Optimizing PACE Operations and Efficiencies (OPOE) Program

1. Optimizing PACE Operations and Efficiencies (OPOE) Program September 16, 2015

2. Introduction • Introduction to OPOE • Learning Collaborative Members: • ArchCare, New York – Henriette Kole and team • Bienvivir, Texas – Rosemary Castillo and team • Midland Care Connection, Kansas – Karren Weichert and team • NewCourtland LIFE, Pennsylvania – Mary Austin and team • PACE Organization of Rhode Island – Joan Kwiatkowski and team

3. Agenda • Introduction to Optimizing PACE Operations and Efficiencies (OPOE) • Learning Collaborative and Introductions • Lean Six Sigma in Healthcare • Program Description and Milestones • Roles & Responsibilities • Case Study • Logistics • Questions & Discussion

4. NOVACES Team • Brian MacClaren • Liaison to NPA • Dr. Bahadir Inozu • Project Director • Marliese Bartz • Program Manager, Green Belt Instructor • Consultant for Bienvivir and Midland Care Connection • Ed Vasko • Consultant for ArchCare, New Courtland LIFE, and PACE Organization of Rhode Island • Charles Mount, CAPT USN (Ret.) • Project Advisor

5. What is Lean Six Sigma? • To your organization … • Increased value delivered to the patient • A methodology for continuous improvement • A management philosophy • A data-driven culture • To you … • A new way of thinking • A focused approach to problem-solving • Management and leadership skills development

6. Lean in Healthcare • Frank and Lillian Gilbreth (Cheaper by the Dozen) wrote numerous articles regarding efficiencies in healthcare • First to promote nurses handing instruments to surgeons, eliminating unnecessary motion • Henry Ford actively promoted patient focused care as more efficient • Examined nursing process to eliminate unneeded steps citing that more time is spent in motion, than caring for patients • A 2009 ASQ Hospital Study showed that 53% of the hospitals reported some level of lean deployment. Examples include: • Clinical deployment • Surgery/operating room (61 percent of hospitals) and emergency department (60 percent) • Ancillary/support services deployment • Admissions/discharge (43 percent) and radiology/imaging (43 percent) • Non-clinical/support deployment • Purchasing/supply (36 percent), information systems (24 percent) and administration (24 percent)

7. Exposure to Lean Six Sigma • What have you seen, learned about or experienced with: • Lean Six Sigma? • Process Improvement? • Continuous Quality Improvement?

8. PACE OPOE Collaborative Roles

9. Role: PACE Champion • Opportunity Selection • Identify the highest priority improvement opportunities and allocate resources • Communicate the need for change with clear problem statements, metrics and goals • Workshop Execution • Ensure the team stays focused on problem resolution • Approve and communicate process improvement action plans • Remove obstacles and provide resources to support project activities • Participation • 1.5 day Champion training • Report out sessions by project team (throughout) • 4 PACE Collaborative webinars (including this one) • Winter Summit

10. Champion Training • Description • Training on how to champion improvement projects, organization, staff performance and an overview of Green Belt training • Selection of projects for each site • Commitment • 1.5 days • Audience • PACE Champions/Executives • Schedule • September 29-30 in Alexandria, VA

11. Role: PACE Green Belt • Workshop Execution • Coaching from consultant to become a lead facilitator and pursue certification • On-site support of pre and post improvement workshop activities • Participation • 4.5 days of Green Belt training • Improvement workshop planning • Improvement workshops (3 ½ days each) • Project Management of Improvement Action Plan • 3 PACE Collaborative Webinars • Winter Summit Planning • Winter Summit

12. Green Belt Training • Description • Training and hands-on simulations in Lean and Six Sigma concepts to lead continuous improvement projects • Mentoring on Project Charter development • First step in pursuing PACE Green Belt certification • Commitment • 4.5 days in central location • Audience • PACE Green Belt Candidates • Tentative Schedule • November 16-20 in Alexandria, VA (TENTATIVE)

13. Green Belt Certification • Complete Green Belt training • Successfully co-lead two improvement workshops under the guidance of a NOVACES consultant • Document improvements achieved • Goal: Become the resident expert at respective PACE sites and continueleading future improvement workshops independently

14. Role: PACE Team Member • Workshop Execution • Involvement in workshop as a subject matter expert • Supporting implementation of improvement action items • Participation • Involvement in improvement workshop planning • Improvement workshops (3 ½ days) • Support of improvement action plan • Selected Collaborative Webinars • Winter Summit (Optional)

15. What Are Improvement Workshops? • A fast-paced and focused problem-solving event • Both action and team-oriented, that uses data to make rapid improvements to a process • A cross-functional team focuses on designing solutions to achieve well defined goals • Other common names are Kaizen and Rapid Improvement Event • Run as a single event, which typically lasts 5 days or less • Follow-Up Phase is designed to complete an action plan and sustain improvements

16. Improvement Workshops 1 & 2 • Commitment • 3.5 days for workshop at site location • Weekly update calls/meetings with team (as determined) • Bi-weekly mentoring calls (Green Belts only) • Implementation of improvements (as needed) • Audience • PACE Green Belt Candidates and SME’s (Team) • Time-Frame • Staggered December 2015 thru March 2016

17. Case Study • University of Alberta Hospital (2012) • Situation: • Emergency Department experiencing longer than desired emergency department length of stay (ED-LOS) for patients • Goal for ED-LOS was 8 hrs. ≥ 60% of Patients but increasing to 90% by 2015 • Average ED-LOS was 17.6 hrs. for Family Medicine & 16.3 hrs. for General Internal Medicine • Rapid Improvement Workshops held to find opportunities for improvement

18. Case Study (continued)

19. Case Study (continued) • Changes to ED process were piloted with the following results GIM LOS dropped 43% & FM dropped by 28%

20. Case Study (continued) Communication & involvement by staff is key !

21. PACE OPOE Collaborative Webinars • Description • Virtual sharing of experiences, lessons learned, challenges, and updates on sites’ progress • Commitment • Total of 4 one-hour webinars (including this one) • Participation in preparing and delivering short presentations • Audience • Champions, Green Belts, NPA Leaders

22. Scheduling • Sam K. will facilitate activities for the Collaborative • Champion training, Green Belt training, Webinars and Summit(s) • NOVACES will coordinate directly with PACE sites for the improvement workshops and project-specific activities

23. Questions & Discussion QUESTIONS?

24. Appendix