More Related Content Similar to "The Nuka system of care: Lessons for healthcare redesign in Wales" (20) "The Nuka system of care: Lessons for healthcare redesign in Wales"1. Katherine Gottlieb, MBA, DPS (h.c.), President/CEO
Steve Tierney, MD, Medical Director – Quality
Improvement
Michelle Tierney, MPA, MA, Vice President
Organizational Development and Innovation
Kevin Gottlieb, DDS, Vice President Resource and
Development and Chief of Staff
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2. Objectives
Describe the customer-owned and
relationship based Southcentral Foundation
Nuka System of Care
Understand a different way of thinking about
healthcare
Answer questions
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3. SCF Board of Directors
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4. Indian Self-Determination and
Education Assistance Act 1975
Government recognized that:
If the people receiving the health service are involved in the
decision making processes, better yet, if they own their own
health care – programs and services have a potential for
enhancement and the people and their health statistics will
improve.
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5. The Drive to Change
Unfriendly and rude staff
Guinea pig for new doctors
Customers waited for everything
• Long waits for scheduled appointments
• Four- to six-hour waits common Long waits on phone,
pharmacy, everywhere
Inconsistent treatment
Risky place to go
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6. Everyone Was Frustrated …
Customers frustrated – waiting, impersonal,
paternalistic, crowded, unfriendly
Clinical staff frustrated – too many people, not
enough time, no personal relationships, too many
demands
Management frustrated – lots of unhappy people,
hard to motivate staff, poor financial performance,
challenging facilities
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7. Our Choice
Alaska Native people were given this choice and we
chose to assume the responsibility for our own
health care
• Change everything
• Total redesign
• With our choices and values
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9. Customer Focus
Key Improvements
Governing board
Advisory committees
Elders Council
Focus Groups
Annual Gathering
24- hour hotline
Community gatherings
Personal interaction with
employees
Satisfaction surveys
Comment cards
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10. Vision
A Native Community
that enjoys physical,
mental, emotional
and spiritual wellness
Mission
Working together with
the Native Community
to achieve wellness
through health and
related services
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12. Operational Principles
Relationships between customer-owner, family and provider must be fostered and supported
Emphasis on wellness of the whole person, family and community
(physical, mental, emotional and spiritual wellness)
Locations convenient for customer-owners with minimal stops to get all their needs addressed
Access optimized and waiting times limited
Together with the customer-owner as an active partner
I ntentional whole-system design to maximize coordination and minimize duplication
Outcome and process measures continuously evaluated and improved
Not complicated but simple and easy to use
Services financially sustainable and viable
Hub of the system is the family
I nterests of customer-owners drive the system to determine what we do and how we do it
Population-based systems and services
Services and systems build on the strengths of Alaska Native cultures
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13. At 591,000 square miles, Alaska is as wide as
the lower 48 states and larger than Texas,
California and Montana combined.
Alaska
San Francisco
Charleston
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16. From 1982 to 2013…
Operating Budget
$227m
• 64,000 Customer-owners
• 54,000 Anchorage and Valley
• 10,000 55 villages
• Employees
• 1982: Fewer than 100
• 2013: About 1,600
• Operating Budget
• 1982: $3 million
• FY 2013: $227 million
$3m
1982
FY
2013
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17. Why Listen to Our Story
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18. Measures of Success
• Utilization
– 75% decrease in hospital admissions since 1999
– 71% decrease in hospital days per 1000 since 1999
– 36% decrease in outpatient visits per 1000 customer-owners
• Clinical quality
– Level 3 NCQA Patient Centered Medical Home
– 75 or 90 percentile for HEDIS outcome measures
o Diabetes
o Cancer
o Cardiovascular disease
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19. Measures of Success
Customer-owner satisfaction
• Overall 93%
Employee satisfaction
• Overall 94%
• Response rate 95%
Employee Turnover
• 10.8%
Baldrige National Quality Award - 2011
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21. SCF Programs and Services
Behavioral Health
• Fireweed
• PCC
BURT
Denaa Yeets’
TRAILS and FASD
The Pathway Home
Quyana Clubhouse
Dena A Coy
• Residential
• Outpatient
• Willa’s Way
Behavioral Health Service McGrath
Behavioral Health Clinics
Therapeutic Family Group Homes
• Cottonwood
• Rendezvous
• Cleveland
Alaska Womens Recovery Project
(AWRP)
Access To Recovery (ATR)
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22. SCF Programs and Services
Compliance
Data Services
Organizational Development
Development Center
Human Resources
Quality Assurance
Research
Nuka Institute
Tribal Relations and Village
Initiatives
Traditional Healing Clinic
Planning Grants
Communications & Public
Relations
RAISE Programs
Elder Program
Seattle Office
Board Support
Corporate Office Support
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23. SCF Programs and Services
Dental (ANMC and Fireweed)
Facilities
General Counsel
Information Technology
Special Assistant Program
Budget Planning and
Management
Contracts
Financial Operations
Patient Accounts
Payroll
Reimbursement
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24. Organizational Structures
Office of the President
• Divisional structure
Executive and Tribal Services, Medical Services, Behavioral Health,
Resource and Development and Organizational Development and
Innovation
• Line Authority
Functional committee structure
• 4 areas of focus to get to high performance
Operations– effective day to day operations
Quality Assurance– compliance with standards etc.
Process Improvement– improving systems and structures
Quality Improvement– improving clinical and educational services
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26. Then and Now …
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27. Then and Now …
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Editor's Notes Slide will be up as we begin
Doug and Katherine to check in with each other.
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KATHERINE
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SCF has grown dramatically in the past 27 years – the workforce has grown…
Katherine
Why listen to us, well of course, we are a Baldrige recipient, but here are some of our results
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