How to Transform Your Orthopedic Program Into A Destination Center

Right Brain Le- Brain VISION

Improving the lives of pa#ents and

employees wherever we go!

Why Choose Right Brain Le; Brain? •  100% Vendor Neutral – Our goals are your goals! •  Proven Track Record – OpImized mulIple TJR Programs improving paIent

outcomes and driving excepIonal business results •  Strategy Development Experts – Our unique blend of Process Engineers and

Specialized Clinicians work with your team to translate your Vision and Mission Statement into a TacIcal ExecuIon Plan in one event gaining buy-‐in and accountability by the whole team.

•  Process Improvement Experts – Each program is customized for your facility, your staff and your paIents by uIlizing state-‐of-‐the-‐art process improvement techniques and technologies.

•  Culture Warriors – Our rapid improvement workshop approach breaks down silos and creates focus, energy and excitement, while enabling swi; and effecIve goal achievement

•  Knowledge Sharing – Our moXo is to share our knowledge in all aspects of our partnership to create confident team members that will be able to sustain gains and charter new improvements with confidence.

How Do You Become An Orthopaedic

DesInaIon Center?

VoC Voice of the Customer

VoE Voice of the Employee

VoB Voice of the Business

Highest Quality Excep=onal Service

Best Value


translates to “The PaIent Experience”

Quality: The New Hospital Shoppers

•  PaIents are more technology savvy than ever before – if not the paIent themselves, then most certainly their care giver. –  InformaIon about your facility is easily available and paIents are accessing it.

•  HealthGrades •  CMS Website: Hospital Compare – HCAHPS, SKIPs and Safety

•  Physician stats are public •  Joint Commission and other CerIficaIons

PAT and Pre-‐OP

Pt EducaIon/Experience •  ScripIng •  guidebooks

Pre-‐Admission TesIng Protocols

•  H&P •  Medical and

Cardiac

Pre-‐Op CommunicaIon Protocol

Hair Removal

Opera=ng Room

Scheduling /Block UIlizaIon

Technical Manuals for StandardizaIon

Anesthesia Process

Back Table Set Up

Skin Prep Protocol

PosiIoning

Draping

Staff Trng OR Choreography

Wound Closure Protocol

Turnover

Wellness Joint Clinic

Physician Order Set Protocol

•  VTE •  InfecIons

Physical Therapy Protocol

Blood Management Guidelines

JC Annual Training for Staff

Pt Rounding Protocols •  UIlizing

communicaIon board

•  HCAHPS

Anesthesia Protocol

Post OP Pain Management Protocol

Inventory

Discharge

Discharge Planning

Pt Outcomes; ComplicaIon Management

•  Falls

Post Discharge Pt Call Protocol

Quality: Evidenced Based PracIces & Protocols

RBLB brings the research and benchmarking to

you. We do not pracIce

medicine, but we make it all available to you!

AddiIonally, RBLB will

help you align everything to enable cerIficaIons and

maximum reimbursements.

RBLB has protocols that enable TJR patients to: Ambulate 2 hours post op Pain never exceeds level 4 PONV minimized or eliminated Falls minimized or eliminated Infec=ons minimized LOS 2.0 days

Risk of Re-‐admissions minimized!!!!

Quality: Same Day Procedures

•  If you are ready and interested in moving your facility to the forefront of Total Joint Replacement pracIces: – We have same day protocols and pathways! – RBLB can help you get there!

•  31% of knee replacements are performed on adults 45-‐55 years of age.

•  OutpaIent knee replacements cost the payer 41% less than inpaIent procedures.


Best Value



Full Implemented

Absent

DissaIsfied

Extremely SaIsfied

Delighters Things they didn’t know they wanted or never expected. They set you apart from the crowd!

SaIsfiers – Typical expectaIons.

Assumed, must be there or you are not even considered!

Basics

KANO Analysis

Service: What Do PaIents Expect Today?

Service: Delighters, SaIsfiers & Basics

11

•  Basics •  Quality of Care – JC CerIficaIon, CompeIIve

HealthGrades, Excellent Safety records

•  SaIsfiers •  PaIent EducaIon •  Clear and consistent expectaIons •  Happy and friendly staff

•  Delighters: •  Total Joint Wellness Center •  Real Ime tablet/smartphone communicaIon

throughout conInuum of care, •  Group Therapy & Group Dinners •  Veterans Reunions •  AmeniIes – gi;s, shirts, mugs, etc

Service: PaIent Experience Extends Across the EnIre Service Line

•  Pre-‐Admission TesIng (PAT) – What is this experience like? Is it easy? Does the paIent have a guide or point of contact and are they easily available?

•  Pre-‐OP –  Is everyone asked to arrive at 0530, regardless of surgery Ime? Is it quiet, organized? Do they know exactly what to expect? Are they asked all the same quesIons over and over again?

You only get 1 chance to make a first impression!


Best Value



Value: PaIent ExpectaIons?

•  Cost EffecIve – Is your pricing compeIIve? –  Is your hospital known for never ending bills that conInue to trickle in…..

–  Are wait Imes so excessive, paIents will pay higher prices elsewhere to avoid your experience?

–  Can you accommodate the huge growth projecIons in TJR in the next few years, or are your paIents already experiencing excessive surgery lead Imes?

Value: Pricing Must Be CompeIIve

•  How do you provide the highest quality and also the best pricing?


DesInaIon Center?




Voice of the Employee (VoE) Culture

Work Place Environment Professional Development

VOE: What Do Employees Desire?

•  Culture –  Respect for each other, no maXer the posiIon –  A voice that is heard and encouraged –  Clear goals and the tools to achieve them

•  Work Place Environment –  Organized, safe and conInuously improving –  Efficient and standardized processes with clear and up-‐to-‐date procedures and protocols

–  Access to and training for advanced technologies •  Professional Development Opportuni=es

–  Furthering educaIon assistance –  CerIficaIons available

Culture: Starts with the Structure

Pa=ent Centric Highest Quality

Excep=onal Service Best Value

Clinic & Surgery

Scheduling

PAT & EducaIon

Pre-‐Op & PaIent Prep

Cut to Capsule Close

Turn Over & PACU

Total Joint Wellness Center

Discharge to Home

PaIent Referrals/MarkeIng

Clinic

PAT

Discharge

Floor Post OP

Peri-‐OP

Pre-‐OP

Home (20%)

Rehab or SNF (70%)

Other (10%)

Hospital Centric – Department Goals and Focus

PaIent Centric – Same goals for everyone across the Service Line

Transforma=on

VoE: Consistent Goals Across the Service Line

•  Break down the silos by providing a working venue for team building –  Kaizen Events are “rapid improvement events” and are one of the most effecIve Lean Six Sigma (LSS) tools available!

•  They enable buy-‐in and ownership by uIlizing a cross-‐funcIonal team across the enIre service line.

•  They provide an on-‐the-‐job learning environment for LSS tools. •  They shorten project compleIon Imes by more than 60% •  RBLB experts will develop kaizen facilitators on your team to ensure independence and enable sustained results!

VoE: Hands On Training of Tools and Techniques

•  Develop Customized Mktg Strategy

•  Cost effecIve AmeniIes

•  PaIent Access and Edu

•  OpImize Discharge Process

•  Increase Discharge DisposiIon to Home

•  CommunicaIon Boards

•  Metric Boards •  Inventory

Control •  PaIent & Staff

Flow

•  Reduce Turn-‐over Time

•  Reduce DownIme B/W Procedures

•  Reduce Case CancellaIons & Late Starts

•  Reduce PaIent Prep Ime

•  OR Staff Training •  Tech Manuals

and Visual Aides for StandardizaIon and Training

•  Reduce Wait Times

•  Increase Hosp/Clinic/PaIent CommunicaIon & CoordinaIon

•  Reduce Pat. Wait Time

•  Improve Scheduling Process

RBLB PracIIoners partner with your team to share their

extensive LSS knowledge via hands on opImizaIon tools

and techniques.

OpImized processes are then ready for

advanced technology communicaIon and tracking systems like

Wellbe!

Clinic & Surgery

Scheduling

PAT & EducaIon

Pre-‐Op & PaIent Prep

Cut to Capsule Close

Turn Over &

PACU

Total Joint Wellness Center

Discharge to Home

PaIent Referrals/MarkeIng

Pa=ent Centric Highest Quality

Excep=onal Service Best Value

VoE: Work Smarter, Not Harder

•  Breakthroughs in medicine and technology are changing rapidly these days, so a different way to perform must be embraced.

•  RBLB brings years of experience creaIng and teaching how to use simple and concise work instrucIons and visual aides on the job. We will create them with your team as we idenIfy the needs!

•  SynchronizaIon of staff during OR paIent prep and turnover greatly reduces Wheels-‐In to Wheels-‐In Time as well as improves uIlizaIon of staff.

VoE: Program TransformaIon

•  A typical transformaIon of an Orthopaedic Program for an average size hospital takes approximately 2.5 to 3 years when driven internally

•  Partnering with RBLB can shrink that Ime to approximately 8-‐10 months

–  Now that you have aligned the VoC and the VoE, we must determine where to take this endeavor.

–  How do we know when we have won?


DesInaIon Center?




Voice of the Business -‐ Profitability

25

VoB: 5 Year Financial Pro Forma

RBLB performs a thorough assessment of your facility to determine your baselines and potenIal for improvement

goals.

We work closely with your finance team so every number is verified and transparent.

We treat your Orthopaedic Service Line as a Business,

creaIng it’s own P&L report.

VoB: Cost ReducIon or Revenue GeneraIon

Mul=ple scenarios analyzed to assess risk and determine total poten=al

Most hospitals assume if they can increase their market share, they will

be fine.

Unfortunately, that is not the case most of the Ime.

RBLB worked with a reIred CFO of an HCA system to develop a mulIple

scenario analysis.

To date, the results have always been similar, in that, revenue generaIon

alone cannot keep up with the pace of inflaIon.

Process Op=miza=on is the key!

VoB: Analyze System Data and Verify with ObservaIon Data

Dr. C Future

Dr. C

Dr. B Future

Dr. B

Dr. A Future

Dr. A

Benchmark

20

31

20

35

20

39

20

69 99

102 132

89

119

45

15

15

15

15

10 5

10 5

10

7

10

10 31

10 32

10 31

10

PP S Close TO Down

Benchmark: WI to WI = 90 mins Dr. A: Current: WI to WI = 196 mins

Future: WI to WI = 141 mins Dr. B: Current: WI to WI = 204 mins

Future: WI to WI = 152 mins Dr. C: Current: WI to WI = 166 mins

Future: WI to WI = 119 mins

Approximately 28% ReducIon for “Wheels In to Wheels In”

Time

Current data from 142 total Hip & Knee Procedures from 10/1/11 to 3/29/12

PP = Pa=ent Prep Time: Begins when paIent enters O.R. and ends with skin incision S = Surgery Time: Begins with skin incision and ends when surgeon breaks scrub TO = Turnover Time: Begins when wound is closed and ends when turnover team leaves room Down = OR Down Time: Begins when turnover crew is complete and ends when next paIent enters O.R.

28

VoB: OR Flipping – Are Your Surgeons & Staff Ready?

•  StandardizaIon and synchronizaIon minimizes Surgeon involvement in Pat. Prep, Close and Turn Over.

•  OpImal Surgeon Ime for flipping is cut to capsule close of approximately 45 minutes or less.

Each block represents cut to capsule close

OR 1

OR 2

Pat 1 Pat 3 Pat 5

Pat 2 Pat 4 Pat 6

OpImized Surgeon’s Time

•  RBLB process engineers analyze your layout and your equipment using 3D state of the art simulaIon so;ware.

•  We work with your team to determine streamline opportuniIes to reduce paIent exposure and improve paIent flow.

•  The analysis determines: –  If you should dedicate OR’s? –  How to schedule block Ime? –  How to level load the schedule? –  How to manage busy days and slow

days?

VoB: Streamline PaIent Flow Across the EnIre Service Line

VoB: Can Your Current Unit Handle Increased Volumes Thru the OR?

31

0 2 4 6

10/1/201

10/15/20

10/29/20

11/12/20

11/26/20

12/10/20

12/24/20

1/7/2012

1/21/201

2/4/2012

2/18/201

3/3/2012

3/17/201

3/31/201

# Surgeries C

ompleted

Date

Total Hip & Knee Procedures Done by Date

0

5

10

12/28/20

1/28/201

2/28/201

3/31/201

4/30/201

5/31/201

6/30/201

7/31/201

8/31/201

9/30/201

10/31/20

11/30/20

12/31/20

Num

ber o

f Pa=

ents

Date

Beds Occupied by Date

Increase capacity with no capital investment!

Avg. LOS Cases per Wk OR Scheduling Max Beds Needed

Current = 4 6 Current 9

Current = 4 6 Level Loaded 6

Current = 4 9 Level Loaded 9

Decreased to 3* 9 Level Loaded 6

VoB: Tier 1 Metric ReporIng

32

Monthly ExecuIve Level Dashboards

Physician Level Dashboards

VoB: Tier 2 & 3 Metrics

Daily Floor Level Metric Boards

Weekly Management Level Metric Boards

VoB: Revenue GeneraIon

Electronic (Website, blogs, social media) Trade Show Design Direct Mail & Sales PromoIons PublicaIons Print – Brochure, business card, poster, etc. IdenIty Design – logo, staIonary, newsleXers, etc. BulleIn Boards Radio We will even help you select a theme for your Physical Therapy program and Wellness Joint Center and then brand all of your materials with your customized theme. Pa#ents will always remember their experience at a facility that makes healing and recupera#on fun!

MarkeIng & Branding

VoB: Billboard MarkeIng

35

VoB: Print & Brochure

36

VoB: Web Design

Many hospital markeIng teams are extremely busy and cannot devote Ime to one specific program: We work with your MarkeIng team to incorporate a page in your exisIng site or to build a new site.

TransformaIon: Become DesInaIon Center

Transform your Orthopedic Program into a DesInaIon Center.

Understand and Address: VoC Voice of the

Customer



Comprehensive Assessment for Baseline

39

TJR Service Line Assessment Clinic Assessment 1.  Market Assessment 2.  Best PracIce Clinical Protocol and Pathway

EvaluaIon 3.  Joint Replacement – Internal Data

Assessment 4.  OperaIng Room Efficiency: System Data &

ObservaIon 5.  Efficiency of PAT, Pre-‐OP, Post-‐OP and

Discharge Processes 6.  Total Joint Wellness Center Gap Analysis 7.  Future State PaIent Centered Strategy 8.  5 YR Financial Pro-‐Forma 9.  Joint Commission Disease Specific

CerIficaIon Gap Analysis 10. Medicare Alignment Analysis 11. MarkeIng & Branding Assessment

1.  PaIent Flow Analysis 2.  PaIent Sat Survey Scores 3.  Office OrganizaIon & CommunicaIon

Systems 4.  Scheduling PracIces 5.  Financials 6.  Inventory Handling 7.  Surgeon and Staff UIlizaIon

Thank You for Your Time.

Please feel free to contact us if you have any quesIons:

Stephanie Allison President & CEO Right Brain Le; Brain steph.allison@rb-‐lb.com 904-‐302-‐2939.

Date post:	05-Dec-2014
Category:	Health & Medicine
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How to Transform Your Orthopedic Program Into A Destination Center

Health & Medicine