HILNNY's 7th Annual Conference is brought to you by:

Agenda

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Oct. 22

Noon – 12:30 p.m.

Log-in and networking

12:30 – 1:15 p.m.

Welcome and opening remarks

Courtney Burke, Chief Operating and Innovation Officer, HANYS

Arthur Gianelli, MBA, MPH, Chief Transformation Officer, Mount Sinai Health System; President, Mount Sinai Morningside

1:15 – 1:20 p.m.

Break

1:20 – 2:05 p.m.

Breakout sessions

Inpatient eConsults Address Increased Consultation Demand and PPE Preservation during COVID-19 Surge

Sharon Rikin, MD, MS, Director of Ambulatory Quality Improvement for the Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine

Session description

This session will explore how Montefiore responded to the demand for increased consultative requests for specialties impacted by COVID-19 and addressed provider safety in the context of shortages of PPE by developing and implementing an inpatient eConsult program. While the implementation of ambulatory eConsult programs have been described, reports of inpatient eConsult programs are limited.

Participants will be guided through important considerations and challenges faced in the development and implementation of an inpatient eConsult program including logistics, electronic medical record support and billing.

Learning objectives

  • discuss performing failure modes and effects analysis for inpatient consultative services in the setting of COVID-19;
  • identify key stakeholders needed for development of an inpatient eConsult program; and
  • determine important components of an inpatient eConsult workflow including requesting, staffing, documentation and billing.

NYP/Columbia Bed Flow Optimization: Lessons from the COVID-19 Pandemic

Marina Landau, MPH, Clinical Systems Engineer, NewYork-Presbyterian

Rushi Shah, PsyD, MBA, CHIE, Clinical Systems Engineer, NewYork-Presbyterian Hospital

Session description

In early April, an average of 55 patients per day, more than double the norm, were in the NewYork-Presbyterian Hospital–Columbia University Emergency Department waiting for a bed. Even after doubling standard ICU capacity, hospital leadership struggled to respond to this increased demand. To help, two physicians created the roles of medical admitting chief and ICU bed czar to oversee patient flow. The MAC directed patients to floor and step-down level beds, while the ICU bed czar managed intensive care level beds. This slimmed-down clinician-driven model dramatically improved accuracy in matching patients to appropriate levels of care, leveraged real-time bed and team availability, decreased time to bed assignments, created a faster endorsement process and improved clinician-to-clinician communication.

Not only did this approach enable our hospital to rapidly react to increasing demand, it energized a strategic initiative to optimize our bed management system. We are currently working to establish standard work for a clinician-driven bed management role, streamline our bed management model and build flexibility into the system to swiftly and effectively respond to the next possible surge.

Learning objectives

  • demonstrate the value of incorporating a clinician-owned role into the bed management process;
  • recognize the importance of standard work and why it is the foundation of successful process design, process improvement and system sustainability; and
  • design a flexible system built to withstand fluctuating demand.

COVID-19 Telehealth Innovation: Accessible Lean Processes for Patient and Clinician Safety

Akash J. Shah, MD, Internal Medicine Clinical Informatics, Nuvance Health

Session description

Nuvance Health is a seven hospital, 250-plus practice system serving patients throughout Western Connecticut and the Hudson Valley. COVID-19 response efforts transformed the way we deliver healthcare, emphasizing telehealth as an essential tool for facilitating clinical interactions.

The sentinel case of COVID-19 identified in our network inspired swift and decisive actions to preemptively mitigate the risk of transmission within our supported communities. It was immediately clear that expanding capabilities to host virtual visits were crucial to continuing to safely deliver vital services to our patients during, and after, this crisis.

Historically, less than 1% of annual office visits had been conducted remotely. Nuvance Health’s Lean approach to the virtual gemba involved establishing governance, consolidating contracts, creative IT engineering and EMR integration, repurposing preexisting technologies and creation and delivery of education to expediently establish a safe, efficient and convenient workflow for conducting patient visits which enabled us to conserve PPE and minimize risk to our patients and caregivers.

All levels of expertise displayed tremendous teamwork and the results proved worth our efforts. At surge peak, 98% of outpatient visits were conducted via telehealth. To date, we have delivered more than 200,000 virtual visits, greater than 20% of our outpatient visit volume.

Learning objectives

  • design telehealth workflow protocols for swift operationalization;
  • outline a strategy to deploy telehealth innovations aimed to maximize patient and clinician safety; and
  • explore approaches to achieve successful multi-state virtual gemba adoption.

2:05 – 2:10 p.m.

Break

2:10 – 3:05 p.m.

The Mount Sinai COVID-19 Experience

Panelists from Mount Sinai Health System include:

Don Boyce, Vice President of Emergency Management

Robbie Freeman, Vice President of Clinical Innovation

Carleigh Gustafson, MBA, BSN, RN, Senior Vice President, Strategic Operations and Integration, Mount Sinai Health System

Brijen J. Shah, MD, AGAF, Associate Dean, Quality Improvement and Patient Safety, GME; Medical Director, Quality, Mount Sinai Hospital and Health System

Session description

Leaders of the Mount Sinai Health System will share highlights of new processes and workflows created to respond to the COVID-19 crisis.

Learning objectives

  • explore examples of processes and workflows created by one organization in its response to the COVID-19 pandemic that you may utilize to increase efficiencies and patient care approaches for your organization.

3:05 – 3:10 p.m.

Break

3:10 – 3:55 p.m.

Breakout sessions

Implementation of Critical Illness Recovery Program as a Collaborative Effort to Improve Discharge Outcomes for Individuals with COVID-19 Associated Critical Illness

Bethan Rague, MS, RN, Vice President of Clinical Operations, UR Medicine Home Care

E. Kate Valcin, DNP, RN, CCRN-K, NEA-BC, CNL, Director of Adult Critical Care Nursing, UR Medicine Strong Memorial Hospital

Session description

The collaboration between a home care agency and an academic medical center to optimize the post-discharge recovery of the individual with COVID-19 associated critical illness is an innovation that occurred because of the pandemic. This program merged the work of the Post-Intensive Care Syndrome Clinic with an in-home pulmonary rehabilitation program. The program was developed through the collaboration of front line experts in both fields. It utilized small tests of change for implementation starting with one patient, evaluating what worked and what didn’t, making adjustments and then enrolling additional patients.

The program incorporates:

  • rapid initiation of physical therapy that continues for the duration of the 90-day home program;
  • formal assessments by nursing and social workers for cognitive dysfunction and psychological sequelae critical illness (depression, anxiety, post-traumatic stress);
  • medication reconciliation by critical care pharmacist; and
  • multi-disciplinary remote Zoom visits including patient, family, nursing, critical care provider, social worker, physical therapist and pharmacist at 14 and 90 days to assess ongoing healthcare needs and optimize recovery from post-intensive care syndrome.

This program is innovative because it is home-based with remote visits, ensuring capture of all patients regardless of socio-economic status or other barriers to healthcare.

Learning objectives

  • define post-intensive care syndrome; and
  • describe the elements of the critical illness recovery program.

Efficient Delivery of Medications for Chronic Conditions: A Response to the COVID-19 Crisis

Andrew Kolbasovsky, PsyD, MBA, CHIE, Chief Performance Improvement Officer, NYC Health + Hospitals/OneCity Health

Session description

The pandemic created challenges for individuals trying to obtain medications for diabetes, hypertension, statins and asthma. Individuals were less likely to leave their homes to obtain medications fearing exposure to coronavirus.

Gaps in medications place individuals at high risk of future admissions and ED visits. Medication adherence is critical to the health of patients and to the financial health of the organization due to the link to value-based payment metrics.

The COVID Rapid Rx Refill program was created during the pandemic to create a more efficient medication process. Patients on 30-day supplies of medications with one or fewer refill orders remaining were identified. Staff worked with prescribers to get orders entered and changed to 90-day supplies. Staff reached out to patients to assess medication and COVID-19-related needs, inform them of their available medications and help arrange medication delivery. More than 2,000 patients were engaged in the program. There has been a 21-percentage point increase in the use of 90-day supplies and the overall system medication adherence rate is almost two-percentage points higher than the corresponding time period the prior year.

Learning objectives

  • recognize how to identify patients at high risk of gaps in medication for chronic conditions;
  • construct more efficient systems to reduce gaps in medication for chronic conditions; and
  • discuss how to help patients and providers utilize resources to reduce waste in the process of obtaining medications.

Reprocessing N95 Masks with UV Light

Pravin Jadhav, MS, EDAC, Performance Improvement Coordinator, United Health Services

Session description

Like many healthcare organizations, UHS began preparing for arrival of COVID-19 patients prior to actually admitting any. PPE preparation was a primary focus-area. UHS began manufacturing face shields, making 5,000 during the first two weeks of April. Due to a shortage of raw materials, this option was not sustainable, and a team began to look at other options.

The solution they came up with was to reprocess N95 masks using a UV system. Binghamton University Watson College for Engineering and Applied Sciences built a UV light panel and rack for use in a space designated at UHS Wilson Hospital. Additional racks were built by the UHS Engineering Department as well as creating a negative pressure room, appropriate outlets, signage and other items needed to create a UV lab in space previously dedicated to offices.

Safety was top of mind when building the lab and process. A sterile processing team worked with PI to create a process and training for the team to begin disinfection with UV light. Infection control, SPD, supply chain, engineering and nursing staff were invited for a walk through and FMEA was conducted by the PE&I team with everyone involved before the process began.

Ultraviolet germicidal irradiation uses ultraviolet light to inactivate microorganisms. The UV system was constructed and staff were trained in less than two weeks. N95 masks were collected and cleaned for three months, from April to June. At the end of June, 1,429 N95 masks were processed. Increased UVC dose ensured that all pathogens were killed in a process time of 21 minutes, increasing capacity to reprocess a greater volume of N95 masks daily.

Learning objectives

  • prepare a PPE calculator to gauge supply chain needs and navigate potential PPE shortages;
  • determine feasibility and effectiveness of UVC light to reprocess N95 masks and other PPE; and
  • examine requirements and logistics to build a UV lab in a hospital.

3:55 – 4 p.m.

Day 1 Closing remarks

Oct. 23

10 – 10:15 a.m.

Log-in and networking

10:15 – 11:15 a.m.

Panel Discussion: Achieving the Triple Aim in a COVID-19 World

Moderator:

Jeremy Boal, MD, President, Mount Sinai Downtown, Executive Vice President and Chief Clinical Officer, Mount Sinai Health System

Panelists:

Niyum Gandhi, Executive Vice President and Chief Population Health Officer, Mount Sinai Health System

Anthony Marinello, MD, PhD, Chief Medical Officer, Capital District Physicians’ Health Plan, Inc.

Ferdinand J. Venditti, Jr., MD, Executive Vice President for System Care Delivery, Hospital General Director and Vice Dean for Clinical Affairs, Albany Medical Center

11:15 – 11:20 a.m.

Break

11:20 a.m. – 12:05 p.m.

Breakout sessions

OR Ramp Up

Sharon Bestle, MSN, RN, Assistant Vice President, Peri-operative Services, Albany Medical Center

Session description

For post-COVID-19 recovery, the operating room at Albany Medical Center utilized a number of Lean principles including plant layout, standardized work, visual and batch reduction to drive out waste and provide a safe, efficient and effective means of introducing surgeries to the center.

From redistributing surgeries to establishing a COVID-19 testing center for the community to developing staff, the entire effort helped to provide the critical care our patients need and jump-start revenue. The cross-functional team developed a close down and ramp up plan that included closing two outpatient surgery centers, moving from 80 cases per day on the main campus to 30, and transitioning staff to labor pools for redistribution or two-week standby leave to avoid layoffs and furloughs.

This session will highlight several key measures taken, including:

  • limiting the number of rooms, establishing PPE process protocols and minimizing academic learning;
  • establishing dedicated anesthesia teams in ORs;
  • stand-up of a COVID-19 drive-thru;
  • shifting all elective cases to SCC for patient safety and ease;
  • rapid ramp up of supply chain;
  • eliminating block time at all campuses and standardizing scheduling;
  • establishing tiered ramp up based on surgical time and case complexity;
  • developing interchangeability model allowing for cross cover and staffing shortages; and
  • utilizing single-point lessons and daily management boards.

Respect for people and continuous improvement were paramount in every decision, equal or higher volumes than pre-COVID-19, in fewer rooms.

Learning objectives

  • review how Lean principles are applied to development of the close down and ramp up plans;
  • outline continuous improvement opportunities; and
  • recognize the importance of respect for people in a crisis.

Bring it to the Lean Lab: How the MSM Lean Team Supported Rapid PDCA during the COVID-19 Crisis

Mary Ghaly, Manager of Process Improvement, Mount Sinai Morningside

Shelcy Kamrud, Manager of Process Improvement, Mount Sinai Morningside

Kim Keller, Senior Manager, Process Improvement, Mount Sinai Morningside

Session description

New York City was the epicenter of the first wave of the COVID-19 crisis in the United States. Rapidly changing guidelines from the New York City and New York State Departments of Health and the CDC presented daily challenges to the incident management team. As these challenges arose, the Lean team became the defacto problem solving arm of the IMT.

As our COVID-19-positive case counts grew, rising from four to 100 within 10 days, it became clear our expertise in facilitating problem-solving was needed real-time. The larger problem to be solved, how do we navigate this unknown virus while providing quality care and keeping our staff safe, led to dozens of smaller problems. As those problems arose, our incident commander could be heard repeating the phrase, bring it to the Lean lab and let me know what you come up with.

Learn how the Lean team used A3 thinking, standard work, visual management and other Lean tools to lead rapid PDCA cycles for problems to be solved today, this morning, this hour and within the next 30 minutes!

Learning objectives

  • examine the structure for how problems are identified and handed over to the Lean Lab;
  • discuss how a Lean team convenes stakeholders, implements solutions and reports out to the incident management team;
  • identify specific examples of problems that may arise in response to the pandemic and the Lean tools utilized to rapidly implement solutions; and
  • describe plans for how a Lean team formally incorporates into emergency management response.

Implementing a Four-tiered Huddle Structure with Cascading A3's utilizing virtual and physical boards

Brian L. Guzy, Senior Performance Excellence Consultant, St. Peter’s Health Partners

Bridget Smith, Performance Excellence Consultant, St. Peter's Health Partners

Session description

On March 9, we implemented a tiered huddle structure. Within two weeks, we realized this would need to be a virtual meeting and become the connective tissue for our three-hospital system.

Our T3 huddle has become a shining star of the system. It is not only our safety huddle, but our state of daily readiness and incident command. The tiered system allows staff to communicate and escalate barriers, from the front-line to the senior leadership team by 10 a.m. daily. We now use cascading A3s to complete the cycle from SLT to staff and back to SLT as a means for strategic alignment.

Learning objectives

  • discuss approaches to implementation of a tiered huddle system; and
  • align objectives and projects with cascading A3s.

12:05 – 12:20 p.m.

Break and poster sessions

12:20 – 1 p.m.

Virtual Gemba

Swati Garg, MPH, Senior Director, Operations Development, Mount Sinai Health System

Hilary Pauli, Associate Director, Health System Operations, Mount Sinai Health System

Chris Anne Scalamandre, RDN, CPHQ, Facilitator, Health System Operations, Mount Sinai Health System

Stacia Studt, Manager, Process Improvement, Mount Sinai Health System

1 – 1:50 p.m.

Keynote Address: Lean Thinking and Innovation during Crises

John Shook, Chairman, Lean Global Network and Senior Advisor, Lean Enterprise Institute

Learning objectives

  • discuss how a culture of Lean thinking can contribute to social, functional and economic stability for an organization; and
  • recognize that the balance of social and technical perspectives is key to an organization’s crisis response.

1:50 – 2 p.m.

Closing reflections