Board of Directors Meeting - 29 March 2012 - Devon Partnership ...

Board of Directors Meeting, 29 March 2012Agenda Item 4a (Minute 033/12 refers)Appendix 1helped to achieve very high rates of patient and employee satisfaction – which areamong the 100 US organisations.The Harbour View Medical Centre is a co-operative with a $750 million annualbudget and a mission to prioritise vulnerable people. Managed by the University ofWashington, it has developed international centres of excellence, in particular in itstrauma and burns units. It has a significant focus on quality, with patient satisfactiondata and directorate-specific comparators being followed-up routinely by the MedicalDirector and clinical directors. It also invests a great deal of time and effort into staffselection and development.Wentachee Medical Centre has pioneered a tele-health programme to target patientswith chronic conditions - who were incurring average costs of more than $17,000 peryear each. Two thirds of this patient group were enrolled in the programme and theresults included a reduction in Emergency Room admissions of 17% and generaladmissions of 13%; a 50% reduction in mortality and cost savings of around $3,000per patient per year.At the Virginia Mason Medical Centre, where the internationally-renowned GaryKaplan is CEO and Chair, they have achieved a position in the top 5% of UShospitals for clinical performance and the accolade of top hospital of the decade.Quality and efficiency are inextricably linked to care and ‘compacts’ betweenclinicians, managers and the executive team have been employed to great effect.Here, too, huddles between different groups of staff are a regular feature of the dailyand weekly routine.Significant investment in the Toyota Production System has led the hospital todevelop its own Virginia Mason Production System (VMPS). This managementmethodology is based on manufacturing principles and seeks to continuouslyimprove how work is done. Essentially, it identifies and eliminates waste andinefficiency and equips staff to deliver high levels of quality and safety bystreamlining repetitive and ‘low touch’ aspects of care. This detailed analysis of costand flow enables staff to spend more time with patients, has eliminated waitscompletely for outpatient clinics and introduced multiple efficiency gains.At Group Health, the major focus is on the reduction of hospital admissions, length ofstay and overall cost. The focus is very much on shared decision making betweenthe doctor and patient – striving to correct the historical imbalance between the two.Evidence tells us that when patients are more informed and actively involved, theytend to make more conservative choices and are more satisfied with their outcomes.The rates of invasive surgery at Group Health have been reduced by 23%.So what did we learn?In many ways, not that much that was completely new to us. What we did see wasplenty of single-minded determination and a shared sense of urgency to put wellevidencedtheory into practice, with some impressive results. Far less focus on thepotential downsides of taking action; a ‘bring it on’ attitude to competition; completeintolerance of underperformance and a readiness to tackle it quickly – better to do50% now than 100% much later, or never.Page 21 of 156