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A Brief History of Tufts Medical Center

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The principal teaching hospital for Tufts University School of Medicine ... In Merriam-Webster Online Dictionary. ... Sigma is a data-driven methodology (DMAIC) ... – PowerPoint PPT presentation

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Title: A Brief History of Tufts Medical Center


1
A Brief History of Tufts Medical Center
1796 Boston Dispensary founded
1981 Worlds first pediatric trauma center
established at the Floating Hospital
1894 Floating Hospital takes ill children
mothers out on Boston Harbor
  • Notable benefactors Sam Adams Paul Revere
  • First permanent medical facility in New England

1997 Creation of Neely House, a
first-of-its-kind BB-style home for cancer
patients their families
1938 100-bed Pratt Clinic constructed, largest
in the world
ca.1919 Similac invented
1852 Tufts University founded
1992 First, full-service private teaching
hospital created, with addition of the maternity
service
1979 Graduate School of Nutrition created, first
in the US
1886 Instructive District Nursing Association
formed, the forerunner of the VNA
2009Adopted the BCBSMA Alternative Quality
Contract
2
Combining Art and Science to Create Value for
Patients and Staff
  • Margaret M. Vosburgh, EVP, COO
  • June 19, 2009

3
What is value1?
  • A fair return or equivalent in good and
    services, or money for something exchanged

1 value. (2009). In Merriam-Webster Online
Dictionary.Retrieved June 16, 2009, from
http//www.merriam-webster.com/dictionary/value
4
Defining our Value Proposition
Patients and Families
  • Access to world-class healthcare
  • Welcoming, calm environment

Physicians
  • Cases
  • Reliable processes
  • Educational experiences for medical students,
    residents, and fellows

Staff
  • Predictable environment
  • Support to provide top-notch service

5
The ART and SCIENCE
  • Trust
  • Relationships
  • Safety
  • Compassion
  • Best Practices
  • Voice of the Customer
  • Lean and Six Sigma
  • Outcomes

6
Throughput
7
Previous State of Hospital Throughput
?
?
?
?
?
8
Obstacles to Throughput
9
Optimization Task Force
  • Purpose
  • To fast track organizational change by having
    process owners analyze current systems and
    propose alternatives.
  • Participants
  • MD, RN, and Staff leaders from across the
    hospital
  • Process
  • Standing meetings and agenda report outs
  • Formal template, complete for presentation

10
Operational Assessment Plan
  • Where we are
  • Inverse correlation between cost of care and
    quality outcomes
  • Unfocused management team
  • Patient volumes do not support our current
    operational and financial structure
  • Where we want to be
  • Over the next 12 months, the Hospital
    Physicians Organization must focus on measurable
    outcomes
  • Increase quality
  • Grow volume
  • Reduce the cost of care
  • Increase productivity
  • How we are going to get there
  • Improve the operational and financial landscape
  • Create high expectations
  • Educate staff drive accountability
  • Measure outcomes regularly relentlessly
  • No excuses

11
2009 Operational Plan
Create infrastructure to increase volume,
decrease cost improve quality outcomes
INCREASE VOLUME
DECREASE COST
12
Summary of 2009 Goals
  • Infuse quality patient safety principles into
    all clinical business decisions establish
    monitor unit-specific goals
  • FY09 Q4 Meet Leapfrog ICU Staffing goals
  • Dedicated ICU Intensivist
  • Pharmacist rounding with team daily
  • FY09 Q4 Meet Leapfrog CPOE implementation goal
  • FY09 Q1 Implement decentralized clinical
    profitability responsibility to the quality triad
  • FY09 Q2 Improve CMS IHI measures to meet or
    exceed required goals
  • Increase discharges to 17,832 an additional 2
    patients per day
  • Reduce the ALOS to 5.5 days decrease of 0.2
    days per unit
  • Reduce Cost per Discharge Unit-specific UHC
    Benchmarking
  • Reduce clinical denials to less than 10 -
    accurate charting
  • Reduce administrative denials to less than 15 -
    accurate charting
  • Establish implement leadership competencies
  • FY09 Q1 Managers complete initial Manager
    Training modules
  • FY09 Q1 Graduate 1 Lean Six Sigma Green Belt
    class

13
Structure and Goals of the Quality Triads
Physician
The mission of the Quality Triad is to ensure
quality within the organization by understanding,
measuring and managing key metrics and processes.
Quality
Staff Development
Profitability

Administration
Nurse
14
Foster a Culture of Quality
  • Lean / Six Sigma is a data-driven methodology
    (DMAIC) to solve issues, eliminate waste and
    improve processes.
  • Lean / Six Sigma is an integrated set of tools
    that produce breakthrough performance
    improvements.
  • Lean / Six Sigma will make it possible for the
    hospital to pursue leadership among our
    competitors through continuous quality
    improvement.

15
Optimization Initiatives
ADT Center
OR Leadership Forum
Critical Care Task Force
Optimization Task Force
16
Solutions
  • ADT Center
  • Optimization Task Force
  • Outpatient Scheduling Project
  • Phlebotomy Improvement Project
  • OR Leadership Forum
  • Critical Care Task Force

17
I. ADT Center
  • Decrease ALOS to Medicare GLOS
  • Increase patient, staff referring MDs
    satisfaction
  • Eliminate OR, PACU holds
  • Eliminate ED diversion hours
  • Decrease interval between referral bed placement
  • Coordinate diagnostic treatment modalities
  • Communicate with MDs to foster movement to an
    alternative level of care in a timely fashion
  • Prioritize access to beds based on patient care
    need and relationship with referring party
  • Establish a seamless, one-stop admission process
    for all non-scheduled and appropriate
    admissions.
  • Eliminate OR, PACU holds and ED diversions

The ADT Center facilitates the right level of
patient care in the right setting at the right
time with the right service
18
ADT Center Design
ADT Team facilitates a disease mgmt model
Patients case enters the ADT Center
  • Hospital Departments
  • Outside Sources
  • Physicians
  • Other

ADT Team consults with appropriate resources
877 - OK - TUFTS
19
II. Discharge Optimization Scheduling Improvement
  • Enhancements to Discharge Order Plan
  • Tufts Medical Center Clinics Follow-up
    Appointments
  • Space for 3 appointments
  • Can designate clinic, visit type, follow-up
    timeframe, type of clinician, and any comments
    needed to ensure continuity of care
  • Tufts Medical Center Ancillary Testing
  • Space for 3 appointments
  • Can designate test, test type, follow-up
    timeframe and the reason for the test/instructions

20
Discharge Orders
21
III. Phlebotomy Improvement Project
Note This reflects report to work in lab
arrival at patient units typically 10 to 15
minutes later, which constitutes the start of AM
draw.
22
A.M. Lab Result Completion Times
By improving Phlebotomist staffing patterns
prioritizing floors AM lab result times
decreased.
Implementation Date
Instrument Problems June 4 5
Sick Calls
23
IV. OR Throughput Improvements
24
Model of Care
25
The Need to Re-evaluate the Current Care Model
Creating a new Model of Care is the most
sustainable long-term strategy for Tufts Medical
Center
  • Consumers are not satisfied with current care
    models
  • Current systems do not work
  • Dissatisfaction of clinical staff moving away
    from the bedside
  • Need to deliver care in a more efficient and less
    costly manner
  • Need to reduce variation and improve outcomes
  • Public mandate / Pay for Performance
  • Current service delivery model has not been able
    to provide desired outcomes

26
New Model of Care
Patient Centered Environmentally
Aware Forward Looking Professionally Rewarding
27
Master Staffing Plan
28
Results Increase Volume
29
Discharges Are Up
April YTD Discharges Above budget by 742 or
7.2 and above prior year 974 or 9.6
30
Clinic Visits Are Up
April YTD Clinic Visits Above budget by 3.494
or 1.8 and above prior year by 11,733 or 6.3
31
Operating Room Cases (IP OP) Are Up
April YTD OR cases are up 462 or 6.9 over prior
year and above budget by 407 cases or 6.0
32
ED Visits are down Admissions from ED Are Up
April YTD ED visits YTD are 502 or 2.3 above
budget but (748) or (3.3) below prior YTD Pedi
ED visits were down (289) or (7.0) from prior
YTD Adult ED visits were down (459) or (2.5)
from prior YTD Inpatient admissions from the ED
are above last year by 11.6
Emergency Department Visits-April YTD
33
INCREASE VOLUME Reduce Emergency Room Diversion
Elimination of ED diversion 1 Hour ED Diversion
1 Lost Inpatient Admission 2008 Dec YTD 1.3
million lost revenue FY 2009 April YTD Lost
Revenue due to ED Diversion 0
34
INCREASE VOLUME Manage of Length of Stay
March 2008 ALOS peaked at 6.12 April 2009 YTD
ALOS 5.21 with LOS down by 1 day
ADT Center Co-Director began working 1-on-1 with
physicians
New Director Case Management implements process
reducing ALOS
35
INCREASE VOLUME Increase OR Volume
Redirected block time to realize a 15 increase
in surgical cases to target or ninety (90)
additional cases/month
36
Volume Has Grown
April YTD discharges are 742 over budget and 974
over prior YTD April YTD surgery cases are 407
over budget and 462 over prior YTD
37
Results Decrease Cost
38
DECREASE COST Operation Room Skill Mix
Shifting RNTech skill mix ratio from 8515 to
66341 Operating Room labor annualized savings of
1 million
Savings 1,014,852
1 AORN Skill Mix Standard is 67 RN to 33 Tech
39
DECREASE COST Inpatient Nursing Skill Mix
RNTech skill mix ratio 31 to 41 SALARY
SAVINGS 1.7 million
Savings
40
DECREASE COST Reduction of Contract Labor FTEs
77 reduction in Nursing Contract Labor FTEs
from high of 73 FTEs in May 2008 to 17 FTEs in
April 2009
41
DECREASE COST Reduction of Contract Labor Expense
Total Contract Labor savings since May 2008
740K
42
Summary
Successful outcomes occur when Art and Science
are combined. Involving people, providing data
encouraging innovation will always lead to
success.
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