Our Outside Consultant Experience Presented to the CHA Respiratory Therapy Directors Forum November 15, 2013 Leo Langga, MBA, RRT-NPS Dan Villareal, MBA,

Our Outside Consultant ExperiencePresented to the CHA Respiratory Therapy Directors

ForumNovember 15, 2013

Leo Langga, MBA, RRT-NPSDan Villareal, MBA, RRT

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Objectives

• Introduction– Laying the foundation with the executive leadership and

finance teams for productivity standards and goals

• How to prepare information for the consultant• The meeting • Following up is critical

– Data review, validation, benchmarking

• Initial & Final Recommendations• Lessons Learned• Today• Questions

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Introduction

– Laying the foundation for productivity standards and goals• Build relationships and understanding of the Respiratory

Care operation at the beginning with COO, DSS, CNO, Patient Care Director – Labor Hours/UOS vs Labor Hours/Patient day

• Understand where all the labor and revenue flows to– Clinical Lab, Pharmacy, Sleep Lab, Transport Team,

ECMO• Understand sources for variances• Use the PACT data to provide operational understanding

and perspective to COO, DSS, CNO, Patient Care Director

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Determining What Data to Present

– Assessing the consultant’s background• Our consultant had a RT (Radiation Therapy) background,

however, had overseen a Respiratory Care operation– How do I help the consultant understand my operation?

• Provide high level perspective • Operational documents for review

– Scope of service– Staffing regulations-

» California Children’s Services » Title 22

– Staffing worksheets– Key Service Trends– Labor goals for the year and financial performance data

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Respiratory Care Division Overview

Prepared for Consulting Group

TABLE OF CONTENTS:

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Topic:

Scope of Service Section I

Operational Performance Data• Service Volume Trend• Mechanical Ventilation Trend• Productive FTEs/Budgeted FTEs

Section II

Regulatory Requirements in California• California Children’s Services

Regional NICU Provider Standards• Title 22: Acute Respiratory Care

Service

Section III

Staffing Tools• Staffing Worksheet for Day Shift• Staffing Worksheet for Night Shift

Section IV

Engaging the Consultant

• Presenting the data– Formal Presentation Packet

• Discussions/Questions• Describing the department operations

– Fact gathering

• Limited time to describe/analyze department operations

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The waiting…follow-up is CRITICAL…

• Timing is critical– Before Executive Leadership Team Presentation– Or, After Executive Leadership Team Presentation

• Data review– What was the process in which the data was collected?

• Validation– Is it accurate?

• Benchmarking– What are they basing their recommendations on?– Is there data to support recommendations?

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Initial Consultant Recommendations

• Labor– FTE reduction of 6.1-8.5 FTE Opportunity ($555K-$777K)

• Operational

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Measures Rating Leading Practice FindingsBenchmarks-External: Productivity

Red Productivity metrics (WHPUOS) are in the top quartile when compared to peer departments

Below 50th percentile

Benchmarks-Internal: Overtime Use

Red Overtime hours are between 2% and 4% of total worked hours

Overtime averages 29.2% (includes 12 hour shift overtime; Uses OT rather than PT or PD.

Management: Productivity Tools

Yellow Productivity tools are utilized, both proactively and reactively, by management

Use of 4 hour staffing toolMonthly review of Budget vs. Actual UOS and Productive

Management: Staffing to Volumes

Yellow Staff scheduled relative to shift and day of week demand with periodic, real-time evaluations and adjustments

Uses 4-hour staffing tool to review workload and flexes staff accordinglyAligned by Service Line to participate in multidisciplinary care model

Operations Cross Training

Red Nurse cross-trained to perform basic O2 admin, mdi/nebulizer treatments on nights

Department functions as an RT staffing model based on CCS Regional NICU Provider Standards: Provides significant support for the Sleep Lab

Operations: Process Improvement

Yellow Staff participate in periodic structured reviews of key processes, seeking to improve efficiency/quality

Regular staff meetings are held as a forum for workflow feedback on concerns or recommendation to improve patient care

Rebuttal to Recommendations

• Timely response is essential• Involving your Chief Patient Care Officer & Patient Care

Director• Backing from Decision Support

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Final Outcome

• COO & DSS Key to Final Decision– Ideally, decisions and recommendations are based on good

data– Education of COO/DSS to Respiratory Care operations is

critical, particularly with limited information

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Lessons Learned

• The initial objective of the consultation was to review patient flow, throughput processes….be wary – Assume that everything is open for review

• Be prepared and have key operational data ready• Validate the information consultants are reviewing because

their understanding of basic processes may not be completely accurate

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Today, how are we working with our outside consultants…

• LEAN Projects– Non- labor initiatives– Patient Flow/throughput– Documentation– MAPS

• CLAIRVIA– Productivity tools, scheduling, staffing

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Questions

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