Wednesday, August 31, 2011

Lean moves out of the box: CCRMC, Pittsburg Health Center and Richmond Health Center-Kaizen Report Out's Friday September 2

The Kaizen Report Outs will occur on Friday, Sept 2nd as follows:

7:45-8:15 AM Richmond Health Center

10-10:30 AM CCRMC Hospital Lobby

12:15-12:45 PM Pittsburg Health Center

The improvement team has organized into three groups after generating improvement ideas related appointment access.

Team one is focused on appointment scheduling. They are examining current system issues surrounding distribution and sorting. They are conducting a trial giving advice nurses access to at least half of all "short notice" appointments. The team hopes to understand better if there is a difference and any improvement if these appointments are distributed through the advice unit.

Team two is exploring the virtual Provider visit. The team is currently testing using two physicians who are providing phone visits with patients referred from the advice nurse unit. Our hypothesis is that a significant number of patient needs can be met without an on site visit. These Providers are occupying unused clinic space at Pittsburg Health Center during the trial.

Team three is focused on the patient access line. They have reviewed other health system's access lines and plan to trial a system utilizing improved human interaction and a more patient centered phone tree. The team believes that these system improvements will increase patient satisfaction and direct calls to the appropriate resources in an efficient manner.

Please join me in supporting the work of your colleagues and our patient and family partners as they draw on science and the energy and creativity of each other to continuously improve our health system.


Sunday, August 28, 2011

Sea Level

In past discussions I have often likened the unprecedented change we are experiencing in health care, here in Contra Costa County and nationally, to a tsunami. I was wrong. This change is not a series of unrelenting waves. The sea itself is rising and so must we. There is no more waiting. Change is here. We must lean directly into the wind with active pursuit of continuous quality improvement at every level of our system. Adoption of Lean Management and the Model for Improvement throughout our system offers a systematic way of improving efficiency and improving, not compromising, quality.

This should be considered the first in a brief series of posts aimed at providing an overview of our primary strategy to transform our system. I will begin with Lean. In the next post I will discuss The Model for Improvement. I hope to link these discussions to what is happening in your work area and/or experience of our system.

What is Lean anyway?
There are many different variations of Lean in practice so I offer a very limited and generic overview that is consistent with the overall philosophy and reflective of CCRMC's Lean efforts.

Generally, Lean is centered on creating more value with less work. Lean Management is a process management philosophy derived mostly from the Toyota Production System (TPS) and grounded in W. Edward Deming's System of Profound Knowledge. Lean focuses on reduction of the original Toyota seven wastes in order to improve overall customer value.

Working from the perspective of the customer who consumes a product or service, "value" is defined as any action or process that a customer would be willing to pay for. Value is defined by the external customer and in our case it's always the patient.

Lean manufacturing is a variation on the theme of efficiency based on optimizing flow; increasing efficiency, decreasing waste, and using empirical methods to decide what matters, rather than uncritically accepting pre-existing ideas.

What are we doing at CCRMC and the Health Centers?

Teams of key stakeholders perform an exercise called value stream mapping (VSM). This mapping examines steps in our processes and determines how much value these steps add to the patients experience of care from their perspective. In partnership with users of our health system/community members, teams then imagine/dream the ideal future state and present that to the system.

To begin developing and testing changes that are aimed at realizing this ideal future state a series of rapid improvement events or kaizen events (also known as kaizen blitz) are conducted. In these improvement events several small tests and simulations are performed. Changes are developed and tested with front-line staff and users of our system. Teams in the site where the work actually occurs then implement changes and continue to refine them on an ongoing/continuous basis, pursuing the ideal future state.

The table below displays upcoming events dates

I know this seems like a foreign language, and that's because it actually is.

There is much to learn. We will learn together. We will take one step at a time. If we fall down seven times, we will get up eight. Please ask questions and keep an eye out for updates. Anyone from the Operations Team can answer your questions so please don't hesitate to ask.


Saturday, August 20, 2011

Got Tdap?

Get a free Tdap (whooping cough) vaccine

TODAY only at the Richmond Recreation Complex, 3230 MacDonald Ave. from 11 a.m. - 2 p.m.

A new State law requires all 7th-12th graders get a Tdap booster to stay in school this fall.

Learn more at Contra Costa Health Services

Friday, August 19, 2011

Visit from LAO, CHEAC and CAPH


Today (Thursday), I had the opportunity to help share the exciting work we have underway in our health system to implement health reform with some special guests from the California Legislative Analyst’s Office (LAO), County Health Executives Association of California and the California Association of Public Hospitals. The LAO provides fiscal and policy advice to the Legislature, serving as its "eyes and ears.” We were one of only three counties in California that the group visited this summer to gather information on efforts around the Medi-Cal Waiver, health care coverage expansion initiatives and other issues facing systems like ours.

CCHS Director Dr. William Walker, Contra Costa Health Plan CEO Patricia Tanquary, Assistant to the Director Wanda Session and I presented an overview of the comprehensive services we provide to our community- from our hospital, 10 primary care federally qualified Health Centers, nationally recognized family practice residency program and Health Plan to our extensive network of mental health and substance abuse providers and array of public health outreach, education and disease management programs. I was excited to talk about our innovation work and Lean Management System to continuously improve our system.

As we covered the array of critical services we provide, I was struck yet again by the groundbreaking work we do every day. I am so proud to work with colleagues committed to excellence and to doing common things uncommonly well. The work we are undertaking now to prepare for 2014 is the most thrilling challenge of my 18-year career here. The work you are doing is remarkable and we are well on our way to achieving our goal of the better health, better care and lower costs.

Thank you for all that you do.

Tuesday, August 16, 2011

Thank you to Senator Mark DeSaulnier and California Legislature for honoring Sergeant Paul Starzyk

Thank you to Senator Mark DeSaulnier and California Legislature for honoring Sergeant Paul Starzyk. Today SCR 21 (DeSaulnier) was approved, naming the Martinez Pine Street overcrossing in Paul's memory. Sergeant Starzyk is a hero who made the ultimate sacrifice to keep our community safe and is greatly missed.

As a member of the Martinez Police Department family you have my deepest gratitude.
Anna Roth

Released today:

Tuesday, August 16, 2011
Senate Concurrent Resolution 21(DeSaulnier) names the Hwy 4 Pine Street Overcrossing for a Martinez Hero

The State Senate has approved SCR 21 (DeSaulnier) to name the Pine Street Overcrossing that crosses State Highway Route 4 in Martinez as the “Police Sergeant Paul Starzyk Memorial Overcrossing.”  Martinez Police Sergeant Paul A. Starzyk served as a full time police officer for 14 years and was tragically killed in the line of duty while protecting those he was sworn to serve.  Sergeant Starzyk also served as a member of the SWAT team, he was a Range Master, and ultimately became an instructor for the SWAT team. 

“Sergeant Starzyk died a hero,” said Senator Mark DeSaulnier (D-Concord).  “Naming this overcrossing in his honor will serve as a constant reminder to all of us that we owe a great debt to this fine officer and his family.”

On the morning of September 6, 2008, Sergeant Starzyk responded to a domestic disturbance.  A man armed with a handgun terrorized patrons at a beauty salon and then forced his way into a second story apartment where his estranged wife’s cousin had sought refuge.

When Sergeant Starzyk and his cover officer arrived, they approached the apartment and heard women screaming and gun fire.  Sergeant Starzyk knowingly and willing placed himself in harms way by confronting the suspect who was threatening the lives of five occupants of the apartment after shooting and killing his estranged wife’s cousin as Sergeant Starzyk and his partner approached.  Sergeant Starzyk was immediately fired upon by the suspect and was critically wounded, but he was able to return fire and fatally wounded the suspect.

Sergeant Starzyk’s decisive and heroic actions saved the lives of two women and three children who were hiding in the apartment.  Sergeant Starzyk did not survive his injuries making the ultimate sacrifice to protect the five occupants of the apartment.  Sergeant Starzyk was awarded the Medal of Valor posthumously for his extraordinary and heroic actions.  The community will forever be indebted for his sacrifice.  He left behind a wife and three children.
In honor of Sergeant Starzyk’s service, the City of Martinez Police Department asked that this overcrossing be named for Sergeant Starzyk.  SCR 21 requests that Caltrans determine the cost of appropriate signs showing the special designation and upon receiving sufficient donations from private sources, erect the appropriate markers.  The resolution need not go to the Governor for consideration as approval by the Legislature alone is sufficient.
                                                                                                                   # # #

Sen. Mark DeSaulnier (D-Concord) represents the Seventh Senate District, which includes most of Contra Costa County.

Michael Miiller, Communications Director
(916) 651-4007 or (916) 204-0485

Sunday, August 14, 2011

Worth the read-

July 4, 2011 ~  A Roth
Two reasons I love this:

1. The message to health care exec's (the real reason)
2. It's about my team (a happy coincidence)

Simple rule - get to the base!

Sunday, August 7, 2011

Many thanks to Patrick Anderson, Executive Director of Chugachmiut, Inc., an Alaska Native Tribal consortium, for taking the time to read about our efforts to improve access to our system. He notes that, " Chugachmiut went from waiting for up to 4 weeks for appointments to same day appointments in a short period of time. While our demand is not as great as Contra Costa’s, and we are nowhere near as big, the tools work the same in both our cultures."

You can read the full post here as well as many other interesting posts on Patrick Anderson's blog, Lean in Alaska.

Saturday, August 6, 2011

CCMRC /CCHS July 22 Kaizen Report Access Value Stream/ Advice Unit

Jeff Selberg speaks to the team
Click on the slide to see the full slide set

I am posting a long overdue summary of the July 22 Kaizen Report out which focused on access to our system with an emphasis on the role of the Advice Unit.

I'd like to thank the team which included employees from across our system and patient volunteers/Healthcare Partners. Without you we could not accomplish what we have thus far. I also want to extend my gratitude to Jeff Selberg, Executive Vice President and Chief Operating Officer of the Institute for Healthcare Improvement (IHI), and Mike Rona, President and CEO of Rona Consulting, who joined us at the report out. Jeff commented that he was "wondering how we will accomplish all that we have to do" he went on to say, "now I know."

I have attached the slides which should be posted both above this post and within this post. If the slide show is not working you can click on the picture above and it will take you to the slides. I will post the rest of the pictures from the report out this week.

In summary, the team formed three work groups:
1. Flow
2. Patient Centered Medical Home
3. Advice Unit

Teams identified areas in need of improvement and in some cases began to cost out the opportunity. Each team developed proposed tests of change and began testing this week.

The Flow team  tested use of a triage system for MD access and sorting of calls.

Several ideas were considered around creation of truly patient-centered medical homes. The team has planned to test the proposed standard work with one physician in the first week of October.

Other test conducted this week included utilization of a MD in the Advice Unit. Based on national standards and protocols the team tested directing calls to an MD for intervention.

This is complex work and work that is now reaching far outside the walls of the medical center (CCRMC) into the health centers (clinics) and the health plan (CCHP). This is not easy work. It takes willingness, courage, caring and honesty to engage in a change effort [*]. Additionally, it takes constancy of purpose and discipline.

There are many distractions along the way and the force of the status quo is strong. Many have mastered the current state and their perceived power, position, and in some extreme cases, their identity can be based on that mastery. To seek a new order, to resist the urge to settle and to lead a transformation effort is indeed the work of the courageous. The first step is to change ourselves, which may be the most frightening step of all. Many will retreat to the status quo. Many will settle. We will not.

My deepest gratitude to the team and to all of you for your commitment to our mission and our community.


Friday, August 5, 2011

"You See"

PH 290.6 bSpace is now open!
I'm looking forward to a great semester.