Sustainability Study - Support for Our Course

This message is from CCHS Director, Dr. William Walker and CCRMC/HCs CEO, Anna Roth

All Staff Message: Sustainability Study - Support for Our Course

After many months, the sustainability study of our Regional Medical Center and Health Centers is complete.

The report describes our strengths and the work we have underway to further improve and transform our system in order to continue to care for our community and help implement changes as part of Health Care Reform.

The County Board of Supervisors (BOS) asked for the sustainability study as part of the budget process in 2009 to look at how we provide care and how we can optimize services while controlling costs. The consultant, Health Management Associates, was awarded a $390,000 contract in January of this year to do the study. The final report has been posted on the county website (http://ca-contracostacounty.civicplus.com/index.aspx?NID=2728)and will be presented to the BOS CCRMC Joint Conference Committee on September 28 and then to the full Board of Supervisors on October 4.

We worked closely with the consultants on this study. In their findings, they point to how our integrated health system is well positioned for Health Care Reform and how we are fully accessing federal funding streams to continue to be the safety net provider of choice for our community.

The study describes our current efforts to improve service delivery and patient experience. Many of these efforts are underway, including implementing an Electronic Health Record, which will "go live" in July; increasing access and improving response time for appointment scheduling; and integrating behavioral health and primary care among many other efforts. In addition, the report highlights our long-standing commitment to quality improvement, applauding and calling for further support of the unique and innovative improvement work we are doing.

The study identifies the critical need to increase capacity and the importance of our current efforts to expand primary care capacity in both our system and in the partnerships we are developing in the community. Information on options for governance structure is presented but no specific recommendations are made. The study also identifies several external factors we do not control that have significant financial impacts on our ability to operate as a health system, such as personnel processes, and the cost of health and retirement benefits.

We view this study as an excellent overview of our planned transition to Health Care Reform in 2014 and beyond. The findings validate that we have been, and are on the right path. We all can be proud of the crucial work we do in caring for and improving the health of our community.

Thank you for your hard work and dedication to the people we serve,

William B. Walker, M.D., Director and Health OfficerContra Costa Health Services

Anna M. Roth, Chief Executive Officer, Contra Costa Regional Medical Center and Health Centers

Message from Alaska

One of the fun things about blogging is the connections one can make. Find a message here about your work from a Lean leader in Alaska. His post is about the work you are doing and how you and your efforts are contributing to the growing swath of knowledge about the application of Lean as a leadership system in health care organizations.

For some time I have followed the blog, "Lean in Alaska." It's written by Patrick Anderson, Executive Director of Chugachmiut, Inc., an Alaska Native Tribal consortium. They too are on a Lean journey. I encourage you to take the time to read his blog as you will find many similarities and strategies to overcome many of the same barriers we face. Each organization has their particular spin on the application of Lean management. What I find of particular interest is that Chugamiut uses Lean as their leadership system much like we do. This is very different than the application of a simple veneer or focus/emphasis on the tools rather than the leadership discipline itself. Could this be the common connection between us that is Rona?

Keep an eye out. More very soon...

Below are the slides from Friday's Report Out

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.

Anna

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.

Anna

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

Visit from LAO, CHEAC and CAPH

Greetings,

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.
Anna