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

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

2. 2 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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5. 5 Visiona picture of the ideal state to be achieved

6. 6 Things to say: Our goal is simple, become a destination. This �measurably better value�, translates into delivering high quality at a low cost. Measurably better value= High Quality at Low Cost These are not tradeoffs Question to Ask: Is there any doubt in your minds that customers will increasingly make decisions based on the equation of cost and quality? (discuss) Things to say: Our goal is simple, become a destination. This �measurably better value�, translates into delivering high quality at a low cost. Measurably better value= High Quality at Low Cost These are not tradeoffs Question to Ask: Is there any doubt in your minds that customers will increasingly make decisions based on the equation of cost and quality? (discuss)

7. True North - Use this slide at the top center of an Area or Value Stream Improvement CenterTrue North - Use this slide at the top center of an Area or Value Stream Improvement Center

8. 8 MethodologyThedaCare Improvement System

9. 9 Respect for People No Layoff Policy Reassignment Process Learning to See Learning Environment � Information flows freely Practice �5 Why�s� v. �5 Who�s� Use Data to Make Decisions No Blame No excuses � Focus on Process not People People A3 Other behaviors and elements of respect for people are reflected in Thedacare�s commitment to a no layoff policy due to improvement, fostering a learning environment where problems are opportunities and because we practice 5 whys v 5 whose information flows freely and we can get to the root of the problem. In such an environment you see evidence of no blame or finger pointing, and ultimately no excuses, or we always do everything to address the problems with process standards and coach and train to them so we can get to no excuses Other behaviors and elements of respect for people are reflected in Thedacare�s commitment to a no layoff policy due to improvement, fostering a learning environment where problems are opportunities and because we practice 5 whys v 5 whose information flows freely and we can get to the root of the problem. In such an environment you see evidence of no blame or finger pointing, and ultimately no excuses, or we always do everything to address the problems with process standards and coach and train to them so we can get to no excuses

10. 10 Use data to make decisions Standard work is the way we do work All work is processUse data to make decisions Standard work is the way we do work All work is process

11. 11 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� When we completed the VSA for the office visit, we were focused on improving work/life balance , creating an overall better experience for the patient, and foundation improvement to eliminate defects in quality. We wanted to make improvement on all aspects of the triangle , not just one side. We did have customers involved in the VSA as well as several RIE�s to help design the future state.When we completed the VSA for the office visit, we were focused on improving work/life balance , creating an overall better experience for the patient, and foundation improvement to eliminate defects in quality. We wanted to make improvement on all aspects of the triangle , not just one side. We did have customers involved in the VSA as well as several RIE�s to help design the future state.

12. 12 New Delivery Model Value Stream Initial State Point out the number of starbursts in the initial state identifying lots of room for improvement. Many handouts!Point out the number of starbursts in the initial state identifying lots of room for improvement. Many handouts!

13. 13 Kelly B-G Quote from Mark (Jimmy Hendrix)Kelly B-G Quote from Mark (Jimmy Hendrix)

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16. 16 Continuous Daily Improvement Visual Management Staff Involvement in Problem Solving Maintenance and Improvement of Processes Answers are in the Work

17. 17 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

18. 18 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

19. 19 New Delivery ModelKimberly Clinic

20. 20 New Delivery ModelKimberly Clinic

21. 21 New Delivery Model Kimberly Clinic

22. 22 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 Series of focus groups and phone surveys (108 patients) were completed. 45-50% response rate for the telephone survey with 69% female and 31% male. Majority of patients in the study said they were �very Likely� to recommend ThedaCare to a friend, family or colleague. These results yield a Net Promoter score of 64. Net promoter is relative indicator of customer loyalty. American Express 50, Southwest airlines 51, Apple 66, Harley Davidson 81 Series of focus groups and phone surveys (108 patients) were completed. 45-50% response rate for the telephone survey with 69% female and 31% male. Majority of patients in the study said they were �very Likely� to recommend ThedaCare to a friend, family or colleague. These results yield a Net Promoter score of 64. Net promoter is relative indicator of customer loyalty. American Express 50, Southwest airlines 51, Apple 66, Harley Davidson 81

23. 23 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

24. 24 New Delivery Model �Wave 1Neenah Lab TAT

25. 25 New Delivery Model � Wave 1IM Provider Sat

26. 26 New Delivery Model-Wave 1 Clintonville Service Factor

27. 27 New Delivery Model - Wave 1New London DM

28. 28 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

29. 29 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 can�t be underestimated Need to prioritize work so this transformation is not just an add on

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