Value Stream Mapping # 2 Report – Discharge Process (July 2017)

Presented at the JCC Meeting, November 14, 2017

by Regina Gomez, Director of Quality and

Jennifer Carton-Wade, Assistant Hospital Administrator

The Team

Gemba Sub-Teams

We broke into teams in order to observe:

• Case conferences

• Discharge huddles

• Resident care conferences

• Interdisciplinary resident care teams

• Individual members of the care team

Going to the Gemba

Processes Observation SummaryProcesses Observed Residents RN MD MSW Rehab

Case conference (initial)

4 10 12 8 6

Discharge assessment 2 5

Counseling plan 1 5 8 1

Medication pass 2 4

Therapy 1 5 3

Psychosocial support 1 6 1 2

Home evaluation 8 2

Patient education 2 6 5 1

Pack belongings 2

TOTAL: 113 8 26 29 35 15

105 hours of observation, 113 processes observed!

Education – lean overview and value stream mapping

Mapping the Current StateHot pink stickies for waiting

Yellow stickies for observations and wastesPink stickies for process steps

Blue stickies for ideas

Current State Data SummaryUnit: PMS S2

TimeCare

PlanningDC

ProcessCare

PlanningDC

Process

LT 1,490 46,750 2,925 75,460

LT in days 1 day 32 days 2 days 52 days

CT 50 490 45 500

WAIT 1,440 46,260 2,880 74,960

VA 50 465 22 380

NVA 1,1440 46,285 2,903 75,080

VA % 3.4% 1% 1% .5%

Summary of current state issues • No clear signal/notification of discharge date

• Home not ready (home eval not scheduled soon enough)

• Durable medical equipment (DME) delays

• Resident participation in discharge meeting

• Lack of a comprehensive discharge plan of care

• Non-standard discharge care plan meeting

• Multiple forms of discharge documentation

• No standard work for linkage/continued care referrals

Idea Generation

Idea Generation Reporting

Future State Mapmutual goals

care coordination

care transitions

resident empowerment

fostering confidence

health and wellness

Lean Concepts to Reflect in the Future State

Future State Data Summary

Current PMS Current S2Future

“Short Stay”

Care Planning

DC Process

Care Planning

DC Process

DC Process Only

LT 1,490 46,750 2,925 75,460 17,550

LT in days 1 day 32 days 2 days 52 days 12.2

CT 50 490 45 500 270

WAIT 1,440 46,260 2,880 74,960 17,280

VA 50 465 22 380 265

NVA 1,1440 46,285 2,903 75,080 17,305

VA % 3.4% 1% 1% .5% 1.4%

Total time for discharge post identification of DC date:

12.2 days in the future vs 32-52 days currently

Our Vision of the Future• Length of stay for short stay residents will drop from 84

to 54 days (a reduction of 36%)

• Lead time from identification of discharge to actual

discharge will drop from a range of 32-52 to 12.2 days

while maintaining time for treatment and care and

maintaining a safe and supportive environment

• Characteristics of the future state include:

Resident developing self-confidence for self-care

Enabling health and wellness of the resident post-

discharge

Fully integrating linkages to community resources

for the betterment of resident outcomes post-

discharge

Problem Statement

The number of residents discharged from Laguna Honda has

been declining over the past 3 fiscal years. Availability of

housing for the population served is increasingly more limited in

San Francisco. There is a need to focus on discharge planning

processes of residents who are able to return to their prior living

situation where housing is not a barrier to discharge.

Targets and Goals

By the end of FY 17-18,

1. Increase by 25% the number of residents (who

are short stay and have a home) discharged

back to the community within 60 days of

admission.

2. Reduce average LOS by 30% by improving

internal and external discharge planning care

coordination processes and reducing wait times

between processes. (Average LOS for S2 from

263 to 184 days, PM from 77 to 54 days)

Implementation Plan

Next Steps:

Just Do Its - 4

Kaizens - 3

Questions & Answers

Thank you.