Tools for Achieving Operational Excellence in Healthcare Organizations

1. Tools for Achieving Operational Excellence in Healthcare Organizations Presented by Kevin Gilson, Associate Consultant Theseus Professional Services, LLC http://www.theseuspro.com at the LifeSpan Annual Conference May 10, 2007

2. Agenda • Introduction • What is Operational Excellence? • What can Operational Excellence contribute to your organization? • MBNQ Program criteria as a tool for achieving Operational Excellence • Case Studies Theseus Professional Services, LLC

3. Introduction • Why should you be interested in operational excellence or performance excellence? • What’s in it for You? • What is the current trend in health care quality programs? Theseus Professional Services, LLC

4. In 1998 the Milbank Memorial Fund asked: • Why has health care lagged behind other sectors of the economy in quality improvement? • Why have clinical quality improvement efforts apparently failed to move the sector quality? • How do we enlist physicians and other health professionals to work on meaningful improvements in the quality of health care? • How will changes in the expectations and behavior of consumers and patients affect quality? • What will be required to transform health care into a sector capable of delivering quality care and constantly improving care? Theseus Professional Services, LLC

5. Is it Complicated? • Applies to everyone regardless of size • Large multi-facility organization • 30 bed facility • 6 bed facility • Its not rocket science • Doesn’t come from a planet far, far away • Is either free or materials cost under $10 Theseus Professional Services, LLC

6. Health Care’s Challenges • Your organizations are facing: • Demands for higher levels of quality • Escalating costs • More expensive procedures and medications • More debilitating disease conditions • Constraints on reimbursements by CMS, Medicare, Medicaid and payers - trying to hold the line on cost • Regulatory issues from CMS, states and payers • Marketplace challenges - increased competition • Challenges are getting more complex Theseus Professional Services, LLC

7. Case Study - Client • Consultation: Write a Quality Plan to implement Continual Quality Improvement • What we did: • Developed method for conducting an assessment • Assessed organization • Identified strengths and opportunities for improvement (OFI) • Suggested next steps • Jointly developed a Plan with management input Theseus Professional Services, LLC

8. Case Study - Client • What we found: • Organization - 250 full-time personnel • Financial reporting comprehensive • Key business processes not known • Absence of key process metrics • “Gut feel” was predominant metric • Some customer survey information • No basis for CQI - problem areas unknown Theseus Professional Services, LLC

9. Case Study - Client • What they need to do: • Understand key processes and programs • Develop metrics and goals • Manage this data to identify CQI opportunities • Quality Councils - upper and middle management • Data display for decision-making • Implement a Corrective Action process • Teams to implement CQI Theseus Professional Services, LLC

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11. Variability - the Enemy • What is Variability? • Dr. Deming: Constancy of Purpose • Characteristics: • Differences among people • Differences among patients or clients • Differences in the way the same service is rendered by the same or different people • Differences in the way relatives or concerned parties perceive service delivery Theseus Professional Services, LLC

12. Variability and Healthcare • Care is great - but only on day shift • This home is great - but the last one….. • The person who answers the phone in the afternoon has answers • We want nurse “X” to work with our mother Are broken processes responsible for this variability? Theseus Professional Services, LLC

13. Aspects of Variability • Variability: • Costs money • Expends time (hidden costs) • Ineffective health care delivery • Patient safety issues • Can result in costly recoveries from errors • Extended stays in higher level of care • Lawsuits or mediation Theseus Professional Services, LLC

14. Definition of Operational (Performance) Excellence • No one definition • Consultants usually define OE in terms of their consulting philosophy • Six Sigma, TQM, Lean, Toyota Production System • Baldrige National Quality Program • Health Care Criteria for Performance Excellence • Used by the Maryland Performance Excellence Award program Theseus Professional Services, LLC

15. Components of OE • OE emphasizes: • Process • Systems thinking or perspective • Patient-focused excellence • Valuing staff and partners input • Results • Managing by fact • Focus on the future - agility • Visionary leadership Theseus Professional Services, LLC

16. Evaluating OE • Baldrige (MBNQA) components • Leadership • Strategic Planning • Focus on Patients, Other Customers, and Markets • Measurement, Analysis and Knowledge Management • Workforce Focus • Process Management • Results Theseus Professional Services, LLC

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18. MBNQA • Leadership • Visionary leadership • How senior leaders guide and sustain your organization - create sustainability • Organizational governance - vision and values • Create and promote a culture of patient safety • Communicate organizational performance with a focus on action - performance measures • Governance and social responsibility Theseus Professional Services, LLC

19. MBNQA • Strategic Planning • Strategy development • What is your process? • What are your Key Strategic Objectives? • Strategy deployment • Action plans • Key performance measures/indicators • Actions based on reviews and fact • “Act on Fact” Theseus Professional Services, LLC

20. MBNQA • Focus on Patients, Other Customers, and Markets • Determine requirements, needs, expectations and preferences of customers • Voice of the customer • Current health care service needs • Customer satisfaction and loyalty Theseus Professional Services, LLC

21. Case Study - VoC • Assessment of needs • All stakeholders have: • Requirements - what must occur • Regulations - CMS, state, local jurisdiction • Medical requirements for the best quality of life • Patient/family requirements • Needs - would be nice if it occurs • Desires of patient or other customers • Expectations - unexpressed requirements • Failure to deliver on expectations = requirement failure Theseus Professional Services, LLC

22. Case Study - VoC • Gathering requirements, needs, expectations • Mom is in your care • Daughter lives in Iowa and is a senior citizen • Neither has really thought through the issues of Mom in assisted living • Limited resources Theseus Professional Services, LLC

23. Voice of Customer Theseus Professional Services, LLC

24. MBNQA • Measurement, Analysis and Knowledge Management • Performance measurement • Performance analysis, review and improvement • Management of information resources • Data, information and knowledge management Theseus Professional Services, LLC

25. MBNQA • Workforce Focus • Workforce enrichment • Workforce and leader development • Workforce capability and capacity • Workforce climate Theseus Professional Services, LLC

26. MBNQA • Process Management • Design of work systems • Core competencies • Work process design with patient safety view • Emergency readiness • Systems thinking point of view • Work process management • Work process improvement (CQI) Theseus Professional Services, LLC

27. Case Study - SSM • SSM Healthcare System • First health care organization to receive a site visit in the MBNQA program • Started CQI program in large multi-state health care system in 1990 • Established focus on management process redesign to achieve bottom-line results • Focus on process from customer viewpoint • 85% of breakdowns are poorly designed processes • 15% are people issues Theseus Professional Services, LLC

28. Case Study - SSM • Two important views: • System thinking • Application of the MBNQA criteria • Writing the application • Feedback from Examiners • First recognition • 1999 Missouri Quality Award Theseus Professional Services, LLC

29. Case Study - SSM • Systems Thinking - 5 principles • Openness - behavior of living systems can only be understood in the context of their environment • Purposefulness - why do people do what they do? • Multidimensionality - complementary relationship between parts • Emergent property - success, failure as measures • Counterintuitiveness - actions may produce an undesired and opposite result Theseus Professional Services, LLC

30. MBNQA • Results • Health care outcomes • Patient and other customer outcomes • Financial and market outcomes • Workforce-focused outcomes • Process effectiveness outcomes • Leadership outcomes Theseus Professional Services, LLC

31. Case Studies • One assisted living applicant in 2006 • Household of Angels Assisted Living • MPEA application was used to help the organization focus on quality improvement • Awarded Certificate for application • Plans on continuing to utilize MPEA and Examiner feedback to focus improvement efforts Theseus Professional Services, LLC

32. Tools of Operational Excellence • Malcom Baldrige National Quality Program • http://www.quality.nist.gov • Download free criteria and survey • Goal QPC Memory Joggers • http://www.goalqpc.com • Under $10 Memory Joggers for: • Quality tools - Memory Jogger II • The Team Memory Jogger Theseus Professional Services, LLC

33. More Tools • Maryland Performance Excellence Award Program (MPEA) http://www.mpea.umd.edu • Inexpensive workshops on creating an application and using the criteria • Examiner training program - free • Annual celebration • American Society for Quality, Baltimore • http://www.asqbaltimore.org or www.asq.org • Local quality experts, monthly meetings Theseus Professional Services, LLC

34. References • Developing a Quality Management System, American Health Care Association, 2005 • Improving Health Care, Case Studies from Leading Practitioners, GOAL QPC, 2006 • CQI and the Renovation of an American Health Care System, Ryan and Thomson, ASQ Press, 1998 • The Nun and the Bureaucrat, Savary and Crawford-Mason, CC-M Publications, 2006 (also a DVD) www.managementwisdom.com • Medical Quality Management Sourcebook, 2000 Edition, Faulkner and Gray, 1999 • System Thinking, Managing Chaos and Complexity, J. Gharajedaghi, Butterworth Heinemann, 2006 Theseus Professional Services, LLC

35. IOM Conference • IOM Forum on the Science of Healthcare Quality Improvement and Implementation: Implementation Science Methods Workshop, 24-25 May 2007, Irvine, California.(http://www.iom.edu/CMS/3809/38607/39184.aspx). • Topics for discussion include: 1. What methods should be used to research quality improvement in health care? 2. What, as shown through research, are reliable quality improvement strategies that can be spread now? 3. What lessons can be leveraged from other industries? 4. How can we address barriers to various research methods, such as funding, ethics, and publication? Theseus Professional Services, LLC

36. In Conclusion • Thank you for considering looking at your organization through the lens of Organizational Excellence • Apply for the Maryland Performance Excellence Award • Application writing workshop May 22nd • Questions? • Look for this presentation on these websites: • http://www.asqbaltimore.org • http://www.theseuspro.com Theseus Professional Services, LLC

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38. Components of OE • Core values and concepts (MBNQA) • Visionary leadership • Patient-focused excellence • Organizational and personal learning • Valuing staff and partners • Agility • Focus on the future • Managing for innovation • Management by fact • Social responsibility and community health • Focus on results and creating value • Systems perspective Theseus Professional Services, LLC