Meet Our Newest Lean Six Sigma Green Belts!
The Participants in VNSNY’s Second Lean Six Sigma Course Tackle Continuous Care Optimization, Hospitalization Rates, Capacity Constraints, and Turnaround Time
VNSNY is now in its second year working with Lean Six Sigma—a set of management tools used by organizations worldwide to help them operate more efficiently and improve the quality of their services and products.
Building on last year’s inaugural program, Tony Dawson, Senior Vice President of Quality and Performance Improvement, recently took another 20 team members through a six-month course that prepared them to become certified as Lean Six Sigma Green Belts.
Tony Dawson, Senior Vice President of Quality and Performance Improvement
“Implementing a problem-solving tool like Lean Six Sigma improves processes throughout the organization,” says Tony. “At the same time, VNSNY team members learn critical thinking and managerial skills as they develop solutions to complex issues that will ultimately improve the customer experience for our patients, members and clients.”
With participants from across VNSNY, the Lean Six Sigma course brings together fresh ideas and diverse perspectives from various departments. “Tony picked people from different groups and mixed them together, to make sure each team had the specific skills it needed to succeed,” says course participant Gerard Christophers, Director of Hospice Referrals and Admissions.
To kick off this year’s program, participants attended a series of classes on Lean Six Sigma basics. The group then divided into four-person teams to tackle specific projects focused on goals such as improving patient care, increasing efficiency, and standardizing work flows.
As the projects progressed, Lean Six Sigma teams regularly updated VNSNY’s senior leadership and their executive sponsors. In December, final presentations were made to VNSNY’s Executive Leadership Team. But the projects don’t end at that point—in fact, it’s often just the beginning.
“Our new Lean Six Sigma Green Belts will continue to apply the knowledge they’ve acquired during their projects to their day-to-day work at VNSNY,” notes Tony. “In so doing, they’ll be making a positive impact and serving as a valuable resource to the organization.” Meanwhile, Tony adds, a new cohort of 20 Green Belt trainees is scheduled to get underway this month.
LEAN SIX SIGMA PROJECT SUMMARIES
Click on the links below to read summaries of the five projects carried out by VNSNY’s 2021 Lean Six Sigma cohort.
- Continuous Care Optimization in Queens
- Reduce the 30-Day Acute-Care Hospitalization Rate for CHHA/CMO Case Rate Patients
- Align Capacity Management and Start of Care for the CHHA
- Reduce Turnaround Time on DME Requests for Wound Care Products for Patients with a Stage 3/4 Pressure Injury in the CHHA
- Reduce Turnaround Time Between HHA Request and HHA Placement in the CHHA and Hospice
Project: Continuous Care Optimization in Queens
Goal: Achieve 33% increase in Continuous Care billable patient days serviced, from approximately 25 to 32 per year, for the Queens North-West, North-East, and Central teams.
Project Leads:
Kristina Turzanski, Director, Hospice Continuous Care and After Hours
Sree Rao, Director, Finance & Business Operations, FP&A
Martin Bae, Associate Project Manager, Quality and Customer Experience, Quality Management Care
Cassandra Collins, Clinical Director, Hospice Brooklyn/Staten Island
Report: Continuous Care is one of the four hospice levels of care, entailing ongoing care in the patient’s home. For a Continuous Care day to be billable, the patient must receive a minimum of eight hours of care, with at least 50% of this being skilled care. The team sought to optimize the use of Continuous Care to improve the overall efficiency of its hospice teams and resources in the Queens North-West, North-East, and Central teams. Benefits of this improvement include better patient symptom management, team support, patient experience, and hospitalization rates.
Outcome: Continuous Care implemented screening questions and standardized case reviews. Hospice team members will be educated around RN and MD collaboration, utilization of checklists, and timely communication. The team reduced RN visits outside Continuous Care and will utilize specialized home health aides to increase billing hours. Teams are meeting in morning huddles to collectively assess the need for Continuous Care visits. Hospitalization will be reviewed against the screening tool in Q4, and the tool will be modified based on need and introduced in Q1 of 2022.
Project: Reduce the 30-Day Acute-Care Hospitalization Rate for CHHA/CMO Case Rate Patients
Goals: Reduce case rate acute-care hospitalization rates by 20% against the Q4 2020 rate of 17.1 % by Q1 2022; by 15% by Q4 2021, and by 13% by Q1 2022.
Project Leads:
Jeri Goodman, Associate Director for SW, Clinical Operations Support, CHHA
Natasha Merjuste, Clinical Intake Manager, Central Intake Business Development Department
Andrea Spencer, Director of the Care Management Organization, VNSNY Care360 Solutions
Myra Cohen, Population Health Quality Reviewer, VNSNY Care360 Solutions
Report: The team’s analysis indicated the current 30-day acute-care hospitalization rate data for VNSNY’s Care Management Organization and Certified Home Health Agency was 17.1% as of Q4 2020. Potentially avoidable hospitalizations lead to poor patient outcomes, higher healthcare costs and inefficient use of resources. The team identified several factors that were contributing to hospitalizations, including gaps and delays in care, Social Determinants of Health (SDOH) factors, poorly managed transitions of care, and inaccurate risk assessment. They sought to increase timely and effective communication and coordination between the CHHA and CMO to address risk factors for potentially avoidable hospitalizations. This would result in improved patient outcomes, meeting of quality care measures, increased customer satisfaction, and healthcare cost savings thanks to a more efficient use of resources and increased revenue from value-based payment incentives. The reduction in rehospitalizations will ensure that community-based homecare continues to be the preferred discharge plan and will uphold VNSNY’s mission to improve the health and well-being of patients/members within the community by providing high-quality and cost-effective care.
Outcome: An evidence-based SDOH screening tool has been added to Homecare Homebase. This screening will be completed by a CHHA RN or PT at OASIS touch points: Start of Care, Recertification, and Resumption of Care. If a patient scores positive for “unmet health-related social needs,” there will be a prompt for referral to Social Work. This standardized screening will help avoid process delays in identifying and addressing SDOH needs. The team also seized an opportunity to focus on cross-enterprise collaboration, which led to the idea of a resource suite housing all risk factors for rehospitalization in one place for patients to access from home.
Project: Align Capacity Management and Start of Care for the CHHA
Goal: Using the Queens branch non-admit rate of 0.2%, reduce non-admits percentage due to capacity constraints in the Brooklyn-01 branch from 19% and Bronx-02 branch from 13.2% to 1.8% by November 2021 for an improvement of 91% and 86%, respectively.
Project Leads:
Larry Lepelstat, AVP, Finance and Operations, CHHA
Gerard Christophers, Director, Referrals and Admissions, Hospice
Pearline Jackson, Branch Director, CHHA
Daniel Belloise, Account Manager, Business Development
Report: The team found that capacity constraints lead to a loss of approximately 600 referrals per month in the CHHA (Certified Home Health Agency), resulting in negative effects for patient experiences, quality outcomes, regulatory requirements, and financial goals. Focusing on the Brooklyn-01 and Bronx-02 branches, they sought to alleviate capacity constraints to accept all referrals by applying best practices based on the Queens-01 branch, which boasts a 0.2% non-admit rate. By correctly aligning staffing to patient volume, the CHHA can increase referrals, yield, and admittance rate, which in turn will improve care quality, patient experience and financial growth. The team analyzed the productivity of RNs by number of visits and number of hours worked.
Outcome: A proposed pilot program for the Brooklyn and Bronx branches includes a standardized start and end time for clinicians of 9:30 a.m. – 4:30 p.m. The team also identified the need for reeducation of branch schedule coordinators in regard to assigning the appropriate visit mix in order to achieve the minimum target of 6.0 points per day (30+ per week). The visit mix will include one SOC, four revisits, and one Recert/ROC/Discharge. Additionally, there was a reduction in external documentation time for revisits from 13 minutes to 7 minutes, and 77 minutes to 30 minutes for Start of Care visits.
By maintaining a 1.8% non-admit rate, the three branches combined will see a $4.3 million revenue growth in 2022, with $12.8 million growth for VNSNY overall.
Project: Reduce Turnaround Time on DME Requests for Wound Care Products for Patients with a Stage 3/4 Pressure Injury in the CHHA
Goals:
- Reduce the turnaround time for wound care supplies delivery for patients with Stage 3 or 4 pressure injuries from an average of 6.1 days to 2 days.
- Evaluate the new process implementation that was put in place for wound care supplies for third party insurance on May 1st.
Project Leads:
Risi Amolegbe, Director, Wellness Care Management, Community Mental Health Services
Victoria Adams, Associate Director, Infection Preventionist, Infection Prevention & Control, Quality
Monica Cayemitte, Clinical Field Manager, CHHA Infusion, Nurse Residency Program
Kendrick Chow, Director, Provider Operations, CHO Provider Operations
Report: The team aimed to reduce the turnaround time for the delivery of wound care supplies to patients with stage 3 and 4 pressure injuries from an average of 6 days to 2 days. Stage 3 pressure injuries can be very serious, and timely treatment is essential for a positive patient outcome. Failure to properly treat the pressure injuries can lead to infection, sepsis, and other life-threatening complications, such as blood poisoning or gangrene. The research team set out to evaluate the process of order fulfillment and to identify contributing factors for delays, including managed care authorizations, obtaining physician prescription orders, and vendor fulfillment.
Outcome: A standard wound care welcome pack will be given to patients with stage 3/4 indication upon intake. The requirement for an MD signature was moved to the end of the process, rather than as a prerequisite of the supplies being shipped. An audit tool was implemented for any order with five or more days turnaround time and cancelled orders are reviewed on a weekly basis. There was a reduction in the number of vendors providing wound care supplies, and clinicians were retrained on completing and submitting wound care supply orders. These changes resulted in a decrease in the average turnaround time for the delivery of supplies from 6 days to 2.65 days by October of 2021.
Project: Reduce Turnaround Time Between HHA Request and HHA Placement in the CHHA and Hospice
Goal: Develop system to capture the time frame of placement of cases in Partners in Care, and increase the number of cases within 24 hours for the CHHA and Hospice from an average of 44.86 hours to 24 hours by Q4 of 2022.
Project Leads:
Marianne Kennedy, Vice President, Regional Business Development, Business Development
Marzena Lambert, Clinical Case Manager, Partners MLTC
Thomas Cocozza, Director Operations, Partners in Care
Marina Lavelle, Director, Finance and Business Operations, Provider FPA
Report: Partners in Care has difficulties placing CHHA and Hospice cases for HHA services within 24 hours of a request, an issue that has only been exacerbated by the COVID-19 pandemic. The CHHA and Hospice have completely different processes for creating and expediting orders. The acceptance rate for Partners in Care has dropped to an average of 73% in 2021 from 88% and 90% in 2020 and 2019, respectively. Partners in Care takes approximately 6.45 hours to accept a case, followed by an average of 32.34 hours to place within HHA services.
Outcome: The team streamlined the process by reducing the numbers of steps from 33 to 14. Hospice team members were trained in a specialty and integrated into a team structure. Intake and clinical staff were trained on how to set realistic expectations and scheduling requests while considering limited workforce, hours, and frequency. The number of new hires increased for Partners in Care and bonuses are being provided for certified HHAs.
