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Howland Medical Center 1 Practice of the Future Increasing Access to Care
Howland Medical Center1
� Practice of the FutureIncreasing Access to Care
Objectives and Goals
1. Understanding of selection process for strategic investment when
multiple opportunities/options exist
2. Understanding of technologies and processes that can aide patient access and allow entry of new patients into an organization
3. Challenges and opportunities when bringing physicians and staff into a new environment where collaboration and new ways of working/thinking are required
Mercy Health - Today
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Largest health system in Ohio with$9 billion economic impact and
nearly 500 points of care
Nearly $1 million a day in Community Benefit
5.9 million patient encounters a year
Mercy Health – YoungstownMaking Healthcare Easier for the Mahoning Valley
Region’s largest workforce with more than 4700 employees across the Valley!
Nearly $350 Million in community benefit since 2012 – through outreach, charity
care, foundation disbursements, research and more…
Area’s Only Level I Trauma Center
Your Family – Our Ministry
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Mercy Health – YoungstownThis is What We Were Meant to Do
Three Hospitals
St. Elizabeth Youngstown
Hospital St. Joseph
Warren Hospital
St. Elizabeth Boardman HospitalLong Term Care Facilities
The Assumption Village
Humility House
Comprehensive Physician Network
More than 600 Providers
Hospice of the Valley (HOV)
Joint Ventures
Partners in Urological Health in Austintown
Home Health Services
Mercy Health Home Medical
Equipment
Howland Medical Center
Practice of the Future
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Mercy Health Youngstown
Practice of the FutureIncreasing Access to Care – Focus of the Project
•Primary Care Focus
•Roof Top Consolidation
•Cohesive Delivery Network
•Population Health Management
Practice of the FutureIncreasing Access to Care - Vision
• Deliver high quality, low cost community based care in a campus setting
• Provide a primary care focus with specialty physician and ancillary services on-site
• Partner physician practice with hospital based programs
• Use technology to leverage efficiency and streamline throughput
• Build an agile and flexible workforce team with customer service centered mindset
• Do all of the above with the guiding theme “Delivering an outstanding patient
experience”
MARKET ASSESSMENT & COMPETITIVE LANDSCAPE
• Demographics
• Market Share and Growth
• Ambulatory Competition
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� Practice of the FutureIncreasing Access to Care
Vision and Strategic Benefits
•Access
• Only integrated ambulatory care center in the market
• Establish open access primary care model (Walk-In Care)
• Decompression of St. Joseph Warren Hospital Emergency Department
•Network Development• Initiate the development of a strong cohesive MHP-Y brand
• Significantly grow MHP-Y primary care presence
• Support filling the gaps of the clinically integrated network
•Service Line Development• Strengthen St. Joe’s market position
• Integration of orthopedics, physiatry, imaging and rehabilitation
• Enhance the presence of neurosciences, general surgery and ENT
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• $15M of strategic capital to fund the development of an ambulatory campus in Howland
• Supports Mercy Health 2014-2018 Strategic Direction for Care Model Transformation
- Physician Alignment
- Cohesive Care Delivery Network
- Population Health Management
• Expansion of MHP-Y and consolidation of current practices within PSA
• Integration of Howland Surgery Center
• 46,000 square foot, 2-story facility
• Project initiation: Q1 2016 with projected completion Q2 2017
ANALYSIS – PROJECT DESCRIPTION14
� Practice of the FutureIncreasing Access to Care
� Practice of the FutureIncreasing Access to Care
PLANNING – PROJECT TIMELINE PHASE 115
� Practice of the FutureIncreasing Access to Care
• Multiple forums with key players from practice and hospital side
• Physicians, physicians, physicians
• Finance
• Human resources
• Practice operations
• Business development and strategy
• Hospital leadership
• Construction team, IT project management, CarePATH, legal
• Decisions on ambulatory models for ancillary services
PLANNING – KEY TEAMS AND RESOURCES16
� Practice of the FutureIncreasing Access to Care
� Floor to ceiling windows to provide natural light and outdoor views
� Spacious shared waiting area
� Strategic placement of furnishings (staggered, with small grouped seating, non-symmetrical for privacy and spacing)
� Electronic bulletin board with continual circulation of required posted documents
� Exam rooms bright and spacious, with eye pleasing artwork, communication board for postings/marketing, exam chairs low and wide, equipment available and mounted on wall out of way
PLANNING – AESTHETICS & ENVIRONMENT17
� Practice of the FutureIncreasing Access to Care
� Kiosks – technology
� Pagers – technology
� Traffic patterns – pre-visit planning
� Electronic wait time board – technology
� Check-out in room/schedule next appointment and discharge instructions
� Midmark vitals – direct integration
� Referrals for available services could be same day
� Phone Room – assigned staff providing care for patients to prevent Guest Service Navigator staff from interruptions during check-in process
PLANNING – PATIENT FLOW/TECHNOLOGY18
� Practice of the FutureIncreasing Access to Care
� The key to success – regular meetings with affected parties
� Concierge approach – new Guest Service Navigator role
� Friendly, welcoming, nimble, adaptable
� Ok with not ‘doing like we always have done it’
� Comfortable with technology
� Focus on delivering an outstanding patient experience
� Group orientation and team building
PLANNING - STAFF19
� Practice of the FutureIncreasing Access to Care
The plan comes together… 20
Construction in our neck of the woods 21
Finished product22
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� Staggered department openings – existing departments with move needs, best practice support ratios, staff morale
� March 2017 – Primary Care, ENT, Audiology, Lab
� April 2017 – Orthopaedics, PMR, Radiology
� September 2017 – Physical, Occupational, Speech Therapies
� October 2017 - Walk In Care
� November 2017 – CT and MRI Imaging
Phase 1 Go-Live Plan
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Current State25
Dept April May June July August Sept Oct Nov Dec Jan Feb Grand Total
Howland ENT [13105104] 302 377 354 387 430 345 410 367 396 411 442 4,221
Howland Orth [13105142] 1,050 1,018 831 949 969 1,154 1,033 708 1,072 1,045 9,829
Howland PC [13105188] 429 757 681 784 1,118 1,010 1,173 897 927 1,206 1,192 10,174
Howland PMR [13105148] 479 410 243 371 313 377 437 250 492 456 3,828
HOWLAND CT [13105212] 3 21 20 44 88
HOWLAND MRI [13105213] 11 9 16 19 55
HOWLAND RAD [13105210] 456 462 428 537 578 668 564 380 626 631 5,330
HOWLAND US [13105211] 37 62 79 96 76 68 64 55 77 84 698
Hwlnd Audio [13105214] 134 171 173 179 203 158 206 187 175 213 222 2,021
Howland OT [13105217] 103 221 163 153 148 173 961
HOWLAND PT [13105216] 192 615 706 674 665 705 3,557
Howland Sp [13105218] 46 123 110 69 95 112 555
HOWLAND WALK [13105228] 24 148 146 208 200 726
Howland Lab Draw 121 121 286 460 502 601 504 766 740 782 852 5,735
Grand Total 986 3,448 3,446 3,391 4,206 4,391 5,543 5,456 4,703 6,031 6,177 47,778
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Month 1 - 986 Completed Appointments---------------------- Month 11 - 6,177 Completed Appointments
� Practice of the FutureIncreasing Access to Care
New Patients into the building
Department April May June July August September October November December January February Grand Total
Howland ENT [13105104] 79 96 81 118 131 108 128 127 127 124 143 1,262
Howland Orth [13105142] 200 214 174 193 194 235 200 131 187 236 1,964
Howland OT [13105217] 7 19 19 14 23 24 106
Howland PC [13105188] 17 40 20 75 102 92 128 111 105 148 147 985
Howland PMR [13105148] 94 74 40 75 61 70 129 66 99 94 802
HOWLAND PT [13105216] 26 87 65 73 75 79 405
Howland Sp [13105218] 46 27 16 7 16 19 131
Grand Total 96 430 389 407 501 534 694 667 523 672 742 5,655
Exam Room Utilization
Visits Monday Tuesday Wednesday Thursday Friday Saturday Grand Total
Week 1 Holiday 317 301 257 200 1,075
Week 2 314 376 258 269 203 1,420
Week 3 344 364 286 304 234 8 1,540
Week 4 379 364 281 287 265 1,576
Week 5 380 286 312 259 221 1,458
Week 6 336 352 226 273 222 1,409
Week 7 394 367 294 321 256 8 1,640
Week 8 315 351 359 299 281 1,605
Grand Total 2,172 2,492 2,023 2,227 1,781 16 10,711
Monday Tuesday Wednesday Thursday Friday Sat
# Pr Rooms
Used
# Pr Rooms
Used
# Pr Rooms
Used
# Pr Rooms
Used
# Pr Rooms
Used
POD A
13 Rooms
Primary Care (1 room Triage/POCT lab) 3rd Sat/am
AM 4 12/12 4 12/12 4 9/12 4 12/12 3 9/12 3/12
PM 4 12/12 4 12/12 4 12/12 3 9/12 3 9/12
POD B
12 Rooms
Ent and Primary Care Walk In Care/Opportunity for Time Share in Yellow or expansion for Dr. Walton or
Ortho CNP
AM 2 9/12 5 12/12 5 12/12 3 7/12 5 12/12
PM 5 12/12 3 9/12 2 6/12 3 7/12 4 7/12
POD C
12 Rooms
Ortho and Physical Medicine and Rehab/ 9 Exam Rooms with 2 EMG Treatment Rooms under PMR
AM 3 12/12 4 12/12 3 12/12 3 12/12 2 9/12
PM 2 12/12 4 12/12 2 9/12 2 9/12 3 12/12
Total 69/72
95.8%
69/72
95.8%
60/72
83.3%
56/72
77.8%
58/72
80.5%
Avg.
86.64%
RE-IMAGINING CARE
“Delivering an outstanding Patient Experience”
Monitor Patient, Provider and Staff Feedback Regularly
•Continue to ASK the Patient “How did we do today?”
Comments-Monitored Daily
Help had a very
nice
personality,
nice
atmosphere.
De-
personalized/no
receptionist.
Small parking lot
on a hill? Glad I
don't have knee
problems! Long
wait times.
Love the fast
was perfect!
Love the fast
check in and
service of all
staff and
volunteers.
Everything
was perfect!
Perfect visit.
Smooth.
Thanks. Smiles
and help much
appreciated.
I feel all the
Drs names
still s/b listed
on outside of
building
Key Action Items and takeaways• Staff and environment pleasing to majority
of patients• Hand and equipment hygiene needs to be
more visible• More signage needed• Provider wait times• Parking needs to be addressed
Kiosk's and pagers Kiosk's and pagers
being wiped down
between patient's
usage.
Employee Engagement
•Created Employee Task Force to allow team members to “own” their environment and become a part of the future.
•Created Innovation Idea Board to allow the teams to think of ways to streamline prior operations to the practice of the future.
•Staff created ways to give back to the community. This was either through T-shirt Fridays collections, Festival of Trees for St Joseph’s Mission, Panerathon teams for Joanie Abdu Breast Cancer Center, Second Harvest Food Bank collections, Sponsoring a Family at Thanksgiving, Pen Pals in our local schools, etc.
Provider and Staff Engagement is Key with this model
Next steps
•Our original plan was to build out the 2nd floor (Phase II) in 5 years after opening to allow for growth in the building.
•This plan was accelerated to 2 years to increase capacity to meet the current demand that was experienced within our first year.
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MHP-Y Provider Current and Future State
Current State
Nov 2017
Phase II
Year 5
Mercy Health Physicians -
Youngstown # of Providers # of Providers
Primary Care 5 13
Orthopaedics 3 3
Physiatry 2 2
ENT 3 4
Specialty Swing Space 0 2
Total 13 24
� 2nd Floor – large primary care hub
� Specialty time share concept
� Continued shaping of processes using people and technology resources
� Patient/Staff Pharmacy
� Patient Education Hub –Chronic disease management, behavioral health
� Community Programs
The future – Phase 2 Opening 2019
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Common Questions
Q: Average time it takes to register on their own on a Kiosk?
A: It is less than 2 minutes. The name, last 4 SSN, last 4 phone, and DOB take the most for the patient to enter as that is the patient recognition steps. Patients can also use the bar codes from My Chart which if they do more online before the appointment to reduce check in time.
Q: How many times does it take before patients become proficient and don’t need help?
A: It is pretty easy for majority even without much help. We have prompts today for certain visit types like New Patients to get all their info correct the first time. You have flexibility by dept or provider or insurance too.
Q: Do you have enough kiosks? Too many?
A: We have 4 today. Planning one more set on this floor. We have up to 350 patients a day and they are utilized well. The Guest Services Navigator role encourage and support the patients utilizing the Kiosks.
Common Questions
Q: What would you do different?
A: Not much. It has been a pretty big win here. Some patients will not use it and it is okay. We have desks and guest services navigators to help them.
Probably more training with the back office/clinical staff so that they understand the kiosk and new registration workflow better and are part of the team more.
Q: What has been your biggest win?
A: Patients love the experience and feel of this building and the innovation. Integration with copay collection and posting, my chart, online signature for consent, AWV and other forms.
Q: What percentage of patients come to the window vs using the kiosk?
A: Ranges between 40 and 50% but more if you count that if they want to pay by cash or
check they have to finish reg at desk since kiosk can take credit card only.
Questions?
Thank youKathy Cook
Mercy Health Youngstown
President of St Joseph Health Center
Warren, OH
Rod Neill
Chief Operating Officer
Mercy Health Physicians Youngstown
Kathleen Kiniklis
Director of Operations
Howland Medical Center
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