[00:00:05.10] That's helped organize panel we invited them they talked to each other [00:00:09.19] [00:00:09.19] they decided on their sequence talking points scored the nation saw [00:00:14.05] [00:00:14.05] truly impressed though they don't need in a moderate. [00:00:16.02] [00:00:25.06] Join me in welcoming. [00:00:26.08] [00:00:29.04] Good afternoon everyone I don't want to go through the bio too much but [00:00:34.00] [00:00:34.00] I did think it was interesting to share maybe a little bit about ourselves because [00:00:38.06] [00:00:38.06] I think we all have unique backgrounds and I know when I was a student I always [00:00:42.16] [00:00:42.16] enjoyed hearing about what folks had done as far as their background so [00:00:48.03] [00:00:48.03] I actually had my bachelor's and master's in industrial and [00:00:51.05] [00:00:51.05] systems engineering from the University of Florida and I knew when I was going to do [00:00:55.11] [00:00:55.11] my master's degree because I had done internships in both me and [00:00:59.06] [00:00:59.06] factoring in health that I wanted to go into health care so when I was doing my [00:01:03.15] [00:01:03.15] master's degree I actually I specialize in engineering management so [00:01:09.01] [00:01:09.01] I took m.b.a. classes to do that but I also used my electives to take [00:01:14.02] [00:01:14.02] some classes in Masters of health systems and m.h.a. masters of health care and [00:01:19.12] [00:01:19.12] ministration because I knew I wanted to go into health care and that's proved very [00:01:23.13] [00:01:23.13] beneficial to me because when I came right out of school I actually did consulting [00:01:28.05] [00:01:28.05] for a while and then Ever since then I've been at your side hospital and [00:01:32.12] [00:01:32.12] I've had several different positions there right now I'm the director of productivity [00:01:37.02] [00:01:37.02] management and so what does that mean that means that I'm involved in help do [00:01:41.23] [00:01:41.23] all of our staffing for the entire More side hospital system so [00:01:46.17] [00:01:46.17] that from the point of entry with our physician practices urgent care [00:01:51.02] [00:01:51.02] centers all the way through the acute care environment and [00:01:54.21] [00:01:54.21] are impatient hospital settings also in all of our outpatient settings so [00:01:59.23] [00:01:59.23] we have our hands in all of the different staffing all the different skill levels [00:02:05.07] [00:02:05.07] with that so I wanted to 1st of all talk about [00:02:08.10] [00:02:08.10] I know that we're talking about data you know I know as industrial engineers [00:02:13.02] [00:02:13.02] we love data you know and how can we use it how can we apply it how [00:02:18.02] [00:02:18.02] can we use it to help make a difference in health care so [00:02:21.09] [00:02:21.09] I'm going to speak a little bit more specifically about the efficiency part and [00:02:26.07] [00:02:26.07] then some of my colleagues are also going to talk about quality and [00:02:29.20] [00:02:29.20] outcomes since that's kind of what we're trying to focus the panel on. [00:02:34.20] [00:02:34.20] So why why are we you know industrial engineers being involved in [00:02:40.11] [00:02:40.11] health care and looking at health systems Well as we've heard previously [00:02:45.13] [00:02:45.13] a little bit we have a lot of issues going on right now with our health care costs [00:02:50.19] [00:02:50.19] I think it was referenced earlier it's about 17.9 percent of the g.d.p. [00:02:56.06] [00:02:56.06] And when we look at kind of what's going on in 2019 we've got aging [00:03:00.22] [00:03:00.22] population we have patients that have multiple chronic conditions [00:03:06.05] [00:03:06.05] we're having to deal a lot with end of life care we have more and more technology [00:03:11.00] [00:03:11.00] available now than probably at any point in healthcare history and [00:03:15.05] [00:03:15.05] we have a lot of different drugs and procedures that are also enabling the end [00:03:19.21] [00:03:19.21] of life care to be more substantial than it's been in the past and [00:03:24.01] [00:03:24.01] on the flip side of that unfortunately with a lot of things that have been going [00:03:28.18] [00:03:28.18] on probably over the past 5 to 10 years we're seeing a decrease in our [00:03:33.16] [00:03:33.16] reimbursement and a lot of that has to do with the Affordable Care Act We've [00:03:38.19] [00:03:38.19] got bundled payments we have value based purchasing insurance exchanges [00:03:43.18] [00:03:43.18] the accountable care organizations if I'm mentioning these words and [00:03:48.12] [00:03:48.12] you're not familiar with them go google them as being in health care and [00:03:53.01] [00:03:53.01] doing health systems you need to know what these are because they're very crucial [00:03:57.15] [00:03:57.15] to all of the health care organizations that we're working with and [00:04:00.23] [00:04:00.23] also the federal deficit 2 percent Medicare reimbursement [00:04:05.15] [00:04:05.15] if you did not have a burning platform of why you want to be in health care and [00:04:09.16] [00:04:09.16] why you want to do health care systems this is a great one. [00:04:13.01] [00:04:14.06] So when we talk about methodology as I know these probably look very [00:04:18.17] [00:04:18.17] basic to you but a lot of times as and does challenge in ears and [00:04:23.07] [00:04:23.07] systems engineers when we go into the health care organizations we're working [00:04:28.10] [00:04:28.10] a lot talking about a multi-disciplinary team we're working with clinicians we're [00:04:33.15] [00:04:33.15] working with physicians we're working with pharmacists we're working with nurses [00:04:38.12] [00:04:38.12] their area of expertise is not going to be process redesign [00:04:43.18] [00:04:43.18] Lean 6 Sigma facility layout optimized [00:04:48.22] [00:04:48.22] how we set everything up benchmarking doing time studies or [00:04:53.10] [00:04:53.10] understanding the data analytics of how their area may work their [00:04:58.16] [00:04:58.16] area of expertise maybe medical you know they know how to take care of the patient [00:05:04.01] [00:05:04.01] we need to help to support them and use our data to do that so [00:05:08.13] [00:05:08.13] what I wanted to do was talk through a few projects you know that I've done [00:05:13.16] [00:05:13.16] over the course of my career but also help to set the stage for [00:05:19.14] [00:05:19.14] what my fellow colleagues are also going to talk about so [00:05:23.10] [00:05:23.10] I want to talk about about staffing operations improvement [00:05:28.06] [00:05:28.06] workflow Capacity Analysis facility design. [00:05:32.20] [00:05:34.06] So health care labor management So this is kind of the bread and [00:05:37.17] [00:05:37.17] butter of an additional engineering or systems engineering and [00:05:40.16] [00:05:40.16] health care I love it I live it it's my life every day and has been for [00:05:45.11] [00:05:45.11] the past several years I cannot I get so much joy and [00:05:49.21] [00:05:49.21] pleasure out of being able to help a clinician be able to figure out [00:05:55.11] [00:05:55.11] how many people what type of people do I need to be able to run my area so [00:06:01.10] [00:06:01.10] that we can provide the best quality care for [00:06:04.22] [00:06:04.22] our patients if you're at 247365 we have to figure [00:06:10.08] [00:06:10.08] out how many people we need here to make that happen you know how do we do that [00:06:15.18] [00:06:15.18] how do we make sure that our patients are taken care of how do we deal with the fact [00:06:20.01] [00:06:20.01] that we don't know the next patient that's going to become in in through labor and [00:06:24.08] [00:06:24.08] delivery are coming through the e.d. So figuring out you know having the right [00:06:29.06] [00:06:29.06] people in the right place at the right time being able to look at what our [00:06:33.09] [00:06:33.09] volumes are what are our demand patterns how can we use forecasting how can we [00:06:38.14] [00:06:38.14] figure all this out and a lot of that what scares me a lot of that has to do with [00:06:43.17] [00:06:43.17] you know productivity management position management figuring all of that out [00:06:49.04] [00:06:49.04] unfortunately in 20191 of the biggest things that we're spacing and [00:06:53.18] [00:06:53.18] health care is a shortage of healthcare workers so now we have to [00:06:58.21] [00:06:58.21] start looking at what the skill mix is now we have to start figuring out well 10 or [00:07:04.17] [00:07:04.17] 15 years ago we had a plethora of x. y. z. healthcare [00:07:10.02] [00:07:10.02] worker Ahrens were a lot more prevalent than they are now even are you know [00:07:15.13] [00:07:15.13] Lab our medical technologies that help run our laboratories where we have to do all [00:07:20.09] [00:07:20.09] of the testing even our pharmacists looking at respiratory therapist [00:07:25.11] [00:07:25.11] our rehab folks physical therapist occupation therapist speech path ologist [00:07:31.03] [00:07:31.03] they are not as readily available as they were so how can we take care of these [00:07:36.01] [00:07:36.01] patients with a different level of health care worker that's out there [00:07:40.18] [00:07:40.18] well those are the types of things that we have to help them figure out. [00:07:44.00] [00:07:46.15] Really really cool project that I got to work on about 5 years ago and [00:07:52.00] [00:07:52.00] there's a ton of literature out there now about it and [00:07:55.07] [00:07:55.07] this actually helped set some precedents that are in place today so [00:08:00.11] [00:08:00.11] I was able Northside Hospital for sites which is one of our hospitals up and [00:08:05.05] [00:08:05.05] coming Georgia started to work on a project in a conglomeration with [00:08:10.23] [00:08:10.23] I am I looking at being able to perform same day total joint replacements so [00:08:17.19] [00:08:17.19] if we go back way back in time when these 1st came about there was easily [00:08:23.02] [00:08:23.02] you would have the procedure done you would be in the hospital for a week easily [00:08:28.19] [00:08:28.19] and then as time goes on has gone on the technology has changed our surgeons have [00:08:33.11] [00:08:33.11] gotten more and more involved with improving things we have more and [00:08:37.05] [00:08:37.05] more biomedical engineering pieces about it. [00:08:40.01] [00:08:41.05] There have been strides made in how to be able to do this you know this was not even [00:08:46.21] [00:08:46.21] fasten the bowl you know 5 or 10 years ago and so when we when I wanted to make [00:08:52.14] [00:08:52.14] the point about with this is we had to use data we had a multi-disciplinary team [00:08:57.22] [00:08:57.22] we had the peat excursions we had the anesthesiologist we had pharmacists [00:09:03.13] [00:09:03.13] we had the physical therapists the nurses the ones that were in the o.r. [00:09:08.02] [00:09:08.02] the ones that were up on the units to help take care of them and so we wanted to [00:09:13.15] [00:09:13.15] figure out what we needed to do that we could do same day surgeries and [00:09:18.14] [00:09:18.14] so we had this whole group work together under the umbrella of the i h [00:09:23.11] [00:09:23.11] i wanted to look at this and this is just some data to show like when we started out [00:09:28.18] [00:09:28.18] you know prepay Illit pre trying to do some Lean 6 Sigma changes we were had [00:09:35.00] [00:09:35.00] 15 percent of the patients were able to be discharged in less than 23 hours so [00:09:41.17] [00:09:41.17] we did some root cause analysis we did some Lean 6 Sigma we had. [00:09:46.00] [00:09:46.00] All these different clinicians involved we came up with some very specific things [00:09:50.13] [00:09:50.13] that we wanted to pilot we did the pilot and we had and it changed from [00:09:55.14] [00:09:55.14] 15 percent to 42 percent that we were able to discharge the patients in 23 hours and [00:10:02.02] [00:10:02.02] this was back in 2014 so jump forward 5 years and [00:10:06.23] [00:10:06.23] I think my data is even a little bit legging because I just had a colleague [00:10:11.20] [00:10:11.20] send me some data this week we have 92 percent of our patients are discharged in [00:10:17.13] [00:10:17.13] less than 8 hours that have a total joint replacement I'm talking about needs and [00:10:22.21] [00:10:22.21] hips their average length of stay is about 4 to 6 hours that's it [00:10:28.19] [00:10:28.19] there's a lot of pre-rock that has to be done there's a lot of obviously post [00:10:34.02] [00:10:34.02] work that has to be done but this is amazing and this is phenomenal and [00:10:38.22] [00:10:38.22] the fact that is industrial engineers we get to be a part of a team to help them [00:10:44.06] [00:10:44.06] figure all this out how do we do the work flow how do we make this happen is just [00:10:49.11] [00:10:49.11] incredible and this is just one example but I mean this is life changing for [00:10:54.01] [00:10:54.01] our patients the outcomes are incredible for them to be able to do this. [00:10:58.12] [00:10:59.23] Also emergency department and I can't mention the emergency department without [00:11:04.15] [00:11:04.15] mentioning the fact of going back to what I was talking about with health care costs [00:11:08.18] [00:11:08.18] in reimbursement we need to have our emergency department be truly for [00:11:15.05] [00:11:15.05] the acute acute episode and we need to make sure that our patients [00:11:20.00] [00:11:20.00] are going to primary care physicians or joint care centers for [00:11:25.01] [00:11:25.01] those types of situations that are not you know urgent and [00:11:28.19] [00:11:28.19] emergent because what's happening is then we're impacting the health care cost that [00:11:34.15] [00:11:34.15] this country is experiencing so we did do a project in the emergency department and [00:11:39.23] [00:11:39.23] again because of my involvement with staffing what this kind of stand [00:11:44.19] [00:11:44.19] around we definitely wanted to decrease the wait time for [00:11:47.23] [00:11:47.23] the patients we definitely wanted to decrease the length of stay for [00:11:51.22] [00:11:51.22] our patients but what we found is that we actually one of the things we needed [00:11:56.21] [00:11:56.21] to do was look at how we were staffing our care teams or [00:12:01.02] [00:12:01.02] our pots I was talking out with the group when we had our break you know one [00:12:06.21] [00:12:06.21] of our challenges is that even though we do our health care workers that more and [00:12:13.00] [00:12:13.00] more of them are novice you know more and more of our experienced health care [00:12:17.04] [00:12:17.04] workers are of the age where they're retiring or [00:12:20.20] [00:12:20.20] they're choosing to do things differently so we've had to set up different models so [00:12:25.13] [00:12:25.13] one of the changes that we made in our care team model was to basically have like [00:12:30.11] [00:12:30.11] a care teen lead that would be able to help [00:12:35.06] [00:12:35.06] the nurses in the techs and help facilitate keeping throughput moving and [00:12:39.22] [00:12:39.22] going so that it wasn't just one Marse or one technologists trying to [00:12:44.18] [00:12:44.18] take care of one patient they were working as a team and [00:12:48.18] [00:12:48.18] what we found is that we were able to. [00:12:51.02] [00:12:52.09] Effect the amount of stay by 20 percent we decreased it and [00:12:57.07] [00:12:57.07] we did discharge to exit the. [00:12:59.13] [00:12:59.13] Because we didn't want the acuity or anything like that to be an impact we [00:13:03.05] [00:13:03.05] wanted to kind of have more of a pure data point and by being able to do this and [00:13:07.21] [00:13:07.21] them working together as a team keeping the flow going getting the patients where [00:13:12.14] [00:13:12.14] they needed to go and getting them discharge we had a huge impact and [00:13:16.11] [00:13:16.11] that's just one example there are so [00:13:18.04] [00:13:18.04] many examples of different especially when it comes to our emergency departments and [00:13:22.22] [00:13:22.22] our surgical services area about a pretty improving the workflow and [00:13:27.22] [00:13:27.22] improving the throughput and that is pure health systems engineering [00:13:33.13] [00:13:33.13] and working in conglomeration with our clinicians. [00:13:36.18] [00:13:37.22] Another thing that we don't really think about too that I want to point out is [00:13:41.12] [00:13:41.12] access to care so I know Emery's big with this more side is big [00:13:46.09] [00:13:46.09] with this when we talk about cancer you know when you are experiencing cancer [00:13:51.08] [00:13:51.08] the last thing you want to do is have to get in a vehicle and drive 2 or [00:13:55.13] [00:13:55.13] 3 hours to go see your care provider so I know that nor [00:14:00.13] [00:14:00.13] side has done this I believe Emery's done this as well we've created several [00:14:05.15] [00:14:05.15] locations throughout all of metro Atlanta even beyond [00:14:10.15] [00:14:10.15] that like in north Georgia all of north Georgia so that if patients do have to get [00:14:16.19] [00:14:16.19] outpatient treatment that they're only going a few miles down the road from their [00:14:21.14] [00:14:21.14] home they're not having to travel really far obviously if they have an acute [00:14:26.13] [00:14:26.13] episode they will but if they're on a care treatment plan that they have a very [00:14:31.23] [00:14:31.23] specified regimen of what they're having to do that they're having to go in 2 or [00:14:36.16] [00:14:36.16] 3 times a week to receive those treatments [00:14:40.03] [00:14:40.03] How can we help them be as close to where they live as possible and [00:14:44.15] [00:14:44.15] again looking at market analysis looking at forecasting look at population [00:14:49.20] [00:14:49.20] density to help make these decisions about where we need to have these locations and [00:14:55.13] [00:14:55.13] then making sure that we have the appropriate staffing and [00:14:58.07] [00:14:58.07] the appropriate equipment to take care of them. [00:15:00.12] [00:15:02.14] My last example that I wanted to go over is also like expansion of facility so [00:15:08.09] [00:15:08.09] you don't necessarily think about that but that's a huge impact when we talk about [00:15:13.23] [00:15:13.23] redesigning a facility or we had the privilege of actually creating [00:15:19.01] [00:15:19.01] a replacement hospital our Northside Hospital Cherokee campus [00:15:24.07] [00:15:24.07] we located about 2 and a half years ago we moved with an $84.00 bed hospital and [00:15:30.11] [00:15:30.11] come about a month from now we will be believe over 250 bed [00:15:35.11] [00:15:35.11] hospital in 2 and a half years and that is by planning [00:15:40.03] [00:15:40.03] being able to create access to care being able to have a good layout so [00:15:44.23] [00:15:44.23] that our clinicians have a good workflow and are able to get their job done in [00:15:50.03] [00:15:50.03] a timely fashion if we know that they need to get to a medication room the last thing [00:15:55.13] [00:15:55.13] we need to do is have the medication room at the end of the hallway we need to have [00:16:00.05] [00:16:00.05] that centrally located so everybody can get to it as easily as possible and [00:16:05.04] [00:16:05.04] that's just one example I mean definitely when we're looking at our nursing units [00:16:09.16] [00:16:09.16] our mergence e. department an outpatient center no matter what we do [00:16:13.20] [00:16:13.20] we need to make sure that we're thinking through all the steps that the clinicians [00:16:19.04] [00:16:19.04] will have to take and how can we make it as efficient as possible from a facility [00:16:24.03] [00:16:24.03] layout standpoint and so with that I will turn it over to Victoria. [00:16:30.04] [00:16:36.23] Q In a.d.m. both love each of this film because well with the. [00:16:40.13] [00:16:42.02] General going on this is really. [00:16:43.08] [00:16:47.06] Ok. [00:16:47.18] [00:16:49.01] Starting Well good afternoon everybody I realize that I have to start [00:16:54.04] [00:16:54.04] off by apologizing for wearing the other schools colors. [00:16:59.10] [00:17:01.09] I had a whole different outfit picked out this morning and [00:17:04.07] [00:17:04.07] then it got really really cold and this was the warmest thing I could find so. [00:17:08.20] [00:17:08.20] Forgive me. [00:17:09.14] [00:17:11.06] Well my my background to get to what I'm [00:17:15.16] [00:17:15.16] doing may I'm currently the vice president of quality for in re health care for [00:17:20.01] [00:17:20.01] the system we have 11 hospitals and over 300 clinics my pastor [00:17:25.06] [00:17:25.06] that was not quite as focused as Joyce's I'm a little older than she is so [00:17:30.05] [00:17:30.05] I had more time to to lose focus and my undergrad is in statistics [00:17:37.11] [00:17:37.11] had no idea what I would do with that just like statistics and was fortunate enough [00:17:42.12] [00:17:42.12] to get involved in quality in the early days of Dr Deming's remerge and. [00:17:47.14] [00:17:48.19] In the us and I worked in industry and manufacturing for many years loved it [00:17:54.12] [00:17:54.12] just fell in love with quality improvement the whole total quality package from [00:17:58.12] [00:17:58.12] Strategic Planning to lean and 6 sigma before it was even called 6 Sigma and. [00:18:03.08] [00:18:05.07] Just trying to improve processes. [00:18:08.02] [00:18:09.07] And from there I got an m.b.a. at Ohio State when I was working for [00:18:13.17] [00:18:13.17] General Electric up there and decided to get into consulting so [00:18:18.03] [00:18:18.03] I traveled 40 weeks a year out on out on Sunday night home on Friday night. [00:18:24.02] [00:18:25.08] Loved it I was young and single it was a great thing to do I highly recommend it [00:18:29.06] [00:18:29.06] when you're before you decide to get married and have kids once I did that I [00:18:33.06] [00:18:33.06] didn't want to do that anymore took off about 10 years when I was raising children [00:18:38.15] [00:18:38.15] and during that time worked on my Ph d. off skipped the Masters I [00:18:43.16] [00:18:43.16] got a master's from Auburn in industrial systems engineering before the m.b.a. and [00:18:47.23] [00:18:47.23] then went back while I was raising my kids and got a Ph d. [00:18:52.06] [00:18:52.06] from Auburn University in industrial systems engineering and [00:18:57.18] [00:18:57.18] during that time I had a I would say a realisation [00:19:03.09] [00:19:03.09] that I wanted to do something more meaningful with my skills. [00:19:08.13] [00:19:08.13] Being a and industrial engineer always liking math and [00:19:12.04] [00:19:12.04] science I always indeed teachers and physicians and nurses and [00:19:17.08] [00:19:17.08] people who could help other people because I thought you know that's great but [00:19:20.19] [00:19:20.19] that's just not me I'm the math and science kind of person. [00:19:23.18] [00:19:25.07] And so being able to find my way into health care was very meaningful for [00:19:29.16] [00:19:29.16] me my sister passed away during that time from cancer and [00:19:34.09] [00:19:34.09] I was able to during her journey see how far behind [00:19:39.22] [00:19:39.22] frankly health care was for manufacturing and realized that it would [00:19:46.11] [00:19:46.11] be important to me to try to use my skills in industrial systems engineering and [00:19:51.13] [00:19:51.13] quality in general to help change that so worked for [00:19:55.06] [00:19:55.06] Vanderbilt for a short period of time and then spent 9 years at Indian or [00:19:59.13] [00:19:59.13] some Cancer Center in Houston before coming to him re 2 years ago and [00:20:03.11] [00:20:03.11] just love it it's it's very meaningful when you can make a difference [00:20:08.18] [00:20:08.18] which is not every day but we will take what we can get right. [00:20:12.01] [00:20:13.20] So. [00:20:14.18] [00:20:18.14] Well so I'll just get in to my section which is sustainability so [00:20:24.06] [00:20:24.06] once we've made improvements because everybody up here on the panel we're all [00:20:29.15] [00:20:29.15] working at applying lean and 6 sigma and other tools [00:20:34.10] [00:20:34.10] like Joyce was talking about matching matching capacity to demand to capacity or [00:20:39.07] [00:20:39.07] vice versa scheduling optimization various things in. [00:20:44.15] [00:20:45.21] Facility integrated facility design lots of opportunities but [00:20:50.03] [00:20:50.03] what I found is that most organizations not just health care [00:20:55.03] [00:20:55.03] have a hard time of sustaining those goals and one of the problems that I found [00:21:00.10] [00:21:00.10] with the implementation of Lean In both manufacturing and in healthcare is that [00:21:05.06] [00:21:05.06] typically people think of lean as just implementing a project so [00:21:10.07] [00:21:10.07] we bring people in we train them all to be green belts black belts so on and [00:21:15.02] [00:21:15.02] then we say go out and work on a project they go out and [00:21:17.18] [00:21:17.18] work on different projects they may or may not be coordinated linked to [00:21:21.01] [00:21:21.01] a strategic plan they may just be what they think is important to work on and [00:21:25.15] [00:21:25.15] at the end of the day that process fails and [00:21:29.22] [00:21:29.22] then the company comes back and says we'll see and do that lean stuff didn't work. [00:21:33.12] [00:21:35.04] Well it doesn't work if all you do are projects it has to be rolled into [00:21:40.02] [00:21:40.02] a lot more and so [00:21:43.00] [00:21:43.00] you know being able to set up a system to sustain the gains is important so [00:21:47.20] [00:21:47.20] I want to talk a little bit about how we're doing that at Emory and so [00:21:52.01] [00:21:52.01] there are 2 parts to that one is measuring of course when you do any kind of [00:21:56.18] [00:21:56.18] improvement project the last step is if you look at the magic the last step is [00:22:01.09] [00:22:01.09] control is put in something to sustain those specific goals and so [00:22:06.03] [00:22:06.03] that's meant using Data Monitor it right and [00:22:10.03] [00:22:10.03] then I'm going to talk more about how do we change the whole [00:22:13.09] [00:22:13.09] whole system to sustain the gains so far as data one of the things that I've. [00:22:18.04] [00:22:18.04] Found in health care and quite frankly an industry alike is [00:22:22.03] [00:22:22.03] a lot of people have score cards that look something like this so [00:22:26.04] [00:22:26.04] this is one for patient experience I don't have the numbers in there but [00:22:30.08] [00:22:30.08] you'll see the red green chart right see those tables all the time and [00:22:34.22] [00:22:34.22] in this case it's how are we doing relative to our goal which may or [00:22:38.12] [00:22:38.12] may not compare to national standards national Minch marks. [00:22:42.21] [00:22:44.05] What's wrong with that well [00:22:49.17] [00:22:49.17] actually you know some of that is red because we set really high goals [00:22:54.09] [00:22:54.09] we may be performing better than everybody else but it's red so [00:22:58.15] [00:22:58.15] that doesn't really tell us much does it if we just look at it and see it's a risk. [00:23:01.21] [00:23:02.23] What else is wrong with that Ok yet it's looking at like the last month which. [00:23:10.11] [00:23:11.15] Believe me in health care that's a challenge because like all the c.m.s. [00:23:14.20] [00:23:14.20] measures that you see posted there like 2 years behind so [00:23:18.15] [00:23:18.15] there's like a 3 year average 2 years back so [00:23:23.01] [00:23:23.01] it's even worse than than it looks here and there's one more problem here scummy. [00:23:28.14] [00:23:33.05] Exactly I have no way I have no historical reference I have no way to [00:23:37.23] [00:23:37.23] know if it's a girl read there because it went up one month and [00:23:43.02] [00:23:43.02] was just natural random variation or we've had a string of them that have gone up or [00:23:49.07] [00:23:49.07] found in this case because we're looking at patient experience so [00:23:52.02] [00:23:52.02] that's that's the point so one of the things that we're doing in and [00:23:56.04] [00:23:56.04] believe it or not you know this is relatively new I would say in health care [00:23:59.20] [00:23:59.20] is using control charts to understand natural versus. [00:24:04.08] [00:24:05.12] Common Cause common cause versus special cause a variation so look at putting [00:24:09.20] [00:24:09.20] all of our data into control chart forms has been a real learning [00:24:14.09] [00:24:14.09] point because people are going you know that's yeah it went up this month but [00:24:19.06] [00:24:19.06] it wasn't anything different it was a natural random variation so [00:24:22.10] [00:24:22.10] the one important thing to take away is tracking sustaining gains by using [00:24:28.07] [00:24:28.07] data to track it is important but it has to be over time with control limits with [00:24:33.10] [00:24:33.10] an understanding of what does even means and so just an important point there and [00:24:37.14] [00:24:37.14] then probably most of you have had them in school but. [00:24:40.13] [00:24:40.13] There's more and so the more is how do we build a culture to [00:24:45.11] [00:24:45.11] sustain continuous improvement and that's a lot more than just a few metrics and [00:24:50.20] [00:24:50.20] that's a lot more than a few projects so in fact we've started. [00:24:54.13] [00:24:55.14] Implementing a lean operating system very similar you see this if you if you're [00:24:59.18] [00:24:59.18] familiar with the Toyota production system this will be familiar to you but [00:25:03.17] [00:25:03.17] it's much easier said than done as you can imagine and so [00:25:07.22] [00:25:07.22] we're right now spending 2 years at least just on this bottom part [00:25:12.16] [00:25:12.16] which is just getting some of the basic cultural changes in place [00:25:18.10] [00:25:18.10] how do we have puddles every day to read huddles so [00:25:22.18] [00:25:22.18] that we're escalating problems a problem of escalation So for example. [00:25:28.00] [00:25:30.09] I mean quality so I have a team of infection prevention is who made and [00:25:35.10] [00:25:35.10] they will be talking about are there particular issues there they then come up [00:25:39.12] [00:25:39.12] to have a larger huddle which is made up of the whole quality group and [00:25:42.16] [00:25:42.16] then we go to a system group plan to hospital groups and [00:25:46.16] [00:25:46.16] what you'll start to see is escalation of problems and getting them fixed and [00:25:51.02] [00:25:51.02] one of the what we've realized from that process is there were a lot of things that [00:25:55.14] [00:25:55.14] we just never as leaders never heard about so [00:25:58.15] [00:25:58.15] our president the other day said you know I was really surprised that we had so [00:26:03.18] [00:26:03.18] many materials issues Well that's a good thing to know because now we know what [00:26:08.05] [00:26:08.05] we need to work on in terms of our strategic planning over the next year so [00:26:12.15] [00:26:12.15] how do we get engaged leaders get leaders as coaches have leaders [00:26:17.22] [00:26:17.22] developing employees in the same mindset set up visual management [00:26:23.20] [00:26:23.20] boards where we can track all of these things that are important to us and [00:26:27.17] [00:26:27.17] see how we do over time implementing standard work in both. [00:26:32.02] [00:26:33.05] In both leaders and physicians in every position and [00:26:37.16] [00:26:37.16] what we've what we realized is that doing this is really kind [00:26:42.02] [00:26:42.02] of a hard sell because what do you think the return on investment from this work. [00:26:46.23] [00:26:49.21] There's not much. [00:26:51.08] [00:26:52.09] I mean this is just foundational 1st step things that we have to do in [00:26:57.06] [00:26:57.06] order to get to the point where we can start doing more on patients low and [00:27:02.10] [00:27:02.10] level loading and staffing to them and so on so so [00:27:07.08] [00:27:07.08] we're investing in trying to get that standard in place for [00:27:12.01] [00:27:12.01] a lean operating system that we can then go into these projects and sustain them. [00:27:17.10] [00:27:20.11] So this is just an example of the tiered huddles and I'm finding more and [00:27:24.10] [00:27:24.10] more health care facilities are doing this these days [00:27:28.08] [00:27:28.08] if you've worked in manufacturing you've probably seen this follow [00:27:32.03] [00:27:32.03] you know some do it better than others. [00:27:33.16] [00:27:34.22] But we start with for example a tier one huddle would be every all the lower [00:27:39.23] [00:27:39.23] levels of if you look at conglomerating organization so [00:27:46.02] [00:27:46.02] I'm talking about maybe a unit nursing unit on the floor [00:27:51.02] [00:27:51.02] having a meeting in the morning 15 minutes stand up in front of the board and [00:27:54.22] [00:27:54.22] say you know are we ready for today have there been any go through the s.m.s. [00:27:59.02] [00:27:59.02] any safety issues any materials issues any equipment and so on and then we. [00:28:04.20] [00:28:06.00] We then go to the next level which would be usually a director level and [00:28:11.00] [00:28:11.00] say hey did anything come from the Tier one huddle that needs to be escalated they [00:28:15.18] [00:28:15.18] couldn't address it and we need to address it likewise in goes a rolled up [00:28:19.17] [00:28:19.17] to hospital huddle and that rolls up to a joint operations huddle and [00:28:23.18] [00:28:23.18] we actually now even have a system Hoddle So we're looking at [00:28:27.04] [00:28:27.04] how do we make sure that we're providing people with the resources they need [00:28:31.11] [00:28:31.11] to do their job well Dr Deming used to say don't provide goals posters and [00:28:36.00] [00:28:36.00] slogans without providing the resources to achieve them and [00:28:39.13] [00:28:39.13] so we're making sure people half what they need to do their job. [00:28:43.05] [00:28:44.21] It doesn't do any good to have an improvement project in one area if we [00:28:48.09] [00:28:48.09] aren't If we then aren't making sure people have what they need to sustain that [00:28:52.13] [00:28:53.16] but it's more than huddles and we'll show you some of the some of the pieces [00:28:58.17] [00:28:58.17] of the daily management system which is really leaders jobs so [00:29:03.11] [00:29:03.11] as a leader or a manager you know this is this is really your job how to coach [00:29:08.08] [00:29:08.08] employees how to make sure they have what they need to do their job [00:29:12.16] [00:29:12.16] make sure that we have standard work in place encourage ideas and commit and [00:29:18.14] [00:29:18.14] coordination communication and a planned work so [00:29:22.13] [00:29:22.13] how do we use that to achieve those goals how do in Time Life Ok [00:29:28.18] [00:29:30.19] so here are some of the elements some just let you take a look at this but [00:29:35.13] [00:29:35.13] one of the things we're finding is we have too many meetings so how many how do we [00:29:39.23] [00:29:39.23] eliminate meetings and one of and the concept of hostiles [00:29:44.21] [00:29:44.21] goes a long way to that many companies that have done that well have found that [00:29:48.20] [00:29:48.20] their number their number of emails goes down the number of phone calls goes down [00:29:52.12] [00:29:52.12] the number of meetings goes down because they're able to work those through [00:29:56.02] [00:29:56.02] right in the moment and relatively quickly. [00:29:58.13] [00:30:02.07] So Standard Work is a big part of this and. [00:30:05.15] [00:30:06.23] Dr Esper is going to talk to us about what we're doing for [00:30:11.11] [00:30:11.11] standard work on the clinical side as well as the operational side any of you so [00:30:17.22] [00:30:17.22] he's an exception to this joke I'm about to tell because he's a he's a very. [00:30:23.15] [00:30:24.18] He's a good team player he looks for process improvement we love Dr esper But [00:30:30.22] [00:30:30.22] do any of y'all know the difference between God and a surgeon. [00:30:35.02] [00:30:36.08] And he heard that joke now. [00:30:38.14] [00:30:40.12] God knows he's not a surgeon. [00:30:42.02] [00:30:44.06] Takes a minute. [00:30:44.23] [00:30:46.15] The point is and [00:30:48.19] [00:30:48.19] note no not to be disparaging of our our physician friends because we love them and [00:30:53.19] [00:30:53.19] they save lives and bring in revenue is a very important role but [00:30:59.01] [00:30:59.01] the traits that make a good surgeon are not typically the traits that make a great [00:31:04.18] [00:31:04.18] team player think about it if you're going to be in the operating room you're getting [00:31:09.10] [00:31:09.10] you're having somebody operate on you don't you want him to be very confident [00:31:13.03] [00:31:13.03] and you want him to make decisions quickly and be sure of their decisions and [00:31:18.09] [00:31:18.09] not go what do you think we should do when so so [00:31:23.05] [00:31:23.05] the traits that make a good surgeon and in general a good physician are not typically [00:31:28.15] [00:31:28.15] the same traits we see when we will have a you know a let's get a whole multitask [00:31:32.18] [00:31:32.18] multiple purpose team multi-functional team together for improvement so [00:31:37.20] [00:31:37.20] when you start talking about implementing standard work. [00:31:41.23] [00:31:43.09] I work in the quality apartment I can come up with my standard work but [00:31:46.09] [00:31:46.09] if I start asking physicians they all think that their process is better than [00:31:50.21] [00:31:50.21] anybody else's and so how do you get to the point where they all [00:31:55.23] [00:31:55.23] agree on standard work that's a real challenge in health care and Dr esper and [00:32:01.11] [00:32:01.11] Dr Borenstein who I work for have really done a good job of identifying how to [00:32:07.03] [00:32:07.03] how a structure that we can put in place to implement standard [00:32:12.07] [00:32:12.07] work across our clinical areas as well as our operational areas so Dr Esther. [00:32:17.17] [00:32:19.10] Salut team can you hear me sing so so thank you Victoria so. [00:32:24.23] [00:32:26.00] So I am just so thankful to have been invited to come and [00:32:31.06] [00:32:31.06] talk to you guys today from professors Cass going to check in is all [00:32:35.16] [00:32:35.16] quite work with in the past I've actually led a number of. [00:32:40.00] [00:32:40.00] Industrial senior does industrial engineering senior design teams I think we [00:32:45.01] [00:32:45.01] won twice or so we put our names up on the board to come in 2nd a couple [00:32:50.03] [00:32:50.03] of times so it's been a real treasure really to to work [00:32:55.07] [00:32:55.07] with our team here at Georgia Tech I think that the cross partnership [00:33:00.13] [00:33:00.13] of Emory University Emory Healthcare and Georgia Tech is so powerful for [00:33:05.01] [00:33:05.01] the Atlanta area so it's great to be here I'm a neurologist I see patients for [00:33:11.05] [00:33:11.05] headache neuron the nerve damage Parkinson's disease epilepsy [00:33:17.18] [00:33:17.18] after stroke and so forth so that's my clinical role I'm still a clinician and [00:33:22.13] [00:33:22.13] my big role at Emory is as the associate chief medical officer for Emory health [00:33:26.18] [00:33:26.18] care for the system our system is now 11 hospitals large it's over 250 clinics [00:33:31.21] [00:33:31.21] we have over 22000 employees I think up 223000 employees and [00:33:39.01] [00:33:39.01] we help take care of people in our local network which is in [00:33:43.23] [00:33:43.23] the greater Atlanta area in our regional network which is the 5 state area and [00:33:48.14] [00:33:48.14] nationally and internationally for various diseases so. [00:33:52.10] [00:33:53.16] And in that role as the associate chief medical officer I have [00:33:59.01] [00:33:59.01] the privilege of waking up every day thinking about how [00:34:04.15] [00:34:04.15] do we standardize clinical care and what I mean by that so [00:34:10.00] [00:34:10.00] if you or your family member became ill and [00:34:15.17] [00:34:15.17] got pneumonia and your blood pressure started feeling bad and [00:34:20.14] [00:34:20.14] you got to the emergency room and [00:34:24.04] [00:34:24.04] your heart rate was up and your blood pressure was dropping. [00:34:27.23] [00:34:29.19] And an e.r. doctor said you know I think you might have [00:34:34.03] [00:34:34.03] sepsis would you what kind of care would you want. [00:34:38.18] [00:34:40.13] Just what kind of care would you want would you want evidence based care or [00:34:45.23] [00:34:45.23] would you want the care that the emergency medicine physician [00:34:49.14] [00:34:49.14] thought was good at that time that was just kind of haphazard evidence based care [00:34:54.13] [00:34:55.16] if you were going to have a cardiac catheterization and [00:34:59.20] [00:34:59.20] there were standards in place for making sure that you got hydrated appropriately [00:35:05.06] [00:35:05.06] before your catheterization so that the contrast that the cardiologist use [00:35:11.11] [00:35:11.11] wasn't going to harm your kidney would you want that standard protocol to be used or [00:35:17.16] [00:35:17.16] would you want any variation that somebody came up with to be used if you had cancer. [00:35:24.12] [00:35:26.01] And there was a standard protocol to be delivered would you want standard protocol [00:35:29.23] [00:35:29.23] to be delivered in the answers to these questions are kind of obvious but [00:35:34.08] [00:35:34.08] in medical care there has been an evolution in medical care variation and [00:35:42.13] [00:35:42.13] variation in that for many folks feels justified because of their experience or [00:35:47.23] [00:35:47.23] this patient that they took care of 10 years ago or something like that and so [00:35:53.13] [00:35:53.13] so want to be issues that we have in Emory is that we grew [00:36:00.16] [00:36:00.16] from a one hospital system to a 2 hospital system Emory University Hospital we. [00:36:05.20] [00:36:06.21] Are long became every midtown hospital we grew from Emory University Hospital Emory [00:36:11.01] [00:36:11.01] midtown hospital 2 systems to 4 hospitals [00:36:14.14] [00:36:14.14] we're adding doctors we're adding clinics over time. [00:36:18.08] [00:36:18.08] And then most recently we've added. [00:36:21.01] [00:36:22.08] The former Dekalb hospital system which is now. [00:36:25.08] [00:36:26.10] Which is now part of Emory health care there a great part of Emory health care [00:36:29.16] [00:36:29.16] and one of the questions becomes over all these areas can we treat sepsis the same [00:36:34.16] [00:36:34.16] way so that if a patient comes in with sepsis in the emergency department [00:36:40.07] [00:36:40.07] at Emory University Hospital gets the same care as they would if they came to [00:36:44.19] [00:36:44.19] Emory St Josephs hospital does a patient who's getting a cardiac catheterization [00:36:50.05] [00:36:50.05] at Emory Johns Creek hospital have the same precast hydration pathway [00:36:56.02] [00:36:56.02] as the one patient who's getting their catheterization at mid-town hospital and [00:37:00.23] [00:37:00.23] that's what consumes us how do we function as a system at Emory health care so [00:37:08.18] [00:37:08.18] that any gains that we make in literature evidence based medicine or [00:37:13.14] [00:37:13.14] any any of the best practices that we have at one location can be disseminated across [00:37:17.19] [00:37:17.19] the whole system that's really the question and that is what basically [00:37:23.15] [00:37:23.15] encouraged us over a period of time from 2016 to 2017 to really [00:37:29.16] [00:37:29.16] start to generate the system governance of clinical standardization at Emory. [00:37:35.08] [00:37:35.08] Well we still we formed a clinical practice Council [00:37:40.15] [00:37:40.15] what is a clinical practice counsel you can read the definition there but [00:37:45.05] [00:37:45.05] basically a clinical practice counsel is a multi-disciplinary group it should be [00:37:50.08] [00:37:50.08] multi display with nurses with physicians with advanced practice providers that come [00:37:55.16] [00:37:55.16] together to look at various standards and [00:38:01.05] [00:38:01.05] make sure that these standards can be deployed across the system to deliver [00:38:07.18] [00:38:07.18] steep care is anybody familiar with the acronym steep s [00:38:12.06] [00:38:12.06] t p it's from the Institute of medicines [00:38:17.20] [00:38:17.20] report in 2001 that the quality chasm safe timely effective efficient equitable and [00:38:23.21] [00:38:23.21] patient centered care that's the whole goal of this of the clinical [00:38:29.07] [00:38:29.07] practice Council we desire to make sure that we have standards in place that [00:38:34.12] [00:38:34.12] our physicians our nurses our advanced practice providers can deploy every time [00:38:40.03] [00:38:40.03] every patient to make sure that they're getting the right care at the right time. [00:38:43.23] [00:38:45.05] The purpose of the clinical practice Council is to [00:38:47.18] [00:38:47.18] oversee clinical standardization but not to make health care workers [00:38:52.16] [00:38:52.16] automatons not to take the thinking out of medicine but [00:38:57.06] [00:38:57.06] to say this is the standard we can make it easy for you to deploy the standard but [00:39:02.10] [00:39:02.10] we allow appropriate justifiable variation when it's necessary because not all [00:39:07.18] [00:39:07.18] patients are the same and we have to make sure that we give the clinicians who can [00:39:12.22] [00:39:12.22] think the ability to actually say you know what I actually need to alter the pathway [00:39:17.12] [00:39:17.12] slightly in this situation to make sure they're getting the exact right care it's [00:39:22.13] [00:39:22.13] to make sure that we had a place to offer input on important funding decisions. [00:39:28.17] [00:39:28.17] So for instance let's say were in we're in the middle of a budget year and [00:39:32.15] [00:39:32.15] it turns out that we actually have to. [00:39:34.22] [00:39:36.11] Implement a change in the way we test for something like Clostridium difficile [00:39:41.14] [00:39:41.14] which is a bad infection that can happen in the gut and that change requires [00:39:45.16] [00:39:45.16] a $200000.00 investment and that's an off that's you know we haven't planned for [00:39:50.17] [00:39:50.17] in the budget and it's something that we think is important to the health care [00:39:54.02] [00:39:54.02] system into the care of the patient how do we actually make a decision as a health [00:39:58.13] [00:39:58.13] system to actually spend that 200000 dollars on that as opposed to something [00:40:03.11] [00:40:03.11] else that's where the clinical practice Council can give clinical input to our [00:40:08.01] [00:40:08.01] system operations team to make sure that they can help make that decision [00:40:12.03] [00:40:12.03] to address the prioritization of the implementation of competing clinical [00:40:16.23] [00:40:16.23] initiatives so who's familiar with information technology [00:40:21.18] [00:40:23.04] thank you half of the room and we're Georgia Tech that's great and [00:40:26.08] [00:40:26.08] just get information technology is very difficult [00:40:30.12] [00:40:30.12] in a health system because we have a bunch of folks submitting a tremendous number [00:40:35.12] [00:40:35.12] of information technology improvements all at the same time what do you do 1st [00:40:40.06] [00:40:40.06] do I do I make sure that the standard pathway for status epilepticus [00:40:45.04] [00:40:45.04] somebody who's continuously having seizures gets done 1st or [00:40:48.10] [00:40:48.10] do I make sure that the upgrade to the oncology power plan for [00:40:51.09] [00:40:51.09] breast cancer gets done 1st which one do I do how do I do it [00:40:56.06] [00:40:56.06] that's where the clinical practice council can be part of the solution [00:41:00.00] [00:41:00.00] we can look to see that we can look to see how wide the standardization is and [00:41:04.11] [00:41:04.11] how we can implement it to facilitate system wide resolution to gaps in care [00:41:10.02] [00:41:10.02] through enhancing coordination between interdisciplinary providers example. [00:41:15.03] [00:41:16.23] So patient let's go back to our patient in the emergency room the blood pressure is [00:41:21.13] [00:41:21.13] dropping the pulse is going up they have a high white blood count it looks like [00:41:26.11] [00:41:26.11] they're septic and alert fires on the electronic medical record [00:41:31.19] [00:41:31.19] positive sepsis ers sepsis trigger initiated [00:41:36.03] [00:41:36.03] nurse please screen patient to see if they are septic [00:41:41.20] [00:41:41.20] the nurse screens the patient says you know what the blood pressure is going down [00:41:46.17] [00:41:46.17] the heart rates going up they have a fever and they're white counts elevated [00:41:50.05] [00:41:50.05] I think they're septic I'm going to screen them positive for sepsis. [00:41:55.01] [00:41:56.13] That would trigger the physician to come and say Hey is that patient septic or [00:42:01.18] [00:42:01.18] not to confirm that we're going to go along the sepsis pathway and [00:42:06.07] [00:42:06.07] give them the full evidence based pathway for sepsis well at certain [00:42:10.20] [00:42:10.20] times there was disagreement between the physician and the nurse as to whether [00:42:15.18] [00:42:15.18] the patient was septic did we screen them positively appropriately do we not screen [00:42:19.01] [00:42:19.01] them positively appropriately and it's especially difficult in certain areas like [00:42:22.18] [00:42:22.18] on college where the patient may not be able to have a high white blood count but [00:42:27.07] [00:42:27.07] they look like they're septic and so there's this there's this. [00:42:30.12] [00:42:31.14] Interdisciplinary nurse physician disconnect as to whether the patient [00:42:36.17] [00:42:36.17] should go on the sepsis pathway Well one of the things that we did in the clinical [00:42:41.03] [00:42:41.03] practice Council is to actually bring that together and say we think that this is [00:42:44.21] [00:42:44.21] probably evidence based medicine you should err on the side of actually doing [00:42:48.02] [00:42:48.02] this and that way we can actually try to deliver the right care and look back and [00:42:53.04] [00:42:53.04] actually err on the side of delivering the evidence based medicine and then look back [00:42:56.20] [00:42:56.20] and see are we delivering it appropriately so that's one that's an example of that. [00:43:03.15] [00:43:03.15] Provide a system wide form for quality and safety data review this actually is [00:43:08.08] [00:43:08.08] developing as we move forward we're actually reviewing quality and safety data [00:43:12.07] [00:43:12.07] in different areas the clinical practice Council will be one of them and [00:43:15.23] [00:43:15.23] right now it's very disease focused but we're going to be moving it forward into [00:43:19.03] [00:43:19.03] more of a system focus in the clinical practice Council and [00:43:22.08] [00:43:22.08] that bottom point is so critical and even in here want to be a physician [00:43:27.18] [00:43:27.18] anybody in here want to be a nurse anybody in here want to be an advanced practice [00:43:31.09] [00:43:31.09] provider anybody want to work in health care hopefully a couple of you. [00:43:35.21] [00:43:37.02] We want to make sure that if you want to work in healthcare [00:43:42.03] [00:43:42.03] that you have joy of practice that we're not doing it in a way [00:43:46.23] [00:43:46.23] that is burdening you to deliver the care that you need to deliver but [00:43:51.04] [00:43:51.04] that we're actually making sure that we're streamlining things so that you can [00:43:55.08] [00:43:55.08] actually have joy in your work that you're not getting killed all the time and [00:44:00.01] [00:44:00.01] that you can actually see the forest for the trees and [00:44:03.22] [00:44:03.22] make sure that your that your existence in the health care world [00:44:08.01] [00:44:08.01] is actually a positive experience for you which will decrease burnout and [00:44:11.16] [00:44:11.16] will make you last longer in the health care space and [00:44:13.16] [00:44:13.16] that's a major principle for why we've developed the clinical practice Council [00:44:17.12] [00:44:18.16] was the clinical practice Council look like well so [00:44:23.16] [00:44:23.16] there are a lot of voting members I think we're up to 39 voting members [00:44:28.14] [00:44:28.14] with the best number of voting members generally on a council that the literature [00:44:33.18] [00:44:33.18] says 7 we have 39 greats so [00:44:39.07] [00:44:39.07] we wanted to err on the side of making sure that we had representation [00:44:43.21] [00:44:43.21] from our Emory University Hospital where we have our Chief Medical Officer [00:44:48.05] [00:44:48.05] our chief quality officer our chief nurse officer and our chief of staff. [00:44:52.10] [00:44:52.10] Going all the way across from Emory University Hospital midtown hospital [00:44:55.17] [00:44:55.17] St Joseph's Hospital Johns Creek our outpatient clinical practice [00:45:00.02] [00:45:01.02] make sure we have Winship Cancer Institute involved because they're still massive. [00:45:05.03] [00:45:06.12] Our Emory health care network chief medical officer chief quality officer is [00:45:10.17] [00:45:10.17] there we are newly the added our newly added former to cab medical system is also [00:45:17.09] [00:45:17.09] added to the clinical practice Council and we also have our Kaiser Permanente team [00:45:21.10] [00:45:21.10] who who are now sending their patients to Emory St Joseph and Mary Johns Creek so [00:45:25.17] [00:45:25.17] we needed to have robust representation of nursing and physicians and [00:45:30.22] [00:45:30.22] as well as to make sure that it was broadly distributed you'll also see that [00:45:36.04] [00:45:36.04] we have a voting faculty who are chairs we have a couple of spots to fill out [00:45:40.23] [00:45:40.23] a couple of our private practice people are now off the council and we have yet [00:45:45.02] [00:45:45.02] to repeat them we have the president of the advanced practice provider Council and [00:45:49.21] [00:45:49.21] our director of A.T.P.'s Bonnie proves there we have a clinical nurse council [00:45:54.08] [00:45:54.08] representative we have 2 of them Cynthia Cindy ost her is our patient safety [00:45:59.03] [00:45:59.03] scientist in nursing and of course we have our g.m.a.t. represented by our [00:46:04.20] [00:46:04.20] dean of Graduate Medical Education and we also have one of our residents [00:46:10.06] [00:46:10.06] who is representing the resident body on the clinical practice Council as well so [00:46:14.03] [00:46:14.03] we try to have a robust representation of people that can say [00:46:18.05] [00:46:18.05] hey wait a 2nd you forgot about the residents when you're implementing [00:46:21.18] [00:46:21.18] the sepsis power plan you didn't think about what the residents doing or [00:46:25.17] [00:46:25.17] you don't think about how the nurse is being affected by the sepsis power plant. [00:46:29.03] [00:46:30.23] And then we have a bunch of non-voting people here who are supposed to support it [00:46:34.20] [00:46:34.20] and we also have our Or see if those in our chief operating officers who [00:46:39.11] [00:46:39.11] are ad hoc when they need to be in the room we can invite them. [00:46:42.21] [00:46:44.08] Now you can't come to Georgia Tech without a colorful slide that has swim lanes so [00:46:49.15] [00:46:49.15] so we put a little swim lane slide in place to make sure that everybody can see [00:46:54.00] [00:46:54.00] the process so what does the process of standardizing [00:46:58.23] [00:46:58.23] clinical care look like so let's say Joe Schmoe wants to come and [00:47:03.23] [00:47:03.23] says you know what I think we need to standardize this so what the 1st thing we [00:47:10.07] [00:47:10.07] do is we do a lot of prework we say Ok how do you want to standardize it what do [00:47:15.08] [00:47:15.08] you want to standardize and is it going to be a system standardization or [00:47:20.13] [00:47:20.13] is it going to be a lower level standard standardization at a hospital so for [00:47:25.10] [00:47:25.10] instance in oncology most of our in college the work is primarily at [00:47:30.04] [00:47:30.04] most of our inpatient oncology work is at Emory University Hospital It wouldn't [00:47:34.01] [00:47:34.01] necessarily make sense to standardize across all hospitals but if we wanted to [00:47:39.05] [00:47:39.05] standardize something across all the hospitals you have all the right Brian and [00:47:43.01] [00:47:43.01] that's this 1st swim lane here so the clinical topic gets chosen [00:47:47.12] [00:47:47.12] in any number of these ways a bunch of clinicians want to [00:47:50.07] [00:47:50.07] do it management identifies an opportunity [00:47:53.14] [00:47:53.14] a team is chartered through a value acceleration process [00:47:57.12] [00:47:57.12] the office of quality says hey we need something worked on here such as the new. [00:48:01.18] [00:48:03.23] Profile access and we need it worked on and we needed systematize and [00:48:06.18] [00:48:06.18] standardised so clinical topic gets chosen a Subject Matter Expert Group [00:48:12.07] [00:48:12.07] is chosen and then they go through this where they look at the topic scope [00:48:16.16] [00:48:16.16] they get data around it and they say Ok how do we want to standardize it they [00:48:21.06] [00:48:21.06] inform the leadership early on that this is being worked on [00:48:26.16] [00:48:26.16] because you have to inform leadership that something's being worked on because you [00:48:29.19] [00:48:29.19] don't want to surprise them on the back and say hey this is what we've done. [00:48:34.08] [00:48:34.08] So then that goes into the next part of the swim lane which is actual presentation [00:48:38.10] [00:48:38.10] at the c.p.c. at the clinical practice Council they get 15 minutes typically [00:48:43.05] [00:48:43.05] to present and they get 15 minutes of questions there's a standard slide back [00:48:48.03] [00:48:48.03] they get 2 slides for background some people come in with 8 slides of background [00:48:51.23] [00:48:51.23] I chop it down to 2 because we don't want everybody talking about the background [00:48:56.21] [00:48:56.21] we want people talking about what is the solution being presented [00:49:00.13] [00:49:00.13] How's it going to affect clinical care and does it need to get moved forward or [00:49:04.13] [00:49:04.13] not does it need to go back for further for further input [00:49:09.09] [00:49:09.09] things happen at the c.p.c. like really broad discussions so for [00:49:13.17] [00:49:13.17] instance when our diabetes group got the inpatient standard insulin powerplants [00:49:19.16] [00:49:19.16] for for standard basal dosing of insulin and [00:49:23.13] [00:49:23.13] correctional table based dosing of insulin it all looked good and what [00:49:28.13] [00:49:28.13] happened was at the end somebody said hey what are we going to do one discharge for [00:49:33.05] [00:49:33.05] the patient how is their outpatient doctor going to know how we've adjusted their [00:49:37.21] [00:49:37.21] insulin on the inpatient side and the team who had done outstanding work said we [00:49:44.02] [00:49:44.02] don't have that and the clinical practice Council said Well before we can ratified [00:49:48.11] [00:49:48.11] you've got to go back to develop and then bring it back. [00:49:50.10] [00:49:51.14] That's the reason for a clinical practice counsel to make sure that we try to think [00:49:54.20] [00:49:54.20] of everything that's patient base are we delivering patient based care [00:50:00.03] [00:50:00.03] that is not going to disenfranchise the patient in the family once the c.p.c. [00:50:04.19] [00:50:04.19] approves a clinical standardization then we submit it to the board patient [00:50:10.15] [00:50:10.15] quality committee why the board because the board is what ultimately Gover governs [00:50:16.20] [00:50:16.20] the medical practice at Emory health care and so we submit it to the board and [00:50:21.05] [00:50:21.05] say Do you agree with our standardization that typically the board agrees because [00:50:26.05] [00:50:26.05] a few real estate folks really don't want to say you know we don't we don't agree [00:50:30.03] [00:50:30.03] with the doctors or the nurses or what have you but they typically agree but [00:50:34.16] [00:50:34.16] it's a very important step it's an important step because it says the board [00:50:40.15] [00:50:40.15] agree that this is the standard of care at Emory health care that's a that's [00:50:46.09] [00:50:46.09] a clear signal that allows us then to make sure that that standard can happen in [00:50:50.19] [00:50:50.19] an appropriate fashion the board reviews the recommendation if they agree they send [00:50:55.17] [00:50:55.17] a letter to the medical executive councils and say Guys this is the new standard [00:51:00.17] [00:51:00.17] gal's this is the new standard do you agree with it it gives local autonomy [00:51:06.15] [00:51:06.15] to the medical Executive Council to say no we don't agree with it and [00:51:10.23] [00:51:10.23] here's why example when we did we did we had we standardized who could determine [00:51:17.14] [00:51:17.14] if a patient was brain dead Ok because there are there are very [00:51:22.07] [00:51:22.07] specific standards to determine who can be brain dead and who is not for instance you [00:51:26.09] [00:51:26.09] can't determine brain death if they're on opiates you can't determine brain death if [00:51:30.03] [00:51:30.03] their temperature is 35.9 degrees Celsius they have to be 36 degree Celsius [00:51:34.23] [00:51:34.23] there are a lot of other standards by which you can turn brain that we have [00:51:37.13] [00:51:37.13] a whole protocol for that. [00:51:39.14] [00:51:39.14] You need to be you we need to make sure that people are trained to do that and [00:51:43.14] [00:51:43.14] one of the aspects that got held up in the in the medical executive council at [00:51:46.18] [00:51:46.18] mid-town was that was that. [00:51:50.08] [00:51:51.23] That the obstetrician had to be. [00:51:54.23] [00:51:56.11] When it when a person a woman who is pregnant if God forbid if she was brain [00:52:01.07] [00:52:01.07] dead what they were requiring in the was that a maternal [00:52:07.07] [00:52:07.07] fetal medicine specialist would need to confirm the viability of the fetus or [00:52:12.09] [00:52:12.09] not versus just an obstetrician who doesn't have specific training [00:52:15.14] [00:52:15.14] in maternal fetal medicine and that was something that midtown for [00:52:19.05] [00:52:19.05] instance wanted to just they said you know what we think that an obstetrician can do [00:52:23.16] [00:52:23.16] that without having need need of maternal fetal medicine specialist who are who [00:52:27.22] [00:52:27.22] are who may not be on call or who may not be available so [00:52:32.02] [00:52:32.02] that was an adjustment that the m.e.c. made based on their local. [00:52:36.11] [00:52:37.12] Their local methodology in how they do things so generally and if the m.e.c. [00:52:43.09] [00:52:43.09] doesn't agree they typically will have to either you know talk about it or if they [00:52:47.14] [00:52:47.14] really don't agree and they don't want to implement the standard they actually have [00:52:50.09] [00:52:50.09] to submit a letter back to the board and they have to appear before the board and [00:52:54.00] [00:52:54.00] say why don't we want to accept the standard and that and [00:52:58.12] [00:52:58.12] we've been doing this for almost 3 years now and and that has not happened so [00:53:03.18] [00:53:03.18] again most of these are well vetted by the time it gets to the board patient quality [00:53:07.13] [00:53:07.13] committee so I can show you data on how our [00:53:13.03] [00:53:13.03] performance has improved on sepsis care on precast hydration on cost and [00:53:18.14] [00:53:18.14] quality I can show you a number of different slides. [00:53:21.08] [00:53:22.18] Yes ma'am yes sir. [00:53:26.05] [00:53:36.01] So it's a great question so the physician group practice [00:53:40.07] [00:53:40.07] the physician we have a number of counsels for instance as diabetes counsel and [00:53:45.04] [00:53:45.04] the opiate Stewardship Council in a number of counts is the do a lot of work on [00:53:48.16] [00:53:48.16] the outpatient side what we don't do is require [00:53:54.07] [00:53:54.07] standards to come through that are kind of no brainer standards in other words so [00:53:59.14] [00:53:59.14] for instance how many how many narcotic pills are allowed to be [00:54:04.00] [00:54:04.00] distributed post-surgery on the outpatient side in a discharging [00:54:08.17] [00:54:08.17] prescription we wouldn't want that to necessarily come to the clinical practice [00:54:12.05] [00:54:12.05] Council because that's something that the that can be standardized without too much. [00:54:17.07] [00:54:18.16] So to say argument or or. [00:54:22.09] [00:54:23.16] Discussion it can be done. [00:54:25.13] [00:54:26.16] The physician group practice has a lot of their own governance system [00:54:31.13] [00:54:31.13] that they have and that that they are able to submit standardization is [00:54:36.11] [00:54:36.11] through without bringing them to the clinical practice counsel and [00:54:41.13] [00:54:41.13] so for the most part the clinical standardization that have happened [00:54:45.02] [00:54:45.02] have mainly been acute care based i.c.u. acute care and so [00:54:49.20] [00:54:49.20] forth it is a good point that says you know what should we be [00:54:54.20] [00:54:54.20] bringing to the clinical practice Council and the physician group practice for [00:54:59.12] [00:54:59.12] instance what are the access criteria so if you know when you have. [00:55:05.20] [00:55:07.21] You know certain specialties like neurology that don't have a lot of access [00:55:12.11] [00:55:12.11] and how do we actually take care of those access problems what are the goals [00:55:16.14] [00:55:16.14] are we going to actually change the way we have access are we going to do [00:55:20.02] [00:55:20.02] econ salts are we not going to eat consuls those types of things that may wind up [00:55:24.19] [00:55:24.19] coming to the clinical practice Council it has not as of as of today but [00:55:29.11] [00:55:29.11] it's a great question other questions. [00:55:31.22] [00:55:35.16] So other questions that are so good i hope in go over my time. [00:55:40.06] [00:55:45.12] It's always hard to follow God. [00:55:47.01] [00:55:49.05] Can you ever follow God I'm just getting so you know it's amazing I think [00:55:54.06] [00:55:54.06] the presentations were really impressive as far as the focus of my presentation [00:56:00.19] [00:56:00.19] I am going to focus more on there's a lot of things happening globally [00:56:06.05] [00:56:06.05] nationally that are influencing change in health care so [00:56:10.16] [00:56:10.16] I'm going to take a step back the continuous improvement work and [00:56:14.06] [00:56:14.06] all of that is necessary but as we're in this transitional phase [00:56:20.01] [00:56:20.01] to get into a new phase of health care a change is unnecessary. [00:56:24.10] [00:56:25.13] And Wyoming Dumond's that through my eyes war do we hope [00:56:29.21] [00:56:29.21] that journey to look like and then what we as an industrial engineer [00:56:34.22] [00:56:34.22] can really call on Tribute the word stacked so. [00:56:37.14] [00:56:39.05] It fits really well with the focus of our session here today of the next [00:56:44.02] [00:56:44.02] generation what is the next generation of health systems going to look like. [00:56:48.00] [00:56:51.10] So you know like I said we are essentially transitioning from [00:56:55.12] [00:56:55.12] the Old World to a new world in health care so [00:56:58.23] [00:56:58.23] what I mean by that is as you talk about moving away from Wall you do value [00:57:04.09] [00:57:04.09] it's all about seeing more and more patients and a cute care setting or [00:57:09.04] [00:57:09.04] the outpatient clinics It's about how we can provide to prevent that get and [00:57:13.20] [00:57:13.20] how we can keep these patients out of coming to the hospital [00:57:18.10] [00:57:18.10] now that's a big driver and that's where health care really needs to go and [00:57:22.13] [00:57:22.13] we saw some of the presentations on in that regard this morning and [00:57:26.12] [00:57:26.12] like idea which is really forcing a lot of hospitals that really [00:57:32.02] [00:57:32.02] operated in an acute care setting and rhyming about patients showing [00:57:37.03] [00:57:37.03] up at the end then how they're getting admitted to the inpatient beds right one [00:57:41.12] [00:57:41.12] of the metric that hospitals still continue to track is Edmonton through [00:57:46.02] [00:57:46.02] the you really want that number to go down are go up in the new n.y.m. [00:57:51.01] [00:57:51.01] And so what that's forcing health systems to do is not just think about their [00:57:55.20] [00:57:55.20] hospitals but talk about how can we have origin care centers and [00:58:00.15] [00:58:00.15] sort of patients conditions that Doughty a thing can that be factored in the urgent [00:58:05.07] [00:58:05.07] care center how can we have more preventive visits with the primary care [00:58:09.03] [00:58:09.03] provider still the patients out having that vitals regularly checked and [00:58:14.08] [00:58:14.08] not reaching to a situation where they really need to be operated on. [00:58:18.09] [00:58:19.10] Duct esper talked a little little about burnout and [00:58:22.22] [00:58:22.22] bringing joy back to the providers we also know because of so [00:58:27.18] [00:58:27.18] much love fluctuation happening in the market really understaffed that [00:58:32.18] [00:58:32.18] is a huge huge shock a giraffe providers specialist nurses [00:58:38.07] [00:58:38.07] you talk about it and that is a huge shock that so it's important for [00:58:42.18] [00:58:42.18] us to make sure that health care specially clinicians being in that [00:58:47.23] [00:58:47.23] profession is not considered to be a dissatisfactory [00:58:52.21] [00:58:52.21] job because we want more providers to be coming out of the clinics and [00:58:57.19] [00:58:57.19] then provide us centric to patient conditions centric So [00:59:02.06] [00:59:02.06] again this kind of gets down to you know there's a lot of patient consumerism [00:59:06.09] [00:59:06.09] happening where I as a patient really want to go to the best and. [00:59:12.10] [00:59:13.13] Greatest provider that that has amazing outcomes that has great quality to offer [00:59:19.05] [00:59:19.05] so patients are becoming more educated and I have a lot more to Venice and [00:59:24.08] [00:59:24.08] that's another big factor that's influencing our health systems [00:59:28.05] [00:59:28.05] that's going to drive that standardize ation and then the last one you've all [00:59:32.18] [00:59:32.18] heard about digit to look at how the market is disrupted in so [00:59:37.14] [00:59:37.14] many industries because of all the data that's available and all the. [00:59:41.23] [00:59:43.18] Information technology research that's happening now that is also happening in [00:59:48.14] [00:59:48.14] health care and that's really transitioning up until now we often [00:59:52.18] [00:59:52.18] talked about have that implemented has a hospital implemented and e.m.r. [00:59:57.14] [00:59:57.14] whether it's standardized or not standardized but now we're talking about [01:00:01.15] [01:00:01.15] 90 percent of the acute care hospitals have already implemented e.m.r. [01:00:05.14] [01:00:05.14] what are we going to do with zillions of data that's going to that's going to come [01:00:10.19] [01:00:10.19] out of it and what are you going to do about it and we really need to push back [01:00:14.14] [01:00:14.14] towards the digital technology so that it was at a global level Now what does that [01:00:19.12] [01:00:19.12] forcing the provided organizations to do when I think provide organizations that's [01:00:24.20] [01:00:24.20] where that care delivery is happening it could happen at an outpatient clinic or [01:00:29.06] [01:00:29.06] it could happen at a hospital right it's really forcing [01:00:33.15] [01:00:33.15] systems to more jobs come together like Dr Esther talked about [01:00:38.14] [01:00:38.14] right Levin hospitals they started with 2 hospitals now it's a it's a system of [01:00:43.11] [01:00:43.11] about 11 hospitals that have come together to be able to realize that Konami's of [01:00:48.01] [01:00:48.01] scale going back to the value and while you construct that I gave you you want [01:00:53.01] [01:00:53.01] to have instead of having 10 cardiologists that are doing everything [01:00:58.09] [01:00:58.09] within the real of Cardiology you want providers Stude really be specialized and [01:01:03.14] [01:01:03.14] you can only do that when they're able to really. [01:01:06.19] [01:01:07.20] Come together and realize those economics of scale as an example provided provide [01:01:13.05] [01:01:13.05] differentiated services right again Joyce talked a little more about how you [01:01:18.15] [01:01:18.15] want to open up those access points and you can really be able to afford all of [01:01:23.06] [01:01:23.06] that when a lot of systems come together and then the last one that also talks [01:01:28.09] [01:01:28.09] about experimenting new business models and I'll get to that in a little bit here. [01:01:33.06] [01:01:34.15] So we're really again talking about the construct of Howard's disrupting [01:01:39.03] [01:01:39.03] the health care market you know a lot of business professionals really study this [01:01:43.15] [01:01:43.15] concept as the Esko of what that is is when [01:01:47.07] [01:01:47.07] when the business is really starting to get influenced by so [01:01:50.22] [01:01:50.22] many environmental factors you need to disrupt how care is being delivered and [01:01:56.01] [01:01:56.01] that's what the north end of the curve that is saying the different strategies [01:01:59.23] [01:01:59.23] health systems are adopting Now the reason I included this slide is this is all so [01:02:05.06] [01:02:05.06] for saying health systems to start thinking about how can we transition from [01:02:11.17] [01:02:11.17] continuous process improvement to really be able to capitalize on that date and [01:02:16.23] [01:02:16.23] that's the way in the thought apply those advantaged analytics principles to be able [01:02:23.09] [01:02:23.09] to move to those solutions that are going to be more proactive in nature and [01:02:28.22] [01:02:28.22] then the next few slides I would walk you through some simple examples that we have [01:02:32.22] [01:02:32.22] done within our system today so one of them is related to population health [01:02:38.22] [01:02:38.22] management dried we heard a beautiful presentation from each other small inning [01:02:44.02] [01:02:44.02] around how we really need to be able to improve the health of our communities so [01:02:49.23] [01:02:49.23] they are able to really identify what are some of those [01:02:54.16] [01:02:54.16] problems are some of those clinical conditions that can be prevented so [01:02:59.07] [01:02:59.07] you don't have to patients really showing up at the Emirates the department [01:03:03.12] [01:03:03.12] going back to the example I gave you so you know again [01:03:07.17] [01:03:07.17] applying analytic principles here we have been doing some geospatial analysis [01:03:12.15] [01:03:12.15] to understand are there certain pockets of the community that are bringing a lot of [01:03:16.22] [01:03:16.22] that are having a lot more missions after they are treated within the hospital and [01:03:22.03] [01:03:22.03] then what is that distribution of chronic illness across the community so [01:03:27.03] [01:03:27.03] we are able to provide the preventive care necessary [01:03:30.05] [01:03:30.05] Joyce talked a little a lot about productivities labor. [01:03:34.07] [01:03:34.07] Management and I talk to you about our holidays a sharp edge of labor and as this [01:03:39.02] [01:03:39.02] life States there's a huge We conceded nurses are critical we are trying to [01:03:43.23] [01:03:43.23] push a lot of care to the nurses because there are no light level licensure but [01:03:48.20] [01:03:48.20] hospitals and health systems are really competing in the sand Ryan meant and [01:03:52.20] [01:03:52.20] struggling which is a quieting to really be proactive instead of waiting for [01:03:57.23] [01:03:57.23] that extradition to happen you have to quieting to really predict what that [01:04:02.10] [01:04:02.10] attrition rate looks like and almost in a sense over the high or [01:04:07.12] [01:04:07.12] so you are prepared to really face those situations then you're not going [01:04:12.11] [01:04:12.11] to have enough nurses and you can bring down that we can see a date. [01:04:17.04] [01:04:18.23] Then patient satisfaction you know it's amazing talk about the Amazon experience [01:04:23.07] [01:04:23.07] you have today. [01:04:23.23] [01:04:25.05] You go to the hospitals the nurses and caregivers are so [01:04:28.15] [01:04:28.15] caught out in trying to juggle through the earmark and [01:04:32.18] [01:04:32.18] really sought through providing clinical care we are forgetting the fact that [01:04:37.01] [01:04:37.01] the patient sitting in front of you has certain needs and it's very important for [01:04:42.01] [01:04:42.01] us to address those we have all the patient satisfaction surveys that [01:04:47.08] [01:04:47.08] Victoria walk through but keep in mind patient satisfaction surveys too are so [01:04:52.11] [01:04:52.11] focused around the age gap surveyed so focused around [01:04:55.18] [01:04:55.18] the basic needs a ride is your festivity clean of course that needs to be clean is. [01:05:00.16] [01:05:01.18] You getting the attention from the care or there is the caregiver responsive to you [01:05:06.06] [01:05:06.06] but in that just looking through those metrics although again I would emphasize [01:05:11.17] [01:05:11.17] that's the starting point we need to get to a point where the able to really also [01:05:16.23] [01:05:16.23] start to understand and analyze the comments that are really provided [01:05:21.23] [01:05:21.23] by those patients because those are personalized to the patient's condition or [01:05:26.13] [01:05:26.13] really complex patient might have completely different needs compared [01:05:30.23] [01:05:30.23] to a patient that's getting a New York hip surgery and start walking the next day [01:05:35.09] [01:05:35.09] how do we start to analyze that through the comments they are providing. [01:05:39.12] [01:05:40.13] And that's where you know a lot of text mining and a lot of analysis that on that [01:05:44.08] [01:05:44.08] space is happening to be able to drive that then last but [01:05:49.07] [01:05:49.07] not believed in in my mind personally that's where health care is going [01:05:54.16] [01:05:54.16] to be for medicine which is personalized preventive and [01:05:59.00] [01:05:59.00] bought dispensary a great example of that is how many of you have Apple Watch. [01:06:03.19] [01:06:05.07] Do you have health abd that really gives you your e.c.g. right so [01:06:10.10] [01:06:10.10] talk about artificial intelligence I'll go to terms that are analyzing [01:06:15.21] [01:06:15.21] a lot of data the signal data that you get from your heart rhythms and [01:06:21.13] [01:06:21.13] are able to prove actively give you diagnosis of certain conditions that [01:06:27.11] [01:06:27.11] the signal is providing before I moved to the health system in Macon I [01:06:32.18] [01:06:32.18] was at the Mayo Clinic and I was ready to close Lee working on this project believe [01:06:38.02] [01:06:38.02] it on art as some of those are good at thems where getting validated e.c.g. [01:06:42.21] [01:06:42.21] all get at them that are really providing you a preventive a proactive [01:06:47.18] [01:06:47.18] analysis at on a truth relation as we were doing some of that validation the e.c.g. [01:06:53.01] [01:06:53.01] all get at them was also giving you the ability or was very accurately [01:06:58.04] [01:06:58.04] predicting the age and the sex of the individual so talk about positive data and [01:07:04.12] [01:07:04.12] walked it can do for health care doc about the standardized ation that it can [01:07:09.08] [01:07:09.08] bring working closely with the clinicians and what decision support it can [01:07:14.03] [01:07:14.03] provide to our clinicians So with that I'll leave you on the no where that [01:07:18.21] [01:07:18.21] as industrial engineer is that it's analytics whether it's [01:07:21.23] [01:07:21.23] going to use improvement whether [01:07:25.14] [01:07:25.14] whether it's standardize ation there is a lot we can bring to this industry and [01:07:30.01] [01:07:30.01] I want you to reflect on what you can do for this industry. [01:07:33.14] [01:07:42.07] And to all our panelists fantastic fantastic comments and lots of food for [01:07:47.11] [01:07:47.11] thought so here's an opening up for questions to pass the microphone. [01:07:53.03] [01:07:54.07] To those of you may want to ask questions or provide become a. [01:07:57.21] [01:07:58.23] Good dog. [01:07:59.11] [01:08:11.08] I'm curious what challenges have you or your organizations faced in regards to new [01:08:16.18] [01:08:16.18] regulations on electronic health records implementation or integration my bad. [01:08:21.17] [01:08:25.09] Well where to start you just throw a softball Why don't you. [01:08:29.09] [01:08:30.12] That's a great question I will actually talk about [01:08:34.21] [01:08:34.21] a regulation that is about to happen. [01:08:37.23] [01:08:39.08] And it's called appropriate use criteria for [01:08:43.05] [01:08:43.05] imaging so c.m.s. actually [01:08:49.03] [01:08:49.03] in 2015 as part of the Medicare access and Chip. [01:08:54.02] [01:08:55.18] Macra Act of 2015. [01:08:58.04] [01:08:59.23] The part of that act was that that in order to make sure that we're getting [01:09:06.01] [01:09:06.01] imaging on appropriate people there have to be appropriate use criteria for [01:09:10.07] [01:09:10.07] the imaging that was actually supposed to be implemented in 2018 and what that means [01:09:16.02] [01:09:16.02] is that there is a significant amount of effort that is required on the front and [01:09:22.16] [01:09:22.16] to be able to have a scan approved for [01:09:27.09] [01:09:27.09] payment on the back end so as a neurologist. [01:09:31.21] [01:09:33.01] Appropriate appropriate use of an m.r.i.. [01:09:37.09] [01:09:38.13] Would have to be done for things that are not primary headaches. [01:09:44.05] [01:09:45.09] And so a primary headache is something like migraine or [01:09:48.10] [01:09:48.10] a primary headache is something like tension headache and so one of the issues [01:09:52.21] [01:09:52.21] would be well what's the appropriate use criteria for getting an m.r.i. for [01:09:57.14] [01:09:57.14] someone with a headache and how does that get justified on the front end compared to [01:10:02.04] [01:10:02.04] the back end in that there are a lot of actually decisions support systems that [01:10:05.18] [01:10:05.18] actually need to be implemented to be able to do that there are so [01:10:09.16] [01:10:09.16] intensive that Medicare backed off that act backed off that requirement for [01:10:14.23] [01:10:14.23] 2018 but it's going to come into place I think in 2020 or [01:10:19.05] [01:10:19.05] 2021 I'm not sure so we are scrambling to try and figure out how to [01:10:23.20] [01:10:23.20] do appropriate use criteria implementation in the electronic medical record. [01:10:28.12] [01:10:30.04] To be compliant by the time that it is it is actually required by Medicare to [01:10:35.11] [01:10:35.11] make sure that the imaging gets paid for so that's just one example of difficulty. [01:10:41.00] [01:10:42.08] I'll just give you a bigger picture view of it you know there [01:10:46.17] [01:10:46.17] are 2 main than hers for him our son or an epic and that's it and [01:10:51.18] [01:10:51.18] those were primarily designed for him for [01:10:56.21] [01:10:56.21] billing and yet. [01:11:00.01] [01:11:01.13] It's evolved over time into much more so [01:11:04.04] [01:11:04.04] all of the publicly reported data that you see on c.m.s. Web sites and [01:11:09.04] [01:11:09.04] so on is really coming from that coded data and [01:11:13.22] [01:11:13.22] it's not necessarily clinical data which is why there are other organizations [01:11:18.18] [01:11:18.18] like misquote the national servery probably improvement program and [01:11:23.12] [01:11:23.12] vision u.h.c. other organizations that that look at more clinical data but [01:11:29.13] [01:11:29.13] but all of that is primarily this the sick administrative code data [01:11:35.18] [01:11:35.18] in order to get the right reimbursement you saw Joyce's chart about how are we in [01:11:40.17] [01:11:40.17] versus have gone down in order to get the right reimbursement of them the most you [01:11:45.02] [01:11:45.02] can appropriately get you have to be coding correctly and [01:11:48.12] [01:11:48.12] that has put a lot of burden on the physicians to make sure they're [01:11:53.06] [01:11:53.06] getting the right information captured at the time they're seeing the patient. [01:11:56.21] [01:11:58.01] So how many you know many of you I'm sure have been to see your doctor where [01:12:01.15] [01:12:01.15] the doctor sitting in front of a computer and looking at the computer more than they [01:12:05.21] [01:12:05.21] look at you I think that's one of the biggest problems that it's caused us is [01:12:09.15] [01:12:09.15] is that it takes time away from the physician with the patient and [01:12:14.08] [01:12:14.08] it also has a serious impact on the joy and work that Dr [01:12:19.12] [01:12:19.12] esper talked about earlier because physicians didn't go into that into [01:12:24.12] [01:12:24.12] medicine to enter data into a computer they went into to see patients and [01:12:30.00] [01:12:30.00] to heal and so they they see it as a real complex I think there are a lot of bigger [01:12:34.07] [01:12:34.07] picture problems with the medical record that we don't have easy answers far we [01:12:38.18] [01:12:38.18] don't you know some people will do scribes were talking about that earlier that's [01:12:42.21] [01:12:42.21] an added cost that we don't have the money to pay so how do you it's a real catch 22 [01:12:47.22] [01:12:47.22] it's a very difficult problem for us but it causes a lot of trouble which I will [01:12:52.08] [01:12:52.08] say that Mark Bronstein here at Georgia Tech is is a real champion of fire [01:12:57.14] [01:12:57.14] fast health care and operability resources and [01:13:01.04] [01:13:01.04] we are looking to fire we've actually implement [01:13:03.16] [01:13:03.16] a fire governance committee at Emory to see how fire can be implemented overlaid [01:13:08.14] [01:13:08.14] atop the electronic medical record to help us with some of these problems so [01:13:13.02] [01:13:13.02] that's an example where the industrial industrial engineering and [01:13:17.22] [01:13:17.22] computer science from Georgia Tech can actually help [01:13:21.03] [01:13:21.03] healthcare systems like Northside in Emory deliver better care of the patients. [01:13:26.03] [01:13:29.01] Sorry I promise we can get off the topic after my question if you guys want [01:13:33.19] [01:13:33.19] to work it health care. [01:13:35.10] [01:13:36.11] So I think it was touched on a 2nd ago and earlier question you know [01:13:41.18] [01:13:41.18] we've been trying to basically take all of the impatience dinners ation success that [01:13:45.17] [01:13:45.17] we've had in translating the abilities base and for all the reasons that have [01:13:49.01] [01:13:49.01] been talked about including the fact that you know it's not just to you Mars for [01:13:52.22] [01:13:52.22] us you know it might be you know somewhere between 20 or [01:13:55.10] [01:13:55.10] 30 across your clinic network. [01:13:57.08] [01:13:58.11] I guess outside is. [01:13:59.11] [01:14:01.10] Is anybody up there and sending physician behavior the new value based [01:14:05.23] [01:14:05.23] arrangements or anything you've seen to sort of help push physicians who are not [01:14:08.22] [01:14:08.22] in the same system to try to drive the same standard of care. [01:14:11.20] [01:14:13.18] Do you have I have an answer I have an answer for that but [01:14:16.23] [01:14:16.23] all the for because I've been talking a lot so. [01:14:18.23] [01:14:20.09] So so the Emory So give an example from the Emory Healthcare network so [01:14:26.00] [01:14:26.00] you're you're exactly right when the Emory Healthcare network started in 2011 [01:14:31.01] [01:14:31.01] a lot of our external physicians who joined the network as private proctors [01:14:35.20] [01:14:35.20] private practice individuals and private practices had equal Were [01:14:43.03] [01:14:43.03] they had athenahealth they had a bunch of different electronic medical records and [01:14:48.13] [01:14:48.13] we had to make a decision how do we actually not [01:14:53.13] [01:14:53.13] disincentive eyes those physicians from joining them or health care network but at [01:14:58.04] [01:14:58.04] the same time take 42 different electronic health records and integrate them together [01:15:03.04] [01:15:03.04] when we had to make a decision right so we said well we're not going to take 42 but [01:15:08.02] [01:15:08.02] we are going to take 10 and we were going to like the 10 top ones and [01:15:12.19] [01:15:12.19] we developed an interface called the h. i.e. [01:15:17.00] [01:15:17.00] the health care information exchange which again many groups have and the h.i.i. [01:15:22.13] [01:15:22.13] easy is a central repository for data from these electronic medical records and [01:15:27.23] [01:15:27.23] now we're actually one of the only clinically integrated networks [01:15:32.10] [01:15:32.10] in Georgia that actually has 100 percent of its x. [01:15:37.06] [01:15:37.06] sternal groups not with Emory not our. [01:15:41.01] [01:15:42.04] Not our faculty practice and not our Emory especially associates employed physicians [01:15:47.06] [01:15:47.06] to have 100 percent integration either private practice docs 100 percent [01:15:51.06] [01:15:51.06] integration in the health information exchange and [01:15:55.16] [01:15:55.16] if we can see that information in our master and [01:15:59.17] [01:15:59.17] our master mill is Cerner Millennium data set so [01:16:04.16] [01:16:04.16] you have to make decisions you have to stick to your governance on that [01:16:09.01] [01:16:09.01] decision but then you have to make it easy for them to actually implement and [01:16:13.22] [01:16:13.22] so and so that's it's a great question now I don't know and [01:16:18.07] [01:16:18.07] I don't know if I answered it completely but. [01:16:20.02] [01:16:21.10] You know. [01:16:21.22] [01:16:35.18] Yeah yeah and [01:16:42.06] [01:16:42.06] you're talking about performance on value based contracts. [01:16:45.02] [01:16:46.13] And so there is a so it's actually interesting because this year there were [01:16:49.19] [01:16:49.19] health care networks said the primary care physicians are really were we [01:16:54.17] [01:16:54.17] want to incentivize the primary care doctors to deliver the care coordination [01:16:58.13] [01:16:58.13] cetera to keep the patients out of the higher q.b. [01:17:03.03] [01:17:03.03] levels of care and so it was agreed upon by their health care network board [01:17:08.11] [01:17:08.11] that the primary care physicians would share in the savings once it gets. [01:17:13.23] [01:17:15.13] There's a division of savings but that the specialists actually would benefit that [01:17:20.08] [01:17:20.08] from the referrals of those patients for the higher levels of care so [01:17:23.23] [01:17:23.23] again decision making board everyone kind of come together for [01:17:27.08] [01:17:27.08] that type of decision making. [01:17:28.08] [01:17:31.05] So. [01:17:31.17] [01:17:32.22] First off on to say each of the president presentations is really insightful really [01:17:38.13] [01:17:38.13] empowering and I have a lot of questions I could ask and [01:17:42.23] [01:17:42.23] there's a lot of thoughts that are going through my mind right now but [01:17:46.20] [01:17:46.20] something that Joyce was talking about earlier about. [01:17:49.04] [01:17:50.05] The workflow and reducing it by 20 percent and [01:17:55.00] [01:17:55.00] you know discharged time so something that I've thought about was. [01:18:00.12] [01:18:01.19] You know what 1st off what were the you know you said you decreased it [01:18:07.01] [01:18:07.01] by 20 percent what kind of things did you do to decrease it what were the what [01:18:13.05] [01:18:13.05] was implemented to actually decrease the time and 2nd you talked about. [01:18:18.08] [01:18:20.01] Rebuilding your. [01:18:21.03] [01:18:22.21] Northside location and so something that I've also thought about is. [01:18:27.17] [01:18:29.06] Have you ever considered. [01:18:30.20] [01:18:33.06] Building a kind of like an emergency department. [01:18:36.20] [01:18:38.00] Room location with. [01:18:40.15] [01:18:41.18] Urgent urgent care clinic attached to it so that you can divide you know you can [01:18:47.00] [01:18:47.00] assess patients on their acuity and send those patients to the urgent care [01:18:52.02] [01:18:52.02] while you're treating them treating your emergent patients so [01:18:57.09] [01:18:57.09] you can say you know you might say We've increased our access by building [01:19:02.10] [01:19:02.10] this new primary care clinic but in the meantime all those patients [01:19:07.10] [01:19:07.10] are always going to come to the emergency department so why you know I thought of [01:19:12.13] [01:19:12.13] building a carrier connected to emerge Department so they come to their mercy [01:19:16.16] [01:19:16.16] department they get assessed and then all they're to do take maybe a bus ride or [01:19:21.21] [01:19:21.21] just simple just a connection to energy and here and then they can be you know so [01:19:26.21] [01:19:26.21] that reduces the emergency department overflow Well I'll answer your [01:19:31.13] [01:19:31.13] latter question 1st so they're I mean there are so many different e.d. [01:19:36.06] [01:19:36.06] models out there right now there's even like a virtual e d like that the patient [01:19:41.06] [01:19:41.06] never even gets to a bad so I mean there are so many different you know ways out [01:19:46.02] [01:19:46.02] there right now but as far as like about you know assessing the acuity of [01:19:49.18] [01:19:49.18] the patients a lot of e.d.s. have gone to models where they are doing the tree [01:19:54.19] [01:19:54.19] eyes and then they they do have where they partially off the patients whether [01:19:59.17] [01:19:59.17] if they're a lower acuity that it might be that they need to get stitches or [01:20:04.02] [01:20:04.02] they you know sprain your ankle those types of things [01:20:07.08] [01:20:07.08] they have an area that they can put them in and do more of a virtual e.-d. [01:20:11.17] [01:20:11.17] because there's not as much of that critical care that needs to be provided [01:20:16.06] [01:20:16.06] however obviously if you have something a lot more traumatic that you have [01:20:20.12] [01:20:20.12] a trauma area that those you know physicians and nurses can be doing those [01:20:24.19] [01:20:24.19] types of things so I would think a lot of e.d.s. are doing now and [01:20:29.00] [01:20:29.00] I can't say that every one of them is but I think to take a step back. [01:20:32.21] [01:20:32.21] Back from there we really have to work with educating our patients on [01:20:36.20] [01:20:36.20] the fact that if they do have a sprained ankle or [01:20:40.10] [01:20:40.10] if they do have a headache or you know Najah or [01:20:44.00] [01:20:44.00] whatever that probably the 1st thing they don't need to do is walk into the e.d. [01:20:49.05] [01:20:49.05] And so that's and that good faith have to do right I mean that gets into you [01:20:54.18] [01:20:54.18] know having that education and having them have either a primary care physician or [01:20:59.02] [01:20:59.02] having some way that they can get that treatment without having to set foot in [01:21:04.00] [01:21:04.00] a needy which is our most expensive care that we have before to [01:21:07.22] [01:21:07.22] go to the other no question let me just add it's actually against the law for [01:21:11.23] [01:21:11.23] us to not treat a patient that walks in the so we can't just say [01:21:16.10] [01:21:16.10] you don't really need this you can go to urgent care but the tree. [01:21:19.17] [01:21:20.20] Serves that purpose basically we have an urgent care built into the if you will [01:21:25.10] [01:21:25.10] to do that but the point the other point I think is really good and [01:21:28.21] [01:21:28.21] that is you that's why you see a lot more hospitals partnering with our joint [01:21:33.12] [01:21:33.12] care centers and trying to get that word out there [01:21:38.06] [01:21:38.06] that if you're part of the Emory network been These are the urgent care centers [01:21:43.03] [01:21:43.03] that you are also covered by like you say it's education but I just want to [01:21:48.02] [01:21:48.02] make the point that we unfortunately we can't just say you don't you don't need to [01:21:51.15] [01:21:51.15] be in the urgency room you can go take a bus to the care but we basically [01:21:56.12] [01:21:56.12] accomplish that same goal so you can look up and Holla if you don't know that and [01:22:00.23] [01:22:00.23] someone has to self that that because yes that's life but then this far as like [01:22:05.20] [01:22:05.20] you know I mean there's so many different pieces I mean this particular project was [01:22:09.10] [01:22:09.10] looking at the fact that if we have a care team so we've kind of potted out you [01:22:14.10] [01:22:14.10] know the care rooms because if we're like a 405060 bad e.d. [01:22:19.15] [01:22:19.15] I mean we're basically having care teams taking care of a certain number of [01:22:23.14] [01:22:23.14] patients or patient rooms if you will and so what we found was that if the nurse or [01:22:29.11] [01:22:29.11] the tech was functioning in a more siloed format. [01:22:33.00] [01:22:33.00] Like that was their patient and they were doing that care that then there wasn't [01:22:37.12] [01:22:37.12] somebody else to kind of help pick up the pieces behind them so [01:22:41.02] [01:22:41.02] what we found without really adding anything to the staffing we allocating how [01:22:46.00] [01:22:46.00] the staff was utilized that by having a care team lead [01:22:50.18] [01:22:50.18] that they were able to facilitate getting the patient from the waiting room and [01:22:54.18] [01:22:54.18] putting them into the empty room when the nurse that maybe there nurse was finishing [01:22:59.22] [01:22:59.22] up with the other patient or maybe they were trying to get the x. ray done or [01:23:04.22] [01:23:04.22] get the x. Ray order in so that that patient could go get that taken care of [01:23:09.12] [01:23:09.12] and the other person was filtering in the next patient that they could help do so [01:23:13.20] [01:23:13.20] we found that it was more creating kind of that coordination of care versus [01:23:18.06] [01:23:18.06] continuing to function like in the siloed way of care and that really did [01:23:23.02] [01:23:23.02] improve us being able to discharge them more quickly by 20 percent the Edis [01:23:28.04] [01:23:28.04] a great place for that I'll also say labor and delivery is a great place for that and [01:23:32.18] [01:23:32.18] really have a care team model of working collaboratively and [01:23:37.10] [01:23:37.10] not siloed which so many people are used to I do my work I'm getting it done and [01:23:43.07] [01:23:43.07] not collaborating with everybody to get everything turned over much more quickly [01:23:48.08] [01:23:48.08] and one of the reasons that you hear about lane so much in health care is that [01:23:52.04] [01:23:52.04] we have so much waste it's just a tremendous amount of waste and [01:23:56.15] [01:23:56.15] so anything that we're doing to reduce waste is going to increase throughput [01:24:00.18] [01:24:00.18] reduce wait times the best example in terms of the most profitable one I've [01:24:06.00] [01:24:06.00] been involved was with the new infusion center and [01:24:10.18] [01:24:10.18] do you understand where we were able to reduce waste in the process and [01:24:16.08] [01:24:16.08] then also stagger the staffing to match demand and stagger the patient demand to [01:24:21.06] [01:24:21.06] the point where we were able to increase our utilization so much that it resulted [01:24:26.04] [01:24:26.04] in $20000000.00 a year in the increased revenue so there's tremendous [01:24:32.08] [01:24:32.08] opportunity in health care I want to make one point quickly on the improvement. [01:24:37.23] [01:24:40.01] It's important especially when we talk about lean principles that [01:24:44.23] [01:24:44.23] lean is a customer focused system so we always have to be thinking about [01:24:49.20] [01:24:49.20] the impact of waste from the customer's perspective so you can do a lot of [01:24:54.12] [01:24:54.12] great work in reducing the easy length of stay which is what we should do but [01:24:58.21] [01:24:58.21] actually we had an interesting problem that happened at Emory and [01:25:01.13] [01:25:01.13] that we actually had patients being discharged. [01:25:04.23] [01:25:06.06] With the labs still pending. [01:25:08.09] [01:25:09.11] Their discharge and so one of the perspectives [01:25:12.23] [01:25:12.23] of the patient is well what did my labs show because they may have gotten their [01:25:16.19] [01:25:16.19] lab results in the in the old system with the longer length of stay in the e d but [01:25:21.18] [01:25:21.18] when you have lab still pending How do you actually get those results back to [01:25:25.12] [01:25:25.12] the patient from a customer focused perspective so you actually have to think [01:25:29.02] [01:25:29.02] of the entire value stream of from the patient's perspective and [01:25:34.01] [01:25:34.01] so we had to implement an entire process to make sure we got labs back on [01:25:37.19] [01:25:37.19] the backend to the patients after they were discharged so [01:25:42.03] [01:25:42.03] just the concepts of lean how they impact the value stream and [01:25:46.00] [01:25:46.00] how improvements in one area of bottleneck can actually produce constraints [01:25:51.03] [01:25:51.03] on the other end theory of constraints etc So if I'm yeah. [01:25:54.11] [01:25:57.23] Hi My name is Linda and I'm a 2nd year master's student in public policy here [01:26:01.12] [01:26:01.12] at Tech so earlier you talked about how physicians really hate spending more time [01:26:06.12] [01:26:06.12] with their computer instead of looking at their patients but at the same time all [01:26:11.04] [01:26:11.04] the information that they're in putting into their Mars and each ours are so [01:26:16.16] [01:26:16.16] valuable for making of it for making decisions and evidence based health [01:26:21.21] [01:26:21.21] care so how do we get around this how are we able to get physicians to spend [01:26:26.21] [01:26:26.21] more quality face time with their patients while still getting the same data. [01:26:30.22] [01:26:33.11] Could be the subject of your dissertation. [01:26:35.07] [01:26:36.17] You can come help us with that but I think that there are a number of [01:26:42.08] [01:26:42.08] things that are happening currently one is. [01:26:47.00] [01:26:48.01] You know there are human solutions that Victoria alluded to earlier which [01:26:51.22] [01:26:51.22] are scribes we are actually implementing a new care model in our primary care clinics [01:26:59.14] [01:26:59.14] where one physician will be partnered with medical assistance and [01:27:04.20] [01:27:04.20] those to medical assistance will actually being not only doing the documentation [01:27:08.17] [01:27:08.17] which is essential to the electronic medical record and in putting orders and [01:27:13.00] [01:27:13.00] so forth with the physicians oversight but [01:27:18.01] [01:27:18.01] also to make sure that the physician actually has the appropriate interaction [01:27:22.11] [01:27:22.11] with the patient so that's a model that actually Christine sings [01:27:26.21] [01:27:26.21] the from the American Medical Association is championed and [01:27:29.19] [01:27:29.19] we're actually trying to implement that here you p.m.c. actually is developing. [01:27:34.16] [01:27:35.17] A. [01:27:36.06] [01:27:37.11] Virtual model of scribing a virtual scribe model [01:27:42.10] [01:27:42.10] where they're actually listening to the visit and actually developing a note with [01:27:45.17] [01:27:45.17] the without the physician having to do anything. [01:27:47.19] [01:27:48.22] That's in the generation right now and that's not we'd love for [01:27:53.10] [01:27:53.10] Georgia Tech to come to you p.m.c. so but to so [01:27:58.11] [01:27:58.11] those are for instance 2 examples of one human based and [01:28:02.06] [01:28:02.06] one automation based that are trying to keep the same amount of information [01:28:07.04] [01:28:07.04] going into the electronic medical record for decision making purposes while yet [01:28:11.16] [01:28:11.16] preserving the physician patient relationship. [01:28:13.21] [01:28:19.22] I really would like to take more questions but we are kind of it down of our time so [01:28:25.02] [01:28:25.02] I suggest we wrap up and then we still have our posters and [01:28:29.13] [01:28:29.13] some more food outside and continue the discussion so please join me in thanking [01:28:34.08] [01:28:34.08] our panelists and all of the other speakers Thank you [01:28:42.07] [01:28:42.07] I would like to give a couple of closing remarks just reflecting on all the great [01:28:46.12] [01:28:46.12] things that we heard today from our repertoire presenters panelists and [01:28:51.04] [01:28:51.04] also some of our course the presenters outside thank you so much for [01:28:54.09] [01:28:54.09] your participation so we heard that the u.s. [01:28:57.06] [01:28:57.06] healthcare spending has been increasing as a percentage of our g.d.p. but [01:29:02.02] [01:29:02.02] we do not see a corresponding improvement in our health outcomes or [01:29:05.15] [01:29:05.15] efficiency of effectiveness so far so that's that's a big issue for [01:29:09.18] [01:29:09.18] all of us in terms of the utilization of our resources there's a lot of waste [01:29:16.01] [01:29:16.01] in clinics and hospitals bigger picture health care system part of it might be due [01:29:20.20] [01:29:20.20] to how we run our health care operations but also how medicine is practiced we [01:29:25.23] [01:29:25.23] heard about over testing over medication or gaps in continuity of care all [01:29:31.02] [01:29:31.02] of these contribute to some of this waste and exacerbating these problems is that [01:29:35.13] [01:29:35.13] our demographics are changing aging population is growing [01:29:39.13] [01:29:39.13] we have a lot of people with multiple chronic conditions that's been growing so [01:29:43.06] [01:29:43.06] all of these and the life care how much time money and effort to spend on all of [01:29:47.23] [01:29:47.23] that is contributing so during our trip it's fire discussion Dr initial. [01:29:52.08] [01:29:53.09] Emphasize the importance of social conditions and how they impact our health [01:29:57.21] [01:29:57.21] and also more so than say our genetics or health care services and [01:30:02.20] [01:30:02.20] especially when it comes to chronic conditions we need to think about our. [01:30:06.06] [01:30:07.08] Infrastructure big picture whether it's physical infrastructure health [01:30:11.07] [01:30:11.07] infrastructure and how changes we can make in our [01:30:15.19] [01:30:15.19] environment can actually encourage healthy choices. [01:30:20.21] [01:30:20.21] Including education and engagement starting at an early age all of these [01:30:24.09] [01:30:24.09] could make a huge difference in what we see in later later time and [01:30:29.08] [01:30:29.08] west from d.d.r. I talked a little bit about the kind of technology that's [01:30:34.00] [01:30:34.00] developed here in Georgia take from drug development and [01:30:37.20] [01:30:37.20] devices to another takes to help us better understand how the outcomes and [01:30:42.09] [01:30:42.09] also disparities and to better locate our our limited precious resources [01:30:47.11] [01:30:47.11] in the space so I want to emphasize again that it's cool over ation with fantastic [01:30:52.04] [01:30:52.04] partners some of them are represented here today and [01:30:55.18] [01:30:55.18] Leon mentioned Emory University Children's Healthcare Marcus of autism sound they're [01:31:00.22] [01:31:00.22] like founders and so on so we really really appreciate these [01:31:05.21] [01:31:05.21] these collaborations bringing different perspectives together and one of [01:31:09.20] [01:31:09.20] the reasons of this forum is to hopefully add to this to these collaborations or [01:31:14.22] [01:31:14.22] expand on what we are doing so several education programs at Georgia Tech also [01:31:19.09] [01:31:19.09] voted down the graduate in graduate levels to engage them in research through these [01:31:23.20] [01:31:23.20] collaborations Dr religion may and Dr Rio She talked about statistics [01:31:29.12] [01:31:29.12] machine learning big data and how we can use some of these tools again in [01:31:34.14] [01:31:34.14] collaboration with partners to answer some of the prison questions in medicine or [01:31:39.22] [01:31:39.22] health care. [01:31:40.11] [01:31:41.16] So very interesting panel discussion thanks again I will share just a couple of [01:31:46.09] [01:31:46.09] highlights that stood out for me Joyce mentioned emergency departments for [01:31:50.22] [01:31:50.22] emergency patients only and the importance of improving workflow and [01:31:56.05] [01:31:56.05] throughput to better use our resources and to better outcomes I think you heard [01:32:01.09] [01:32:01.09] this theme a lot in our discussions today limited resources what's [01:32:06.14] [01:32:06.14] the best way to utilize these resources so that they actually help us h.-e. [01:32:10.14] [01:32:10.14] what we are hoping to achieve in terms of patient outcomes as well as provider [01:32:14.17] [01:32:14.17] satisfaction and patient satisfaction Victoria pointed out there. [01:32:19.22] [01:32:19.22] Sometimes you make improvements we are very happy and proud about them but [01:32:23.07] [01:32:23.07] how do you sustain them in the long run so that they don't become one of projects we [01:32:27.16] [01:32:27.16] clap ourselves or pat ourselves in the back but how do we make it sustainable [01:32:32.23] [01:32:32.23] over a longer term she emphasized the importance of having some context when we [01:32:36.15] [01:32:36.15] talk about metrics data are monitoring our performance that don't think [01:32:41.07] [01:32:41.07] about an isolation but really have a big picture context and [01:32:46.04] [01:32:46.04] to promote a culture to ensure continuous improvement because things change so [01:32:51.04] [01:32:51.04] what we have done today might work great but a couple of months or years later we [01:32:55.19] [01:32:55.19] might need to reevaluate what we are doing so having this focus on continuous [01:32:59.13] [01:32:59.13] improvement Greg talked about how we can establish evidence based standards for [01:33:04.05] [01:33:04.05] clinical care so everybody doesn't do what they feel like the best thing to do it [01:33:08.10] [01:33:08.10] that point in time to ensure efficient effective equitable [01:33:12.15] [01:33:12.15] patient centered care again leading to build a better outcomes and [01:33:17.05] [01:33:17.05] especially if you think about think about health care being provided by different [01:33:20.11] [01:33:20.11] people in different locations sometimes and how do we call the night and [01:33:25.20] [01:33:25.20] make sure that we have a care continuity Toronto about [01:33:30.14] [01:33:30.14] the changes that are either necessary we have to do it or [01:33:34.15] [01:33:34.15] we want to do it because it's it's desired focusing not just [01:33:39.07] [01:33:39.07] on acute care about to expand our services and focus to and to and care. [01:33:44.05] [01:33:45.16] Including preventive services and [01:33:47.15] [01:33:47.15] in some cases possibly reorganizing the way we operate to achieve some scale and [01:33:52.21] [01:33:52.21] better coordination across these different components in the system he said the next [01:33:57.12] [01:33:57.12] on the example of combining emergency room with missions to population health so [01:34:02.15] [01:34:02.15] that we can actually identify the risk patients and take proactive [01:34:07.02] [01:34:07.02] action to make sure that they receive the kind of care they need and [01:34:10.19] [01:34:10.19] don't end up back in the in the again sometime soon and in some [01:34:15.12] [01:34:15.12] cases we can do our best but prevention may still not be enough which me. [01:34:20.02] [01:34:20.02] We still need to have. [01:34:21.06] [01:34:22.09] Good methods to identify disease it early stages and offer proactive personalized [01:34:27.00] [01:34:27.00] care to ensure good outcomes so the big question that we try to address today and [01:34:31.17] [01:34:31.17] will probably continue to address in for a while to come is how do we move from [01:34:35.15] [01:34:35.15] secure to health care that's what we call health care but the way we practice and [01:34:39.02] [01:34:39.02] experience it is is for the most part this secure not health care so [01:34:43.18] [01:34:43.18] we want to provide the right care at the right place at the right time care [01:34:48.11] [01:34:48.11] defined broadly again not just treatment after someone gets sick but proactively [01:34:53.17] [01:34:53.17] to promote health and well being again paying attention to access as well so [01:34:59.08] [01:34:59.08] I'm a systems engineer so I'm going to promote We need to take a systems approach [01:35:03.21] [01:35:03.21] collaborations between engineers medical and public health professionals [01:35:08.12] [01:35:08.12] the planners economists many people right so because these are very complex problems [01:35:13.15] [01:35:13.15] and such collaborations offer a lot of potential for for address in some of these [01:35:18.11] [01:35:18.11] complex issues at the root and not with a kind of Band-Aid approach so [01:35:24.03] [01:35:24.03] going back to the most comment earlier we are professors we love to give homework so [01:35:28.09] [01:35:28.09] your homework after today is to think about what you are and [01:35:32.07] [01:35:32.07] reflect on on some of the things takeaways from today. [01:35:35.08] [01:35:36.12] Think about what you can take away and share with your colleagues classmates. [01:35:40.23] [01:35:42.04] Others that your organization or the constituents that you serve what action [01:35:47.04] [01:35:47.04] you can take what action you want your organization your group to take and [01:35:51.04] [01:35:51.04] how can we also motivate others to take a positive action in the space so [01:35:56.15] [01:35:56.15] I'm going to leave you with all of that thank you again all of you for [01:36:00.18] [01:36:00.18] participating today and I again invited to continue the discussion outside thank you. [01:36:06.01]