The Covid-19 pandemic exposed difficulties that patients in the Los Angeles Department of Health Services system face in accessing specialty medical care, with wait times to see a specialist averaging around 89 days. To address these delays and decompress backlogs for potentially lifesaving radiology tests, FUSE will work to initiate an enterprise-wide system of care for radiology in the County.
This fellowship project begins on October 25, 2021, and ends on October 23, 2022. The fellowship begins with a multi-day virtual orientation the week of October 25, 2021. The selected Executive Fellow will begin their first day of providing services to the host agency on November 1, 2021.
The Los Angeles Department of Health Services (DHS) is the second-largest municipal health system in the nation. Through its integrated system of 26 Ambulatory Care Network (ACN) health centers and four hospitals, as well as partnerships with 70 community-based clinics and various academic institutions, DHS cares for 750,000 unique patients each year, employs over 23,000 staff, and has an annual operating budget of $6.2 billion. In addition, DHS is a sprawling safety-net system, primarily serving Black and Hispanic and low-income populations – residents who are uninsured or covered by Medi-Cal – in addition to youth and individuals in the LA County criminal justice system.
Over the past several years, DHS has undertaken significant reorganizations to respond to changes in the healthcare industry and increase the system’s efficiency. This included the adoption of eConsult, an electronic system that enables primary care providers and specialists to share health information and discuss patient care securely. DHS’s adoption of this program has reduced patient wait times for care by 17%, forming a promising intervention that could improve access to specialist care for the underserved populations that utilize DHS services. Most recently, during the Covid-19 pandemic, DHS launched the County’s new DHS Transfer Center, which enabled hospitals to respond to the surge of Covid-19 patients and free up the capacity at the County’s acute-care hospitals. During the winter peak of Covid-19 in January 2021, DHS served and treated 7000 Covid-positive patients in a two-week span, with the Transfer Center ensuring coordinated and continuous care for all. Despite these continuous improvements, the pandemic exposed the remaining difficulties that many DHS patients face in accessing specialty medical care. For example, recent data analysis showed that the average wait to see a specialist in the system was 89 days, with particular frustration among patients receiving potentially lifesaving radiology tests.
DHS is committed to addressing these delays and is looking to institute concrete improvements and enhancements that ensure its residents’ highest quality of care. The LA County Department of Health Services will partner with FUSE Corps to host an Executive Fellow for one year to initiate an enterprise-wide system of care for radiology in the County. The Executive Fellow will implement standardize operating procedures across clinics and leverage DHS’ expansive network of community partners to decompress current backlogs. These efforts will enable LA County to reimagine one of its primary specialty care units – transforming it into one that provides the highest quality of care to many of the County’s uninsured and Covid-19 vulnerable populations, building healthier communities across the LA region.
PROJECT SUMMARY & POTENTIAL DELIVERABLES
The following provides a general overview of the proposed fellowship project. This summary and the potential deliverables will be collaboratively revisited by the host agency, the executive fellow, and FUSE staff during the first few months of the fellowship, after which a revised scope of work may be developed and agreed upon by the FUSE fellow and the host agency.
Starting in November 2021, the FUSE Executive Fellow will first conduct a landscape assessment of DHS’ current system for care for the radiology specialty. The Executive Fellow will conduct an initial listening tour and quickly build deep relationships with a wide range of critical stakeholders. Through these conversations, the Executive Fellow will explore the on-site realities of radiology operations, understanding how the various providers currently function, how staff members work cross-operationally, where silos are present, and what system-wide procedures are currently in place. The Executive Fellow will review current data and dashboards, analyzing inefficiencies and disparities across teams to establish a baseline for service time and other critical aspects of operations. The Executive Fellow will also conduct national research on other large health systems and their management of radiology services, gathering insights on central administration or ‘hub and spoke’ models of radiology services – assessing applicability locally.
Utilizing this landscape assessment, the Executive Fellow will form a short (1 year) and long-term plan (3-5 years) for an enterprise-wide system of radiology services in LA County. The Executive Fellow will define how this system will ideally function, make recommendations to optimize internal and external operations, break down silos, increase cross-provider coordination, improve processes, and integrate best practices and specific technologies or tools. The plans will include a cohesive strategy around the execution of the system, establishing clear phases of integration, clear roles of internal and external stakeholders, workflows, timelines around milestones, and metrics for tracking progress. Each plan will ensure that investments address both short-term goals and allow for future scalability.
The Executive Fellow will then initiate activities that are most urgent and or are considered low-hanging fruit. This will include primarily working to consolidate and scale DHS’s external radiology vendor relationships. The Executive Fellow will determine which strategic partner relationships to utilize better or phase out, how to manage and track the efficacy of these vendors, map out the facilitation and smooth transfer of data across health care information technology systems, and institute new processes to better leverage these partners and decompress backlogs long-term, forming strong year over year relationships between external and internal providers. The Executive Fellow will also begin internal capacity building and stewardship of the adoption and usage of the new processes and resources, ensuring radiology is more responsive among ACN clinics first.
By October 2022, the Executive Fellow will have overseen critical stages of implementing an enterprise-wide system of radiology services for LA County. This will include the following:
- Conduct a thorough review of the current landscape and identify best practices – Conduct an in-depth landscape analysis of the current system, collating all relevant policies and processes; map potential gaps and identify opportunities and cross-cutting themes; learn the services of each provider, the roles and responsibilities of clinicians and technicians, and review vendors; travel to various providers to gain first-hand knowledge of how they function and meet with staff members; review best practices at other systems throughout the country
- Analyze available operational data – Review current data and dashboards, analyze internal inefficiencies and establish a baseline standard for critical operations; track the various data streams and healthcare information systems across providers; set Key Performance Indicators for internal improvement and external vendor evaluation
- Engage stakeholders and catalyze buy-in – Conduct interviews with all stakeholders, including executives at the DHS, internal staff across radiology departments in DHS hospitals, ACN clinics, and telehealth providers, and external technical and professional service providers, such as private hospitals, imaging contractors, community-based nonprofit providers, and academic institutions; understand their various viewpoints and concerns, and discuss the importance of implementing new business practices
- Form recommendations and develop a holistic implementation plan – Create both a 1-year and 3–5-year plan to achieve an enterprise-wide radiology system of care for the County; build-out recommendations that address any gaps identified, support process improvements and align resource investments; establish short-term and long-term goals, identify a timeline for each recommendation’s integration, set roles and responsibilities for all stakeholders, determine workflows; identify barriers to implementing new operating procedures and build cross-departmental collaborations and private-public partnerships that can facilitate implementation; solicit and incorporate input from stakeholders to build consensus around the plan
- Oversee implementation of possible “early wins” – Begin to advance an ongoing process of change management; promote a strong sense of unity and collaboration among the various internal and external service providers; consolidate and scale the DHS’s external radiology vendor relationships; kick-off implementation of a handful of processes that can be instituted quickly using existing resources or altering existing procedures across clinics, hospitals, and teleradiology contractors, including re- distributing caseloads among radiologists, modifying staffing allocations based on location and case intake, instituting new standardized operating procedures, and forming key performance indicators to measure efficiency, availability, and productivity of studies across clinicians
- Support long-term implementation and ensure initiative sustainability – Develop the necessary internal and external systems to ensure that strategies are sustainable and successfully implemented; work with stakeholders and department leadership to manage the program; measure and assess progress, identify relevant data and metrics that intersect with each recommendation; integrate a system of tracking progress on recommendations
- Project Supervisor – Dr. Jack Brunner, Radiology Operations, Department of Health Services Executive Sponsor – Donna Nagaoka, Associate Director of Organizational Performance, Department of Health Services
- Dr. Evan Raff, Director – Specialty Care, Department of Health Services
- At least 15 years of professional experience in health care operations or consulting, particularly with a strong record of success in project management, vendor management, organizational management, organizational redesign, systems building, and/or data analysis.
- Knowledge of and interest in the medical field as it relates to IT, easily able to discuss healthcare information systems and connecting data across systems
- Ability to quickly get up to speed on complex issues and organizations
- Robust change management and business improvement practices experience, Six Sigma or similar training, supporting process improvements across multiple coalitions of stakeholders
- Acute data acumen, having designed metrics, managed key performance indicators, and performed outcome evaluations
- Ability to understand data and evidence and use it to support a business case and make a persuasive argument to support recommendations
- Robust success in cultivating partnerships, relationship and coalition building, and fostering collaborative environments
- Ability to work within a highly bureaucratic, slow-moving, risk-averse culture, patience creating direction, and quickly pivot within potentially ambiguous environments
- Ability to confront challenges with tenacity, resilience, and patience
- Superior critical thinking analytical skills
- Excellent stakeholder engagement skills and cross-cultural agility, relating to a wide variety of diverse audiences with strong emotional intelligence and empathy
- Strong record of success engaging a variety of cross-sector stakeholders and managing cross-functional teams.
- Exceptional written and verbal communication skills with ease in public presentations
- A self-motivated and goal-oriented leader who can also be an independent worker
- Ability to synthesize complex information into clear and concise recommendations
- Understands the need for solutions to support all people in a community regardless of race, religion, gender, immigration status, or ethnicity
FUSE Corps is an equal opportunity employer with a core value of incorporating diverse perspectives into our work at every level. We encourage candidates from all backgrounds to apply for this position.