4 - Bill Taylor - Healthcare - 23 Tocpa - Usa - 21-22 Handout March 2016

23rd International Conference of the
TOC Practitioners Alliance - TOCPA

www.tocpractice.com
21-22 March, 2016, Tennessee, USA
TOC in US Healthcare Strategy and

Operations
Experiences with CCPM in Planned Discharge Date Scheduling
And Care Management at
the Erlanger Childrens Hospital Neonatal Intensive Care Unit
NICU
April 2012-March 2016

Bill Taylor, BusinessRx Consulting, U.S.A
March, 2016
www.businessrxconsulting.com
I am looking forward to utilizing this methodology

as a primary Care Management" tool for our NICU
and in other predictive procedures.
Don Mueller
Chief Executive Officer
Childrens Hospital at Erlanger
March 12, 2016
23rd International Conference of the

TOC Practitioners Alliance - TOCPA
www.tocpractice.com
21-22 March, 2016, Tennessee, USA
Theory Of Constraints in US
Healthcare Strategy and Operations
and
Experiences with Critical Chain Project

Management in Planned Discharge
Date Scheduling
U.S. Healthcare Provider

Generic Conflict
www.tocpractice.com
Your logo
23rd International Conference of the TOC Practitioners Alliance - TOCPA
Project #1
MORE STRATEGIC THINKING NEEDED AT SERVICE LINE LEADERSHIP
Work With Operating And Medical Leadership Including COO, Senior
VPs Of Operations and VPs and CMO Of Various Service Lines* at a
Large Pediatric Health Care Provider
(* INCLUDING MEDICAL, CARDIOLOGY, SURGERY SERVICES, EMERGENCY SERVICES, TRANSPLANT
SERVICES, AUTISM, NEUROSCIENCE, ORTHOPEDIC, HEMATOLOGY AND ONCOLOGY)
Chronic Conflict for

Each Service Line Leader
and Generic
www.tocpractice.com
Your logo
Your
Service Line Leaders
Generic Conflict Resolution Diagram
logo
www.tocpractice.com
Hospital IT, EHR, HIPPA,

IT Applications, etc.
Your logo
Existing state-of-the-art EHR systems and IT tools,

together with dedicated and willing people,
confidentially manage data well for Conformance:
Regulatory, Legal, Tax, Government, Medicare and
Medicaid (CMS), Insurance and so on.
Very advanced EHR systems also support Research
and provide a great variety of Performance Metrics

For Operations, Quality, Efficiency, Cost,
Collections, Consumer Satisfaction, Budgeting,
Finance, Strategy and presentations to various
internal and mixed Committees, C-level, Board,
Donors and Government.
www.tocpractice.com

Root Conflict Cause-Effect Diagram
Your logo
Solution Injections
1- PRT for BD2
2- Resolve Cloud for DD1
3- PRT for DD2
www.tocpractice.com

CD-B Jeopardy Negative Loop
Your logo
Solution Injections
4 - PRT for CD-B1
5 NBR for CD-B2
www.tocpractice.com
10

BD-C Jeopardy Negative Loop
Your logo
Solution Injections
6 - PRT for BD-C1
7 NBR for BD-C2
www.tocpractice.com
11
EHR Systems in Scheduling
Your logo
Example: Description of EPIC Cadence Capabilities:
Advanced EHR scheduling systems use rules based scheduling to
Cadence Enterprise Scheduling makes it easy for users to
efficiently manage healthcare providers, staff and resources. The EHR
schedule any type of visit or procedure from anywhere in your
software works out compromises and generally tries to optimize or
organization. It also enhances your ability to keep appropriate
maximize efficiencies, lower costs, improve resource utilization, etc. (see
slots open, take patient preferences into account and deliver

high-quality service that will distinguish your organization.
Example).
Cadence serves as an intelligent partner for users, providing
Because the EHR tries to do so much, its scheduling solutions are often
context-specific instructions, conflict checking and solutions for
not clinically led or patient centered.
complicated appointment searches. Comprehensive rules-
Dedicated and willing people work out compromises and try to
eliminate conflict and provide input to the management of patient
based scheduling features accommodate the needs of each

clinician, room and piece of equipment optimizing the use of
staff and capital resources throughout your organization.
needs, often through multiple cross functional meetings which can

consume large amounts of time and fill up staff agendas.
This situation becomes critical when certain resources become

bottlenecks or system constraints. Systems constraints create ripple
effects throughout the hospital system which often create the need to
manually override EHR scheduling decisions.
www.tocpractice.com
Your logo
Project #2
Reduce Rescheduling of Cardiac Surgery
Increase Patient Flow Through Cardiac Intensive Care Unit
October November 2014
www.tocpractice.com
Project #2: CICU Improvement -1
Your logo
Problem: Increasing percentage of heart

surgeries being rescheduled
Caused by Cardiac Intensive Care Unit

(CICU) bed constraint. A monitored bed
always must be available immediately

after heart surgery.
In a daily huddle meeting, surgery

priorities are discussed, CICU bed
availability analyzed and surgeries

rescheduled as needed
www.tocpractice.com
Your logo
Project #2: CICU Improvement - 2
Six weeks in October-November 2014
Process analysis of CICU operations. Individual patient CICU and Step Down Unit stay plans mapped
onto Exepron CCPM. CICU flow Process improvement emerged. Bed capacity increased without extra
staff through better utilization.
Conflict resolution (TOC Thinking Processes) between current way of doing things and patient needs.
Subordinate everything in the system to the constraint: CICU beds.
Pilot individual patient treatment plans in CICU on Exepron CCPM multi-project management.
Partial screenshot of internal report forwarded by customer and received December 2014:
www.tocpractice.com
EXTENDED CICU FLOW
Your logo
Constraint
www.tocpractice.com
Individual Patient CICU Stay Plan
www.tocpractice.com
Your logo
Patient Centered CICU Scheduling Pilot

(Each Dot Represents a Patient Plan)
Your logo
Patient
Name
www.tocpractice.com
Patient CICU Care Management Plan Dashboard

Pilot November 2014
www.tocpractice.com
Your logo
Your logo
Full CICU Care Management Plan
CICU BEDS The Dynamic Drum of the Cardiac Surgery System

Scheduled Heart Surgeries
CICU Pipeline
ACTIVE AND PIPELINE 11/11/14
Patients in the CICU Starting November2014
www.tocpractice.com
Your logo
Project #2: CICU Improvement - 3
Key learnings:
Surgery rescheduling problem solved through emerging process improvement CICU bed utilization from
pilot implementation.
Staff time critical. Resistance to CCPM Software from need to update so many tasks internally.
HIPPA obstacle to CCPM SAAS Software. Decision to replicate internally.

Corporate IT staff overburdened. IT resource constraint conflict
www.tocpractice.com
Your logo
Project #3
LONG WAIT LINES AT AUTISM CENTER
October 2014 August 2015
Work With Operating And Medical Leadership to Resolve Intake Problem
Implement Patient Focused, Clinically Led, Throughput Based
Intake and Trhoughput Strategy
www.tocpractice.com
Prior Center Scheduling
Your logo
Learning and Language

Severe Behavior
Feeding.
Etc.
School
Family
INTAKE
Psychology
Developmental Pediatrics
Psychiatry
PNC
PCP
www.tocpractice.com
Research
Evaluation
January 2015
Your logo
TOC TP WORKSHOP WITH 45 LEADERS
RESULT: Total 111 Ds
(Discomforts, Dilemmas, Difficulties and Doubts)
78 Ds Related to Internal Root Conflicts
16 Related to Intake
27 Related to Process Approach versus Project View
12 Related to Strategy Implementation versus Operations Needs
27 Related to Silos Culture
33 Ds Related to External Root Conflicts
7 Related to Value versus Cost Measurements

7 Related to IS&T EHR versus Operational Tools Needed
7 Related to Implementation of Rules/Legal
9 Related to People and Organization Issues
www.tocpractice.com
24
Root Problem Interaction Ds Overlap
Silos 3/27
(Clinical/Research/
Admin/Operations/
Finance)
HR/
People
0/9
www.tocpractice.com
Your logo
Legal/
Regs.
2/7
IS&T
Intake 6/7 Strategy
Value
16
3/12
/ Cost
6/7
Project/Process
13/27
46/111 Ds
RELATE TO INTAKE
Principal Paradigm Shifts Required

to Solve Intake Problem
Your logo
Subject
From
To
Diagnostic Capacity
The more patients we

diagnose, the more money we
lose. Limit diagnostic staffing.
Be able to diagnose and

prepare a Continuum of Care
plan for around all ASD
children born in Region every
year
Length of Center Treatment
Provider Discretion
Limited by Medical Director
Associates Goals and Metrics
Individual
Global
Diagnostic Treatment Lead

Time Measurement
Size of Wait List
PQT (Patient Queue Time to

Treatment)
Patient Throughput
# of Patients Served
# of Patients Transitioned to
Treatment or Community
www.tocpractice.com
Marcus Autism Center

Integrated Patient Scheduling
Classify
Patients by
Protocol and
Level, PNC
Diagnosis,
and Design
Care Plan
(CCPM)
Your logo
IPS
IPS
Integrated Patient Scheduling
Epic/Emric/Excel/Others
Replenishment
Exepron/Excel/Epic
Critical Chain
www.tocpractice.com
23rd
Epic/Emric/Excel/Others
Drum-Buffer
Rope
International Conference of the TOC Practitioners Alliance - TOCPA
Your logo
Priority System Proposed for PNC Pre-Test

Scheduled
A
Standby
Wait List
D
E
PT-12
PT-11 PT-10
www.tocpractice.com
PT-9
PT-8
PT-7
PT-6 PT-5
PT-4of thePT-3
PT-2 PT-1
PreTest
23rd International
Conference
TOC Practitioners
Alliance
- TOCPA
Your logo
Project #4
Neonatal Intensive Care Unit (NICU)
October 2015 March 2016 (Ongoing)
Highly Variable Demand for Neonatal Care for Premature Babies
(23-36 weeks of gestation). 64 Bed Capacity, organized in 8 Care
pods sometimes needing to care for demand surges of more than 70
Premature Babies, with varying Medical Needs. Forward Looking,
Clinically Led, Patient Centered Neonatal Intensive
Care Management is Needed
www.tocpractice.com
Your logo
Project #4: NICU Implementation (1)
During 2015 we continued work using Exepron to manage patient care treatment plans at customers.
in January 2016, we were asked to pilot Care Management with Exepron at a 64 bed Neonatal
Intensive Care Unit (NICU).
Customer requested as much simplicity as possible. To minimize staff time needed during the pilot at
the outset, plan just one task per project (NICU bed stay). Include ATU (Automated Task Updating).
For healthy babies, there is less variability in length of stay compared with the previous CICU case. The
one task should be planned to work with almost with no buffer. This means that almost all Care
Management projects at the NICU start in the Red Zone and with an Early Warning in black. This
represents no risk to the baby, just to the scheduled discharge date.
Stays are planned using Experience Based Averages (Current rule of thumb). The intent is to prepare
over time a statistically validated database using the Exepron generated information for future data
based decision making in Care Management.
An expected final conclusion is that we may be able to economically justify seeing mothers at risk for
free in order to delay premature births. Depending on the case, a one-week delay in a premature
birth can shorten the ICU stays by two or more weeks, increasing the chance of a better outcome
while increasing NICU Capacity.
www.tocpractice.com
Patient 1 Task Care Plan

Minimum Buffer
www.tocpractice.com
Your logo
Planned vs. Actual NICU Stays

Early Warnings Mostly Black
www.tocpractice.com
Your logo
Most NICU Care Management Stays

Following Aggressive Plan Schedule
www.tocpractice.com
Your logo
33
Most NICU Stays Scheduled Aggressively

(Red Buffer, Black Early Warning)
Your logo
Every Dot Represents a Patient Care Management Plan
www.tocpractice.com
Your logo
Resources Required Over Time
to Serve Patient Care Management Plan
www.tocpractice.com
35
Patient Care Management

Treatment Plan Durations
NICU
www.tocpractice.com
Your logo
36
Care Management Plans

of Unborn, Anticipated Premature Babies
Are Placed In The Project Pipeline
www.tocpractice.com
Your logo
37
Full NICU Care Management Plan
NICU BEDS The Dynamic Drum of the

Preemies Treatment Plans
Your logo
Details on
each baby
within
individual
treatment
plan
www.tocpractice.com
Projected NICU Occupancy

Facilitates Staffing and
Anticipates Other Resource Needs
www.tocpractice.com
Your logo
Project #4:
NICU Implementation (2)
Your logo
Next Steps:
Continued development of pilot at Erlanger Childrens Hospital
Incorporate doctors, charge nurses and others into use of and input to Care
Management tool (Exepron). Analyze customizing tool for Healthcare.
Develop and use special portfolios by NICU pods, patient conditions, etc.
Expecting HIPPA approval of Exepron CCPM.

Data generated by this Care Management approach can lead to breakthrough
thinking in scheduling At-Risk pregnancies, and providing preventive measures to delay
premature births as much as possible. A one-week delay in a premature birth can
shorten the babys NICU stays by two weeks or more. This would increase the number
of babies attended per year at the NICU with the same capacity. Final conclusion can
economically justify seeing mothers at risk for free in order to delay premature births
www.tocpractice.com
Bill Taylor
Your logo
www.businessrcconsulting.com
During 2001-2012, Bill was Principal of
Taylors Of Curitiba, based in Curitiba,

Brazil. Bill moved to Atlanta, GA in April
2012, and currently is a Principal in
BusinessRx Consulting.
Bill has been associated with the CocaCola system for more than 45 years, as
an international executive and also as a
consultant, living in six countries and
executing projects in more than 30. Bill
was on the TOCICO Board of Directors
for seven years and was the 2011-2012
Chairman
of
the
Board
of
this
organization.
www.tocpractice.com
Place for the photo of the

presenter
bill@taylors-oc.com
1-678-925-1976

4 - Bill Taylor - Healthcare - 23 Tocpa - Usa - 21-22 Handout March 2016

Enviado por

Dados do documento

Título original

Direitos autorais

Formatos disponíveis

Compartilhar este documento

Compartilhar ou incorporar documento

Opções de compartilhamento

Você considera este documento útil?

Este conteúdo é inapropriado?

Direitos autorais:

Formatos disponíveis

4 - Bill Taylor - Healthcare - 23 Tocpa - Usa - 21-22 Handout March 2016

Enviado por

Direitos autorais:

Formatos disponíveis

23rd International Conference of the

TOC Practitioners Alliance - TOCPA

21-22 March, 2016, Tennessee, USA

TOC in US Healthcare Strategy and

April 2012-March 2016

I am looking forward to utilizing this methodology

23rd International Conference of the

21-22 March, 2016, Tennessee, USA

Experiences with Critical Chain Project

U.S. Healthcare Provider

23rd International Conference of the TOC Practitioners Alliance - TOCPA

Chronic Conflict for

23rd International Conference of the TOC Practitioners Alliance - TOCPA

23rd International Conference of the TOC Practitioners Alliance - TOCPA

Hospital IT, EHR, HIPPA,

Existing state-of-the-art EHR systems and IT tools,

Very advanced EHR systems also support Research

and provide a great variety of Performance Metrics

Donors and Government.

23rd International Conference of the TOC Practitioners Alliance - TOCPA

Service Line Leaders

23rd International Conference of the TOC Practitioners Alliance - TOCPA

Service Line Leaders

23rd International Conference of the TOC Practitioners Alliance - TOCPA

Service Line Leaders

23rd International Conference of the TOC Practitioners Alliance - TOCPA

EHR Systems in Scheduling

Example: Description of EPIC Cadence Capabilities:

Advanced EHR scheduling systems use rules based scheduling to

Cadence Enterprise Scheduling makes it easy for users to

efficiently manage healthcare providers, staff and resources. The EHR

schedule any type of visit or procedure from anywhere in your

software works out compromises and generally tries to optimize or

organization. It also enhances your ability to keep appropriate

maximize efficiencies, lower costs, improve resource utilization, etc. (see

slots open, take patient preferences into account and deliver

Cadence serves as an intelligent partner for users, providing

context-specific instructions, conflict checking and solutions for

not clinically led or patient centered.

complicated appointment searches. Comprehensive rules-

Dedicated and willing people work out compromises and try to

eliminate conflict and provide input to the management of patient

based scheduling features accommodate the needs of each

needs, often through multiple cross functional meetings which can

This situation becomes critical when certain resources become

manually override EHR scheduling decisions.

23rd International Conference of the TOC Practitioners Alliance - TOCPA

23rd International Conference of the TOC Practitioners Alliance - TOCPA

Project #2: CICU Improvement -1

Problem: Increasing percentage of heart

Caused by Cardiac Intensive Care Unit

always must be available immediately

In a daily huddle meeting, surgery

availability analyzed and surgeries

23rd International Conference of the TOC Practitioners Alliance - TOCPA

Project #2: CICU Improvement - 2

Six weeks in October-November 2014

23rd International Conference of the TOC Practitioners Alliance - TOCPA

EXTENDED CICU FLOW

23rd International Conference of the TOC Practitioners Alliance - TOCPA

Individual Patient CICU Stay Plan

23rd International Conference of the TOC Practitioners Alliance - TOCPA

Patient Centered CICU Scheduling Pilot