Case Study: Transforming the Worker's Compensation Experience
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This document provides an overview of transforming the worker's compensation experience through an experience-based design approach. Key elements discussed include: 1) Experience-based design aims to promote healing through a wellness-designed environment, provide measurable outcomes, and reduce costs. 2) A patient advocacy difference is created through a workers compensation liaison who understands patient and company needs upfront to create individualized treatment plans. 3) Generating protocols for common injuries establishes baselines for expected recovery timelines. 4) Elements like pre-registration intervention, on-site prevention, and a tracking system solution help provide a seamless experience and monitor progress. 5) The transformed experience focuses on improved outcomes
Case Study: Transforming the Worker's Compensation Experience
- 1. Case Study: Transforming the Worker’s Compensation Experience “As co-creators of the worker’s compensation process; physicians, clinical assistants and associate practitioner’s modeled the new inspiration of how it could look, feel and ultimately provide better care. Each process was detailed, understood and broken down. We then transformed how it could be, how it should be.” ~ Curt Kubiak, Executive Director
- 2. Transforming the Worker’s Compensation Experience... Emerging Trends: Page Patient Focused Healing Environment 3 Experience Ecology 4-5 So What’s Different 6 Executive Summary 7-10 Experience Based Design - Orthopedic M.D. 11-12 Patient Advocacy Difference 13-17 Generated Protocols 18-19 Total Cost Containment 20-21 Pre-registration Intervention 22-23 Tracking System Solution 24-25 Onsite Prevention 26-27 Not Just Another Building 28 The Institute Solution 29-30
- 3. Patient Focused Healing Environment Comfort Healing gardens If you think of a health care facility as a bleak environment with insensitive lighting, stiff furniture and views of ceiling tile from Therapeutic art and sculpture a rigid bed, read on. Picture a medical facility highlighted in warm, tender colors, which integrate the exterior feel with the Exam room patient scheduling heart of your medical experience. How about an atmosphere that creates patient outcomes of comfort, ease, warmth, Oversized private rooms contentment, and a truly welcome feeling. Is this a vision? Yes. Is this reality? Yes. Discrete storage of supplies and equipment With the help of Miron Construction, progressive medical Integration of the natural environment into the facility organizations have re-invented the concept of health care and are creating the spirit of the ideal patient experience. “Village” campuses of ambulatory facilities This revolutionary approach to patient experience design and patient attachment, places emphasis on healing design. It is Integrated physician offices based on how patients feel and how quickly they are brought serving multiple functions back to productivity as they are immersed into our process. Cafe, library, Caregivers in the healing environment understand that patients’ bookstores and surroundings affect their well-being. Below are ideas that this health-related process uncovered: services Wellness, ‘I Spot’ Patient Registration Areas fitness and complementary Natural lighting throughout the interior medicines Noise reduction design elements Patient environment control
- 4. Experience Ecology The ideal worker’s compensation experience should encompass specifically for each patient. Staffing a Workers Compensation three ecology items that must be integrated as the basis for Liaison as the primary contact and project management the transformation. By understanding the outcomes of all three resource, saves time and creates, efficiencies in communication.. areas in conjunction, with one another sustainable change can take place allowing for a patient-specific, effective, time-saving Informational experience. How well has the process been optimized to eliminate The three critical elements are required to build this type of redundancies and handoffs and ensure that poor practices have transforming healing environment are: Physical, Behavioral, not been automated to create rework? Informational. It is important to align each element with the needs of the patient and his organization. However, it is even Informational elements include all forms, reports, more critical that each element is designed to support and communication collateral, signage, and internet technology. compliment the other elements. One or more of these main All information elements are provided online with easy access elements are often forgotten, executed poorly, leaving their for the patient, case manager and company. Patients without uniqueness unappreciated and separate. internet access should be contacted to complete forms prior to arrival at the medical care facility. Physical “We used the expected emotional outcomes from How convenient, accessible and effective is the physical layout process users connected with the optimized toward delivering the service that the patient needs? patient flow from functional owners, to create value for patients, employers and physicians Physical elements include all aspects of spatial integration. alike.” What was once a sacred space was up Physical These include the facility, access to all services, one point for discussion. Anything was possible,” said registration, on-site services such as physical therapy, MRI, Kubiak. surgery, orthotics, imaging, and patient preparation and post operative care. Behavioral Behavioral ECOLOGY How friendly, thoughtful and respectful are the Individuals delivering the care to meet patient needs? Behavioral elements include all interactions between the patient Informational and facility staff in progressing medical care as prescribed
- 5. So What is Different? An opportunity for Workers Compensation transformation Great processes transform your focus… Health care providers have long been working on improving People want to feel better. People from all walks of life have an care processes and staff efficiencies. The notion of placing innate desire to feel part of something, to believe they matter. patient outcomes first, complimented by provider and partner At essential moments in which individuals connect with a health efficiencies creates an experience that is uniquely different. care provider, healing opportunities become available. Innovative companies want to fulfill customer needs and build Ask the tough questions… strong bases of loyal employees, and business partners who are also advocates for the company. Companies have long Review patient scenarios, analyze sequential movement, understood that employee and partner health is vital to the long examine people interchanges and emotional connectivity. term success of any organization. Identify exactly what patients need, precisely how to provide the appropriate care and deliver it in a way that all users won’t forget. According to the most recent health care research, worker compensation patients are 50% more likely to return to work Re-design the experience from start to finish. through innovative patient experience design as compared to the more traditional process. (cite) By providing injured workers appropriate care more quickly and by efficiently managing the treatment process with a single resource the entire process can be completed in less time saving more money. What will remain. . . We live in a world of over-stimulation, pressure, insecurities and economically fragmented lifestyles. The Orthopedic & Sports Institute has developed a methodical, workers compensation approach for delivering the experience in a brand new way. We have embraced the complexity of the process, dismantled connectivity flaws and integrated design tools so injured employees feel great about the experience and return to work faster.
- 6. Transforming the Worker’s Compensation Experience Executive Summary Experienced-Based Design accomplishes three objectives: For over 80 years, the worker’s compensation system in the United promotes healing through a wellness-designed environment. States was created with one end in mind. To provide a healing provides measurable outcomes environment, one in which a worker is cared for and back to work in a timely manner. Over the years much has changed; the bureaucracy reduces operational costs of the insurance system, the inadequacy of medical system We have integrated the patient vision into the process, giving an administration and the lack of understanding of the process have extraordinary experience-based design application which advocates all caused system failure. What was once an efficient and effective actively managing healing time and creating cost savings. methodology, is now a frustration, a process of complexity and concern. The Miron Construction Experience-Based Design team Patient Advocacy Difference was asked to assist in creating a solution that didn’t exist... Through a revolutionary Workers Compensation Liaison Guided Reinvent the experience... Solution, worker and company needs are understood at the beginning of the process as opposed to the middle or end. Through the understanding of desired user outcomes and the “We understand the needs for a patient designed experience”, identification of (7) seven key solution areas, leading worker’s commented Diane, Dappern Workers Compensation Liaison. “We compensation providers embrace what makes a difference for understand the need for a new way of thinking.” patient’s , case managers, insurance providers and companies revealing a new way of thinking. Throughout a four month period, Generated Protocols we researched, detailed and illustrated what worked and what didn’t work with the current worker’s compensation system. What Rarely have clinics and health care providers outlined the expected we found was astonishing. Our research showed that very little had healing process and time line for recovery from an injury. Advanced changed throughout the past years. “We were curious of how it processes require protocols for 10 different surgical procedures as could be”, commented Dave Eggert, MD. “We knew that through the baseline for a patients recovery. Unprecedented for the industry, the changes we imagined, the difference could be felt, by our protocols serve as the basis, the foundation for expected back to patients their companies and ultimately in the bottom line for every work dates. organization we serve.” Experience Based Design The Institute realized that the worker’s compensation environment must be therapeutic, supportive of family involvement, efficient for staff performance, and restorative for workers under stress. We made decisions based on the best information available from research and case evaluations. Critical thinking was required to develop appropriate solutions with experience to back up the changes.
- 7. Transforming the Worker’s Compensation Experience Advanced Total Cost Containment Plan Tracking System Solution The economics of health care in the United States are changing. According to The Institute research, it is critical that case managers Baby boomers are headed into their high-maintenance years, and and company representatives know the status of patients while they’re living longer than their parents, they will need and throughout the duration of the medical care plan including: injury expect a state-of-the-art health care experience. The 18 to 40 age diagnosis, treatment and follow-up care. Leading facilities have population will be decreasing by 3% over the next 10 years. The developed a web-based tracking system, that allows for access to fact remains...there won’t be enough workers for the current pro- expected treatment times and the return to work date . Orthopedic duction capacity. The time for transformation is now. Our research M.D. Brian Lohrbach agrees, “The tracking system identifies process allows for these changes and quantifies the outcomes, serving the owners and treatment cycle times to better manage return to needs for the short and long-term. work dates. Any breakdowns, system fragmentation and overall inefficiencies are addressed proactively. Our team knows what is Pre-Registration Intervention working and what needs assistance. There is never a finish line with the journey of continuous improvement.” Registration processes are typically the first opportunity for major breakdown in any health care system. It is often overlooked and By understanding where a patient is in the process and what is misunderstood. The current system is cumbersome and anxiety next, plans can be formulated, demonstrating the best possible ridden. Medical facilities need to recognize that the traditional outcome, patient health and recovery. system is broken. It is time for a change and to create a plan which allows for the growth and efficient treatment of the patient.
- 8. Transforming the Worker’s Compensation Experience On-site Primary Prevention It is no secret that the key to controlling health care costs is avoiding Creating hardier employees is the secondary prevention aspect of the incurring these costs in the first place. Therapists must start by process. Connecting to the PCP early assists in many ways. Including reviewing the ergonomics of the existing workplace to see if there are jobs that may be prone to injury. In addition, visit the workplace with The identification of barriers to recovery, which are also predictors medical staff regularly (minimum once per week) in order to address of re-injury and referring these personal medical conditions for any minor issues early in the process before they progress into more treatment. serious issues. Patient education, empowerment, self-treatment and wise Emergency room visits have become common place as work consumption. related injuries get referred on to the ER more often than any other medical provider. Avoiding the ER will save cost in the visit, but more Teaching patients how to distinguish “discomfort” from injury. importantly, reducing recordable accidents is a realistic target of on- site first aid/nursing/medical care. The key is to provide incentive for employees to choose the most effective and economical choice in medical care from the start. The stakes are high when it comes to worker’s compensation prevention. Through on-site intervention, worker and company needs are understood at the beginning of the process as opposed to the middle or end. This early intervention allows for the employee to feel confident in the provider and the employer to be confident that the care is provided in an integrated fashion to avoid unnecessary costs, or time off.
- 9. Competencies of the Transformed Experience Experience Based Design Generated Protocols Patient Advocacy Difference Time Cost Advanced Total Cost Containment Pre-Registration Intervention Tracking System Solution Onsite Prevention
- 10. Experience Based Design Experience based health care centers create environments that One Mind, One Process are therapeutic, supportive of family involvement, efficient for staff performance, and restorative for workers under stress. In To address these traditional issues, the following key researching the best outcomes for patients, consistent access components were designed in this and the remaining 6 to orthopedic trained physicians was viewed as the single most competencies: critical element by patients and case managers alike. Orthopedic physician care delivery embodies how functional groups and One Mind, One Process: All points of care are aligned with patient focused process owners collaborate to fulfill patient- the same outcome based vision and this is communicated for centric strategies and tactics. For example, it is important adjust every point of contact. The workers compensation process is organizational boundaries and measurements to facilitate not complete until staff deliver a solution consistent with the patient healing activity by redefining days to healing. By doing protocol with any exceptions clearly noted and plainly explained. so, 20 days of healing can be saved over a more traditional Build the process that take the concept to reality. approach (see figure 2). Segment-Influenced Operating Model: Redefine expectations, silos and divisional boundaries are removed so that decision Current Issues making can be made in the best interest of the patient outcomes, not departmental profit objectives. An experience based design focused organization relies on empirical data in managing and nurturing a patient driven Cross-Functional Transparency: Enable departments and enterprise. The following issues were identified by reviewing the channels to collaborate together for the effectiveness and data: efficiency of the process. With a redefined process in place, automation through IT resources can make the tough tasks of Diagnose Causation driving data easier to manage. Complete & Timely Documentation Return to Work - Limited Duty Process-Focused Architecture: Define the foundational elements that align the business expectations and patient Too Many People/Undefined Roles/Accountability experience outcomes. The optimal comprehensive solution OSHA Log - Recordable combines the optimal process, the appropriate tools and the requisite staff to bring the service to life. From the beginning, Consistency of Message Among Providers plan for the people, systems, and data to define the healing IME Process process. Contained Costs
- 11. Experience Based Design - Orthopedic M.D. Access Effective worker’s compensation solutions and strategies are original and authentic. After researching over 160 individual treatment plans and surgeries, it was apparent that access to Orthopedic M.D. was one of the most important elements to an effective and efficient healing process. With the initial access to a surgeon and not a associate practitioner or orthopedic mid- level, 10 days of wait time - ultimately 20 days can be saved. This ultimately provides a tremendous savings of time and costs for all stakeholders. (see figure 2). Figure 2 OTHERS: ORTHOPEDIC & SPORTS:
- 12. Patient Advocacy Difference Attached patients feel better... about their company, the provider and The key competencies and indicators of the patient advocacy ultimately their healing. difference are designed to capture information from patient interactions at the start to help create a patient treatment time line to The Workers Compensation Liaison process begins with an drive the design of the healing environment include: understanding of what patient and company needs are and subsequently creates a plan specific to them based on the ideal Patient Understanding: In recognizing the best method for patient healing outcome. treatment, the Workers Compensation Liaison must ask 10 fundamental baseline questions which serve as the blueprint for the individual plan. Resolve Inconsistency Outside-in Treatment Design: Patient treatment plans are based on Communication is identified as the most frequent source of a full discovery of the baseline expectations and desired outcomes breakdown between the provider, worker and company. Inconsistency combined with expected tactile and protocol performance. in information gathered and reported can create fragmentation between the three groups. The Workers Compensation Liaison Feedback Loop: A communications matrix is established to ensure serves as the liaison within the system allowing for a consistent that all parties involved are identified and their contact information communication process, eliminates any adversarial relationships. and area of expertise are readily available. Formal means are established to learn about the patient and company information and Emotions tell the brain what issues to pay attention to throughout the use them - at both the patient and aggregate levels - to continuously process. A system that requires immense mental effort to navigate will update treatment the plan. frustrate users and provide a negative experience. Patients, who find it complicated to obtain information, experience detached employees Personalized Treatment Plan: Patients are given a unique, relevant or have difficulty maneuvering through a process, will often become treatment plan that aids in the healing allowing for a quicker return to aggravated. This negative experience reflects directly on the time work. taken to heal and time away from work. Worker’s Compensation Research: A system comprised of highly Companies who work in a patient advocacy system are able to trained individuals, operating the latest technology is devised to “learn” approach the worker’s compensation process in a way that builds about changes that occur which will affect the workers compensation efficiency and confidence through knowing at all times where the system including: reporting needs, communication requirements patient is in the system, while simultaneously understanding the time and most significantly patient needs, emotions and behaviors which and cost ramification to decision making. are utilized to advance the designs of the worker’s compensation experience.
- 13. Patient Advocacy Difference The good news for injured workers is that interest in improving the Total Time - Return to Work quality of workers’ compensation medical care is expanding. The Workers Compensation Liaison process aids in this expansion by differentiating the return to work system as well as the aggressiveness of limited duty. Diagnose Causation 70% The challenge is not only to continue to advance this area, but to Time Off Work translate the knowledge gained throughout the process into a treatment schedule which provides the best outcomes while bringing the injured worker back to their place of employment. Driving the design of the return include: 30% Treatment Return to Work: Early intervention for the injured worker requires the Process advocate difference by connecting the individual to the proper care provider. This speeds up the often weighted down traditional process, allowing a rapid deployment time line and added company value. Limited Duty: The differentiation is establishing protocols and guidelines to allow the patient to return to work in some capacity during the healing process. This value added activity limits the exposure the company has, reducing down time and adding to the overall productivity of the working environment. Causation Guidance and Determination: Resource availability for the medical staff to assist in determining causation of the injury. Access to this resource ensures that treatment plans can be executed with confidence and accuracy. No Extra Charges: Early resolution of causation will allow a provider to determine the correct payor for the injured worker. This eliminates extra (often overlooked) expenses associated with a treatment plan.
- 14. Patient Advocacy Difference Fragmented Communication Typically, the worker’s compensation process involves multiple locations, registration systems, information sources, people and confusing channels. Research indicates that it is often the most misguided system in the entire process. Effective systems create one source for patient, case manager and company communication allowing for consistent communication, feedback and correspondence. Without this clear source, information and points of access are confusing adding stress and anxiety to the injured worker (see figure 3). Figure 3
- 15. Patient Advocacy Difference Phone / PCP Liaison Concierge Referral Connection The Workers Compensation Workers Liaison serves as the Compensation liaison within the system Figure 4 Liaison allowing for a smooth communication process, a less adversarial connection. Orthopedic M.D. Communication is the first source of breakdown between the provider, worker and company. The X-Ray Advocate follows a precise, guided path avoiding fragmented communication. Noninvasive MRI Care Surgery Physical Therpay
- 16. Patient Advocacy Difference 10 Fundamental Baseline Questions 5. Describe/provide information on the hazard/incident or other causative agent involved in this injury/illness. That Need to be Asked. . . 6. What is the resulting injury/illness? 1. What are the patient/employee demographics of the case: 7. Describe your job: Name, address, DOB, phone, etc. What hours/shifts How many hours per shift 2. What is your employer data: Other environmental elements ( wet, hot, cold, Who is employer cement, etc.) Who do you report to regarding injuries (supervisor, HR, EHS) 8. Describe other activities you participate in: Employer address, phone, fax etc Sports Hobbies 3. Has the incident/injury been reported? Secondary jobs To Whom When 9. Describe pain and or discomfort elements: Do you have a copy of a written report? Use of pain chart for area Have you been treated for this incident (whom, Pain level where, etc) Limitations because of discomfort 4. What is the WC carrier info? 10. Past History: Name of company Any similar incidents Name of adjuster This joint vs, other joints Name of case manager File number Contact info. Have you been contacted by the WC carrier to give a statement?
- 17. Generated Protocols Effective worker’s compensation solutions and strategies are based Expected to Actual upon a standard protocols of expected outcomes based upon historical treatment plans and actual recovery times. Each patient If you don’t know where you’re going how will you know when you treatment plan is then gauged against the protocol and any variances get there? explained to ensure that the system progresses timely and accurately without compromising quality. After researching over 160 (validate) Every challenge requires a plan, and workers compensation challenges individual treatment plans and surgeries, it was apparent that are no different. Immediately following the injury, the employee protocols must deliver needs-based solutions that contribute to the should be directed to a medical staff member that assigns a team holistic patient care expected. of professionals to the workers compensation case. The first team members would be the Workers Compensation Liaison and the Key competencies and solution indicators enhance the ability to orthopedic physicians medical staff member. These medical staff develop and provide relevant, integrated and personalized treatment members will ensure that all relevant information is retrieved and plans. recorded properly and that the patient is seen as soon as practical after the incident. At this initial visit a treatment plan should be put Total Cost Containment in place based upon standard protocols to clearly define the desired outcome and time line of the process. Workers compensation costing activities often concentrate on the cost of the medical treatment alone. Companies request and The higher-level challenge to the organization as a whole is making sometimes even pay employees for second opinions and shop for the this practice a routine part of the corporate culture. By have the lowest procedure cost. Our analysis demonstrated that the procedure existing team members create detailed process flow documents cost, while significant, was only a fraction of the Total Treatment Cost. of existing the workers compensation process, including activities, By far the most significant cost of the treatment plan was the lost owners, value-added time and queue times areas of change - productivity and replacement cost related to employee time off the including when, where and how were identified. The employees that job. The Workers Compensation Liaison not only ensures accuracy we asked to implement the changes were an integral part of crafting of treatment plan and ensures communication of progress, but the solution, so that they not only knew what they needed to do also measures progress toward the desired outcome to explain any differently, but why it must change as well. unexpected variances.
- 18. Generated Protocols Expected outcomes must be aligned to fuel the change across the Protocol Based Expectations: Communication from the medical entire organization. Providers must establish an environment that care facility is triggered proactively based upon expected outcomes promotes a systematic capability to cultivate the expected treatment spelled out in the customized treatment plan based upon industry- plan. Each of the protocols must be driven through innovation during wide protocols. The protocols ensure that the medical facility is the deployment (see figure 5). actively managing the employee progress with a single point of communication and accountability. Define and maintain a library Real Time Information: Motivate internal providers to access of event-based rules that trigger communication events based on information and outline process expectations and owners up front. company and patient actions. This method ensures accountability for timely turnaround of ‘after visit summaries’, and company follow-up. Innovation comes to life through the eyes of the user experience and helps to ensure outcomes happen every time, without fail. Solutions Realistic Segment Treatment: Encourage internal feedback must be diagnosed from the collected data and causation outlined to to leverage the change required to accomplish the outcomes. achieve the expected results. Ensure that this will be a continuous change process rather than a destination. Active Guided Discovery: Teams meet regularly to review potential areas of improvement based upon metrics and actual results. The executive management team evaluates suggested areas of improvement from the user groups in order to prioritize and resource the greatest opportunities for improvement. Create a nurturing structure that not only avoids turf battles, but rewards process efficiency and effectiveness. Value Exchange: In order to ensure that the team is working on the root cause of any inefficiency, data is collected, analyzed and reviewed in a systematic fashion. Cross-functional innovation teams ensure that any impact up or down stream from the change in the process Is considered. Invest in measuring in and aligning out the right technology and tools to drive the environment and protocol delivery models.
- 19. Generated Protocols Figure 5 Phase II – Active Motion Phase (Week 4-10) Effective worker’s compensation solutions and strategies are original and authentic. After researching over 160 individual treatment plans Goals: Improve shoulder strength and surgeries, it was apparent that protocols must deliver needs-based Improve range of motion solutions that contribute to the holistic patient care expected. Decrease pain/inflammation Increase functional activities An example of the protocol philosophy includes the following total shoulder replacement: Exercises Active assisted ROM exercises with L-Bar Knee Arthroscopy with Portized Medical Menisectiomy o Flexion o ER (not past 30 degrees for 6-8 weeks post-op) Phase I – Immediate Motion Phase (Week 0-4) o IR Rope and pulley Goals: Increase passive range of motion o Flexion Decrease shoulder pain Pendulum exercises Retard muscular atrophy and prevent RTC shutdown AROM exercises o Seated flexion (short are 45-90 degrees) Exercises: o Supine flexion (full available range) Passive range of motion o Seated abduction (0-90 degrees) o Flexion (0-90 degrees) Exercise tubing ER (week 4), IR to begin week 6 o ER (at 30 degrees abduction) 0-20 degrees Dumbbell bicep/tricep o IR (at 30 degrees abduction) 0-35 degrees Scapulothoracic strengthening Elbow/wrist ROM Joint mobilization Grasping exercises for hand Ice & modalities Isometrics (day 10) For more information on phases 3 & 4, click on www.osifv.com for a o Abductors complete listing of all 10 worker’s compensation protocols. o ER Electrical muscle stimulation (if needed) Rope and pulley (2nd week)
- 20. Total Cost Containment Reduced Down Time Integrated execution is how effective worker’s compensation organizations deliver a consistent treatment plan that allows To uncover the total cost of the workers compensation process the intelligent, cross-channel execution. By simply altering process, analysis starts with the initial phone call to the medical provider modeling impression areas and attachpoints, understanding post injury and continues until the worker is back to his prior desired outcomes and shifting behaviors, the processes are position without restrictions. understood and subsequently, non-value-added steps reduced. *Note: The outcome may not end with return to work without Key understandings and indicators of Total Cost Containment are restrictions for all employees, but our analysis focused on patients integrated with channels to drive seamless integration: that fall into this category. Cross Channel Interaction: Enable patients to move from one Through the use of lean-sigma tools such as decision trees and channel to another, allowing for a saving of time and movement. value stream maps the team identified all potential causes for delay and inefficiency. Then by process of elimination team Operational Profile: Create a consistent profile of all treatment members identified the root causes of the delay. The team noted plans and the connected profiles associated with the cost that the environment can hide patients from or expose patients to containment. their subsequent healing. Component-Based Systems: Design patient systems in a By identifying the main impression areas and the many attach modular fashion such that components of the treatment plan can points associated with the selected impression area, process steps, be seamlessly inserted, or removed based upon specific patient handoffs and queue (wait) times can be determined. Without needs. this breakdown, the task is unmanageable and generally focuses efforts on the transactional portions of care which are less likely Distributed Delivery: Deploy resources to reduce the need for to be the significant areas for improvement in a process that has repetition. Often plans are redesigned for each patient, while been reviewed many times before. consistent protocol management can reduce queue times and allow for greater return to work efficiency. Fewer Steps & Handoffs Method of Choice: Allow patients and providers to personalize and choose channels in the treatment plan that best fit their Outcomes become integrated within the behaviors needs as prescribed by the orthopedic physician. of the providers creating a transparent “pull” delivery system. Providers focus on the larger outcome of getting employees back to work, rather than just what it will take to get the patient to their next appointment.
- 21. Total Cost Containment Effective worker’s compensation solutions and strategies are original and authentic. After researching over 160 individual treatment plans and surgeries, it was apparent that wait time and handoffs must be understood and reduced. A realized savings can be gained by delivering a needs-based solution that contributes to the holistic patient care expected. Figure 6 Process Improvement 200 150 Before 100 After 50 0 Handoffs Steps
- 22. Pre-Registration Intervention Solution Based Barriers to the worker’s compensation experience must be Solution based thinking is about delivering needs-based identified and understood. Average registration time can solutions like pre-registration that contribute to the holistic be reduced from 14 minutes to 45 seconds through the patient plan. The objective of SBT is to translate the design transformation of solution based thinking and pre-registration. elements established to directly impact patients’ physical Without the pre-registration process, patients line up in the and psychological health, thus reducing patient stress and care reception areas at peak times and wait to be assisted. promoting rapid recovery. Similar to lines at an amusement park where stanchions keep people in line and weaving forward. Due to the questions Key competencies and indicators of pre-registration intervention mandated by federal, state and health care protocol, the desired enhance the ability to develop and provide relevant, integrated patient outcomes of “cared for, welcomed, respected and outcomes for patient care: acknowledged” were lost and patient anxiety increased from the moment they entered the experience. Knowing they may have Needs-based Orientation: Transform traditional delivery to a serious health concern, the traditional process added to their address the needs of the individual patient and their recovery stress and healing time (see figure 7). program versus a one-size-fits-all registration process. In creating this new approach to registration, three main Patient & Case Focused Design: Bring the voice of the questions were posed: patient and case insights into the solutions. Understand tactile expectations to speed up the process, allowing for less down How can we best understand patient health history and time. information? On Demand Availability: Refine the system to allow for a How can wait time be reduced when registering? registration process that provides real-time information back to the case manager and company. What are the outcomes we want patients to feel about the process thus aiding in their healing? On-Line Reporting: Channels which are designed to provide on-line reporting for easy access to information required for Outcome based thinking becomes integrated within the insurance authorization. behaviors of the providers creating a transparent and effective delivery system.
- 23. Pre-Registration Intervention By offering an alternative to the traditional method of capturing Thirty-three vs. Three Questions worker information, pre-registration can effectively reduce the time required to obtain needed this needed information by over OTHERS: 70%. This advance equates to a savings of time and dollars by the company and worker. Often registration processes ask the same questions over a multitude of departments or providers. By offering this state-of- the-art system, information is captured once allowing for greater movement within the system aiding in the speed and healing of the patient. This reduces the questions asked from 33 to 3 (see figure 7). Figure 7 Forty-five seconds vs. Fourteen minutes ORTHOPEDIC & SPORTS:
- 24. Tracking System Solution Health Status By taking the current process and documents and making them available online companies can allow real-time “As cocreators of the workers compensation process, communication to all of the parties involved in the patient physicians, clinical assistants and associate practitioner’s healing process. Starting with the treatment components modeled the new inspiration of how it could look, feel and and time line based upon the injury protocol, patient ultimately provide better care. Each process was detailed, progress can be charted and documented to the protocol broken down and understood. We then transformed how it and any variances explained in a written summary. should be, how it could be.” ~ Curt Kubiak, The Institute Executive Director Critical milestone dates are captured such as initial visits, diagnosis, treatment and follow-up care to ensure that Once the systems were in place, illustrated and identified, the progress toward the desired outcome can be clearly tracked. creativity could begin. Cycle times can then be calculated between any two “In researching and asking our patients what they expected, milestone dates in the process to gauge timeliness against a it was clear that communication and understanding of next desired outcome. Any outliers to the acceptable cycle times steps was paramount”. are analyzed as opportunities for improvement. Explanation for any cycle time variance is captured to reveal one-off issues versus chronic system failures. Reduced Cycle Times Once the process is reviewed and optimized, the system must contain the proper tools to allow the greatest efficiency. In reviewing the current standard tools: documents, forms, phones, copiers and fax machines, the team realized that there was a better answer. Patients, case managers and employers alike wanted to know “next steps” in the employee treatment plan and ultimately when the employee could reasonably be expected to return to work.
- 25. Tracking System Solution Real-time access to data: Align the expected steps of the process Early Warning System: The online system will alert participants to the actual steps providing a basis for alignment. Every day, each when a critical due date is pending and encourage action be step of the treatment can be viewed online and is outlined and taken to stay on track with the prescribed protocol. Any missed understood. milestone dates require a written explanation and subsequent follow-up analysis to ensure that variances are not chronic issues. Security: Few data sources currently contain detailed information addressing the quality of workers’ compensation medical care. Capability to Attach Notes & Documents for Single Access: To Once the systems are developed, security of the information is ensure that important information reaches affected stakeholders, paramount. Access of this proprietary information should be notes and documents should be communicated quickly. This available to all stakeholders real-time. improves workers’ compensation medical care for the benefit of the injured workers, employers, insurers, and health care providers. Data Access: Align interests and motivations enabling resources the ability to leverage cycle time knowledge quickly and Easy access to patient information and treatment plan progress systemically. Provide a basis for continuous learning about the enable providers down stream to view patient records in advance patient treatment plan to eliminate unwanted surprises. of an appointment and pull the patient into the next phase of the treatment plan. Timely access to data allows each team member On-site cycle time reporting: Provide web-based tools that allow to be efficient in delivering his service as part of the overall plan. for a unique interchange of cycle time information from the users finger tips. Allows for a greater understanding of times deployed reducing the variability in the system (see figure 8). Figure 8 Cycle Time Role Alignment: Provide patients and case managers with development progression planning capabilities based on personal 35 and lifestyle objectives. Build the ability to redeploy resources as 30 required to meet patient needs.. 25 20 Business Days 15 Cycle Time Functional Ownership and Accountability: Environment has the 10 ability to strengthen or impair a patients’ health status by reducing 5 or encouraging existing conditions and feelings. Each functional 0 owner in the process is responsible for entering the cycle time data Jan Feb Mar Apr May Jun and letting other members in the plan how they may be impacted. Months
- 26. On-Site Prevention Timely Preventive Care The next best solution is to have a medical advisor on-site to evaluate injuries at the workplace. Part of the workers As the saying goes, “An ounce of prevention is worth a compensation solution should include on-site evaluation of pound of cure”. A comprehensive workers compensation injuries, such that the injured worker gets the appropriate plan must include up-front workplace evaluation, training medical attention required as soon as practical and maintenance designed to keep a work force healthy and incident-free. By providing an analysis of existing working Workplace evaluation is how companies foster sustained conditions and on-site follow-up care, this first phase of the employee commitment and attachment to allows employees workers compensation solution can help to save time and to better meet personal and organizational objectives, all while money by reducing work related injuries, time off the job and serving and being advocates. OSHA recordable incidents. The key competencies and indicators of on sight prevention Prevention is such a golden opportunity, sadly accidents speak include the evaluation, training and coaching of employees for themselves. When an employee has the misfortune of include: suffering a work injury, co-workers must take note of how easily the same could happen to them. Nothing gets that message Agile Workforce: Provide employees with prevention planning across as clearly as does thorough post-accident follow-up. capabilities based on company objectives and personal habits. Safety specialists know this and do this routinely. Post-accident Construct the ability to best use the prevention techniques. investigations and de briefings are the norm. But, when ergonomic experts and human motion specialists are called in Delivering Tactile Performance: Based on the outcomes to the “post-accident SWAT Team”, employees see the full picture; expected, create an environment of ‘guided discovery’ namely that in order to save them from the same fate, the immersing employees in the understood behaviors that will employer is serious about safety. prevent the injury from reoccurring again. A critical evaluation of workplace ergonomics by a trained eye can detect potentially problematic issues such as repetitive motion and work station misalignment. The objective of this process is to prevent injury from occurring.
- 27. On-site Prevention Workplace Evaluation Experiences must trigger, not close down, creative innovations; identifying the highest form of patient feelings. Environments should sustain positive thoughts and not provoke boredom, anger, apprehension or apathy. Traditional worker’s compensation solutions rarely capture the essence of the reason for reoccurrence in the first place. “Our research data showed that if prevention doesn’t exist within the Accomplis workplace, the recovery process will be longer.” Commented Rob Worth, Advanced Physical Therapy founder. We capture the Figure 9 hm three elements and encourage the questions of what if, how should be, and what is it? “What is it that will continue get your e nt nt nt nt nt nt employees, healthier quicker.?” “Capabilities must be based on s s s s s s company objectives and personal habits. Construct the ability to best use the prevention techniques for your culture, not ours”. Recordable Incidents: Based on the outcomes expected, create an understanding of the incidents that can be reduced through a well-thought out, designed process. (see figure 9). Build a System of Accountability: Develop and validate a set of performance measurement standards for worker’s to rally around and celebrate to. Hold all involved to the same level of accountability Establish Effective Assessment: Assess routinely the health status of workers and the workplace. Design and test new Recordable Incidents processes for routine safety and construct a ongoing, effective by Month system.
- 28. Building the Ideal Worker’s Compensation Experience Not Just Another Building Outpatient – Private pre-operative and post-surgical patient Like any building, which has been designed to withstand the rigor rooms for comfortable and seamless recovery, enhanced of customer demands and the enduring test of time, experiences infection control and greater privacy. need to be agile and sustainable as well. Typically, very little thought is given as to how the physical space integrates with the behavioral Advanced Data Retrieval System – Providing physician needs and requirements of the users. The Orthopedic & Sports information, secure access to patient records via integrated Institute facility readily accommodates the essence of the worker’s PC. This includes up to the minute lab results, radiology compensation process, embraces the unique qualities of the clinic reports, vital signs and medication lists. and stimulates the innovation that helps patients return to work quicker Daybeds - Visitors enjoy in-room daybeds to remain connected to their family and friends being treated. Imagine This…. Hospitality Center – Fox River Brewing coffee assists you in preparing the coffee of the day. Juices, coffee and Workers Compensation Liaison- A personal guide leads you sandwiches are available as well. through the process to ease communication and clarify navigation. In-room Scheduling – Rather than sending the patient to another sub waiting area, patients are scheduled for the Prescriptions: Filled immediately through Physician diagnostics and imaging from the exam room. interaction and on-sight dispensing. Community Outreach – Golf, running, joint pain Concierge - Services to assist with direct patient needs while management, strength and flexibility seminars help to ease at the Institute including elderly guidance, and also ancillary your pain and complete your recovery. services at your request. Soundscapes – Music is offered and available through Children’s Activities - Activities for children to stay engaged headphones of their favorite downloaded artists. and entertained while family members are treated. Flex Room – Nurses move patients less often when all operating rooms have equipment that folds out to provide Anything is possible… critical systems such as anesthesia gases, and heart monitors.
- 29. The Institute Solution Emotions pave the way for patient and community attachment. productive contributions as quickly as feasible. Patients make decisions based on how they feel and the treatment they receive versus services provided to them. Understand what it takes to generate a compelling reason to Innovative thinking in the health care field understands and return, to captivate the patients’ interest and emotions so they encourages this type of patient/caregiver engagement and must are healed quicker. be integrated within all facets of the worker’s compensation Understand why the entire process is a reflection on every team process. member of the health care delivery system. Why their thoughts, feelings and ideas need to be incorporated into the process. Based on this notion, a revolutionary solution, unique in Why the research we help to identify serves as the basis for all approach has been born to combat this often confusing and innovation. typically transactional process. Understand the power of experienced based design and why it Most importantly, apart from a purpose built facility and state- is so important to design an experience that gets patients back of-the-art technology, the significant difference in the health to work quicker saving time and money. care industry are the people. People are the element that creates the emotion and connection to all users of the workers Understand the importance of a healing environment and why compensation process. From the registration team to the post the fabric pattern on the chair, the sounds you hear, the smells operative surgery area, the staff must be functionally competent, you have and the sights you witness have tremendous relevance emotionally aware and responsive and critical thinkers to have to the patient getting better faster. the best understanding of what it takes to create healing. This is not simply another process. It is a systematic approach to excellence based on your vision and values, which truly identify and separate this process from the rest. This case study illustrates this approach throughout. Included are proprietary methods, research systems, tools and concepts that must be included for complete transformation. Case studies in health care prove the viability and sustainability of the ideology. Take the time and research to understand what it takes from start to finish to create an original experience that make patients feel great, meets case manager needs and returns workers to
- 30. The Institute Solution We understand that it is about lives. The lives of your team members, the community, your company. People remember experiences. We live in a world of over-stimulation, pressure, insecurities and economically fragmented lifestyles. They want to live and be treated in ways they never imagined. This overview has provided an understanding of what it takes, to transform the overall worker’s compensation experience. We understand. . . it has to be different.