Improving the Patient Experience for

Joint Replacement by Using a

Guided Process

Julie Benz

Director of Outpatient Therapy Services

March 20, 2014

Avera McKennan – Sioux Falls SD

* Hub of the Avera Health System

* Established over 100 years ago

Within the Avera McKennan network…

• 13 regional hospitals

• Avera Behavioral Health Center

• Avera Heart Hospital of South Dakota

• 85 primary and specialty care clinics

We are nationally recognized for excellence in:

Cancer treatment Stroke care and neurosciences

Orthopedics Women’s health care

Pediatrics and neonatal intensive care Behavioral health

Emergency, trauma and critical care Surgery

Gastrointestinal care

Avera McKennan’s

flagship facility is

our 545-bed

tertiary care

hospital in Sioux

Falls.

Our Aspiration

Through service and process

excellence, Avera McKennan will

lead the nation in high quality,

affordable health care.

Rural Innovative

Most advanced use of e-services

Strives to be at the forefront of

innovation

Top 10 Trailblazing Hospitals

“Goals determine what you

are going to be."

Julius Erving

Objectives

1. Identify problems facing the

Orthopedic Unit

2. Identify innovative concepts that

improve the processes to positive

outcomes.

Orthopedics at Avera

McKennan

•32 – bed unit

•700 Jt Replacements/year

•2 - Primary Orthopedic Groups

•1987 established Easy Street

•2002 initiated Joint Camp

Challenges

Competitive environment

Reducing volumes

Patient Satisfaction below the Top Box

performers.

* Quality Outcomes

Falls

Pain Management

Innovative Ideas & Proven

Concepts

• Process Excellence - Lean

• Purposeful Hourly Rounding

• Leader Rounding

• Pain Team – one call response

• Total Care - PGS

Lean – Process Excellence

Visual Management Control

• To clearly and immediately notify

management and workers whether

the work area is normal or abnormal.

–Shadowing/Labeling

–Andon Signals

–Downtime Clocks

–Process Control Centers

© 2007 OpEx, Inc. All Rights Reserved.

Supplies at POU on 2WB pod

Purposeful Hourly Rounding

Visual Management Control

Patient out of room

Even Hour Round Complete

Odd Hour Round Complete

Intentful Leader Rounding

Leader with staff

Daily with staff on shift

Quarterly with every staff

Senior Leadership - weekly

Pain Team

Instituted a Pain Team –

Anesthesiologist - Pharmacist

Pharmacist on the floor during the

day and available at night for med

review

What were we challenged by-

Getting the right

information to the patient

and their family at the

right time

“To shoulder greater accountability for

outcomes, health systems must partner

with patients to close gaps in

communication and coordination while

managing care beyond the acute care

or physician office setting”» The Advisory Board

Program Goals

1. Improve patient experience

2. Ensure patient adoption and

engagement

3. Improve Patient Satisfaction

4. Drive staff efficiency

5. Create a compelling

competitive differentiator

Reports Available

To numerous to mention but

valuable information that drives

our process changes.

Weekly Report SummaryMarch 3, 2014 - March 9, 2014

Patient ActivityNew Enrollments 4

New Registrations 4

Total User Logins 46

Unique User Logins 22

Item Completion 1st Functional Outcome 5

Preparedness Survey 1

Hospital Experience Survey 2

Recovery Survey 1

Surgeon Experience Survey 2

Transition Experience Survey 1

2nd Functional Outcome 1

Avera TotalCare Program Survey 0

6 Month Functional Outcome 0

Other Changes

• Aquatic Therapy Post Op Day1

• Dietary Aid on the floor 8hours/day to

assist with nutritional need of the

patient.

• Daily Rounds with RN, Case Manager,

Social Worker, Therapy and physician

liaison

Results of our Efforts

Fall Reductions

3.06

5.59

8.03

10.70

5.37

13.16

4.58

5.88

15.97

2.81

1.74

3.64

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

16.00

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Rate

per

1,0

00 P

CD

2 West Ortho FallsJan-Dec 2012

Fall RateMagnet BenchmarkMagnet Benchmark is

the average rate for 8 quarters. Actual

5.61

1.95

3.453.44

1.58

9.12

1.59

0.00

3.42

5.845.37

3.452.97

0.000.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

16.00

Jan Feb Mar Apr MayJun Jul AugSep Oct NovDec Jan Feb

Rate

per

1,0

00 P

CD

2 West Ortho FallsJanuary 2013-February 2014

Fall RateMagnet Benchmark is the average rate for 8 quarters . Actual

Patient Satisfaction

Question Mar – 12 to Feb 13 Mar-13 to Feb-14

Overall Rating of

Hospital

70.7% 75.5%

Likelihood to

Recommend

75.3% 86.8%

Transitions of Care 59.6% 64.5%

Pain Management 68.1% 74.6%

Surgical Growth

Total Care

Avera Total Care

Nationally Recognized Quality

2014 Healthgrades Awards

Five-Star Awards in:

• Orthopedics

• Neuroscience

• Gastrointestinal services

• Critical care

Nationally Recognized Quality

One of the 100 Top Hospitals®

in the nation in 2013 as named by Truven Health Analytics

Nationally Recognized Quality

• No. 1 hospital in South

Dakota in 2012-13

and 2013-14

Nationally Recognized Quality

• QUEST High Performing

Hospital in 2013

Premier Health Care Alliance

Nationally Recognized Quality

• Community Value

Leadership Award

• Community Value 100®

Hospitals list

Cleverley + Associates

Questions

Thank you