Adult Enterprise Leadership
Update
February 10, 2015
Mitch Edgeworth and Robin Steaban
Today’s Agenda
• The Triple Aim
• Goal Alignment
• Our Journey
Our agenda is consistent with the national
movements in healthcare…
The IHI Triple Aim
The national agenda is moving rapidly…
Future
Delivery System
Changes
Value-driven,
Coordinated Care
CMS Bundled Payment
 Care
Coordination
Hospital-Acquired Conditions Penalties
HITECH/ Meaningful Use Penalties
TennCare Bundles
Commercial Bundles
 Provider
Feedback &
Accountability
CMS Bundled Payment Pilot
 Measurement
around Quality
& Efficiency
DRG Readmissions Penalties
Value-Based Purchasing Incentives
HITECH/Meaningful Use Incentives
CMS Community Care Transition Program
Today
 Fragmented
event driven care
Volume-driven,
Fragmented Care
 Fee-for-Service
5
Payment System Changes
 Episode or Comprehensive
Care Payment
 Clinical Integration
Fee-for-service will soon be in our past
www.insidenorth.com
What does “Care Across the Continuum”
mean?
Admission
Discharge
30 Days
Pre-op
Admissions/
Discharge
planning
Complex
Catastrophic
Fragile
Unstable
Simple
Stable
Routine
Surgery/
Post-op
Diagnostic
Treatment
Discharge
SNF/HH/Home/PCP
Personalizing Care Across the
Continuum Matching Resources to
Patient Care Needs
“Everything the Patient Needs ad Nothing They Don
How are we responding to these new
challenges?
1.
2.
3.
4.
5.
Creation of PCC structure
Better measurement in cost and quality
Redesigning the entire episode of care
Development of VHAN
Investment in information technology
Group feedback
• There are many efforts underway to
accomplish the triple aim. What are ideas in
your area where we can:
– Prepare for population heath
– Improve the experience of care
– Reduce costs per capita
Goal alignment is critical
Pillar Goals Focus Our Efforts
Goal Attainment Requires Action at
Every Level of the Organization
Goal
• Perceived quality of care
• HCAHPS
Administration
• Connect goals with actions
• Create and share results
• Provide resources
Managers
• Patient Leader Rounding
• Measure and manage
Staff
Standard Work
Measurement /Reporting
Role Clarity / Accountability
• Aidet
• Patient engaged bedside
report
• Key words at key times
• Shared goal setting
Goal Attainment - Action at Every Level
Goal
• Accuracy and
access to date
• Ensure access
to best
practices
Reduce
Hospital
Acquired
Injuries
PCC
Administration
Reduce PCC
Falls with injury
rate
• Standardize
approach to
falls reduction
at unit level
•
Managers
Reduce falls
with injury on a
unit
•
•
Educate staff on best
practice standard
Leader Rounding Measure
performance at an
individual level
Coach for success
•
Staff
Standard Work
Measurement /Reporting
Role Clarity / Accountability
Increase time
to last fall
•
•
•
Targeted
toileting
Hourly Rounding
Bedside report
Falls prevention
bundle
Our Journey
Tremendous work is underway thanks to many
people in this room
•
•
•
•
•
•
Case management redesign
Discharge phone calls
Time to fill vacancies
Nurse triage
B/P acquisition accuracy
The Vanderbilt Clinic Model (aka
Standard Clinic Operating Model)
• iRound
• Nurse call replacement
• Documentation of start and stop
times of medication infusions for
outpatients
•
•
•
•
•
•
•
•
Clinical documentation excellence
Standard check-in / check-out
Continuous monitoring
EVS workflow improvement
New food production and menus
Estimated date of discharge
Lab ready labels
New units - 7 South and TVC
Observation
• Standard Inpatient Operating
Model
• Rapid cycle redesign
Other Important Challenges Are Before Us
•
•
•
•
VU/VUMC Split
Replacement of all clinical IT systems
Replacement of Medication Cabinets
Hiring and onboarding
Preparing ourselves through constant training is
vital as we pursue the Triple Aim…
•
•
•
•
Preparation for quality and TJC
Lean training - HPP
Communication training – Kimberly Pace
Staff engagement tactics – Advisory Board
Summary
IHI Triple Aim
- Connecting the Dots •
•
•
•
•
Episode of Care
Care coordination
Case- management redesign
Discharge phone calls
VHAN
•
•
•
•
Falls prevention
•
Pressure ulcer prevention•
CLABSI
•
CAUTI
•
•
•
•
•
HCAHPS
Access
Discharge phone calls
Nurse triage
Readmissions
Mortality
LOS
Episode of Care/Bundle work
Questions & Answers
Thank You
Future of Outcomes Monitoring