San Mateo Medical Center’sSan Mateo Medical Center’sSan Mateo Medical Center sSan Mateo Medical Center sTransformation JourneyTransformation Journeyyy
Susan P. Ehrlich, MD, MPPSusan P. Ehrlich, MD, MPPCalifornia Improvement Network WebinarCalifornia Improvement Network Webinar
M h 23 2011M h 23 2011March 23, 2011March 23, 2011
SMMC MISSION:
O i D t E llOpening Doors to Excellence in Health Care
SMMC: Integrated System of Care
SMMC Clinic SystemSMMC Clinic System• North CountyNorth County
– Daly City Clinic– Daly City Youth Health Center– South San Francisco Clinic
• Main Campus Clinics– Senior Care Center, Innovative
Care Clinic, OB-GYN, Pediatric, , , ,Specialty, Urgent Care
• Coastside Clinic• South CountySouth County
– Fair Oaks Clinic– Fair Oaks Children’s Clinic– Sequoia Teen Wellness CenterSequoia Teen Wellness Center– Willow Clinic– Methadone Clinic
The San Mateo County Community Health Network
Health Plan ofSan Mateo
Ravenswood, Community
San Mateo
,Samaritan
House
yMD’s &
HospitalsSan Mateo Co.Health SystemHealth System
HumanServicesAgency
Health Care Districtsg y
SMMC Volumes 2009 10SMMC Volumes, 2009-10
SERVICE-Visits/Days Daily AnnuallyCli i i it 238 600Clinic visits 238,600Medical ED 105 35,500Psychiatric ED 7 3,500Medical/Surgical/ICU 27 11 100Medical/Surgical/ICU 27 11,100Psychiatry 30 9,700Long Term Care 282 103,000
SMMC PatientsSMMC Patients78 000 unique individuals served78,000 unique individuals served
• 56% women
• 30% under 18, 11% over 60
• 53% Hispanic, 35% White
• 30% Medi-Cal, 30% ACE
• 26% Mid-County, 23% North County, 28% South Countyy
SMMC Strategic Goals
Patient ExperienceTo become the provider of choice by
2015
Financial StewardshipHelp guide SMMC to be known 2015;
the medical center to which employees would want to take their loved ones
Help guide SMMC to be known nationally as a high quality, low cost
provider by 2015
Quality & SafetyTo be recognized as the best integrated delivery system in the country by 2015
Staff EngagementT b h h l h l f h i
Community PartnershipTo be the healthcare employer of choice in the region by 2015 for staff who are passionately committed to serving our
community
By 2015, all community healthcare resources will be meaningfully committed
to meeting the health needs of the underserved
The Beginning of Transformation: 2004• One collaborative• One clinicOne clinic• One team: MD, RN, MSA• One diagnosis: diabetes• One hundred patients• One hundred patients• One registry
The Journey Since the BeginningThe Journey Since the Beginning• Primary Care Redesign• Health Care Interpreter Network• Health Care Interpreter Network• Ron Robinson Senior Care Center• Heart 2 Heart Collaboration with Stanford• Pediatric Asthma Registry—Willow ClinicPediatric Asthma Registry Willow Clinic• Pediatric Asthma Cell Phones• SEED Diabetes Chronic Care Project• Chronic Pain Management Clinicg• Innovative Care Clinic• Care Transitions• Ambulatory Electronic Medical Record• LEAN Process Improvement• Retinal Camera• Palliative Care
S i lt C R d i• Specialty Care Redesign• Integrated Nurse Leadership Project—Medication management/Sepsis• Teledermatology• SMART Electronic Referral• SMART Electronic Referral
Challenges AheadChallenges Ahead
• Local budget, State budget, Federal budget• Preparing for 2014: reduce costs, provide p g p
exceptional quality, and provide the optimal patient experience
• Predict and manage our rapidly changing external environmentexternal environment
• Recruit and retain exceptional leaders and staff
Lessons Learned: TransformationLessons Learned: Transformation• Have a vision and goals from which you are undeterred g y
and undistracted• It’s everyone’s responsibility: from leadership to line staff• It’s impossible without everyone’s dedicated involvement• It’s impossible without staff involved in teams outside of
traditional silostraditional silos• Must be focused on measurable outcomes• It’s all about reaching to take advantage of manyIt s all about reaching to take advantage of many
opportunities• It involves constant tests of change — and failureg• It’s a long journey that requires constant vigilance
Innovative Care ClinicInnovative Care Clinic
Evelyn Haddad, MD Evelyn Haddad, MD yyMarch 23, 2011March 23, 2011
Innovative Care ClinicInnovative Care ClinicInnovative Care ClinicInnovative Care Clinic
The Innovative Care Clinic uses a teamThe Innovative Care Clinic uses a team approach and strives for high quality care that
dd t t l h lth ith h i lfaddresses total health with emphasis on self empowerment, education, and prevention by
improving access and efficiency
Key Features of ModelKey Features of ModelKey Features of ModelKey Features of Model•• Team BasedTeam Based CareCare•• Team Based Team Based CareCare
•• Support StaffSupport Staff
•• Expand Patient InteractionExpand Patient Interaction
•• Effective Use of Information TechnologyEffective Use of Information Technology
•• Open AccessOpen AccessOpen AccessOpen Access
•• Focus on Health Promotion and EducationFocus on Health Promotion and Education
•• Performance and Outcomes MeasurementPerformance and Outcomes Measurement
Team Based CareTeam Based CareTeam Based CareTeam Based Care
•• Formation Formation of Podsof Pods
•• Flexible and Expanded Staff RolesFlexible and Expanded Staff Roles
•• Effective use of TeamsEffective use of Teams•• Effective use of TeamsEffective use of Teams
•• Regular Meetings/HuddlesRegular Meetings/Huddles
The Support StaffThe Support StaffThe Support StaffThe Support Staff
•• Certified Diabetes EducatorCertified Diabetes Educator•• NutritionistNutritionistNutritionistNutritionist•• PharmacistPharmacist•• PsychologistPsychologist•• VolunteersVolunteers•• VolunteersVolunteers•• IT StaffIT Staff
Expanding Patient InteractionExpanding Patient InteractionExpanding Patient InteractionExpanding Patient Interaction
•• Group VisitsGroup Visits
•• Telephone VisitsTelephone Visits
•• Panel ManagementPanel Management•• Panel ManagementPanel Management
Information TechnologyInformation TechnologyInformation TechnologyInformation Technology
•• Electronic Medical Record: eClinical WorksElectronic Medical Record: eClinical Works
WalkieWalkie TalkiesTalkies•• WalkieWalkie--TalkiesTalkies
•• Health Care Interpreter NetworkHealth Care Interpreter NetworkHealth Care Interpreter NetworkHealth Care Interpreter Network
•• Diabetes Retinal CameraDiabetes Retinal Camera
•• Teledermatology Teledermatology
Open AccessOpen AccessOpen AccessOpen Access
•• Establishment of Patient PanelsEstablishment of Patient Panels
•• SameSame--day access to the provider teamday access to the provider team•• SameSame--day access to the provider teamday access to the provider team
•• Redesign of Phone TreeRedesign of Phone Tree
•• ImproveImprove NoNo ShowShow RatesRates•• Improve Improve NoNo--Show Show RatesRates
Health Promotion & EducationHealth Promotion & EducationHealth Promotion & EducationHealth Promotion & Education
•• Brown Bag lunch presentationsBrown Bag lunch presentations
•• Nurse visitsNurse visits
•• Medical Assistance providing informationMedical Assistance providing information•• Medical Assistance providing informationMedical Assistance providing information
•• Patient set goalsPatient set goals
Performance and Outcomes Performance and Outcomes MeasurementMeasurement
•• CapacityCapacity•• Panel SizePanel SizePanel SizePanel Size•• No Show RatesNo Show Rates•• Third Next AvailableThird Next Available•• Emergency Room VisitsEmergency Room Visits•• Emergency Room VisitsEmergency Room Visits•• HospitalizationsHospitalizations
Capacity for All PCP
150%
170%
130%
150%
90%
110%
Perc
ent
70%
90%
30%
50%
30%
6/11
/201
06/
18/2
010
6/25
/201
07/
2/20
107/
9/20
107/
16/2
010
7/23
/201
07/
30/2
010
8/6/
2010
8/13
/201
08/
20/2
010
8/27
/201
09/
3/20
109/
10/2
010
9/17
/201
09/
24/2
010
10/1
/201
010
/8/2
010
10/1
5/20
1010
/22/
2010
10/2
7/20
1011
/3/2
010
11/1
0/20
1011
/17/
2010
11/2
4/20
1012
/1/2
010
12/8
/201
012
/17/
2010
12/2
4/20
1012
/31/
2010
1/7/
2011
1/21
/201
11/
14/2
011
1/28
/201
12/
4/20
112/
11/2
011
2/25
/201
1
Ti P i dTime Period
ICC 12 Month Panel Graph (P12)
5000
4000
4500
5000
Size
3500
4000
nt P
anel
2500
3000
Patie
n
2000
03/10
04/10
05/10
06/10
07/10
08/10
09/10
10/10
11/10
12/10
01/11
02/11
03 04 05 06 07 08 09 10 11 12 01 02
Period Ending
N Sh P t f All PCPNo Show Percent for All PCP
18%
20%
14%
16%
18%
10%
12%
erce
nt
6%
8%
Pe
0%
2%
4%
0%
4/2/
2010
4/9/
2010
4/16
/201
04/
23/2
010
4/30
/201
05/
7/20
105/
14/2
010
5/21
/201
05/
28/2
010
6/4/
2010
6/8/
2010
6/18
/201
06/
25/2
010
7/2/
2010
7/9/
2010
7/16
/201
07/
23/2
010
7/30
/201
08/
6/20
108/
13/2
010
8/20
/201
08/
27/2
010
9/3/
2010
9/10
/201
09/
17/2
010
9/24
/201
010
/1/2
010
10/8
/201
010
/15/
2010
10/2
2/20
1010
/29/
2010
11/5
/201
011
/12/
2010
11/1
9/20
1011
/26/
2010
12/3
/201
012
/10/
2010
12/1
7/20
1012
/24/
2010
12/3
1/20
101/
7/20
111/
14/2
011
1/21
/201
11/
28/2
011
2/4/
2011
2/11
/201
12/
18/2
011
2/25
/201
13/
4/20
11
Time PeriodTime Period
Third Next Available All PCP Average
25
20
15
Day
s
5
10
0
5
0
6/4/
2010
6/11
/201
06/
18/2
010
6/25
/201
07/
2/20
107/
9/20
107/
16/2
010
7/23
/201
07/
30/2
010
8/6/
2010
8/13
/201
08/
20/2
010
8/28
/201
09/
3/20
109/
10/2
010
9/17
/201
09/
24/2
010
10/1
/201
010
/8/2
010
10/1
5/20
1010
/22/
2010
10/2
9/20
1011
/5/2
010
11/1
2/20
1011
/19/
2010
11/2
3/20
1012
/3/2
010
12/1
0/20
1012
/16/
2010
12/2
4/20
1012
/31/
2010
1/7/
2011
1/14
/201
11/
21/2
011
1/28
/201
12/
4/20
112/
11/2
011
2/18
/201
12/
25/2
011
3/4/
2011
3/11
/201
1
Time PeriodTime Period
ICC P l d P ti t S i ED G hICC Paneled Patients Seen in ED Graph
60
55 ED
nts)
50
t Vis
its In
000
patie
n
45Patie
nt(P
er 1
0
40MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN 'FEB
10 10 10 10 10 10 10 10 10 '10 '11 11
Period Ending
ICC Paneled Patients Hospitalized
10
6
8
Visi
tstie
nts)
4
6
npat
ient
Vr 1
000
pat
0
2
In(P
er
0
MAR 10APR 10MAY 10JU
N 10JU
L 10AUG 10SEP 10OCT 10NOV10DEC10JA
N11FEB 11
MA AP MA JU JU AU SE OC NO DE JA FE
Month Ending
ChallengesChallenges
• Change is difficult
• If the process does not fit the clinic, change the processprocess
Making process work with minimal exceptions• Making process work with minimal exceptions
• EMR implementation
Keys to SuccessKeys to SuccessS t f Ad i i t ti• Support from Administration
• Engaging “Early Adopters”• Engaging Early Adopters
• Staff involvement in feedback• Staff involvement in feedback
• Using PDSA when implementing changeUsing PDSA when implementing change
• Having data to confirm successg
• Communication to all staff members
Future GoalsFuture Goals
• New Patient Process
• Expanding Panel Management
• Continuing to expand Staff Roles• Continuing to expand Staff Roles
Innovative Care ClinicInnovative Care ClinicInnovative Care ClinicInnovative Care Clinic
Susan P. Ehrlich, MD, MPP Chief Executive Officer, San Mateo Medical Center SMMC is an integrated county system of physical and mental health care serving 80,000 individuals annually with emergency, acute, long-term and ambulatory primary and specialty care. Prior to this role, Ehrlich was SMMC’s first chief medical officer, the medical director and vice president for ambulatory services, and the founding medical director for the SMMC Ron Robinson Senior Care Center. The RRSCC is a unique clinic that offers offering primary care and interdisciplinary geriatric assessment and treatment services to older adults. Ehrlich received a medical doctorate from the University of California, San Francisco; a master’s in public policy from the University of California, Berkeley; and a bachelor’s in public policy from Duke University. She completed her residency training in internal medicine/primary care at the Brigham and Women’s Hospital in Boston and is a diplomate of the American Board of Internal Medicine. Ehrlich has held numerous positions in health care services delivery and health policy and finance including budget and planning director for the San Francisco Department of Public Health, assistant health officer for the San Mateo County Health Services Agency, and senior manager for Lewin-VHI, a national health care consulting firm. She chairs the California Health Care Safety Net Institute board and is on the boards of the California Association of Public Hospitals and the Health Care Interpreter Network. Ehrlich's career has focused on health care policy and services to the underserved, and she continues to practice primary care internal medicine at the Ron Robinson Senior Care Center. Evelyn Haddad, MD Director, Innovative Care Clinic, San Mateo Medical Center Dr. Evelyn Haddad is the acting medical director of the Innovative Care Clinic at the San Mateo Medical Center. The Innovative Care Clinic was recreated in January 2009, highlighting its goal to improve the quality of care, the cost of care and patient and staff satisfaction by using a team approach model in primary care. Prior to her role as medical director, Haddad was an active participant in several collaboration initiatives in the Innovative Care Clinic. Haddad received a bachelor’s degree in physiological science and psychobiology from University of California, Los Angeles; a master’s in biology from the University of Texas, San Antonio; and a medical doctorate from the University of Texas Health Science Center, San Antonio. She is a board-certified internist.
