Improving the Effectiveness and Efficiency of Care Delivery Systems in the Acute Hospital Setting icarequality, Inc. April, 2015

Transcription

1 Improving the Effectiveness and Efficiency of Care Delivery Systems in the Acute Hospital Setting icarequality, Inc. April, icarequality is a provider and systems engineer-lead company that is incorporated in Pennsylvania as a Benefit organization and operates as a learning lab. Our focus is on helping to extend best practices into enterprise capabilities, deploying these capabilities globally and sharing our experience openly. We believe that the Quality of Healthcare is dependent on the competency and engagement of frontline care providers. The key to success is the development and deployment of advanced health information management solutions in a rapid and affordable manner that fit the natural care delivery process.

2 Healthcare Delivery Challenges The icarequality team has over 25 years of expertise in System Engineering, Clinical, Quality and Business Development. Collectively, the team has recognized the following fundamental obstacles that must be strategically managed to improve the effectiveness and efficiency of the healthcare delivery system, in both the US and globally: 1. The assumption that the entire health system can be improved by optimizing each sub-system individually; this is the antithesis of systems thinking. 2. Initially, the healthcare delivery system was rooted in a single clinician providing care with a multitude of expertise and skills. Over time, healthcare complexity has increased, and the system has not evolved to engage multiple care delivery disciplines to manage the complexity accordingly. 3. Current information systems, delivered to care providers, do not fit the natural work-flow and care delivery process. Unfortunately, the systems presently deployed focus on data collection for multiple stakeholders; clinician need for real-time feedback is often not the top priority. 4. The existing Electronic Health Record (EHR) system is not a technical or clinical challenge; many best practices currently exist. The challenge is the lack of organization change management expertise that requires coordinated, firm visionary leadership. 5. The healthcare industry has adopted the Lean Six Sigma Methodology for incremental improvement; however, skills to cultivate strategic change are often missing among healthcare executives and leadership. Our Approach icarequality adapts scientifically-proven, evidence-based practices in healthcare delivery and builds pragmatic enterprise capabilities. icarequality s approach is to advance frontline care delivery by integrating people, process, technology and performance metrics; our solution uses a learning management framework, infused with quality improvement and engagement principles. Our system design leverages user-centric principles adopted by most social media platforms, and not the technology-centric interfaces seen in most Enterprise Resource Planning (ERP) and EHRs. Our incremental approach builds engagement at the frontline; it both systematically and incrementally enables Disruptive Change without the Disruptions to current hospital operations. Our rapid system development and deployment management approach, using system engineering methods, enables us to quickly address both technology and organizational challenges as they become self-evident: 1. Iteration 1: Using a Health Failure Mode Effects Analysis (hfmea), identify gaps in care and help close those gaps through improved information. Build a minimum viable system as part of the whole system architecture and engage front line providers in managed simulations. icarequality Inc. 2 P a g e

3 2. Iteration 2: Once the system meets the needs of all stakeholders, rapidly deploy in a single unit. At this point, we monitor both capability performance and outcomes. For example, we would evaluate service compliance to interprofessional communication and its impact on expected discharge date delays. 3. Iteration 3: Next, we deploy the capability at the entire system-level and monitor both capability performance and outcomes. The upgraded system is released every 12 months. Figure 1. hfmea Process Current HIT System Capabilities Since 2010, the icarequality team has successfully built and deployed the following frontline capabilities for Hospital organizations and Providers using current EHR technology. Please see Table 1 for a list of capabilities and performance measures that are currently in operation. Table 1: icarequality System Capabilities and Performance Measures The performance measures use naturally-generated data by the direct care delivery process: # Capability Name Capability Description 1 Patient List Ability to identify and manage selected population of patients Metrics to Measure/Track 1. Time and effort to create and maintain patient hotlist 2. Information concurrency (in minutes) icarequality Inc. 3 P a g e

4 # Capability Name 2 Handoff, Hand-Over or Sign-Out Capability Description Ability to transfer essential health information and the responsibility for care of the patient from one healthcare Provider to another in a safe, effective and efficient manner using a service-centric standardized process Metrics to Measure/Track 1. Time and effort to complete handoff 2. Completeness of handoff information 3. Concurrency of handoff information 3 Care Team Ability to define and manage crossfunctional teams from multiple organizations. 4 Interprofessional Communication 5 Transition of Care pending hfmea approval Ability to provide real-time, facility-wide communication to all care team members using a secure, patient-centric platform for text messaging and clinical collaboration for patient care issues. The safe and secure transition of essential healthcare information to ensure the coordination and continuity of healthcare as patients transfer between different physical locations. Data is transferred electronically without need to integrate disparate EHR systems. 1. Time and effort to create and maintain care team 2. Care team information concurrency 1. Type of text messages disruption factor 2. Duration and effort of text messages sent 3. Number of messages responded to on time 1. Length of time to transfer essential data discharge report 2. Effort (time) it takes to transition essential data to assume care. 6 Care Coordination (pending hfmea approval) Deliberately organizing and sharing patient care activities and information electronically with the patient and care team members across the care continuum to safely, effectively and efficiently improve health outcomes. 1. Effort to coordinate care activities across continuum 2. Meet patient care goals within time frame 7 Bedside Measure gaps in the frontline care delivery processes based on best practice standards. Upload common checklists for orientation, Peer-2-Peer, hospital readiness monitoring, and others. Provide targeted staff education and award Continuing Nursing Education (CNE) or Continuing Medical Education (CME) credits for quality improvement projects. 1. Process variance 1. Competency level 2. Number of at risk areas on each patient care unit 8 Staff Engagement (in design) Systematically motivate, measure and engage frontline provider activity using reward-based learning. Formally recognize and monitor staff contributions using engagement points. This represents 1. Number of providers above benchmark expectations 2. Number of total engagement points awarded at the individual, unit and icarequality Inc. 4 P a g e

5 # Capability Name Capability Description a practical mechanism for senior management to actively engage with frontline staff in a non-punitive way. Metrics to Measure/Track organization-level 9 Adverse Event Reporting Using AHRQ Common Formats, systematically report and track adverse safety events and near misses such as falls, CAUTI, medication errors, etc. at the unit, provider, and organization levels. 1. Number of events at unit and organization-levels as OFI 2. # of patient EDD changes due to adverse events 10 Quality Projects Develop targeted action plans using the mini project toolkit allowing for provider accountability and transparency in quality improvement projects. Track progress and capture idea generation. 1. Number of projects completed on unit and organization scorecard. 2. Number of projects that (+) or (-) affect the capability 11 Transparency and Accountability ( in design phase) 12 Dashboard and Report Ability to see enterprise performance in real-time visual charts and responses from resource accountable for the selected performance indicator. Ability to see individual performance and a brief list of reports. 1. Effort required to compute the performance indicators that help create a transparent and accountable culture. 1. Engagement by performance visibility (self and unit) About icarequality icarequality is a systems engineer and provider lead benefit corporation in PA. icarequality leverages the concept of a Global Learning Lab to advance healthcare delivery science. Social change is part of the company s anchor and its core values include: be thankful, live in the moment, earn an honest living, share your blessings, and consider the well-being of all. The Corporate Charter for icarequality explicitly defines the company commitment to healthcare providers globally. Executive (VPs and CEO) compensation is capped at three and four times those of average staff salaries, respectively. icarequality is privately owned by four (4) principles that are actively engaged in the business. The Principles have pledged their commitment to the company s mission, vision and values. Additionally, the Board of Directors has formally pledged to allocate corporate earnings accordingly: Re-Investment: 90% - Fund Leaning Lab research and development Shareholder: 10% - Fair return as dividends to shareholders icarequality Inc. 5 P a g e

6 icarequality Investors and Senior Management Team: Jason Uppal, P.Eng. - Chief Architect o Role: Healthcare Systems Engineer and Program Chief Architect o Experience: Over 25 years of experience and is global expert in Systems Engineering. Serves as a Level 3 International Architect and Board Member for the Open Group. Has expertise and global success in business transformation programs, including manufacturing, banking, finance, and healthcare. Known as thought leader, writer and Lead SE faculty for Mumbai MBA program. Kate ONeill, DNPc, MSN, RN Chief Nursing Officer, Vice President of Quality and Safety o Role: Senior Clinical, Quality and Safety Program Lead o Experience: Nursing and LEAN Leader with over 25 years of clinical experience. She has a diverse healthcare background in regulatory compliance, quality improvement, practice standards, HIT integration, patient safety, and staff development. Franz Ho Chief Technology Officer o Role: Senior Systems Developer, Design and Integration Lead o Experience: Systems Engineer with passion for building systems that dynamically and naturally fit the workflow. Two click rule (after two clicks provider should be working), provider must become functional within less than 10 minutes of self-training. Brings nearly 30 years of experience working with low-level technologies that control submarines, a free mobile phone app to help support small businesses in China, and designs intuitive, user-friendly systems. Other icarequality Projects: Applications of icarequality Systems Wellness and Care Management: The icarequality team is working with a number of healthcare insurance providers to build an integrated network to manage care for chronically-ill members more effectively. This system extends the initial work performed by Blue Cross and Blue Shield of Michigan and the Health Science Institute American Council for Graduate Medical Education (ACGME): Build collaboration between icarequality, several teaching hospitals and third-party investors/participants to architect, develop and deliver a system that can help automate the ACGME Milestone and CLER program processes for US Medical Education. icarequality Inc. 6 P a g e