West Michigan Heart NextGen Lean Projects Enable MU

1. Cardiovascular Customer Summit August 19, 2011 Jennifer Fanning, Director IT Services, WMH Denise Brown, VP Consulting, MedAxiom West Michigan HeartNextGen Lean Projects Enable MU

2. WMH � Lean Sigma Leads Change WMH: Cardiovascular specialty group located in Grand Rapids and an integrated member of Spectrum Health Practice locations in 13 counties of West Michigan, 15 locations with 32 physicians and over 18 MLP�s EP, PV, AHF, TX, Adv Imaging Member of the Fredrick Meijer Heart & Vascular Institute Adopted the challenges and created a key market differentiator with the adoption of Lean Sigma for Healthcare� in 2007 Committed to NextGen in 2007

3. WMH � Lean Sigma Leads Change Lean Sigma Tenants = Operational Efficiency Eliminate waste or non-value added activities (value engineering, eliminating rework) Create continuous flow Build quality at the source Standardize processes Engage and respect everyone�s contribution

4. WMH � Lean Sigma Leads Change WMH has 6 Green Belts in House To date has completed 15 projects in process redesign in key clinical areas Is engaged with Spectrum Health and directs key system activity via the Dept of Operational Improvement Is COMMITTED to PROCESS EXCELLENCE!

5. Project Charter

6. Lean Project Approach Map Current State Identify Waste Identify baseline data needed Root Cause Analysis of major areas of waste Identify Solutions Map Future State Establish timeline of work to be completed to go live with Future State Determine Performance Management Plan to hold staff accountable for complying with new process

7. Virtual Office Visit All calls to Nurse Line All calls to Script Line All patient calls to the PODs All Urgent Calls

8. Areas of Waste

9. Root Cause Analysis

10. Baseline Data

11. Solutions Create RN Phone Triage to handle all urgent clinical and Nurse Line calls Centralize �Virtual Patient� processes Create Team Nurse Approach Implement use of Telephone Template in EMR for RN Phone Triage and Script Reduce Chart Dependency

15. Chart Pull Reductions due to change in Phone Call Process

16. Physical Office Visit

17. Areas of Waste

18. Root Cause Analysis

19. Root Cause Analysis

20. Baseline Data

21. Solutions Standardize Chart Prep with MA initiating electronic review of last office Standardize process for rooming patients Standardize �layout� of where items are located in each POD Track rooming time and create standard for rooming time

22. Solutions (cont.) Increase # of wheelchairs by waiting room for patients needing assist to decrease time traveling from waiting room to exam room. MA/LPN/RN will discharge patient from POD Review all meds/med instructions/renew scripts Print lab slips Review any test prep instructions All PPP instruction

23. Patient Rooming Process

25. Physical Office Flow w/ EMR

26. Don�t Stop�..

27. MA Rooming Trials Patient Stands in line -0-5 min Checks in -2-10 min Waits -18 minutes Walks-3-5 minutes Roomed-6-18 minutes Avg Arrival Time18 minutes early Average Start Time2 minutes late Average Rooming Time10 minutesStandard Deviation of Rooming Time: 3-8 minutes

28. MA Rooming Time

29. Early Solutions Start Shift 15 minutes earlier (stagger shifts) Raise expectation of getting patients roomed ASAP Share responsibility for various providers..any MA rooms any provider patient if a patient has checked in Do NOT Team up in the room

30. Increasing Utilization of EMR Tool

31. Provider Adoption

32. Physical Office Flow Meets Meaningful Use

33. What we know now Standardized Processes a MUST for MU implementation Meaningful use adds work but can be offset by meaningful work It�s a Team Sport Leaders do the right thing even when no one else is looking