Workflow Optimization Project

1. Workflow Optimization Project Martin’s Point Health Care Portland Health Center Julie Trimmer, Practice Director January 18, 2007

2. Share our Journey / Strategy What’s Inside our Toolbox Objectives

3. Process Mapping Initiative – 2005 Opportunities Identified: Communication: How we communicate with our patients. Multiple modes, many bottlenecks and rework loops. Designing new processes Electronic Health Record Implementation – 2005/2006 Preload (data/information extracted from paper records and loaded into EHR) - 2005 Scanning and Indexing – 2005 Full implementation – May 2006 New Clinic Planning – 2006/2007 Our Transformation Journey…..

4. Prepare a High Level Map Minimum of 4 steps, maximum of 7 steps Defines boundaries of the process to be mapped High Level Example: Paper Medical Record Flow Break down each high level into detailed steps: Mapping Your Process Patient Info generated on Paper Medical Record Created, Formatted &/or Maintained Patient care provided, patient info generated on paper Request for Release of Records, pt. transfer, or deceased Is Med Rec w/ pt info? Pt Info signed? yes Label pt information with name, DOB, Med Rec # File per format/ P&P yes no no Place in numerizor/loose filing bin for med rec to return Identify the “clogs” or “pain points” that cause the most breakdowns Return to staff for signature

5. Problem / Aim/ Theme Statement Scope the project: How do we get from a “boil the ocean” to a precise target/goal? From / To format (from x to y by z) Decrease cycle time from 72 hrs to 48 hrs by 12/31/06 SMART goals (Specific, Measurable, Action Oriented, Realistic, Time-bound) – example High Level Goal: Eat Healthier Food in 2007 SMART Goal: Eat 5 servings of Fruits and Vegetables each day. Method/Tools: Affinity Diagram Takes groups of data (brainstorming) and organizes to get consensus on the theme/issue. What Are We Aiming For?

6. Summary of Affinity Diagram Agree on issue – what prevents us from getting there? Our Project Results: Post It Notes- each team member answers – 1 complete sentence per note Answers are grouped, titled, and voted by team

7. Translate broad requirements to details that can be measured: Example: Excellent Patient Service What does that mean? (Knowledgeable Reps, Short wait) How?(Rep accuracy, time on hold, time in waiting area) Method/Tools: Voice of the Customer Takes the voice of the customer or customer needs and uses that information to produce design or improvements that meets those needs. What Do Our Customers Require?

8. Project Example: Staff Needs: What: reduce rework, adequate training, defined and consistent workflows How: standard operating procedures, matching roles and responsibilities with skills and knowledge, training forums, reference guides/tools Requirements / Specifications

9. Measurement Systems / Data Collection Primary Metrics (results measures) Secondary Metrics (process measures) Methods/Tools: Surveys Reports Tally Sheets (reliability) How Will We Know If We Made a Difference?

10. Data Collection Provide an explanation of why/what/how to track • Reliability Factors: • Provide a sample tally sheet as a guide • Walk through with staff how to record the data

11. Change Management Success at change can be directly impacted by effective change management. How do you take a group or individual from the current state to the future state? Methods/Tools: ADKAR: 5 Building blocks for successful change: Awareness – where change begins, (WIIFM) Desire – personal choice to support the change Knowledge – understanding of HOW to change Ability – achievement of the desired change in performance or behavior Reinforcement – any action or event that sustains the change Stakeholder Analysis: Identifies people or group inside and outside the organization who are impacted by the project or can influence it: Gage level of commitment and develop communication strategy and ideas to relieve the resistance to change. How Do We Manage the People Side of Change?

12. Change Assessment ADKAR – Project Results (Providers, Clinical Support, Admin support) Stakeholders - Sample Action Plan to fill the gap

13. Process Mapping Roles and Responsibilities Matrix Functional Job Analysis: Role Task Training and Education required Upon what instructions (knowledge, skill, ability, & performance standards) To accomplish what organizational outcome or result? For each task: verify task in question is performed, how frequently the task is performed, and how many minutes to complete one instance of the task. Getting the right work to the right people Methods/Tools: Matrix Analysis Identifies overlap in work performance in identifying opportunities to reassign task responsibilities. Functional and skill ratings offers guidance as to who should perform tasks given the complexity of task performance. Who Does What?

14. Our Roles & Responsibilities Matrix Project Sample: Sort for overlap/duplicate tasks Staff/Skill assessment comparison

15. Julie Trimmer, Practice Director: 791-3841; JulieT@martinspoint.org Black Belt, EHR Implementation Lauren Rice, Project Manager: 791-6986; LaurenR@martinspoint.org Green Belt & Coordinator for Practice Projects Michelle Wyman, Manager of Organizational Effectiveness: 253-6109; Michellew@martinspoint.org Certified in Change Management Suellen Shaw, Black Belt: 253-6288; Suellens@martinspoint.org Project Leader: Workflow Optimization Project Joanne O’Neil Lafferty, Manager Health Professional Development: 253-6316; JoanneLA@martinspoint.org Learning Collaboratives (Practice Redesign; Clinical Microsystems; Physician Leadership) How and Who to Contact