Now, it's my pleasure to introduce two of my Hopkins colleagues who will help us better understand how to leverage data to improve performance. Mary Rose Hess has been with Johns Hopkins Hospital for 25 years, and she's currently the nursing manager of the endoscopy suite. She is known for creating standards of care for the introduction of new products and new procedures into practice. Mary Rose is a very passionate person about education and works very close with SGNA. She's the co-director of a very successful international conference called HITECH, which is the Hopkins International Therapeutic Endoscopy course. Now, Mr. Xianxian Heng is the administrative director of the business and clinical intelligence program manager at Johns Hopkins Medicine. Xianxian's expertise is in project management, financial modeling, information technology system management, and ethic, and has certainly served Hopkins very, very well. So Mary Rose and Xianxian, the audience is yours. Thank you so much, Dr. Abde, for the introduction, and it is truly a pleasure to be here to share on behalf of the Johns Hopkins Hospital endoscopy team with Mary Rose the work that we have done with our process improvement initiatives. So this is a quick overview of our presentation today. I'll outline the key performance indicators and then summarize the process improvement strategies. I'll also highlight the progress we've made so far through views of operational dashboard. First of all, we all love data, charts, and pictures, right? And then Mary Rose is going to share how we actually got there through engagement and culture change. Our performance improvement journey began in early 2020 as part of a broader system-wide initiative. This has been quite a long journey for us, and the pandemic was not the only barrier that we encountered along the way. We aim to accomplish four main goals, realign services with patient demand, identify the metrics to set expectations, establish monitoring tools for these metrics, and implement process enhancement to build a healthier practice. Using this visual here, as you can see, of the procedure room schedule, I'll walk you through the core KPIs that we've identified and the fundamental guiding principles in our process improvement efforts. If your institution uses EPIC system, this visual will likely be familiar, but for those ones who are not, the blue highlighted portion of the schedule here represents the operating hours between 7.30 a.m. and 5 p.m. The overarching goal of our performance improvement is to optimize procedural time within staffed hours. We also build a 20 minutes as turnover time in our calculation, which we'll discuss in the next slide. Our target is for 85% of the staff time to be case time or the turnover time. The second KPI is the turnover time. We define this as the previous patient wheels out of room time and the next patient wheels in time. Our goal is to achieve a turnover time of less than 20 minutes. The first case on time start is also the KPI measure that we keep track of. Our target is to have 75% of the room to start on time. This metric is tracked without any grace period, meaning we only meet the standard when patients are in room earlier than or by the block start time. Delaying the room on time avoids the domino effect of delays, especially when the outpatient rooms in our endoscopy center are often scheduled over 95% full. Our focused work group spearheads our efforts in turnaround time and first case on time start. We've introduced the scenario-based delay documentation manual, enabling each nurse to capture accurate data for our interventions. Bi-weekly, we analyze delay trends and develop action plans, including using timers on the procedure room doors and communication boards, as you can see here. These boards offer clear visual cues for patient readiness in PrEP and PACU bays. Our staffing schedule has also been adjusted to ensure morning coverage, while our charge nurse and PACU staff help in complex case room turnovers as well. At the same time, I'm not going to go over every single intervention, but we examine each and every step of pre- and post-patient cases and prioritize our effort based on the impact of our performance overall. Here's a chart looking at our first case on time start, with the target actually being 75%. This is since fiscal year 22. Our fiscal year starts with July and ends in June. Actually, our fiscal year 21 baseline, which is not shown here, is only 29% of first case on time starts. However, with the coordinated effort, we achieved 50% on time start in fiscal year 22 and improved further into 63% in fiscal year 23, and also in this fiscal year, as of now, as you can see starting from September, we're seeing an improvement over 25%. This is a chart here that we monitor our room turnover time. This is also consistently improved, and we have been remaining under 20 minutes of room turnover time on average, below 20 minutes, since last November. We're also monitoring our same-day cancellation rate as well. This chart here shows our same-day cancellation rate. The blue bar reflects the overall rate, and the orange and yellow dotted line represents inpatient and outpatient cancellation rates. In anticipation of the same-day cancellation rates, we implemented the standby program with one colonoscopy and one EGDs on Thursdays, which are our lowest-utilized days with the highest same-day cancellation rate. During our discussions with inpatient nursing units over lunch table talk, our nursing teams also identified obstacles contributing to inpatient cancellations and transportation issues as well. To achieve the utilization goal of 85%, we have implemented multiple monitoring and reviewing process, daily reviews with nursing, physician, scheduling team, making sure the gaps on the schedule are filled. And based on patient types and provide a specific same-day cancellation rate, we created a scheduling algorithm allowing overbook for urgent cases as well. This chart here shows the Johns Hopkins hospital and hospital unit utilization trend for the past 32 months. We have improved 3% year-over-year and exceeded our 85% utilization goal for nine consecutive months since January last year. We have increased our daily volume by 11% with only 4% incremental scheduled time, boosting our capacity to serve our patients. And of course, we have some fluctuations as well, especially recently from inconsistent inpatient volume and also cancellations, but our team showed great resilience and were able to get back on track with our goals. We're delighted to share our encouraging progress in our journey of process improvement. This is a direct outcome of the collaborative dedication of our teams, including the physicians or nursing team and supporting staff, which we deeply appreciate and are proud of. With that, I'm going to turn this over to Mary Rose to share with you how she does her wonders and make this into reality. Thank you, Shan Shan. So I'm going to review how we achieve these amazing results as a team. We're going to get into the nuts and bolts of how we achieve these results. So first and foremost, we want to make sure that our goals are in line with everyone, including our providers, our anesthesia team, our schedulers, operation, nursing, cleantechs, everyone. And secondly, we want to make sure that our goals are measurable, that they're SMART goals, they're achievable, and they're realistic. So our first step in this journey is to get the buy-in. So how we got our buy-in is by surveying our staff, our physicians, anesthesia, everyone. And on the survey, what we found were the most important questions were, what's your passion? What's your vision? If you could choose anywhere you want to work in our department, where would that be? And if you were granted to work in that area, what short-term and long-term goals would you create and make change? And what tools would be required in your toolbox to be successful? Well, I have to tell you, I'm very proud of my staff and the physicians that we work with because the suggestions that came back were amazing. And we used their suggestions as a compass to guide us. And what I did find is that the folks that are boots on the ground and, you know, function in those daily operational roles in the weeds, they really had the best ideas. So we gathered everybody's opinions, and we met as a multidisciplinary team, and we wanted to start our collaboration first to make sure that all of our interests were aligned and we had agreed-upon vision. And most importantly, through this, our relationships started to change because we started to understand each other's barriers. And once we understood each other's barriers, together, we were able to create shared goals for agreed-aligned quality improvement projects to improve our metrics, our workflow, and the quality of care for our patients. So the next step in this process is to start our process improvement plans. So goals were created and lined with our QI projects, and most importantly, again, those smart, realistic, measurable goals were implemented. And as Shanshan reviewed prior, a data collection process was instituted. And so what I found on Monday mornings, Shanshan would be here waiting for me in my office, and we would become those Monday morning quarterbacks. We didn't want to miss any opportunities to improve our initiatives. And we both live by, if you have an expectation, you need to have an inspection process. And most importantly, in our journey to improve our workflow here in patient experience, we wanted to make sure that through this journey, we're meeting these incentives, that we're meeting them, and meeting the expectations that we agreed upon. Because again, the focus is to improve the quality of patient care and our workflow. And one thing that I'm not noting is through this process is that it was very important to communicate these results with your staff, because we took the results from the survey and implemented them into quality improvement projects. So they needed to know the status and the progress and where we were. And through the delays that the staff was documenting through our data collection process, we did a deep dive into these delays as a united team. And we looked at what I like to refer to are actionable education opportunities. And these are the opportunities that we as a team can change. And when we look at these actionable delays, we look to see, is this a system process issue? Is this equipment issue, a supply issue, or people issue? So I'll give you an example of a people issue. We found that, you know, we're endoscopy, our patients come in dehydrated from the bowel preps that they're receiving. And we deal with a lot of cancer patients who are going through chemo and radiation. And these folks leave their vessels at home. So sometimes they can be very challenging. So with that said, this is something that was actionable. So we sent our nurses out with the venous access team in Hopkins to get more experience for placing peripheral IVs. We've also created a certified ultrasound and training along with implementation of cord access. And we started to also look at other areas that we could improve on. We were looking into our research. We're known for our research. You know, is those additional consentings, blood draws, holding up, delaying us? And if so, what are those barriers and what tools can we give them and what algorithms can we create together to keep our research here? Make it a part of our daily operations and our workflow, still meeting those metrics. Any new procedures and products we introduce, we want to make sure that we provide the appropriate training for our staff so they can be successful as well. And through all those actionable education items that I was just describing, and through this process of working together as a team, there became a change in our culture, this transformation of trust that we were no longer segregated, we were working together. And the leaders here were viewed by the staff as support, and we were here to serve them. And we wanted to make sure that we were credible for our character, that we were walking that talk, right? Giving them the tools that they need to be successful, communicating that good, that bad, that ugly, making sure that through this process, everything is transparent, and showing our capability and our daily actions. Our daily actions are more important than what our words are. So we live by here in endoscopy, and if you ask any of our staff, they'll tell you, we promote each other's best version. What we permit, we promote. There's fairness and equity across the board. Everybody's voice is heard. Everybody has a seat at the table. And through all this process, this huge mental shift and change of culture, we started doing more team building activities. We wanted to start strengthening those existing bonds we already had. Everyone is more comfortable with each other. We speak more freely from our environmental services, our housekeepers, all the way up to our director in the departments. So through these team building activities, we found that we started fostering an environment where people wanted to plant their roots and grow while we're building confidence. And it became a win-win situation. We created a nurse physician procedure group where we educate together. We go to outside venues for CU education. As mentioned, high tech, our conference, we run. Nurses are able to earn money. And that money that we earn, we send other nurses to other conferences to promote our profession and to have a presence. Shanshan talked about our table talk. Our nurses and the MICU nurses together created a policy when what's called our purple people that transport patients that are on vents and on pressures. What do we do when they're not available to transport in a world where everybody's short? So we've created a policy of when we can transport and help each other. We've created fun competitive games, best turnover time, best transport time. You get a gift card. When you put processes in place, you just don't, I believe in a stick and a carrot. You have to hold people accountable, but there has to be an award. They need to know that what they're doing matters and they're rewarded for their hard work and their passion. We have a younger generation here. That love to make TikToks and opened up a Facebook. Currently, they just won an award for their last TikTok video, not just for endoscopy or Hopkins, but under the enterprise of Hopkins, first place, very proud of them. We reach out to our community, not forgetting through these team building activities, all these bonds are built through these activities. You know, we work together to reach out to the homeless. We have a mentoring program of high school students that come here. And through this journey of success, and we're not forgetting to celebrate our wins. And we have become the best of the best. And I'm proud to say in our institution, we have the best utilization. We have the best turnover time, the highest retention rate. Our Glenn scores have increased significantly. We were recently featured in EndoPro magazine as a top endoscopy team. So takeaways is inspect what you expect, set up performance expectations that matter, measure right and measure often, communicate and embed these QI projects into your daily workflow. And remember, every minute counts in building that firm foundation of trust. Thank you.

Johns Hopkins Hospital

data leverage

performance improvement

key performance indicators

culture change