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High-Performance Healthcare:

High-Performance Healthcare:. By Dr. Tony Lybarger. Employment Security Selective Hiring of New Personnel Self-managed Teams & Decentralized Decision Making Comparatively High Compensation Contingent on Organizational Performance (Pay-for-Performance)

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High-Performance Healthcare:

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  1. High-Performance Healthcare: By Dr. Tony Lybarger

  2. Employment Security Selective Hiring of New Personnel Self-managed Teams & Decentralized Decision Making Comparatively High Compensation Contingent on Organizational Performance (Pay-for-Performance) Extensive Training (60 hours --- My Number) Reduced Status Distinctions & Barriers, including Parking, Dress, Language & Office Arrangements Extensive Sharing of Financial & Performance Information Throughout the Organization Seven Practices of Successful Organizations:

  3. A Journey From Where You Are to High-Performance: • As managers we manipulate resources in pursuit of organizational success. The probability of organizational success increases if that success is defined in a way that we understand, can explain to employees and is measurable. • This is a two-part Webinar with three assignments. Today [1] we will review the characteristics of a High-Performance Organization (HPO), [2] there will be a three week break during which you can/will compare the performance of your organization to that of a HPO and [3] on 10/28/08 (my 47th wedding anniversary) we will come back together to review and discuss the results of your comparison. • I would like for you to share as much of your comparison as possible with me before the 10/28/08 Webinar. Obviously, your name and the name of your organization will not be revealed. During the second Webinar we will discuss your findings and talk about management strategies for resolving performance gaps between where you are and HPO (where you want to be). • Your participation will either strengthen or weaken this effort.

  4. Creating Change :How Do We Proceed? • It seems (at least to me) there are two ways to organizationally approach the change process; • [1] Deal with each challenge (trauma or opportunity) in isolation. • [2] Create a high-performance healthcare organization that is fundamentally healthy and capable of reacting assertively to all types of challenges and traumas as a normal part of the business cycle. • What do you think?

  5. Three Questions: • What to Change? • What to Change to? • How to create that Change?

  6. What to Change? • Administrative and organizational practices at XXXX that are not in alignment with characteristics of a high-performance healthcare organization.

  7. What to Change to? • A High-Performance Healthcare Organization (HPO).

  8. What is a High-Performance Organization? • A high-performance healthcare organization is excellent in so many areas of operation that it consistently outperforms most of its competitors for extended periods of time (sustainable competitive advantage).

  9. Characteristics of High-Performance Organizations: • Strategic Approach: • [1] Organization’s philosophy statement is consistent with its strategy. • [a] XXXX’s core values (5) are represented in the strategic plan. • [2] Managers and employees know what they need know about the organization’s strategy in order to do their jobs. • [a] All employees have access to the strategic plan and understand the role they play in achieving strategic goals. • [3] Organization-wide performance measures match the organizations strategy. • [a] XXXX identifies 10 preferred work behaviors (PWBs) which if exhibited correctly and consistently by employees (Hardwired) increases the probability of achieving strategic goals. • [4] Employees act in ways that are consistent with the behaviors needed to execute the strategic plan. • [a] 90% of XXXX employees exhibit PWBs correctly 90% of the time. • [b] All XXXX employees consistently do what they say they will do.

  10. Characteristics of High-Performance Organizations: • Customer Approach: • [1] The organization believes that they exist primarily to serve their customers. • [2] The organization strives to be the best in their region at providing a high-quality service to their customers. • [a] 95 - 99% of customers rate their interaction with XXXX as excellent. • [3] The organizations assesses and determines its customers future needs. • [4] The organization exceeds customer expectations. • [a] 95% of all customers rate the quality of their interaction with XXXX as excellent after discharge. • [b] 95% of customers are satisfied with their wait time for service. • [c] 95% of customers (random sample/20 per day) surveyed during their hospital stay are satisfied with their care.

  11. Characteristics of High-Performance Organizations: • Leadership Approach: • [1] Everyone is clear about the organizations performance expectations. • [a] 95% of XXXX employees can verbalize their PWB’s. • [2] Executive Management, Department Managers & Supervisors “walk the talk.” • [a] BS walks and behavior talks. • [3] Employees believe that their behaviors affect the organization. • [a] Employees of XXXX act like owners rather than renters. • [4] HPOs had more innovative HR than Low-Performance Organizations (LPOs). • [a] HR’s first priority is employee and patient satisfaction rather than compliance with regulations. • [5] Management promotes the person who has the best skills and knowledge to do the job. • [a] Executive Management, Department Managers & Supervisors at XXXX create organizational equity. Employees (all) get what they deserve. • [b] HP employees receive rewards substantially different from LP employees. • [c] LP employees are coached (one strike), transferred (two strikes) or (three strikes) fired. • [6] Employees are comfortable with being able to express disagreement with the organization’s policies and practices. • [a] Executive Management, Department Managers & Supervisors at XXXX create a “Culture of Execution” which honors open and honest communication (Robust Dialogue). • [b] Crap sometimes roles uphill. • [c] Executive Management wants to know “what we do worst.”

  12. Characteristics of High-Performance Organizations: • Processes & Structures: • [1] The organization places the highest priority on meeting customer needs. • [a] Profit comes from service rather than service from profit. • [2] The organizations views information as something to be shared rather than hoarded for the purpose of power and control. • [a] Executive Management, Department Managers & Supervisors share information freely. • [3] The organization, as a result of its focus on customer satisfaction, is more likely to use state-of-the-art customer-relationship technology. • [4] Performance measures are leveraged to drive clarity and focus throughout the organization. • [a] Information is gathered and disseminated related to employee performance and customer satisfaction.

  13. Characteristics of High-Performance Organizations: • Values & Beliefs: • [1] Most employees (85%) think the organization is a good place to work. • [a] 10% of employees (LPOs) are uncomfortable with XXXX. • [b] 5% (very LPO) don’t like XXXX at all. • [c] What is a good place to work? • [2] Employees tend to be loyal to the facility and they tend to participate in the organization’s social events. • [a] 80% of invited employees attend XXXX sponsored social events. • [3] The work environment fosters cohesiveness, loyalty and readiness to change. Employees tend to be treated with dignity and respect and the employees treat the organization the same way. • [4] Employees and supervisors have more freedom to use their own discretion related to changing procedures and processes to improve outcomes. • [a] Employees are allowed to take risks and fail, within reasonable limits, without fear. • [b] Every employee, within reasonable limits, is a decision maker.

  14. What is a Good Place to Work? • I would like for each of you to answer this question. As a part of the two-step Webinar, please e-mail your definition to me.

  15. Fortune 2008100 Best Places to Work: • # 10 – Methodist Hospital (Houston) • Last year Methodist added a new program called “No One Dies Alone,” in which employees volunteer time with terminal patients • $78,746 average hourly annual pay • $88,972 average annual salaried • 11 hours of training per year (07) • 11% turnover

  16. 100 Best Places to Work:# 18 OhioHealth (Columbus) Rewards everything: customer service, community service, stars of the month & perfect attendance $77,175 average hourly annual pay $108,143 average annual salaried 103 hours of training (07) 8% turnover

  17. 100 Best Places to Work:# 45 Children’s Healthcare of Atlanta Provides backup care for children, elders & pet insurance $58,139 average hourly annual pay $43,286 average annual salaried 20 hours of training (07) 9% turnover

  18. 100 Best Places to Work:# 49 Griffin Hospital (Derby, Conn.) Over 580 other hospitals have visited to learn how Griffin provides exceptional patient service. There were 6,691 applications for 180 open positions 10% turnover Average annual salaried not available $68, 640 average annual hourly pay 110 hours of training a year (07)

  19. 100 Best Places to Work:# 59 Mayo Clinic (Rochester, Minn.) “Hire for Life” is the HR goal, and it seems to be working --- 17% of the workforce has been there 20 or more years 31 hours of training (07) 5% turnover Annual pay information not available

  20. 100 Best Places to Work:# 75 • Southern Ohio Medical Center (Portsmouth) • Hospital provides home-based medical care & engages all employees in care giving. Even housekeepers are urged to ask patients how they can be of help. • $82,077 average annual salaried pay • $58,407 average annual hourly pay • 4 % turnover

  21. 100 Best Places to Work:# 76 • Arkansas Children’s Hospital (Little Rock) • They have invested more than$17 million in wages increases since 2001 • $62,860 average annual salaried pay • $61,266 average annual hourly pay • 8% turnover

  22. 100 Best Places to Work:# 80 • Healthways (Nashville, Tenn.) • This disease-management company provides walking trails, bikes for rent, and easy-to-locate stairways for exercise • $82,613 average annual salaried pay • $63,545 average annual hourly pay • 13% turnover

  23. 100 Best Places to Work:# 85 Lehigh Valley Hospital & Health Network (Allentown, Pa.) Employees pay nothing for healthcare and get bonuses tied to patient satisfaction scores & financial performance. $60,043 average annual hourly pay. $69,256 average annual salaried 88 hours of training (07) 7% turnover

  24. 100 Best Places to Work:# 94 Baptist Health South Florida (Coral Gables) Offers employees adoption aid (just increased from $4,000 to $10,000), three child care centers & nursing retention bonuses 11% turnover 16 hours of training (07) $67,406 average annual hourly pay $89,100 average annual salaried

  25. 100 Best Places to Work:Health Care # 10 – Methodist Hospital System # 18 – OhioHealth # 45 – Children’s Healthcare of Atlanta # 49 – Griffin Hospital # 59 – Mayo Clinic # 75 – Southern Ohio Medical Center # 76 – Arkansas Children’s Hospital # 80 – Lehigh Valley Hospital # 94 – Baptist Health South Florida

  26. Summary of High-Performance Characteristics: • XXXX’s core values (5) are represented in the strategic plan. • All employees have access to the strategic plan and understand the role they play in achieving strategic goals. • XXXX identifies 10 preferred work behaviors (PWBs) which if exhibited correctly and consistently by employees increases the probability of achieving strategic goals • 90% of XXXX employees exhibit PWBs correctly 90% of the time • All XXXX employees consistently do what they say they will do. • 99% of customers rate their interaction with XXXX as excellent. • 95% of all customers rate the quality of their interaction with XXXX as excellent after discharge. • 95% of customers are satisfied with their wait time for service. • Customers (random sample) are surveyed for level of satisfaction during their hospital stay. • 95% of XXXX employees can verbalize their PWB’s • BS walks and behavior talks. • Employees of XXXX act like owners rather than renters. • HR’s first priority is employee and patient satisfaction rather than compliance with regulations.

  27. Summary of High-PerformanceCharacteristics: • Executive Management, Department Managers & Supervisors at XXXX create organizational equity. Employees (all) get what they deserve. • HP employees receive rewards substantially different from LP employees. • LP employees are coached (one strike), transferred (two strikes) or (three strikes) fired. • Executive Management, Department Managers & Supervisors at XXXX create a “Culture of Execution” which honors open and honest communication (Robust Dialogue). • Crap sometimes roles uphill. • Executive Management wants to know “what we do worst.” • Profit comes from service rather than service from profit. • Executive management, Department Managers & Supervisors share information freely. • Information is gathered and disseminated related to employee performance. • 80% of invited employees attend XXXX sponsored social events • Employee satisfaction surveys show that 85% of employees say XXXX is a good place to work. • 10% of employees (LPEs) are uncomfortable with their relationship with XXXX. • 5% of employees (VLPEs) don’t like PCMC at all! • Employees are allowed to take risks and fail, within reasonable limits, without fear. • Every employee, within reasonable limits, is a decision maker. • High-performance healthcare organizations have competent Department Managers.

  28. Culture and High-Performance in Healthcare Organizations: • Hospitals with the best business practices (in particular, leadership and operational effectiveness) had the best workplace culture (employee satisfaction, loyalty, engagement & retention). • Hospitals with the best workplace cultures had the highest patient satisfaction/loyalty scores. • Hospitals with the highest patient satisfaction/loyalty scores were financially more successful than the average hospital and exhibited the best community stewardship.

  29. Culture and High-Performance in Healthcare Organizations: • The numbers don’t lie: Healthcare providers who earn high marks for the caliber of their organizational and department culture rank highest on overall performance outcomes and financial success. • Hospitals with the best business practices (in particular, leadership and operational effectiveness) had the best workplace culture (employee satisfaction, loyalty, engagement and retention). • Hospitals with the best workplace cultures had the highest patient satisfaction/loyalty scores. • Hospitals with the highest satisfaction/loyalty (employee) scores were financially more successful than the average hospital and exhibited the best community stewardship.

  30. Department Managers & High-Performance: • Organizational researchers, for 50 years, have found the most important relationship within any organization is the one between the employee and her immediate supervisor.

  31. Department Managers & Healthcare Organizations: • Overall, the study found three “macro” drivers ofperformance that contributes most to a satisfied, loyal and engaged workforce. • [1] Confidence in, and performance of executive leadership. (People with Offices in the Executive Suite) • [2] Front-line manager capability and performance. (Department Managers) • [3] The degree of patient focus within the organization.

  32. The Trifecta Index:Leadership =‘s Performance • Job Satisfaction – I am satisfied with my job. • Organizational Loyalty – I am willing to recommend my organization to friends as a great place to work. • Professional Engagement – I see my profession in a positive light and encourage others to consider my career. • Effective front-line leadership contributes to higher job satisfaction, loyalty and professional engagement.

  33. Front-Line Management & Employee Retention: • My manager or immediate supervisor is effective at retaining good staff. • My manager or immediate supervisor seems to care about me. • My manager or immediate supervisor is receptive to staff (my) suggestions. • When front-line managers are respected and effective, employees tend to want to stay with their organization for longer periods of time.

  34. Front-Line Leadership & Patient Satisfaction: • There is a positive relationship between effective front-line leadership performance (as evaluated by staff) and increased patient satisfaction.

  35. Front-Line Manager Performance & Budget Targets: • Departments led by ineffective performing front-line managers missed budget projections by an average of 8.3%. • Departments led by somewhat effective front-line managers missed budget targets by an average of 6.7%. • Departments led by effective front-line managers missed budget targets by an average of .4% • Departments led by highly-effective front-line managers consistently hit their projected budget targets.

  36. Department Managers & Performance: • High-performance healthcare organizations have competent Department Managers.

  37. Can Your Organization Change? YES! • People don’t think themselves into a new way of acting. People act themselves into a new way of thinking. (Ex 89) • Identify PWB’s --- then reward employees who exhibit those behaviors correctly/consistently and coach, transfer or fire those employees that don’t. • The foundation for changing behavior is linking rewards to performance and making that linkage transparent. (Ex 92) • If you, the leaders, at XXXX reward and promote people that Execute, the end result will be a “Culture of Execution.” (Ex 92)

  38. How To Create Change: • People don’t think themselves into a new way of acting. People act themselves into a new way of thinking. (Ex 89) • Tell people what results you expect. • Discuss how to get those results. • Reward people for getting those results. • For those people coming up short, provide coaching, withdraw rewards, move them to other jobs or fire them. • (EX 86)

  39. Best Hospitals 2008:Characteristics • Index of Hospital Quality (IHQ): The IHQ describes the interrelationships between [1] structure, [2] process and [3] outcomes. • [1] Structure refers to resources related directly to patient care. Examples of structural measures include intensity of nursing staffing, availability of desirable technologies and patient services. • [2] Process of care delivery encompasses diagnosis, treatment, prevention and patient education. • [3] Outcomes relates to mortality.

  40. Best Hospitals in America:2008 • [1] Johns Hopkins Hospital (Baltimore • [2] Mayo Clinic (Rochester) • [3] Ronald Reagan UCLA Medical Center • [4] Cleveland Clinic • [5] Massachusetts General Hospital • [6] New York-Presbyterian Univ Hospital • [7] Unvi of California San Fran Med Center • [8] Duke University Med Center (Durham) • [10] Hospital of the Univ of Pennsylvania • [10] Univ of Washington Med Cnter (Seattle)

  41. Best Hospitals in America:2008 • [12] Barnes-Jewish Hospital (St. Louis) • [13] Univ of Michigan Hosps (Ann Arbor) • [14] Univ of Pittsburg Med Center • [15] Vanderbilt Univ Med Cnter (Nashville) • [16] Stanford Hosps & Clinics (Stanford) • [17] Univ of Chicago Medical Center • [18] Cedars-Sinai Med Center (Los Angeles) • [19] Yale-New Haven Hospitals (New Haven)

  42. References: • Fortune 2008 Best Places to Work • Execution by Larry Bossidy & Ram Charan • How to Build a High-Performance Organization: American Management Association • The Connection Between Organizational Culture and Performance in Healthcare Organizations: Healthcare Performance Solutions • U.S. News Best Hospitals 2008 • Hardwiring Excellence by Quint Studer • The Baptist Health Care Journey to Excellence by Al Stubblefield

  43. Dr. Tony Lybarger:Contact Information • Phone – 316-630-9320 • Fax – 316-630-9332 • E-mail – tlybarge@yahoo.com

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