Hospitals must find ways to differentiate their services and programs from their competition, while facing the obstacles of reduced reimbursement, a larger focus on patient satisfaction, and increased accountability and quality requirements. The Avera Orthopedics department did an evaluation of the patient experience for their Total Joint Replacements program from end-to-end, including an assessment of their online experience for e-patients. A care path was then optimized with transition gaps resolved and duplicative work eliminated. A web-based patient guidance system was implemented that provided patient benefits in convenience and efficiency. Avera found that guided patient engagement through the total episode of care improves patient readiness, increases treatment adherence, reduces risks of setbacks, and speeds up recovery. In this session you will learn The problems faced by the Avera ortho dept Defining a process to evaluate hospital service line patient experience from end-to-end Addressing pain management scores through multiple initiatives Innovative concepts that used lean processes to positive outcomes The effects of purposeful hourly rounding and leader rounding How to create a streamlined care path, reducing variances and duplicative work Benefits seen in setting patient expectations early and offering convenience of online e-patient engagement About the Speaker: Benz Julie_color_smallJulie Benz is the Director of Outpatient Therapy Services at Avera McKennan. Julie has been employed with Avera McKennan for 30 years. She received her degree in Physical Therapy from the University of Iowa and Masters in Administrative Studies from the University of South Dakota.

1. Improving the Patient Experience for
Joint Replacement by Using a
Guided Process
Julie Benz
Director of Outpatient Therapy Services
March 20, 2014

2. Avera McKennan – Sioux Falls SD
* Hub of the Avera Health System
* Established over 100 years ago

4. Within the Avera McKennan network…
• 13 regional hospitals
• Avera Behavioral Health Center
• Avera Heart Hospital of South Dakota
• 85 primary and specialty care clinics

5. We are nationally recognized for excellence in:
Cancer treatment Stroke care and neurosciences
Orthopedics Women’s health care
Pediatrics and neonatal intensive care Behavioral health
Emergency, trauma and critical care Surgery
Gastrointestinal care
Avera McKennan’s
flagship facility is
our 545-bed
tertiary care
hospital in Sioux
Falls.

6. Our Aspiration
Through service and process
excellence, Avera McKennan will
lead the nation in high quality,
affordable health care.

7. Rural Innovative
Most advanced use of e-services
Strives to be at the forefront of
innovation
Top 10 Trailblazing Hospitals

8. “Goals determine what you
are going to be."
Julius Erving

9. Objectives
1. Identify problems facing the
Orthopedic Unit
2. Identify innovative concepts that
improve the processes to positive
outcomes.

10. Orthopedics at Avera
McKennan
•32 – bed unit
•700 Jt Replacements/year
•2 - Primary Orthopedic Groups
•1987 established Easy Street
•2002 initiated Joint Camp

11. Challenges
Competitive environment
 Reducing volumes
Patient Satisfaction below the Top Box
performers.
 * Quality Outcomes
 Falls
 Pain Management

12. Innovative Ideas & Proven
Concepts
• Process Excellence - Lean
• Purposeful Hourly Rounding
• Leader Rounding
• Pain Team – one call response
• Total Care - PGS

13. Lean – Process Excellence

14. Visual Management Control
•To clearly and immediately notify
management and workers whether
the work area is normal or abnormal.
–Shadowing/Labeling
–Andon Signals
–Downtime Clocks
–Process Control Centers
© 2007 OpEx, Inc. All Rights Reserved.

16. Supplies at POU on 2WB pod

17. Purposeful Hourly Rounding

18. Visual Management Control
Patient out of room
Even Hour Round Complete
Odd Hour Round Complete

19. Intentful Leader Rounding
Leader with staff
Daily with staff on shift
Quarterly with every staff
Senior Leadership - weekly

20. Pain Team
Instituted a Pain Team –
Anesthesiologist - Pharmacist
Pharmacist on the floor during the
day and available at night for med
review

21. What were we challenged by-
Getting the right
information to the patient
and their family at the
right time

22. “To shoulder greater accountability for
outcomes, health systems must partner
with patients to close gaps in
communication and coordination while
managing care beyond the acute care
or physician office setting”
» The Advisory Board

24. Program Goals
1. Improve patient experience
2. Ensure patient adoption and
engagement
3. Improve Patient Satisfaction
4. Drive staff efficiency
5. Create a compelling
competitive differentiator

31. Reports Available
To numerous to mention but
valuable information that drives
our process changes.

33. Weekly Report Summary
March 3, 2014 - March 9, 2014
Patient Activity
New Enrollments 4
New Registrations 4
Total User Logins 46
Unique User Logins 22
Item Completion
1st Functional Outcome 5
Preparedness Survey 1
Hospital Experience Survey 2
Recovery Survey 1
Surgeon Experience Survey 2
Transition Experience Survey 1
2nd Functional Outcome 1
Avera TotalCare Program Survey 0
6 Month Functional Outcome 0

34. Other Changes
• Aquatic Therapy Post Op Day1
• Dietary Aid on the floor 8hours/day to
assist with nutritional need of the
patient.
• Daily Rounds with RN, Case Manager,
Social Worker, Therapy and physician
liaison

35. Results of our Efforts

36. Fall Reductions
3.06
5.59
8.03
10.70
5.37
13.16
4.58
5.88
15.97
2.81
1.74
3.64
0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
16.00
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Rateper1,000PCD
2 West Ortho Falls
Jan-Dec 2012
Fall Rate
Magnet BenchmarkMagnet Benchmark is
the average rate for 8
quarters. Actual
5.61
1.95
3.453.44
1.58
9.12
1.59
0.00
3.42
5.84
5.37
3.45
2.97
0.000.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
16.00
Jan FebMar AprMayJun Jul AugSep Oct NovDec Jan Feb
Rateper1,000PCD
2 West Ortho Falls
January 2013-February 2014
Fall RateMagnet Benchmark is
the average rate for 8
quarters . Actual

37. Patient Satisfaction
Question Mar – 12 to Feb 13 Mar-13 to Feb-14
Overall Rating of
Hospital
70.7% 75.5%
Likelihood to
Recommend
75.3% 86.8%
Transitions of Care 59.6% 64.5%
Pain Management 68.1% 74.6%

38. Surgical Growth

39. Total Care
Avera Total Care

40. Nationally Recognized Quality
2014 Healthgrades Awards
Five-Star Awards in:
• Orthopedics
• Neuroscience
• Gastrointestinal services
• Critical care

41. Nationally Recognized Quality
One of the 100 Top Hospitals®
in the nation in 2013 as
named by Truven Health
Analytics

42. Nationally Recognized Quality
• No. 1 hospital in South
Dakota in 2012-13
and 2013-14

43. Nationally Recognized Quality
• QUEST High Performing
Hospital in 2013
Premier Health Care Alliance

44. Nationally Recognized Quality
• Community Value
Leadership Award
• Community Value 100®
Hospitals list
Cleverley + Associates

45. Questions
Thank you