How to use mobile devices to transform businesses that use mobile teams?

1. Performance improvement in the mobile age
Sawad Thotathil MD
Care Coordinates
MA, USA

2. Organizational complexity
Organizations and systems become complex over
time
3 types of complexity are endemic in healthcare or
human services organizations
1. Structural complexity
2. Mission creep
3. Processes complexity
Complexity is costly

6. Current approaches to tackling Cost
and Quality issues
Restructuring
System or process improvement
Reducing or limiting service offerings
We believe that Mobile devices and applications provide a
new approach to performance improvement

7. How can mobile apps help a human
services organization?
Mobile devices have become cognitive prosthesis
Mobile connect knowledge workers
Businesses can use this additional capability to embed continuous improvement in
the system and power innovation
How?
1.
Data collection at point of service is seamless and can be rapidly
reconfigured to accommodate changes in the environment
2.
Employee can access data, information and metrics that help make
informed decisions while performing tasks or making judgments
3.
Employees can be connected to each other to enable knowledge sharing
as well as easier group decision making

8. Common hurdles to improvement
Other than cultural impediments, the 2 tactical hurdles to
change are
1. Difficulty in quickly deploying and field testing
redesigned processes
2. Rigid information structures that prevent iterative
improvement
Mobile devices can be used to overcome these hurdles as well
as promote a new type of culture where performance is
transparent and information/knowledge sharing is the norm

9. How do Apps help business mangers?
Platforms such as Salesforce allow managers to
1. Focus on the business problem
2. Test out solutions without fear of a costly failure
3. Not be constrained by the possibilities predetermined
by a software designer
4. Embed continuous improvement

10. Implementing Improvement
Owning the change
During App design
a) Teams can map out processes and workflows that
help achieve team objectives and company goals
b) Obtain group consensus on performance metrics
that align the company goals with individual work

11. Implementing Improvement
Facilitating adoption
a) Incremental deployment of features and functions
b) Data streams start working immediately thereby
allowing testing of all strategic or operational
hypothesis
c) Feedback is used for easy redesign when necessary

12. Current App scenario
Most organizations face the App Gap – No in-house
resources to design and maintain apps
External Software developers do not have
performance improvement expertise
New platforms like Salesforce allow organizations to
deliver apps without an in-house IT department.

13. Case study
A Group of physicians and Nurse practitioners near Boston,
USA providing care to patients at 18 independent skilled
nursing facilities
The provider group and the nursing homes are different
business entities.
Traditional working styles that are dependent on
a) paper based information systems
b) Coordination of work is dependent on meetings or
phone-calls
c) Field data collection is very limited thereby hampering
improvement efforts

14. Business strategy
Providing high quality physician/nurse practitioner care for
patients at multiple skilled nursing facilities
What is required to make this happen?
Resources - Availability of providers when care is needed
Information systems - Record keeping of each visit
regarding clinical care and for billing purposes
Operations competencies – Seamless coordinated care
despite different providers
Focus on cost and quality- Discharging appropriately while
length of stay remains optimal

15. Getting to the App

16. Approaching the business problem


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Is the operational structure adequate?
What are the Coordination and Collaboration needs?
How to use the data?
How to use knowledge for repeatability?
We try to explain this approach using a case
study

17. Redesigning operations

18. Requirement 1: Realtime Information
systems for managing operations
Scenario: Each facility has their own paper and/or electronic method of clinical
record keeping.
Problem:
1.
Provider notes in the patient records from different facilities are not
integrated into one system as the facilities are different businesses.
Hence they cannot be used in a single system
2.
Provider notes for billing are paper based ,non-uniform and erratically
prepared. Errors and missing notes are a frequent occurrence. New
patient face-sheets, which are also required for the billing process, have
to be collated in parallel. The information has to move from provider to
corporate and from there to the billing company
Solution
1.
Encounter information should come directly from point of care
2.
Safeguards to prevent errors and missing notes

19. Design for Req 1
Using imaging to move face-sheets direct from point
of care to billing company
Point of care electronic submission of encounter
information
Reducing missing information with mandated fields
Billing process is tied to the patient follow up process
required in Objective 2

20. Requirement 2: Provider availability
when it is needed where it is needed
Scenario– Frequency of visit to a facility based on crude estimation of
need.
Problem
1.
No levelling of daily patient visits by each provider and hence
resources stretched on some days.
2. More random visits than planned visits
3. Accurate provider resource planning not possible
Solution
1.
Force schedule follow up visits.
2. Plan for a certain load of emergent needs every day
3. Level out visits across the weekdays
4. Level out visits across providers

21. Design for Req 2
Planning a Follow-up visit become a mandated
process when completing a patient encounter
Automatic creation of follow- up lists
Visual tool that helps monitor visit load across the
week
Central ability to reschedule evenly across weekdays
and providers

24. A providers schedule seen as a week view
A provider schedule in a week view

25. Communicating and aligning workflows
Coordination

26. Coordination needs
Scenario: On the go coordination through texting, phone calls, multiple lists (paper and
Online)
Problem: As the number of facilities, patients and providers increased, it became
inefficient and unsafe to continue this way
Solution
New processed that are needed :
Who will see the patient and when? (previously addressed)
Knowledge of previous interactions with the patient to be shared other team
members
Sharing the care ‘thought process’ with the other providers
Delegation of tasks between providers
Ensuring closing of tasks
Sharing specifics on the social/family environment of the patient

27. How to implement?
Each visit information would include a note that
makes aware key issues or care ‘pointers’ which are
then seen by the follow up provider
Task delegation by provider and date
Sharing of notes about the family or other specifics
on the patient record
Notes about the patient directed to a specific
providers but available to all providers

31. You cannot manage what you don’t measure
Performance Measurement

32. Data vacuum
Scenario:
1. The only ‘truth’ is the billing information available at long
intervals from the billing company
2. No information on clinical metrics or for other business
needs
Problem
Data from the visits is inadequate from clinical perspective
There is no standardized data collection

33. How to implement Improvement?
Data collection and the dashboard are on the same
system
The dashboard, report generation and data collection
can be easily redesigned as new business questions or
problems arise
Ex: How many patient encounters related to treating
cellulitis among other problems? How broad is the
problem that new interventions need to be
incorporated?

34. New Business question
Regular operational info

35. Getting it right every time, everywhere
Knowledge management

36. Repeatable service quality through
utilization of explicit knowledge
Explicit knowledge is knowledge that can be codified
into protocols and algorithm
Scenario: Knowledge sharing was currently through
training sessions in the monthly staff meetings
Problem: The protocols are not accessible at the point
of service Ex: Best practice in Antibiotic selection

37. How is this achieved?
Protocols and algorithms for areas of concern are
created or obtained from expert sources
This is made available on the mobile app in a
searchable format
Example of a treatment guideline on next slide

39. Performance improvement in the
mobile age
Where can you apply this approach?
1. Mobile teams in healthcare
2. Field work such as social workers, service teams
3. Wherever Plan-do-study-act cycles need to be
deployed quickly
4. Other environments where there are opportunities
to expedite data collection or decision making using
tablets or smartphone use

40. sawad72@yahoo.com