sample reinventions

Deb McGill R.N. MPH - Sr. Director Population Health at Maine Health

“Marj & Mischa helped us with the creation of a unique and innovative complex ambulatory care management delivery model, "Lend a Hand". The Lend a Hand program supports our most vulnerable patients to access necessary care, improve quality of life, lower total cost of care and to support our providers and care teams. This practical and economically feasible program has been rolled out to all of our primary care providers and continues to flourish - in summary - this approach to building new delivery models works without question!"

With a loss of 20% of available hospitalist shifts due to a departure of physicians, the four-hospital regional health system had to find a solution quickly to avoid bed closures and reduction of services. Recruiting physicians and locums to address the issue was not viable in the short term.  The only practical option was a model of care redesign that would change the working environment for physicians going forward. 

The project delivered a modernized model of care, properly utilizing all care providers within their scope of practice. The solution gave physicians control and provided the team with real time dashboards and management tools.  This reduced peak physician loads by 44%, and adjacent measures such as Length of Stay and ED wait times all improved.

ED wait times at the regional medical center had reached unacceptable levels and left without being seen metrics were skyrocketing in response.

A team consisting of ED physicians, nursing, and administrative staff was challenged to create solutions that could be implemented quickly while solving the issue sustainably.

Among many of the elements reviewed and designed, a key change was the implementation of a workflow tool creating transparency across functions, and a rethinking of standing lab orders based on presenting symptoms using statistical & cost analytics, initiating labs and other diagnostics prior to rooming patients. The totality of changes accelerated ED flow and dramatically cut total patient ED durations.

This regional hospital was unable to obtain and retain the nursing, PA and NP staffing required for operations. Over the course of the last two- years it had gravitated towards the use of contract resources, creating several issues ranging from labor cost escalations to quality-of-care challenges and cultural and organizational loyalty issues.

A fundamental reinvention of the recruiting process was the only solution to exit the costly staffing spiral.

The solution involved revamping the process and taking on the DNA of a sales process. Direct outreach rather than passive recruiting - head hunter style - led to finding full time employed replacements of agency staff, lowering overall labor cost. The efforts were further supported by model of care changes increasing the desirability of the organization as an employer of choice.

 Avoidable days for the regional health system was creating not only financial losses of $8.7M, but the correlating length of stay led to operational issues with patient flow and subsequently ED wait time and diversion. The solution had to address issues in two sub systems: Inpatient Care Management and Bed Control.

A cross functional team facilitated through a formal process redesigned both operations creating staff ownership, clear processes, and dashboards with an accountability structure. LOS was reduced by 1.1 days and turnaround times for bed requests were improved by 30%.

"Every time a company triples in size, everything breaks" - Hiroshi Mikitani.

This insurance payer had been very successful in growing market share and presence.  The next strategic stepping stone required rapid growth.  The leadership team concluded that the organization needed a fresh design of the performance management system as a solid foundation to achieve the goals and minimize strategy losses.  Organizational alignment had to be adjusted, success measures deployed, and each unit had to be clear on how they contributed to the overall objectives. 

ReInvent Work facilitated the performance management design across the organizational layers and supported the internal team to build out the revised performance management system to enable the rapid growth.