From the CEO’s Desk: Lean Management Update

Brad Haws

We are proud that UPG has led the Health System in using Lean management practices in administrative operations in order to serve as efficient stewards of Health System resources. The following is an update on some important results of those efforts.

  • UPG has had Lean projects in every unit in the past 24 months.
  •  To date, UPG Lean projects have created $2.5M of value for the Health System. 
  • Generated margin in administrative unit in FY2016 and rebated $380K of fees back to clinical units.
  • Last year, UPG was the only organization in the Health System not to add a single FTE. UPG’s FY18 budget continues this trend.
  • Lean Successes include:
    • Zion Crossroads
      • Redesigned scheduling process, reducing rate of errors from 30% to near zero.
      • Reduced referral errors from 30% to near zero so that patient connects with the right physician for their condition the first time.
      • Improved communication between physicians and staff.
    • Life of a Surgical Charge
      • Developed automated OR log in Epic, used by 11 Clinical Departments
        • Estimated increase of $800K/year in collections by adding Accustream to identify missed charges.
        • Time savings of ~960 hours/year.
    • In FY17, Billing and Collections teams have seen a 20% increase in productivity while absorbing a 14% decrease in time processing.
      • Charges and collections are up 8.2%.
      • Timely adjustments are down 60% from $1,217,217 to $481,204.
      • 35 process improvements identified; 33 of which have been implemented.
    • Electronic Enrollment with Medicare, Medicaid and VA.
      • Reduces held charges and increases timely payment
    • Monthly Financial Close Cycle
      • Shortened close cycle from 16th to 10th business day
      • More timely financial statements to the Health System
      • Eliminated waste
      • Team freed up to work on other projects
    • Physician Hiring Platform
      • Creation of a streamlined hiring platform for providers, aligning credentialing and date of hire with ability to bill for services.

Epic Phase 2 Update

The Epic Training Course Catalog and Schedule was recently published on the Epic Phase 2 Project’s website. Managers are registering team members now for classes scheduled during the 10-week training period, from April 17 to June 25. The Training Schedule provides an inventory of all planned offerings and is designed to give you advanced notice of the schedule prior to availability in the NetLearning LMS.

If you are a team member and think you need Epic training, please consult with your manager. Managers are developing appropriate backfill plans now to ensure that operations continue during training.

The Physician Course Catalog is also now available online for viewing. It includes course information about the following new applications:

  • Beaker Laboratory Clinical Pathology (CP)
  • Beaker Laboratory Anatomical Pathology (AP)
  • OpTime (Perioperative)
  • Advanced Reporting

Operational Readiness: Getting to Go-live

The Epic Phase 2 Operational Guide provides a framework for the changes in processes and workflows stemming from Epic Phase 2 implementation. Operational leaders are critical to implementation because they will:

  • Identify changes and risks for each operational group and escalate as needed
  • Inform operational group team members about all expected changes
  • Create and execute a change management/risk mitigation plan for each change
  • Develop a go-live preparation plan and participate in all 90-, 60- and 30-day Go-Live Readiness Assessments (GLRA) and Dress Rehearsals

Still have questions or want to learn more? Send the Epic Phase 2 team an email.

Lean Successes: Zion Crossroads

When the Zion Crossroads Multi-Specialty Clinic opened in August 2013, it represented a new business model of outreach care for the UVA Health System. Housing 22 primary and secondary specialties, a pharmacy and imaging under one roof, the practice was intended to be a “one-stop-shop” of multi-disciplinary UVA health care for the community.

A little over three years later, after what Zion Crossroads Director of Clinical Operations Renee Viette refers to as “a few stumbles along the way”, the practice is thriving and growing, and leads by example when it comes to the high-quality, value-added lean success model. “We think of it as an intersection between the Be Safe initiative in patient care, and administrative process improvement,” says Viette.

According to Supervisor of Practice Teshema Anderson, one of the earliest hurdles they needed to surmount at the new practice was streamlining the scheduling process. “The challenge was to meet the needs of all the physicians and all the patients across the multi-disciplinary practice, but the way the scheduling was originally set up was inefficient and complicated,” says Anderson. The resulting lean project was to redesign the scheduling templates and work closely with physicians to accommodate their calendars and configure the best method for patient access. The results have been successful: Scheduling and referral errors have been reduced to near zero, and the communication between physicians and staff has improved measurably. “Being able to quell the frustrations of our physicians and staff has been really rewarding,” reflects Anderson. “They have all the tools they need to succeed.”

Michelle Young, Assistant Nurse Manager for the clinic, readily admits that at first she questioned whether or not nursing had a place in the lean model. Until, she says, the matter of patient medical records reached a critical juncture. The volume of information on a patient’s history was often extensive and at least partially irrelevant to their current situation. However, determining which information was important and what was obsolete lay outside the area of expertise of the administrative staff who were generally tasked with managing patient records. The result? Often inclusion of extraneous information which takes time and resources to go through. “One day,” Young recalls, “I just looked at it and said, “This is a nursing issue. We have the background to determine what medical history is relevant for a patient’s present care.”

Once nurses took charge of patient medical records, under Young’s leadership, the amount of time taken by physicians to scan records looking for vital information was greatly reduced. “What this translates to is exponentially more face-to-face time between doctor and patient,” says Young. “This allows us to provide the best, most personalized care possible – and that’s our ultimate goal.”

Michelle Young, Renee Viette, Jeffrey Moore, Teshema Anderson

 

 

Viette is quick to point out that while the clinic’s lean successes are certainly worth celebrating, the thing she is perhaps most pleased with is their team member engagement. “When I learned that we had measured in the 92nd percentile of employee engagement, I was just floored. I’m so proud of our team,” she says. “The spirit of collaboration can be felt throughout the clinic, from nurses to administration to physicians and housekeeping staff.”

When asked what the future holds for the Zion Crossroads Clinic, Viette answers: “Growth. We have grown so fast, which is wonderful. We’ve maxed out our current operating space and are ready to expand.” She has proposed expanding hours, and the team is ready to make use of the 8000 square feet of reserved space at their facility. “We are clearly meeting a need here,” she remarks. “Both serving regional patients closer to home, and attracting new patients to the UVA Health System.”

 

ZCR Halloween 2016

Zion Crossroads Halloween Celebration

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