Enhancing the Patient Experience in the Head & Neck Center

1. Enhancing the Patient Experience in the Head & Neck Center Pheba Philip Office of Performance Improvement Head & Neck Center

2. MD Anderson Cancer Center • Located in Houston, TX • Found in 1941 • 20,000 Employees (1,600 faculty) • 650 inpatient beds • 1.3 M outpatient visits • Provided care to 120,000 patients in 2013 • Ranked Number 1 in cancer care by U.S. News and World Report

3. Approach: Engagement and Integration HN Center OPI Departments HNS, HNMO, RT

4. Participants Head and Neck Center: • Laura Baker, Ursula Broussard, Gloria Brown, Sheila Harris, Hettie Hebert, Eve Huang, Sharon Jamison, Grady Johnson, May Johnson, Rita Langner, Shirley McKenzie, Judy Moore, Maria Morales, Julie Ngo, Mary Penkwitz, Marie Pope, Letitia Reed, Missy Robinson, Marvin Saavedra, Shalamar Spears, EstieThompson Head and Neck Surgery: • Kerith Brandt, Ehab Hanna, M.D., Amy Hessel, M.D., Stephen Lai, M.D., Carol Lewis, M.D., Jeff Myers, M.D., Justine Robinson, Shawn Terry, Abram Trigazis, Randal Weber, M.D. Head and Neck Medical Oncology: • Michele Neskey, Karen Oishi Radiation Oncology: • Beth Beadle, M.D., Amanda Coldiron, Jennifer Gates, Hamlin Williams Office of Performance Improvement: • John Bingham, Laura Burke, ParvizKheirkhah, Victoria Jordan, Miguel Lozano, Jeremy Meade, Pheba Philip, Larry Vines Marketing: • Cecilia Kenneally, Gelb Consulting Clinical Operations: • Kathy Denton

5. Background Head and Neck Center formed a partnership with the Office of Performance Improvement to: • Define a series of performance improvement initiatives to enhance the patient experience • Align projects with Institute of Medicine aims: • Safe • Effective • Patient-Centered • Timely • Efficient • Equitable

6. Initiatives

7. New Patient Access Time Faculty Leader Carol Lewis, M.D. Assistant Professor, Head and Neck Surgery Team Leader Sheila Harris Patient Access Supervisor, Head and Neck Center Facilitator Pheba PhilipIndustrial Engineer, Performance Improvement • Members • HettieHebert (PAC), ShalamarSpears (PAS), Judy Moore (CAD), Jeremy Meade (OPI)

8. NP Access New Patient Access

9. NP Access Cause and Effect

10. NP Access Main Interventions

11. NP Access Improvement of Metrics • Reinforced email policy for redirecting referrals to other physicians • Corrected CARE default time issue for next available appointment • HC Transfers • Low sample size sensitive to outliers • Timely filling of delay indicators • PAS education & training • Enforced 24-hour rule • Trained/Re-educated PAS staff on round robin approach • Standardized new patient appt durations on templates

12. NP Access Keys to Sustainment

13. Clinical Variation & Overuse of Testing Faculty Leader Amy Hessel, M.D. Professor & Chair, Head and Neck Surgery Team Leader Judy Moore Clinical Administrative Director, Head and Neck Center Facilitator Laura Burke Performance Improvement Associate • Members • Jeremy Meade (OPI), Laura Baker (PAS), May Johnson (CBM), Hamlin Williams (PSC), Missy Robinson (PSC), Eve Huang (RN), Julie Ngo (RN), Dr. Beth Beadle (XRT Faculty), Karen Oishi (APN), Justine Robinson (PA), Abram Trigazis (PA), Michele Neskey (PA), Amanda Coldiron (PSC), Jennifer Gates (RN, NM XRT)

14. Clinical Variation Aims • Standardize the treatment planning and follow up schedules for all HNS cancer patients requiring multidisciplinary care including oropharynx, larynx and hypopharynx • Reduction of redundancy of imaging and laboratory tests • Increase efficiency and decompress the volume of the clinics • Improve patient satisfaction: fewer appointments and decreased wait times • Facilitates accommodation of new patients and greater focus on patients with acute care needs

15. Clinical Variation Baseline Data:After 6 months (Post radiation summary date) • 43% of appts are within 3 months of last appt • 11% of CT scans are within 3 months of last scan

16. Main Interventions

17. Clinical Variation Continuity of Care Pathway • Developed a “leap frog” system for follow up appointments after completion of treatment • 3 Month Follow Up Radiation Oncology • 6 Month Follow Up Medical Oncology • 9 Month Follow Up Surgery • 12 Month Follow Up Radiation Oncology • 16 Month Follow Up Medical Oncology • 20 Month Follow Up Surgery • 24 Month Follow Up Radiation Oncology • After 2 years Survivorship • Allows patient to have one appointment and one set of tests rather than follow up with each provider team independently

18. Clinical Variation Patient Report Card

19. Clinical Variation Transition to Follow Up • Standardized CSR to include predefined testing

20. Clinical Variation Faculty Involvement Target = 24 Current = 22 • Faculty involvement has increased • 65% eligible patients are on pathway

21. Clinical Variation Preliminary Trends/Results

22. Patient Wait Time Faculty Leaders Ehab Hanna, M.D. Professor & Medical Director, Head and Neck Surgery Randal Weber, M.D. Professor & Chair, Head and Neck Surgery Team Leaders Judy Moore Clinical Administrative Director, Head and Neck Center Facilitators Miguel Lozano Sr. Quality Engineer, Performance Improvement • Members • KerithBrandt (PA), Marvin Saavedra (PSC), Jeff Myers, M.D. (HNS), Carol Lewis, M.D. (HNS), Grady Johnson (PSC), Shawn Terry (PA), Mary Penkwitz(RN), Julie Ngo (RN), Amy Hessel, M.D. (HNS)

23. Wait Time Patient Wait Time • Identified lowest wait time performers • Documented best practices • Analyzed template and scheduling practice and its impact on wait time Classic PI approach using the DMAIC process • Defined the problem • Observed and documented patient process flow • Identified patient characteristics and expectations for each appointment type • Collected baseline patient wait time data for all physicians

24. Wait Time Patient Wait Time Preliminary findings to be trialed • Reinforce & prioritize best practices around team communication, scheduling decisions, and startup/preparation activities. • Avoid appointment clusters in same time slots • Spread NP appointments throughout the day • Make scheduling arrangements for high need patients

25. Wait Time Scheduling Changes • Earlier start time • Reduced appointment clusters • New patients spread during day • Improved schedule load leveling

26. The Patient’s PerspectiveOpportunities for Improvement Through Patient Interviews Faculty Leader Ehab Hanna, M.D. Professor, Head and Neck Surgery Team Leader Judy Moore Clinical Administrative Director, Head and Neck Center Facilitator Cecilia KenneallyManager, Marketing • Members • Gelb Consulting, May Johnson (CBM), Shirley McKenzie (CCC), Jeremy Meade (OPI), Ehab Hanna, MD (HNS Faculty)

27. Patient Interviews Patient Interviews • 41 interviews were completed with patients from June 11 – June 22, 2012. Interviews conducted by Gelb Consulting through Marketing. • Interviews were completed on site at the Head & Neck Center. On-site interviews provide visual cues for recall. • Some patient interviews included family/caregivers, revealing unique roles and needs. • Discussion areas: • Decision criteria • Scheduling • Wait times during and between appointments • Experience with treatment team • Communication processes and gaps • Sources of anxiety • Areas of praise

28. Key Touchpoints Patient Interviews Head & Neck Center Patient Experience Map Need Scheduling First Visit Treatment Follow Up Symptoms Diagnosis Awareness of MD Anderson Evaluation of healthcare providers Reputation of MD Anderson’s Specialists Choose healthcare provider Scheduling first visit Resources for patients and their families Scheduling and intake Treatment/exam room Chemotherapy, Radiation Treatment, Surgery Nursing care, Physician care Support groups and wellness services Communication with referring physician Follow-up visits Call-backs for assistance Parking Getting to Head & Neck Center Checking-in Waiting area, including vitals Clinic faculty/staff interactions Primary Experience Stewards • MDACC Faculty/Staff • Patients and their Families • Front Desk Staff • Faculty/Medical Staff • Faculty/Medical Staff • Support Staff • Faculty/Medical Staff • Support Staff • Faculty/Medical Staff • Support Staff • Patient’s Primary Physician

29. Patient Interviews Action Item Summary

30. Ambulatory Nursing Staffing Model • Nursing Personnel Staffing Model was developed to help leadership: • Make staffing decisions based on data • Make sure resources are properly allocated • Analyze “what-if” scenario for improvement initiatives

31. Keys to Success

32. Questions?