Sunday, October 30, 2011

CCRMC and HC's, Patient Centered Health Home

If they don't load, please find Friday's slides here.
Presented by this weeks improvement event team, here is the future vision of the Contra Costa Regional Medical Center and Health Centers, Patient Centered Health Home (PCHH).

I was happy to see the migration from the term "medical" to the term "health." This is an example of the critical thinking that went into this vision and the push to move toward a model that goes beyond care only and focuses on health.

The team drew from the The National Committee for Quality Assurance's (NCQA), Patient-Centered Medical Home (PCMH) guidelines as a foundation for design. The NCQA describes the PCMH as,
"a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner."
In a set of standards that describe clear and specific criteria, the program gives practices information about organizing care around patients, working in teams and coordinating and tracking care over time.The NCQA PCMH 2011 program’s six standards are:
• Enhance Access and Continuity
• Identify and Manage Patient Populations
• Plan and Manage Care
• Provide Self-Care and Community Support
• Track and Coordinate Care
• Measure and Improve Performance

The team arrayed some (not all) of CCHS and community services as they relate to each of these standards. The key will be developing and maintaining meaningful connections
As we pursue seamless transitions through the health and health care experience we will become increasingly reliant on the ability to move information reliably. Below is the vision of standard movement of information.
I chose to present drawings rather than the electronic version of the forms here. I have received feedback by some that the forms can feel a bit off putting and intimidating. I am testing use of multiple forms of communication. For those who are counting on seeing the A3, you can find it and the entire presentation on Picasa here.

Exciting times are ahead of us. The first rapid improvement event for the PCHH is in just two weeks!

More, very soon.

Friday, October 28, 2011

Patient Centered Health Home: Value Stream Mapping Report Outs are Today

The Patient Centered Health Home:Value Stream Mapping Report-Outs are happening today, Friday, October 28th 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

Please support 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.


Monday, October 24, 2011

Observance in Cynthia Palomata's memory - October 28th

Dear Contra Costa Health Services Community,

This week marks a year since we lost one of our own in a brutal assault at the Martinez Detention Facility. Cynthia Palomata, a longtime nurse working at the facility, was violently attacked by an inmate whom she was treating. She succumbed to her injuries three days later.

In Cynthia’s memory, I invite you to observe a moment of silence on Friday, October 28th, at 3:30 p.m. Please feel free to gather with your colleagues at that time if you are able.

As we go through this painful period, I also want to remind you that you may contact the Contra Costa Crisis Line for confidential counseling anytime at 1-800-833-2900. Employees can also call our Employee Assistance Program at 1-925-930-3661 to make an appointment for counseling if needed.

I know you join me in sending your thoughts and prayers to Cynthia’s family at this difficult time.


Sunday, October 23, 2011

"No one left out"

I thought some of you may like to read this Contra Costa Times article, Public hospitals carry burden of charity care despite big tax breaks for nonprofits. The article examines the distribution of care provided for people who are under-insured or uninsured in our region. For those who have followed the cantankerous discussion around Contra Costa Regional Medical Center and whether we need such a hospital in our community, I think you will find it worth the read.

"In Contra Costa, the county hospital alone accounted for more than 75 percent of the countywide charity care total in 2010." Sandy Kleffman, Contra Costa Times

Click on the images to enlarge
Image Source: Bay Area News Group

Many people continue to have a limited understanding of the essential role public hospitals and health systems. California ’s 19 public hospital systems make up the core of the state’s medical safety net – delivering care to all who need it, regardless of ability to pay or insurance status.

Though just 6% of all California hospitals statewide, public hospitals:
• Serve 2.5 million Californians each year
• Are located in counties where 81% of all Californians reside
• Deliver 10 million outpatient visits per year
• Operate more than half of the top-level trauma centers
• Operate almost half of the state’s burn centers
• Are teaching hospitals, training 43% of new doctors in the state
• Provide nearly half of all hospital care to the state’s 6.7 million uninsured (in some regions like Contra Costa County it's even greater than half)
• Provide 69% of their care to patients who receive Medi-Cal benefits or are uninsured; all other hospitals together provide 25% of their care to this population
• Deliver 30% of the state's inpatient care to the Medi-Cal population
• Serve a diverse patient population that is 48% Hispanic/Latino, 29% White, 12.5% Black, 6.5% Asian and 3.9% Other

Although there are many differing perspectives, we all look to the future of health care in our nation with great hope. For me, my hopes for our nation's health care system, and for our community, are summarized in the Institute for Healthcare Improvement's (IHI) "No Needless List":
• No needless deaths
• No needless pain or suffering
• No helplessness in those served or serving
• No unwanted waiting
• No waste
• No one left out

...No one.

Friday, October 21, 2011

Lean Forward

In November 2008, the California Health Care Safety Net Institute (SNI) launched its Lean Core Measures Improvement Initiative.The program introduced the use of Lean/ Toyota Management System (TMS) as a strategy to streamline processes and create a more patient-focused environment that supports timely delivery of treatment and other healthcare services with optimum quality at the least cost. Over the last two years we have been working with deliberate focus and speed to integrate Lean/TMS as our leadership system. Many of you have participated in improvement events (rapid/kaizen), and/or had the opportunity to learn of the ongoing efforts at one of our many monthly “report-outs.”

As a next step CCRMC was selected as one of five public hospitals to participate in the Embedding Lean initiative. This ambitious two-year initiative aims to support system-wide Lean transformation by increasing the number of staff who are trained in performance improvement, and the Toyota Management System (TMS).

What's happening here?

Mike Rona and Patti Crome from Rona Consulting provided the first of a series of Lean Intensive workshops for partners (users and providers) across our county involved in the delivery of health care. You may have seen some of the teams out in the medical center and clinics participating in an exercise called a waste walk. This was an eye opening experience for those of us who went. We went out to CCRMC in search of waste. We wrote down our examples on sticky notes and placed them on a wheel based on what type of waste they were. At times it was almost laughable, until we began to see the waste literally falling off our waste wheel. Some of us did what is called a spaghetti diagram. We followed the path of workers to see where they go to get their work done. The movement was phenomenal to watch. In summary, although it was a fun and very easy exercise, it was also quite sobering.

What is Lean?

Lean manufacturing or lean production, which is often known simply as "Lean", is a production practice that considers the expenditure of resources for any goal other than the creation of value for the end customer to be wasteful, and thus a target for elimination. 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 always defined by the external customer and in our case it's always the patient. Lean is centered on creating more value with less work. Lean manufacturing is a generic process management philosophy derived by and large from the Toyota Management System (TMS). It focuses on reduction of the original Toyota seven wastes in order to improve overall customer value. 

Why Lean/ TMS and why now? 

"The future is already here…it’s just not evenly distributed yet." *

Currently health care makes up about 17% of the GDP and is climbing at a steady and very unsustainable rate. Although the solutions are still in the development phase it is clear we must change course nationally and it is just as clear we must do the same here at the local level. Lean/ TMS offer a systematic way of improving efficiency, while improving- not compromising- quality. 

What's Next?

On October 24, 2011, a team of key stakeholders will perform an exercise called value stream mapping focused on the Patient Centered Medical/Health Home (PCMH). The team will examine steps in our processes and assign value to them from a patient’s perspective. We will then follow this up with a series of rapid improvement events or kaizen events (also known as kaizen blitz).

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

It feels like so much to learn, but 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. If you have questions so please don't hesitate to ask.

More very soon...


Wednesday, October 12, 2011

CCRMC and HCs Delivery System Reform Update

Dear Contra Costa Health Services employees and partners,

As many of you know, Contra Costa Regional Medical Center (CCRMC) and Health Centers (HC) is involved in a major effort under a new five-year Medicaid (Medi-Cal) Waiver that will allow us to make significant, widespread improvements in access and care throughout our system. The project, entitled the "Delivery System Reform Incentive Payments (DSRIP)" program, is designed to build on the improvements and innovations we've already accomplished and to help us prepare for the full implementation of Health Care Reform in 2014.

This major effort involves the time and dedication of everyone at CCRMC & HC, and will continue to do so throughout the project. However, most staff are involved in only a portion of the plan, and thus we wanted to give you some details about all the work we are undertaking as part of the Incentive Program. To that end, we have created a short summary that describes the improvements we've achieved thus far and those in progress, as well as what we hope to accomplish by the end of the five-year period.

I am pleased to share this information with you, and also want to take this opportunity to say thank you for all the tremendous work you've achieved thus far and for your continued commitment to providing the best quality care for our patients. Please let Shelly Whalon or me know if you have any questions.


Wednesday, October 5, 2011

Go and See

Thanks to Mark Graban for his post “Management By Walking Around” vs. “Gemba Walks"

I agree, leaders must go and see what is really happening.

Without knowing what you are watching for, "stand in the process and think for yourself," The Toyota Way, on Ohno circle.

For those who feel uncomfortable with the emphasis on Lean or TPS, Graban shared this quote from Deming.

"Management by walking around’ is hardly ever effective. The reason is that someone in management, walking around, has little idea about what questions to ask, and usually does not pause long enough at any spot to get the right answer.”–W. Edwards Deming, Out of the Crisis