


Strategy structure system alignment
STRATEGY-STRUCTURE--SYSTEM ALIGNMENT wheeze; s.c retractions; prolonged expiratory phase, and oxygen sats of 93%. Afebrile; Nl mental status.


Alignment
Alignment wheeze; s.c retractions; prolonged expiratory phase, and oxygen sats of 93%. Afebrile; Nl mental status.

  • Physician Fee for Service vs DRG payment for Hospitals

  • Value Based Purchasing for Hospitals

  • Bundled Payment

  • Accountable Care Organizations


Step 4 communicate for understanding and buy in
Step 4: Communicate for Understanding and Buy-In wheeze; s.c retractions; prolonged expiratory phase, and oxygen sats of 93%. Afebrile; Nl mental status.


Step 7 create a new culture
Step 7: Create a New Culture. wheeze; s.c retractions; prolonged expiratory phase, and oxygen sats of 93%. Afebrile; Nl mental status.


Step 8 don t let up
Step 8: Don’t Let Up. wheeze; s.c retractions; prolonged expiratory phase, and oxygen sats of 93%. Afebrile; Nl mental status.

  • “We must become the change we want to see”

  • Mahatma Gandhi


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