Whole systems change –“what, why, when and who .../media/Confederation... · Emphasis on...

Whole systems change –“what, why, when and who!”

Intentional whole system redesign – lessons from

AlaskaSteve Tierney - Medical Director of Quality

Improvement and Chief Medical Informatics Officer for

Southcentral Foundation (SCF), Alaska

Michelle Tierney - Vice President of Organizational Development

and Innovation for Southcentral Foundation (SCF), Alaska

SCF Nuka System of Care June 29, 2016

Northern Ireland Confederation for Health and Social Care Annual Conference

Steve Tierney, MD| Senior Medical Director of Quality Improvement

Michelle Tierney, PhD| Vice President of Organizational Development and Innovation

65,000 voices

We Changed Everything

©2016. Southcentral Foundation. All rights reserved.

Southcentral Foundation Fast Facts

• Incorporated in 1982

• Serving 65,000 Customer-owners• 55,000 Anchorage and

Valley

• 10,000 55+ villages

• Employees• 1987: 24 staff

• 2016: 2,000 staff

We provide primary care services and 80+ programs and departments, such as:• Dental

• Behavioral health

• Optometry

• Complementary medicine

• Traditional Healing

• RAISE program

• Family Wellness Warriors Initiative

• Alaska Native Medical Center

Alaska

San Francisco

Charleston

591,000 square miles 1,530,682 square kilometers

Alaska is larger than Texas, California and Montana combined


Indian Self-Determination and Education Assistance Act 1975

Summary of Congressional Findings:

Prolonged federal domination of Indian Health Service programs has

• served to retard rather than enhance progress of Indian people and their communities

• denied an effective voice in the planning and implementation of programs that respond to the true needs of the people


Government recognized If the people receiving the health service are involved in the decision making processes, better yet, if they own their own health care –programs and services have a potential for enhancement and the people and their health statistics will improve.


Step ONE

Ask the community

Vision A Native Community that enjoys physical, mental, emotional and spiritual wellness

MissionWorking together with the Native Community to

achieve wellness through health and related services


GoalsShared ResponsibilityCommitment to QualityFamily Wellness


Relationships between customer-owner, family and provider must be fostered and supportedEmphasis on wellness of the whole person, family and community

(physical, mental, emotional and spiritual wellness)Locations convenient for customer-owners with minimal stops to get all their needs addressedAccess optimized and waiting times limitedTogether with the customer-owner as an active partnerI ntentional whole-system design to maximize coordination and minimize duplicationOutcome and process measures continuously evaluated and improvedNot complicated but simple and easy to useServices financially sustainable and viable Hub of the system is the familyI nterests of customer-owners drive the system to determine what we do and how we do itPopulation-based systems and servicesServices and systems build on the strengths of Alaska Native cultures

Operational Principles

Customer Ownership

Sustained Improvements

93 96% Employee Satisfaction

% Customer Satisfaction

25 25% ReductionIn ER Visits

From 2008-2015

% Reduction InPrimary Care Visits from 2008-2015


Work that could be handled differently :

20% were for Rx refill of controlled diseases

20% were for ongoing monitoring of chronic diseases

20% needed known preventive medical interventions

10% came requesting outside referrals

50% business volume already had known pathways or protocols

Value-added visits:

30% were new customers without a diagnosis or plan to date

Clinical WorkloadPrior to Redesigning The System


Provider

Chronic

Disease

Monitoring

Preventive

Med

Intervention

Mental Health

Provider

Referral to

Specialist

after

Assessment

Medication

Refill

New Acute

Complaint

Certified

Medical

Assistant

Case

Manager

Test Results

Healthcare

Support

Team

Traditional Methods of Managing Workflow


Healthcare

Support

Team

Chronic

Disease

Monitoring

Preventive

Med

Intervention

Behavioral Health

ConsultantProvider

Medication

Refill

New Acute

Complaint

Certified Medical

Assistant

Case

Manager

Test

Results

Point of

Care

Testing

Acute Mental

Health

Complaint Chronic

Disease

Compliance

Barriers

Parallel Work Flow Redesign


Integrated Care Teams


PCP (1,100-1,400 empaneled customer-owners and customer-owners in assigned villages)

1 RN Case Manager : 1 PCP

1.5 Certified Medical Assistant : 1 PCP

1 Case Management Support : 1 PCP

1.5 Midwives : 6 PCP

1 Behavioral Health Consultant : 6 PCP

0.5 Registered Dietitian : 6 PCP

1 PharmD : 6 PCP

Integrated Care Team Ratios


Corporate Data Aggregated Over Time


Comparison Charts to Identify Best Practices


Clinical Performance Dashboard


SCF Data Mall IntegratingKnowledge into Action

Fictitious customer-owner information

Thank You!

QaĝaasakungAleut

QuyanaqInupiaq

Háw'aa Haida

‘Awa'ahdahEyak

Mahsi'Gwich’in Athabascan

IgamsiqanaghhalekSiberian Yupik

Tsin'aenAhtna Athabascan

Way DankooTsimshian

GunalchéeshTlingit

QuyanaYup’ik

Chin’anDena’ina Athabascan

QuyanaaAlutiiq

Whole systems change –“what, why, when and who .../media/Confederation... · Emphasis on...

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