Innovation and quality – strategic management at a Danish university hospital

1. Innovation and quality – strategic management at a Danish university hospital Chief nursing officer, MPH Vibeke Krøll Aarhus University Hospital, Skejby

2. Denmark

3. Denmark 2007 Public, integrated, tax-financed, politically decentralised health care delivery with private practices and public hospitals from 5 regions and public health from 98 municipalities Source: Danish Institute for Health Services Research

4. Performance 2nd to The Netherlands in Europe 2009 Source: Health Consumer Powerhouse, 2009

5. By SINDYA N. BHANOO, Published: January 11, 2010. New York Times

6. Aarhus University Hospital, Skejby

7. Aarhus University Hospital, Skejby Operating budget 2010 (billion, DKK): 2,1 Employees-2010: 3400 persons

8. Aarhus University Hospital, Skejby – health service profile Aarhus University Hospital, Skejby is a tertiary receiving hospital. The hospital treats and cares for patients with: Infectious diseases Heart and lung diseases Urinary tract and kidney diseases Vascular diseases Paediatric diseases Obstetrical and gynaecological diseases Moreover, functions as local hospital for citizens primarily in Aarhus Municipality

9. Awarded the best hospital in Denmark in 2008 og 2009 All departments rank 1 or 2 in Denmark – high professional quality Scores high in general areas such as hygiene and patient involvement Most health professionals prefer our hospital if their relatives need treatment Great sense of team spirit Focus on constantly improving performance Source: Dagens Medicin, 2008 and 2009

10. The role as a highly specialised hospital challenges The obligation to conduct research and development – integration of research and clinical work. High degree of innovation force The obligation to educate all staff groups The high degree of specialisation = many special teams The demands to productivity, innovation and research must go hand in hand

11. The Balanced Scorecard The start

13. The process We created a vision Decided on the core values Designed our strategy using the principles of the Balanced Scorecard. Result: A strategy map with 24 focus areas Each focus area was defined and indicators and standards were established We ended up with 213 measurement criteria!

14. Balanced scorecard – Dashboard

15. The management task

16. Management – a constant process of change… ”Every system is perfectly designed to achive the results it achives.” (Berwick 1996) Translation Cultural work Activities Results

17. Leadership is to create results for patients, employees, the professional quality and for the organisation to create a culture willing to create results and willing to ”go the extra mile” to monitor that results are achieved

18. to create results for patients, employees, the professional quality and for the organisation to create a culture willing to create results and willing to ”go the extra mile” to monitor that results are achieved Leadership is

19. to create results for patients, employees, the professional quality and for the organisation to create a culture willing to create results and willing to ”go the extra mile” to monitor that results are achieved Leadership is

20. ”At the end of the day, metrics are important. However, what you do with the results is even more so” Kinney CS: Competing Values in Healthcare: Balancing the (Un) Balanced Scorecard. Journal of Health Care Management; 2007;52,5, page 323.

21. Vision and strategy

22. Best quality in healthcare services Reliable and well-run hospital Attractive place of work and education Internationally recognised research and development High patient satisfaction Meaningful, effective working procedures High patient safety Good working environment Implementation of new knowledge Coherent patient pathways Documented professional quality Visible research activities Relevant Competence development Creating good cooperation Updating of guidelines and descriptions Prioritisation of education, training and development Prioritisation of research and development Professional management Adequate physical framework Up-dated technology Optimal use of resources

23. Best quality in healthcare services Reliable and well-run hospital Attractive place of work and education Internationally recognised research and development High patient satisfaction Meaningful, effective working procedures High patient safety Good working environment Implementation of new knowledge Coherent patient pathways Documented professional quality Visible research activities Relevant Competence development Creating good cooperation Updating of guidelines and descriptions Prioritisation of education, training and development Prioritisation of research and development Professional management Adequate physical framework Up-dated technology Optimal use of resources

24. Vision and strategy Vision What we do The way we do it Culture Strategy Management dilemmas

25. Re-operation due to postoperative bleeding or later sternum infection Outcome variable, Re-do Focus area 2002-2003 New focus in 2009

27. to support the vision of being ”a professional and well-run university hospital with high objectives and in continuous development” to maintain a holistic perspective on management and leadership to ensure a strategic dialogue, support and progress in relation to the strategic priority areas to ensure coherence between the overall strategies at the hospital and the local strategies at the departments Intention behind the strategy process

28. National and regional demands Highlights demands from the hospital management Strategy agreement Draft for strategy agreement Dialogue between hospital management and department management Department’s own strategy Demands from the hospital management

29. Source: Jes Søgaard, Head of the Danish Health Institute

30. Selected strategic focus areas in 2010

31. Best quality in healthcare services Reliable and well-run hospital Attractive place of work and education Internationally recognised research and development High patient satisfaction Meaningful, effective working procedures High patient safety Good working environment Implementation of new knowledge Coherent patient pathways Documented professional quality Visible research activities Relevant Competence development Creating good cooperation Updating of guidelines and descriptions Prioritisation of education, training and development Prioritisation of research and development Professional management Adequate physical framework Up-dated technology Optimal use of resources Internationalisation

32. Surgeons from Aarhus University Hospital, Skejby Operate (education or non-profit activities) Educate themselves further Receive patients

33. Best quality in healthcare services Reliable and well-run hospital Attractive place of work and education Internationally recognised research and development High patient satisfaction Meaningful, effective working procedures High patient safety Good working environment Implementation of new knowledge Coherent patient pathways Documented professional quality Visible research activities Relevant Competence development Creating good cooperation Updating of guidelines and descriptions Prioritisation of education, training and development Prioritisation of research and development Professional management Adequate physical framework Up-dated technology Optimal use of resources Increase the strategic research effort among nurses, physiotherapists, midwives etc.

34. Best quality in healthcare services Reliable and well-run hospital Attractive place of work and education Internationally recognised research and development High patient satisfaction Meaningful, effective working procedures High patient safety Good working environment Implementation of new knowledge Coherent patient pathways Documented professional quality Visible research activities Relevant Competence development Creating good cooperation Updating of guidelines and descriptions Prioritisation of education, training and development Prioritisation of research and development Professional management Adequate physical framework Up-dated technology Optimal use of resources Modern and innovative bed units

35. Best quality in healthcare services Reliable and well-run hospital Attractive place of work and education Internationally recognised research and development High patient satisfaction Meaningful, effective working procedures High patient safety Good working environment Implementation of new knowledge Coherent patient pathways Documented professional quality Visible research activities Relevant Competence development Creating good cooperation Updating of guidelines and descriptions Prioritisation of education, training and development Prioritisation of research and development Professional management Adequate physical framework Up-dated technology Optimal use of resources Digitalisation

36. Conclusion It is important to balance between innovation and quality improvement initiatives – Balance Scorecard (BS) is a tool to ensure that balance BS is a very suitable framework for developing your own strategy and for communicating the strategy BS is very suitable for integrating other quality initiatives Remember your focus – measurements cannot stand alone

37. Thank you for your attention