Post on 03-Jan-2016
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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