Improving the Medication Refill Process through Standard Work: CCRMC Rapid Improvement Event (Kaizen) Report Outs Tomorrow

This week's Rapid Improvement Event (Kaizen) is working to streamline the process of refilling medications.  

The improvement team is testing the most effective combination of manpower, materials and machinery in the process to develop "Standard Work" to improve the medication refill process in our system. I am often asked how we can have Standard Work and continuously improve at the same time? Taiichi Ohno described Standard Work as "the most effective" approach until the standard is improved. This, he said, is done through a continuous process called kaizen or, as we refer to it, a rapid improvement using Plan-Do-Study-Act cycles that are designed and tested by front-line staff, patients and family members. I'll write more on Standard Work and its role in continuous improvement in an upcoming post.

So what is the Contra Costa team up to this week? 

 

The team is hard at work developing Standard Work for our Medication Refill Rewrite Desk. Our Rewrite Desk helps to process refill requests received from retail pharmacies. A multidisciplinary team of pharmacy staff, nurses, providers, and our patient partner, Sylvy, have come together to test ideas aimed at reducing the amount of time patients have to wait for their refills.  By developing Standard Work for our Rewrite Desk they predict they will also reduce the amount of time that our Health Home Coordinators spend working on patient requests related to medication.  One example the team is looking at is eliminating faxes between our Rewrite staff and our clinics through the optimization of our ccLink (EHR) messaging capabilities.  This is only one example of many tests being conducted this week. To learn more, keep an eye out for my post with the tests and results in the coming days. Better yet, join us for one of the Report Out presentations tomorrow!

More very soon,
Anna
 

Contra Costa Regional Medical Center and Health Centers Rapid Improvement Event Report Outs:

 

Friday April 26, 2013

West County Health Center
13601 San Pablo Ave
San Pablo, CA 94806

7:45am - 8:15am

Contra Costa Regional Medical Center Lobby
2500 Alhambra Avenue
Martinez, CA 94553

10:00am - 10:30am

Pittsburg Health Center
2311 Loveridge Road,
Pittsburg, CA 94565

12:15am - 12:45am

CCRMC Improving Primary Care: Welcome to your Health Home

The Kaizen this week was held at Concord Health Center (CHC). The team focused on improving the clinic visit "intake" process.

The team tested and developed standard work/practice to improve the intake process. Some of the improvements this week include: shifting tasks from the clinician to the intake MA/nurse, improved communication between clinician and nursing staff, a revised ccLink clinic roster "dot system," and quick huddles at the start of clinic to help anticipate the patient needs that day and ensure a smooth flowing clinic. You can review the slides above to "see" some of these improvements.

In the coming weeks, these changes will be tested with all the CHC primary care clinicians. Once, refined, standardized and sustained we will roll our new process system-wide. The work you see on the action bulletin begins Monday. Our Lean Promotion Office staff will be heading to CHC to work with front line teams to measure progress and continue to test with those who provide and receive care at CHC. Here is an example of some of the feedback the tea gathered this week as they were conducting tests. Your feedback is important and needed to design a process that works for those we serve and YOU. Please take the time to review the slides which show some of the many tests and improvements from this week. Many thanks to our Patient Healthcare Partner, Louisa, who was an essential member of the team providing much needed perspective as an expert in what it is to experience our system.

I've pulled out the A3 and A4 for your review. The Kaizen Post Card will be sent out in the coming days. Data/Results for this work can be found Conference Room One at CCRMC as well as on iSite in the Lean Folder.

How is it decided what we are going to work on during a rapid improvement event (Kaizen)? See the A4 below. This is designed by the team itself after review of performance and analysis of areas in need of improvement. The A4 helps the team segment the improvement work into achievable steps.

Many thanks to the team for your work this week and for all of those who came out at the three sites to hear this important report-out.

 

More very soon,
Anna

Mapping the Way Forward: Concord Health Center Primary Care VSM Report Out

If you can't see the slideshow click here.

It was a great Report-Out this Friday. The VSM team which was made up of employees from clinics across our system and a patient Healthcare Partner came together to review the flow and experience of care in the Concord Health Center. The team uses direct observation to see and time our processes and then, from the patients perspective, value or non-value is assigned to time and tasks.

The team looked at direct care activities which focused on what happens when someone comes to the clinic, an example being an appointment to see your primary care provider at the clinic. Indirect care activities are processes happening in the background usually while a patient waits for something. A common indirect care activity are the process steps and time spent waiting for a prescription refill request from a patient calling in to their providers office. I've posted A4 above for your review.


The headline from the report: Unexplained Variation Must Go!

The team found multiple ways of refilling a prescription, they showed us six ways after only 3 days of observation at one clinic site. Roles and responsibilities of staff were variable as well. What the team reported and what you will see on the A3 is that the upcoming focus of the teams have a clear theme of removing variation and organizing to create predictable flow for both direct and indirect care processes.

The A3 is below for your review and the Kaizen Post Card will be sent out in the coming days. The data for this work can be found Conference Room One at CCRMC. Results of the tests of new work flows will be displayed there as well.


Many thanks to the team for your work this week and for all of those who came out at the three sites to hear this important report-out.

More very soon,
Anna

A Mother Knows

I was honored to join the Chair of our Behavioral Healthcare Partnership, Teresa Pasquini, on a webinar with the National Association of Public Hospitals yesterday to discuss the importance of patients and family members as equal partners in our system. Paul Levy, former CEO of Beth Israel Deaconess Medical Center, author of "Goal Play! Leadership Lessons from the Soccer Field" and advocate for patient-driven care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement was also in the room. Paul is an avid blogger and wrote about Teresa's comments. Here is an excert from his blog post:

"Nothing is scarier than the health system when your child is sick. Please, don't be afraid of an an angry mom or patient. Invite family members like mine to tell you our experiences and let us help you create solutions. Nobody comes to work to harm others. We are the expert system navigators and we will help you design a better system for all."  Click here to read his full post.

If you're interested in learning more about our work with patients and families you can find more information on our Patient and Family Partner webpage. I've also included a short video below so you can hear from some of our Partners about how they are improving CCRMC and the Health Centers. We welcome your perspective and hope you will consider joining our team.

More very soon,
Anna

Patient Centered Health Home Value Stream Mapping Report Out this Friday

How can we make the clinic experience better for our patients and staff?

Strong Primary Care = Patient and Family-Centered Care
 
You are all invited to join this Friday's Primary Care Value Stream Mapping Report Out Presentation on March 1, 2013.
A multidisciplinary team from across the health centers came together this week to critically observe and analyze the current state of our clinic system experience, identify the gaps and design the ideal future state to guide our improvement work moving forward.

This is complex work. We are 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.

Please join me in support of our colleagues and our partners for their hard work this week. This is an important opportunity to hear about the plan for future rapid improvement events to improve primary care at our health centers for patients and staff.  

Report Out Locations/Times:

Friday, March 1, 2013

West County Health Center Conference Room: 7:45-8:15am
CCRMC Lobby: 10-10:30am
Pittsburg Health Center Cypress Room: 12:15-12:45pm

I look forward to seeing you there!

More very soon,
Anna

CCRMC welcomes Paul Levy

We have a very special guest speaking on the CCRMC campus Tuesday, February 26.

Paul Levy, author and former CEO of Beth Israel Deaconess Medical Center in Boston, will be sharing his insights on the principles of servant leadership and their application in building high-performance teams. He is an internationally recognized advocate for patient-driven care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement.

Mr. Levy’s 2012 book, Goal Play! Leadership Lessons from the Soccer Field, offers insights from sports, health care, business and government to help leaders get better outcomes. As a practical guide to improved leadership, his book highlights unconventional thinking and actions that can be used to bring about outstanding results. He also is an avid blogger.

Please join me for his presentation at noon Tuesday in the Building One Conference Room, Martinez Health Center on the CCRMC campus.

Anna

CCRMC welcomes Tom Bodenheimer, MD to discuss Primary Care Redesign

Dear CCRMC Community:
I'm delighted to announce that one of the world's thought leaders and demonstrated experts in primary care redesign, Dr. Tom Bodenheimer, will be joining us at CCRMC this Wednesday for noon conference. See details below. We will open lines for those dialing in. Please join us for this important event as we continue our planned efforts in the redesign of our primary care system.
More very soon,
Anna

Click on the image