Improving the Patient, Family & Clinician Experience

System Engineering:Improving the Patient,

Family & Clinician ExperienceGary S. Kaplan, MD

National Academy of MedicineSymposium on Health Services Research

© 2018 Virginia Mason Medical Center


The VMMC Quality Equation

Q: QualityA: AppropriatenessO: OutcomesS: Service W: Waste

Q = A × (O + S) W


Strive for Highest Satisfaction

Listen to understand

Keep your promises

Be encouraging

Connect with others

Express gratitude

Speak up

Walk in their shoes

Grow and develop

Be a team player

Share information


Experience-Based Design Is…

A philosophy and set of methodsfocused on an understanding of theexperiences and emotions of thosewho are involved in receiving anddelivering healthcare services, strivingto understand what people naturallydo and feel.

What really matters to our customers?


Where We’re Heading


Synchronized Ongoing Support (SOS): An Integrated Response to Unanticipated Outcomes

1. Major unexpected clinical need; or2. Major immediate family need; or3. Urgent non-clinical support need

SOS – A standard response that is transparent, individualized and phased to promote restoration and growth for all touched by the event.

Time zero –tailored

Within 30 minutes Within 12 hours Tailored to needs Tailored to needs Within 8 weeks

Dial ‘0’ for Patient Safety &

Patient Relations

Team debrief

Patient support ongoing

Resource huddle

Acknow

ledgement

Staff support ongoing

Quality im

provement

Identify needs,just-in-time coaching Administrator

Patient advocate

Mgr/Primary RN

RN supervisor

Spiritual care

Social work

Patient safety

Area leader

Involved team

Spiritual care

Patient safety

PSA processCare ReviewRoot Cause

Analysis

PreparationFollow up family meeting

Assess needs,align resources, plan next steps

Patient advocate

Patient safety

Provider

Clinical team

Peer to Peer

Support immediateneeds of team

Support needs of patient andfamily

Support needsof team member(s)

Systems review

Patient advocate

Tailored check-ins

Navigates needs

Coordinates follow up meeting

Team debrief

Tailored Check-ins

Spiritual care

EAP

Schwartz Rounds

Safety Innovation


Alignment


Requirements for Transformation

Sense of Urgency

Visible & Committed Leadership

AlignedExpectations

Improvement Method

Technical & Human

Dimensions of Change

Shared Vision


VMPS Evolution

Time

Impa

ct

2002 2003 2004 20052006

20072008

2012

20092010

2011

2013

2014

2015

2016

2017-2020

The environment demands a continued acceleration of our improvement results:• Increased pace of change• Increase quality outcomes, reduce costs• Reduce stress and burnout


VMPS Evolution:House 2.0

Patients as Partners• Patient/family

partners• Experience

Based Design• Co-design

Accelerate the Impact• Speed and agility• Innovation• Plan-Do-Study-

Act (continuously evaluate and improve)

World Class ManagementManagement by Policy, Cross Functional Management, Daily Management

Engage Individuals and Teams• Organizational

compacts• Personal growth

& recognition• Leader

competencies

Quality Leader• Q = A * (O+S)

WQ: QualityA: AppropriatenessO: OutcomesS: Service W: Waste

• Patient Safety Alert System

Mas

ter t

he

basi

cs

Mak

e it

our o

wn,

fo

r our

pat

ient

s, te

am

mem

bers

and

com

mun

ities

VMPS Principles, Tools and Methods5S, Standard Work, Visual Control, PDSA, Innovation, Just in Time, Mistake Proof (Jidoka), Leveled Production (Heijunka)

Improving the Flows of Health Care

Respect for People Continuous Improvement

BUILD A STRONG FOUNDATION

Safe and Respectful Environment Increase Reliability and Effectiveness

Virginia Mason Production System


Our VMPS Journey

2002 20032004

20052006

20072008

20092010 2011

20122013

20142015

2016

2017

-Implemented Strategic Plan with Patient at the top

-Declared VMPS as our management method-Executives to Japan-Implemented PSA system-49 RPIWs, 3 3Ps

-Executives & KPO first to be VMPS Certified-7 KPO Staff Members

-Mrs. McClinton

-All Execs & Admin Directors Certified-110 RPIWs, 4 3Ps

-Kaizen Fellowship program-KPO rotational leader position created-24 KPO staff members-One organizational goal of Quality-KPO Goals instituted-Tuesday Standup begins

-HealthGradesDistinguished hospital award-Integrated VMPS efforts with supplier partners-VMPS training for managers-44 RPIWs, 1 3P, 51 Kaizen Events

-Defined standards for a Model Line-Improved VMPS curriculum for all supervisors and above-25 KPO staff members

-Virginia Mason Institute formed-Large integrated value streams-3P Certification-VMPS for Leaders prerequisite for Certification-31 KPO staff members

-Super-flow RPIWs-Study & apply Toyota Talent (TWI) training methods-66 RPIWs, 6 3Ps, 119 Kaizen Events

-Top Hospital of the Decade

-World Class Management system-Standard Work for Leaders

-Experience Based Design training-82 RPIWs, 8 3Ps, 238 Kaizen Events-26 KPO staff members

-Respect for People Training-Continuing education for VMPS Certified leaders-Innovation Events

-Patients as partners with our improvements-VMPS for Leaders training becomes “fit for duty” requirement of all admin and physician leaders

-One KPO-First daily management assessment org-wide-Introduced daily kaizen

-VMPS Priorities focused on improving the patient, family and staff member experience

-First Advanced VMPS Cohort- Memorial partnership & training

-Patient Co-Design next steps-Patient/Family Partners required for all RPIWs

2018-

2020

“In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists.”

- Eric Hoffer

Improving the Patient, Family & Clinician Experience

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