Structural Empowerment: Commitment to Community Involvement

SE11: Nurses are recognized for their contributions in addressing the strategic priorities of the organization.

SE11a: Provide one example, with supporting evidence, of recognition of a clinical nurse for his or her contribution(s) in addressing the strategic priorities of the organization.

Introduction

Overview of Health Care Costs

According to the Centers for Medicare and Medicaid Services, health care spending in the United States (US) increased 5.8 percent in 2015. This increase translates to a total annual cost of health care of $3.2 trillion which equates to a per person annual expense of approximately $10,000 and 17.8 percent of the entire US economy. Leadership at the Massachusetts General Hospital (MGH) is constantly monitoring the trends and planning strategically about how to contain costs. The ten-year MGH/Massachusetts General Physicians Organization Strategic Plan (attachment SE11a.a) is built around four interconnected strategic imperatives, two of which specifically relate to cost:

• “To define and deliver the highest-quality care to our patients whilecontrolling health care costs”

• “To maintain our financial stability”

Staff from all disciplines and from all role groups are aware of concerns related to rising health care costs and are encouraged to identify possible ways to decrease/contain costs. The example that follows demonstrates how a clinical nurse took advantage of a unique opportunity to design and implement a creative project that led to a significant supply cost reduction on her unit. This effort was recognized with both an Ether Dome Challenge Award and a Partners in Excellence Award.

Clinical Nurse Involvement in Cost Reduction Strategies

In her practice as a clinical nurse in the Cardiac Catheterization Laboratory (Blake 9), Margaret McCleary, RN, BSN, CCRN, CMC, observed that there were no standard product and supply lists for procedures and that choices were made based on provider preferences, unit culture and the ongoing development of new products. She learned that there were significant cost differences among the products and supplies and observed a general lack of awareness about these cost differences among members of the interdisciplinary team. Aware of the health care spending crisis both nationally and locally, she began to wonder how she could make a difference. Additionally, given the varying practices among staff, she wanted to know the cost of a cardiac catheterization (cath) procedure and how much it could be reduced by making staff aware of the differences in supply costs.

Ether Dome Challenge Recognition

In June 2014, McCleary became aware of the Ether Dome Challenge (EDC), one of three transformation projects supported by the MGH Healthcare Transformation Lab (HTL). The EDC is a contest that was developed in collaboration with the Harvard Business School with a primary goal of engaging front-line staff in identifying and solving actual problems that they encounter in everyday practice. Staff is encouraged to brainstorm creative, collaborative solutions for the problems and submit them to the EDC to be considered for funding to plan and implement their proposed changes. The ideas are first put through a “crowd voting” process and the ideas with the greatest number of votes are invited to formally apply for an EDC award. McCleary discussed her observations and concerns with colleagues from a variety of disciplines and role groups. She received supportive feedback and interest in joining her team, as well as pushback against the possibility of changing the current system. McCleary submitted a proposal for a project aptly named, “What is the Cost to Cath?” The aim of the project was to reduce resource utilization and decrease spending by implementing initiatives that educate and empower staff to make cost-effective decisions. There were three identified project goals:

• To increase staff knowledge and awareness of spending on Blake 9• To develop interdisciplinary collaborative decision-making with regard to

making cost-effective product choices, and• To develop a sustainable system for making cost-effective product

choices.

The project scored highly in the crowd voting, so a formal application was submitted. In October 2014, McCleary received notification that her project was awarded a $10,000.00 EDC grant (attachment SE11a.b). The EDC project timeline officially began in January 2015 when funding became available, but preparatory work and team development took place during November and December 2014. McCleary recognized the importance of having a formal link to Materials Management, so she asked David Bourque, Inventory Manager, to be a co-leader for the project. He gladly accepted and was able to provide information about supply utilization and costs. The following is a summary of the major interventions and timeline of the “Cost to Cath” (C2C) project:

Month of 2015

Interventions

January Official Kick-Off Meeting

February Designed and administered pre-intervention awareness and perception survey

March Identified cost of products and supplies used in procedures

April Labeled items based on cost (attachment SE11a.c). Began planning for invited expert speaker

May-June Fairs for staff to learn about costs of products and supplies. Heightened awareness of two labeling systems that had been placed on supplies to alert staff to the cost of products and supplies on Blake 9 (attachment SE11a.c). Beginning discussions/consensus building on standards for procedures

July Expert speaker conference: Sean Lyden, MD, FACS, Professor and Chairman, Department of Vascular Surgery, and Medical Director of Supply Chain at the Cleveland Clinic

August Post-intervention awareness and perception survey

September Analyzed survey results and cost data

October Identified next steps

November Presented outcomes to Healthcare Transformation Lab

Addressing Strategic Priorities

The aim of the C2C project was to reduce resource utilization and decrease spending by Blake 9 staff by educating and empowering them to make cost-effective decisions regarding product and supply use. This was completely in-line with organizational strategic initiatives and the first step of achieving the goal was to increase staff awareness and knowledge of product and supply costs. Staff awareness and perceptions were measured before and after the implementation of several interventions. There were three major categories on the survey as noted in the grid below:

Category Pre-intervention

Post-intervention

Awareness: Percentage of staff reporting being very aware of cost of supplies and procedures

16% 31%

Utilization: Percentage of staff that believe Blake 9 utilizes more supplies than other units they have worked in

50% 34%

Wastefulness: Percentage of staff who “rarely” or “never” open items before they are needed

49% 53%

In a six month period, Mc Cleary’s work was successful in increasing her colleagues’ awareness of the cost of supplies. This awareness might have influenced their utilization of products as well. The survey asked staff to write in answers to the

question: “What would motivate you to pay more attention to the cost/consumption of supplies on Blake 9?” Examples of responses are as follows:

• “Grocery store labels” (referring to labels displayed in attachment SE 11a.c)• “Knowing the better alternatives”• “Seeing the impact on patients”• “Incentives for saving money”• “Having more conference opportunities”

In the post-intervention survey, 96% of respondents reported that the C2C initiative “completely,” “very much,” or “somewhat,” influenced their supply usage and/or the way they think about supplies and resource utilization on Blake 9.

Cost Reduction

Cost reduction was a priority aim of the C2C initiative and to the achievement of key organizational strategic priorities. Attachment SE11a.d contains three samples of small changes that contributed to the overall achievement of goals, as well as a summary of the C2C initiative that was included in the Healthcare Transformation Lab’s (HTL) 2015-2016 Annual Report. The report indicates that if changes were sustained, an annual cost savings of $990,000.00 would be realized.

Partners in Excellence Recognition

The EDC Award that supported McCleary’s work was the impetus for three other cost savings initiatives, referred to as “spinoff projects,” that resulted in an additional savings of close to one million dollars. As a result of Mc Cleary’s leadership on the C2C initiative and its successful outcomes, both for the project itself and for the organization, Julia Jackson, MBA, Managing Director of the HTL, nominated McCleary for a Partners in Excellence Award (attachment SE11a.e). The Partners in Excellence Award program honors employees for their outstanding contributions in one of six categories:

• Quality treatment and service• Leadership and innovation• Teamwork• Operational efficiency• Outstanding community contributions• Sustainability

On March 31, 2016, Jackson was notified that McCleary and the C2C Team were selected for a 2015 Partners in Excellence Award for Teamwork (attachment SE11a.e). McCleary accepted the award at a ceremony held on April 21, 2016. This award provided organizational recognition for the work of a clinical nurse that had tremendous impact on cost savings and contributed to the achievement of two strategic initiatives for the organization. It is also important to note that McCleary has since been recognized by the organization as a Clinical Scholar. A clinical scholar is the highest level of clinical

practice recognized by the MGH Clinical Recognition Program, a voluntary advancement program for nurses and other direct care professionals. She has also enrolled in the Masters Program at Simmons College in pursuit of a Healthcare MBA.

WHAT IS THE COST TO CATH?

Look for these labels next to supplies tohelp you make cost-conscious choices!

Red means there is a cheaper alternativethat may get the job done

Yellow means this isn't the mostexpensive choice, but there is a cheaperoption.

Green means this is the most cost-conscious choice for this type of item!

Red items are at least 25% more expensive than their alternatives

Yellow items are 5-24% more expensive than their alternatives

Key for Labels Placed on Supplies on Blake 9.

WHAT IS THE COST TO CATH?Cost guidance for supplies:

$$$$$ means the item costs between $0 - $100

$$$$$ means the item costs between $101 - $250

$$$$$ means the item costs between $251 - $500

$$$$$ means the item costs between $501 - $1000

$$$$$ means the item costs more than $1000

Excerpt from MGH Healthcare Transportation Lab 2015-2016 Annual Report

Projected Cost Savings

Little Changes BIG IMPACT

PRECISION: $31 MAK + SHEATH: $34

$3 differencemultiplied by 766 RHC in 2014

$2,298 POTENTIAL IMPACT

Samples of Small Changes

Little Changes BIG IMPACT

Launcher GuidingCatheter: $40.00

Mach GuidingCatheter: $61.00

$21 differencemultiplied by 1019 PCI in 2014

$21,399 POTENTIAL IMPACT

Little Changes BIG IMPACT

Manifold: $41.58Transducer+Tubing+Stopcock: $5.99

$35.59 differencemultiplied by 766 RHC + 354 Biopsies in 2014

$39,860.80 POTENTIAL IMPACT

From: MGH Healthcare Transformation Lab Sent: Wednesday, September 24, 2014 3:11 PMTo: McCleary, Margaret O'Connor,R.N.Subject: Margaret - You're an EDC Finalist!

Hello Margaret,

Congratulations – You are a finalist in the Ether Dome Challenge! Overall, we received 130 total submissions from 67 different people- a level ofparticipation that exceeded our expectations. We’ve invited 28 submissions to continue and submit final applications for grant funding. Your ideato provide physician and staff education regarding costs of care (medical equipment, ancillary services, diagnosis and treatment, etc.) was highlyvoted by your peers and resonated with the Healthcare Transformation Lab. We would like to invite you to submit a full application for grantfunding. Attached, you will find the grant application, which is due on October 10th.

If you’re interested in getting input on your application, the HTL will have “office hours” to provide support. We understand a lot of thesesubmissions were created by a team, so bring all your team members if you have more! The office hours will be held in Yawkey 516:

Friday, September 26th: 3 – 4 PM Wednesday, October 1st: 12 – 1 PM Friday, October 3rd: 10 – 11 AM, Wednesday October 8th: 12 – 1 PM

Please reply and let the HTL know which session you plan to attend. If you’re interested in receiving support but are unable to meet at thesetimes, please reach out to us and we will work to find a solution. If for some reason you are unable to participate on a group application, but wouldlike to submit individually, please let the HTL know.Finally, our EDC Awards Ceremony is scheduled for Thursday, October 30th from 4-6 PM. Besure to save the date! Again, congratulations on being a finalist and we look forward to reading your application!

Ether Dome Challenge Notification & Overview of Project

What is the Cost to Cath?

Project Lead: Meg McCleary, BSN, R.N., CCRNEther Dome Challenge Winner ­ 2014

Project Summary:"What is the Cost to Cath" aims to reduce resource utilization and decreasespending in the Cath Lab by implementing initiatives that educate andempower staff to make cost­effective decisions.

Interventions:­ Highlight "Hot" Items: Expired, New, Frequently Overused, or Expensive­ The Price is Right Game for Staff­ Stickers/Labeling System for Inventory

­ Fairs/Focus Groups­ Conference:

Project Goals:­ Increase Staff Knowledge and Awareness of Spending in Cath Lab­ Develop Interdisciplinary Collaborative Decision­Making­ Develop a Sustainable System

Success Measurements:­ Spending per Procedure­ Staff Knowledge Survey (Pre and Post Intervention)­ Staff Consensus at Fairs/Focus Groups

Project Timeline: January 2015 ­ November 2015

The Cost to Cath is a winner of the Ether Dome Challenge, an open­innovation grant contest conducted by the Healthcare TransformationLab throughout the Heart Center. For more information about the EtherDome Challenge, please contact hctransformationlab@partners.org

­ Green, Yellow and Red ­ $, $$, $$$, $$$$, $$$$$

­ Speaker on Cost Containment ­ Interdisciplinary Brainstorming Session

The Ether Dome Challenge Awards 2015

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Project Process

• Discovery• Design• Build• Implement• Research/Maintain

Project Process

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Lessons Learned

Pain point • Disconnect between HC providers and the cost of care

• Our decision-making impacts: – MGH – Patient care– Insurance Premiums – Healthcare Delivery System

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Discovery & Design

• Talk, then Listen!• Build an Interdisciplinary Team• Consult the Experts• Crunch Data• Rapid Iteration• Little Changes --> Big Impact• Engage, Listen, Repeat

“I think it’s raising an awareness and I don't know if anybody else has mentioned it to you but it’s caused other people to be critical of things that they weren’t aware of before… So this smaller project has spun off other thoughts that staff members have.”

2015 Partners in Excellence Award

Team Nomination Form

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I Cost to Gath*Team's Name:

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I Massachusetts General Hospital

Health Center or other site if applicable):

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*AwardC�a_te_.g"-o_ry.__: ------------.j Teamwork

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*Description of Accomplishments (400 words or less):

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Please describe the "above and beyond the call of duty" contribution made by this team, highlighting the outcome of the accomplishments in terms of quality improvement, financial savings or improved efficiency. Please provide as much detail as possible to accurately describe the reason for the nomination

Partners in Excellence Award Nomination & Congratulatory Letter

them. Then you may email the team list (which must include: First Name, Last Name, and member Institution) to partnersinexcellence@partners.org.

• In your email, please reference the confirmation number which will appear once yousubmit this nomination.

*If the Team Member is a Team Leader, please complete Gray Area.

*FirstName

Margaret

David

William

Martin

Christine

Kenny

Robert

Doug

Christine

*Last*Institution

Name

McCleary

Bourque

Marsh

Doherty

Dunlap

Rosenfield

Yeh

Drachman

Joyce

MGH

Employee Leader Leader ID#: (Yes) Email

X ,

Leader Phone:

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The 'Cost to Cath' (C2C) project is a winner of the 2014 Ether Dome Challenge - an innovation contest

run by the Healthcare Transformation Lab that asks front line staff to submit ideas and then allows the

crowd to vote on which ideas should be implemented. The C2C team, led by Cath Lab nurse Meg

McCleary and Inventory Manager, David Bourque, has dedicated significant time and energy to

understand, analyze, and reduce unnecessary use of supplies in the Cath Lab.

As a result of their hard work, the team has seen incredible staff engagement and resource reduction.

"Meg's work has created a lot of interest in cost containment...! think its raising awareness, causing

other people to be critical of things that they weren't aware of before. So Meg's smaller project has

spun off other thoughts that other staff members have." (Cath Lab Nurse)

This team has implemented creative strategies to engage staff including labeling supplies in the stock

room with color-coded cost guidance, simplifying trays to remove extraneous items, and rearranging

rooms to reduce excessive supply use.

Notable victories during this project include:

• Correcting oversights in the 'soiled-linen' processes in the Cath Lab that had been resulting in

staff throwing away linens rather than returning them.

• Bill Marsh and Christa belle Joyce spearheaded a switch in the contrast used in TAVRs from

Visapaque to lsovue resulting in a potential savings of �$25,000/year. Additionally, Christabelle

took the initiative to assess the amount of blood and plasma being taken out for TAVR cases.

Her assessment led to a process overhaul that decreased the amount of blood and plasma by

50%!• A vendor saw that their product was labeled "red" in the stock room (indicating that staff was

being encouraged to at least consider the less expensive option which was labeled "green").

The vendor asked, "How do we change our product from red to green?" Because of the colored

labels, David was able to negotiate a better rate for the product.

Every step of the way, the C2C team has checked-in with leadership and staff to gauge how the changes

were being received and if they were having an impact. They continue to think outside the box and

come up with new and creative ways to engage staff and conserve supplies. This type of dedication is

what makes MGH and Partners outstanding!

Team Members

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Massachusetts General Hospital Massachusetts General Physicians Organization

Strategic Plan: 2014 -2024

Excerpts from MGH/MGPO 2014-2024 Strategic Plan Contained in OOD3.

1

Massachusetts General Hospital/ Massachusetts General Physicians Organization 

 Strategic Plan 

Executive Summary 

This strategic plan represents the culmination of work by over one hundred Massachusetts General Hospital faculty and staff over the course of nearly two years.

It sets forth four key strategic imperatives: 1. To define and deliver the highest-quality care to our patients while controlling health care

costs2. To sustain and enhance our academic and community missions3. To strengthen our ability as an organization to deliver on the above4. To maintain our financial sustainability

Within these imperatives, twelve key strategies are detailed, capturing institutional priorities across the clinical care, research, education and community missions.

It is an ambitious plan, designed to serve as a roadmap for the institution over the next ten years.

Background 

Strategic plan history 

Massachusetts General Hospital/Massachusetts General Physicians Organization issued its last strategic plan in 2004. Over the intervening ten years, the institution has thrived, using this plan to guide investments and activities, but significant changes in the external environment have necessitated a fresh look at how best to take advantage of opportunities and manage challenges in the years ahead.

The management of healthcare costs remains a focus at the national and local levels. Government and commercial insurers have introduced new payment models designed to manage costs, which Partners and the MGH have been proactive in piloting. At the same time, patients are increasingly being asked to pay more for care at academic medical centers that had previously been covered under their health plans. As a result of these changes, many expect a decline in clinical margins, which could in turn reduce the MGH’s ability to support its research, education and community health missions. On the research side, extramural funding has become scarcer, with budget reductions at the National Institutes of Health. And the education mission, already heavily subsidized by the MGH, expects to receive reduced external support – both at the federal level and from industry, the latter due to heightened conflict of interest concerns -- as it needs to implement major changes in graduate medical education. Changes in health care