Stop Wasting Time And Start HEALTH CENTER PROGRAM 

Healthcare providers must not waste patients' notes.

Many patients believe that healthcare providers disregard a crucial metric in raising patient satisfaction: the patient's time. As a result, patients frequently wait longer than they receive treatment. In 2014, Jess Jacobs, a director of an innovation lab, began blogging about her treatment for two rare diseases. Kaiser Permanente is working to improve... more Jess received Six Sigma Green Belt training. She described a 12-hour wait in Health Center Program  the emergency room as having a "7% process cycle efficiency," which is so unlike the typical patient.

Similarly, she found that only 29% of her 56 outpatient visits were helpful. 

She made 20 trips to the emergency room and spent nine hospital stays totaling 54 days, but according to her calculations, only 0.08 percent of that time was spent treating her condition. In one blog post, Jess wrote, "Stop wasting my time." Please don't waste my life.

While Jess's writing was distinctive, her attitude was not. In the same way as other patients, Jess felt her suppliers were conveying next to no nature of care when characterized by the one metric that made the most significant difference to her: time.

We are working to improve this metric, even though Jess did not receive treatment from Kaiser Permanente. However, we have had to challenge established paradigms and include time-saving measures for our patients as standard quality measures.

In the United States, for instance, the typical hip or knee replacement procedure requires a hospital stay of three days. This is large because many hospitals receive reimbursement for each day a patient is in a bed, and it is simpler for the care team to monitor the healing process when all of their patients are in a single unit. The system was designed by and optimized for hospitals and surgeons to provide safe care and favorable outcomes. What about our patients, however?

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We could examine the experiences of a wide range of our hip community health center replacement patients due to Kaiser Permanente's integrated care model, which combines both treatment and insurance. Amazingly, we concluded that up to half of our patients could safely go home the same day as their surgeries. However, this could only happen if the entire care team followed a set of coordinated procedures, many of which would need to be performed outside the hospital.

The process follows:

 A care coordinator gives patients and their families information about what to expect before surgery. Next, they have a home visit from a physical therapist to review their education and conduct a safety assessment. A pharmacist then examines the patient's prescriptions. Finally, other care team members visit the patient's home to deliver walkers of the appropriate size and ensure that the patient's bed is on the ground floor. These actions not only set expectations for home recovery but also allow the patient to get to know the care team and build trust in them.

Orthopedic surgeons take an anterior approach on the day of the surgery. 

Although they may find this more challenging to Health Centers learn, it significantly lessens the pain of surgery and recovery and enables the patient to walk right after the procedure. In a similar vein, orthopedic surgeons select from a restricted, predetermined collection of standard instruments. As a result, nurses and other team members only need to learn how to use a small number of devices. We have determined that this expertise with fewer devices lowers the rate of infections and complications.

The patient goes home after demonstrating that they can get dressed and walk 30 to 50 feet safely after surgery and a meal in the recovery area. A physical therapist arrives at the residence the following morning, ready to begin the first of six in-home PT sessions. The care coordinator calls to check on the patient and ensure they have a contact number for any questions or concerns. A nurse might show up to take vital signs. A physician's assistant reviews the electronic health record and adjusts the treatment plan if necessary. 

The loop is closed when the patient visits the surgeon in their office about two weeks later.

In a psychologically secure setting where everyone is responsible for speaking up, and team members are collectively accountable for responding to patient needs and ensuring the best clinical outcomes, reliable, excellent care is provided throughout the process with multiple safety nets. However, strict adherence to protocols and standards is required for this scenario to work. For example, the system will only succeed if the physical therapist shows up the day after surgery. Then, the patient will go to the emergency room, where they may be admitted if they do not feel safe or know what to expect.

Most importantly, patients are at the forefront of every workflow's design. 

After all, what is the zero-day hospital stay rate of hospital-acquired infections? Much closer to zero than for a more extended stay. What are the home visiting hours? Generous. What about the food's quality? We hope that it will be better than the hospital. What are the patient satisfaction ratings with their own home experiences? Outstanding. And how much quality time do we give patients so they can recuperate at home, surrounded by family, and away from the constant noise of the hospital? Exceeding three days.

About 15,000 elective knee surgeries and 8,000 elective hip surgeries are performed annually by Kaiser Permanente physicians in our practice area of Southern California. Recently, 11 percent of our hip and knee patients have recovered at home without going to the hospital. We plan to increase that number to 25% by the end of this year. It will be 50 percent at the end of 2018. Additionally, most of a zero-day stay's time is spent treating the patient, a crucial metric to many of our patients—saving time.

Although the strategy may sound appealing, what Health Center Program about the outcomes? Our information shows that the readmission rate for patients who return home following a medical procedure is around 2% — precisely what it is going after who recuperate in the emergency clinic.

We often think of people like Jess Jacobs as we implement this strategy throughout Kaiser Permanente.

 Yet, according to Jess's calculations, less than one-tenth of one percent of the time she received treatment went toward treating her conditions. To put it another way, rather than healing, Jess spent 54 days, or almost two months, in the hospital. Tragically, 29-year-old Jess Jacobs passed away in August. Imagine how much she would have appreciated having those two months back.