achieving mayo’s value equation: the role of systems and ... conference--mayo clinic.pdf · •...

Achieving MayoAchieving Mayo’’s Value Equation:s Value Equation:The Role of Systems and The Role of Systems and

ProceduresProceduresAIMC Health Care WorkshopAIMC Health Care Workshop

April 28, 2010April 28, 2010

Sharon Gabrielson, BS, MASharon Gabrielson, BS, MASection Head, Systems and ProceduresSection Head, Systems and Procedures

Mayo Clinic, Rochester, MNMayo Clinic, Rochester, MN

Group ExerciseGroup Exercise

•• What do your customers value?What do your customers value?

Group ExerciseGroup Exercise

•• How do you know what your How do you know what your customers value?customers value?

The Mayo Clinic ValueThe Mayo Clinic ValueEquationEquation

Value =Quality

(Outcomes, Safety, Service)

Cost

Value increases when quality is improvedand when cost is decreased

OverviewOverview

•• Mayo Organization/Systems and Mayo Organization/Systems and Procedures OverviewProcedures Overview

•• Systems and Procedures as a Value Systems and Procedures as a Value Add to Mayo ClinicAdd to Mayo Clinic

•• Recruitment, On boarding, RetentionRecruitment, On boarding, Retention•• Quantifying the Value AddQuantifying the Value Add

Mayo Clinic in FloridaMayo Clinic in Arizona

Mayo Clinic in Rochester

Physicians and scientistsPhysicians and scientists 3,6493,649Allied health staffAllied health staff 48,91348,913Residents and fellowsResidents and fellows 2,2712,271Total personnelTotal personnel 54,83354,833

Mayo Clinic Mayo Clinic ––February 2010February 2010

7

Primary Value: The needs of the patient come firstMission: Mayo Clinic will provide the best care to every patient every day through

integrated clinical practice, education, and researchVision: Mayo Clinic will be the premier patient-centered academic medical organization

Satisfy Our Patients Achieve Mission-Advancing Financial Performance

Improve and Demonstrate Quality, Safety, Service, and Value

Attract, Develop, and Retain the Best People

Mayo Clinic Strategic PlanMayo Clinic Strategic PlanMayo Clinic Strategic Plan

•• Achieve the highest levels of patient service Achieve the highest levels of patient service and satisfactionand satisfaction

•• Demonstrate Mayo Clinic as the choiceDemonstrate Mayo Clinic as the choicedestination medical centerdestination medical center

•• Achieve operating margin targetAchieve operating margin target•• Achieve sufficient and stable sourcesAchieve sufficient and stable sources

of funding for Research and Educationof funding for Research and Education

•• Achieve the highest levels of quality care and safetyAchieve the highest levels of quality care and safety•• Develop highDevelop high--value care models targeted to specific patient populationsvalue care models targeted to specific patient populations

•• Improve staff satisfaction, training, retention, Improve staff satisfaction, training, retention, and recognitionand recognition

•• Increase diversity of all staffIncrease diversity of all staff

•• Strengthen leadership developmentStrengthen leadership development•• Establish a culture of innovation and discoveryEstablish a culture of innovation and discovery

VISI

ON

EXEC

UTI

ON

PRIO

RIT

IES

QualityQualityIntegrationIntegration

Science ofHealth Care Delivery


IndividualizedMedicine


01-15-08

Systems and ProceduresSystems and Procedures

•• Internal business consulting group at Mayo Internal business consulting group at Mayo •• Objective resource with a focus on applying a Objective resource with a focus on applying a

systems approach to the design, systems approach to the design, development, and implementation of development, and implementation of solutionssolutions

•• Strong business knowledge, systems Strong business knowledge, systems engineering, analytical, process improvement engineering, analytical, process improvement and execution skillsand execution skills

S&P Staff Education/BackgroundS&P Staff Education/BackgroundS&P Staff Education/Background

•• Industrial EngineeringIndustrial Engineering•• Business AdministrationBusiness Administration•• Operations Research/Systems Operations Research/Systems

EngineeringEngineering•• Healthcare AdministrationHealthcare Administration•• Public HealthPublic Health•• MD, PhD, Nursing, Operations, MD, PhD, Nursing, Operations,

Finance, etc.Finance, etc.

Systems and Procedures Systems and Procedures –– Adding Adding Value to Mayo ClinicValue to Mayo Clinic

•• Case StudyCase Study--What Customers ValueWhat Customers Value•• 2008 Internal and External customer 2008 Internal and External customer

surveyssurveys•• Common themes surrounding our Common themes surrounding our

services, on boarding, skill sets, tools services, on boarding, skill sets, tools and methodologies, competition from and methodologies, competition from other internal groupsother internal groups

•• How do we leverage these value How do we leverage these value drivers to increase the value of our drivers to increase the value of our service to our customers and enhance service to our customers and enhance MayoMayo’’s businesss business

Redesign Around ValueRedesign Around Value

•• Standardize the way we workStandardize the way we work•• Define our business lines and servicesDefine our business lines and services•• Develop an S&P consulting model Develop an S&P consulting model •• Invest in orientation, training, & Invest in orientation, training, &

continuous educationcontinuous education•• Create a portfolio of tools, processes Create a portfolio of tools, processes

methodologies, best practices methodologies, best practices •• Leverage what we do bestLeverage what we do best

•• End to end solutionsEnd to end solutions•• ObjectiveObjective•• Trusted partnerTrusted partner

Business Line and ServicesBusiness Line and Services

• Business Strategy and Planning• Business assessment• Business case analysis• Facilities planning• New product/services

•• BuBusiness Strategy and Planningsiness Strategy and Planning•• Business assessmentBusiness assessment•• Business case analysisBusiness case analysis•• Facilities planningFacilities planning•• New product/servicesNew product/services


• Business Process Engineering• Re engineering• Process improvement• Workflows• Optimization through simulation

modeling/analytics

•• Business Process EngineeringBusiness Process Engineering•• Re engineeringRe engineering•• Process improvementProcess improvement•• WorkflowsWorkflows•• Optimization through simulation Optimization through simulation

modeling/analyticsmodeling/analytics


Business Transformation Business Transformation •• Current to future stateCurrent to future state•• Resource managementResource management•• Change managementChange management•• Organization transformationOrganization transformation•• Solution implementation/executionSolution implementation/execution

RecommendSolutions

RecommendSolutions

ImplementSolutions

ImplementSolutions

AnalyzeInformation

AnalyzeInformation

CloseEngagement

CloseEngagement Discover,

Diagnose &Gather Data

Discover,Diagnose &Gather Data

EstablishPartnership


Consulting ModelSystems & Procedures

The consulting model is comprised of 9 core elements: 3 Integrated process groups which support, enhance, and enable the 6 sequential stages.

Each element and IPG consists of key principles, tools/techniques, and critical steps

©2010 Mayo Foundation for Medical Education and Research (MFMER)

Create lasting value for

Mayo Clinic, our patients &

our staff

IPG: Managing Change

IPG: Communicating

IPG: Knowledge Sharing

Close Engagement

RecommendSolutions

AnalyzeInformation

Discover, Diagnose & Gather Data


Implement

Consulting ModelDay 2


FacilitationTechniques





ObservationalResearch

FacilitationTechniques Benchmarking

SystemsThinking

Problem‐SolvingTools

Decision Support&

Data AnalysisBenchmarking

Committee Navigation

ManagingProjects in S&P

BalancedScorecard

CustomerFeedback


ManagingProjects in S&P

Change Management


Crucial Conversation®

HR class

Negotiation Skills&

Techniques

Consulting ModelDay 1 More coming in EPD Phase 2

EPD Delivery Framework

RecommendSolutions

ImplementSolutions

AnalyzeInformation

CloseEngagement

Discover,Diagnose &

GatherData


Createvalue

RecommendSolutions

ImplementSolutions

AnalyzeInformation

CloseEngagement

Discover,Diagnose &

GatherData


Createvalue

RecommendSolutions

ImplementSolutions

AnalyzeInformation

CloseEngagement

Discover,Diagnose &

Gather


Create value

RecommendSolutions

ImplementSolutions

AnalyzeInformation

CloseEngagement

Discover,Diagnose &

GatherData


Createvalue

RecommendSolutions

ImplementSolutions

AnalyzeInformation

CloseEngagement

Discover,Diagnose &

GatherData


Createvalue

RecommendSolutions

ImplementSolutions

AnalyzeInformation

Discover,Diagnose &

GatherData


Createvalue

CloseEngagement

Integr

ated Pro

cess Gro

ups

Recruitment, On boarding, Recruitment, On boarding, RetentionRetention

RecruitmentRecruitment

•• Rigorous processRigorous process•• Telephone screeningTelephone screening•• In person interviewIn person interview

•• Submission of written workSubmission of written work•• PresentationPresentation•• Behavioral interviewBehavioral interview•• Case studyCase study

On boardingOn boarding

•• Competency Assessment to analyze Competency Assessment to analyze competency gaps (incorporate AIMC competency gaps (incorporate AIMC assessment tool)assessment tool)

•• Training curriculum Training curriculum •• aligned with the 6 stage project aligned with the 6 stage project

consulting model and its 3 core consulting model and its 3 core integrated process groupsintegrated process groups

Education and Professional Education and Professional Development (EPD) ProgramDevelopment (EPD) Program

•• The goal of this program is to:The goal of this program is to:•• Obtain greater consistency in Obtain greater consistency in

project approach and consultant project approach and consultant skill levelsskill levels

•• Introduce the tools, processes, Introduce the tools, processes, and methodologies to analysts for and methodologies to analysts for use in the front line workuse in the front line work

•• Provide continuous learning Provide continuous learning environment environment --retention factorretention factor

DecisionSupportMethods

AdvancedTeam Skills

Forecasting& ModelingTechniques

Advanced Portfolio

Management

SE/ORMethods

AdvancedResearchMethods

OrganizationTransformation

Methods

Business Intelligence& Analytics

S&P Ed &

S&P Ed &

PD Program

PD Program

RelationalDatabase Use

Mathematical Modeling

Of Systems

S&P ConsultingModel

DS/DAMayo CommitteeSystem Navigation

StaffingModel Designs

& Uses

Managing ProjectsIn S&P

Business Strategy & Development

ObservationalResearch

Software & ToolSelection/Approval/

Implementation HealthcareBusiness

Environment

IndustrialEngineeringTechniques

Benchmarking

The MGPs

IT at Mayo

ChangeManagement

Knowledge Sharing

Problem-SolvingTools

Human FactorsEngineering

Library Resources& Services Prototyping

FacilitationTechniques

Balanced Scorecard

Healthcare Finance

SystemsThinking

Customer Feedback

Strategic Thinking& Business Planning

Emerging Technologies

Negotiation

Workflow Optimization

Organizing, Delivering & Presenting Information

Patient ExperienceAt Mayo Clinic

Value Creation& Value Engineering

Publishing

MeetingFacilitation

TeamSkills

BusinessWriting

ComputerBasics

PresentationSkills

CommunicationSkills

InterpersonalSkills

HRNEO

AdministrativeOrientation

ComputerBasics

UnitHeads

IT SystemsNon-EMR

Intro toClinical

Systems

S&P1-DayNEO

Mentors

November 11, 2009

Quantifying Value AddQuantifying Value Add

•• MetricsMetrics•• Key performance indicatorsKey performance indicators•• Aligned with the Mayo Clinic Aligned with the Mayo Clinic

Strategic PlanStrategic Plan

23

Primary Value: The needs of the patient come firstMission: Mayo Clinic will provide the best care to every patient every day through

integrated clinical practice, education, and researchVision: Mayo Clinic will be the premier patient-centered academic medical organization

Satisfy Our Patients Achieve Mission-Advancing Financial Performance



Mayo Clinic Strategic PlanMayo Clinic Strategic PlanMayo Clinic Strategic Plan

•• Achieve the highest levels of patient service Achieve the highest levels of patient service and satisfactionand satisfaction

•• Demonstrate Mayo Clinic as the choiceDemonstrate Mayo Clinic as the choicedestination medical centerdestination medical center

•• Achieve operating margin targetAchieve operating margin target•• Achieve sufficient and stable sourcesAchieve sufficient and stable sources

of funding for Research and Educationof funding for Research and Education

•• Achieve the highest levels of quality care and safetyAchieve the highest levels of quality care and safety•• Develop highDevelop high--value care models targeted to specific patient populationsvalue care models targeted to specific patient populations

•• Improve staff satisfaction, training, retention, Improve staff satisfaction, training, retention, and recognitionand recognition

•• Increase diversity of all staffIncrease diversity of all staff

•• Strengthen leadership developmentStrengthen leadership development•• Establish a culture of innovation and discoveryEstablish a culture of innovation and discovery

VISI

ON

EXEC

UTI

ON

PRIO

RIT

IES

QualityQualityIntegrationIntegration





01-15-08

Mayo Clinic Rochester Systems & ProceduresMayo Clinic Rochester Systems & Procedures

Financial Performance



Customer Service

1.1 Overall Customer Satisfaction1.2 Project Requests (clinical, research, education, administration)

4.1 Staff Satisfaction• Key Drivers for Overall Satisfaction and

Discretionary Effort

3.2 Strategic Partnerships

4.3 Staff Demographics• Turnover Rate • Diversity Rate4.4 Leadership Development/

Succession Planning• Staff Prepared • Internal Hires

3.1 Alignment with MC or MCR Strategic Priorities

3.3 Committee Assignments Institutional Departmental

4.2 Education and Professional Development

• Staff Development & Training • Scholarly Activity


IntegrationIntegrationQuality &Quality &SafetySafety

Science ofScience ofHealthcare DeliveryHealthcare Delivery

IndividualizedIndividualizedMedicineMedicine

Primary Value: The needs of the patient come first.Mission: Systems and Procedures will partner with our Mayo Clinic colleagues to achieve the best patient experience through objective, innovative, and integrative business consulting. Vision: Systems & Procedures will be Mayo Clinic’s premier business consulting team.

2.1 Projects with Expense Reduction, Efficiency, Revenue Growth2.2 Estimated Project Duration

3.4 Support for MayoTransformation Initiatives

1/1/09-12/31/09

3.5 S&P Quantitative Metrics

3.6 S&P Qualitative Advantage

2.1 Projects with Expense Reduction, 2.1 Projects with Expense Reduction, Efficiency, and Revenue GrowthEfficiency, and Revenue Growth

The cumulative number of active projects that should yield The cumulative number of active projects that should yield significant expense reduction, efficiency, or revenue growth significant expense reduction, efficiency, or revenue growth benefits.benefits.

Project Requests Year end 2009

Expense Reduction 100

Efficiency 235

Revenue Growth 69

3.4 Support for Mayo Transformation 3.4 Support for Mayo Transformation InitiativesInitiatives

On target to meet plan Moderate risk of not meeting plan

$4,000,000$4,000,000

TBDTBD

$5,385,000 $5,385,000

TBDTBD

TBDTBD

$12,200,000$12,200,000

$9,100,000$9,100,000

$1,400,000$1,400,000

$4,996,000$4,996,000

TBDTBD

$4,160,000$4,160,000

NANA

$5,000,000$5,000,000

$5,000,000$5,000,000

YESYES

YESYES

YESYES

YESYES

YESYES

YESYES

YESYES

YESYES

YESYES

YESYES

YESYES

YESYES

YESYES

YESYES

1. Hospital Census Management1. Hospital Census Management

2. Manage Patient Mix/Access2. Manage Patient Mix/Access

3. New Models for Internal Consults3. New Models for Internal Consults

4. Surgical Redesign & Coding Improvement4. Surgical Redesign & Coding Improvement

5. Critical Care Delivery System of the Future5. Critical Care Delivery System of the Future

6. Manage to Reimbursement6. Manage to Reimbursement

7. Staff to Workload for Outpatient Practice7. Staff to Workload for Outpatient Practice

8. Transcription Services Redesign8. Transcription Services Redesign

9. Center for Innovation (CFI)9. Center for Innovation (CFI)

10. Employee and Community Health IMP 10. Employee and Community Health IMP ProjectsProjects

11. International Destination Medical Center11. International Destination Medical Center

12. Lab PACE12. Lab PACE

13. Blood Management13. Blood Management

14. MS14. MS--DRG/DocumentationDRG/Documentation

Potential Potential ImpactImpact

S&P S&P SupportSupport

StatusStatusProjectProject

3.5 – S&P Quantitative Metrics3.5 3.5 –– S&P Quantitative MetricsS&P Quantitative Metrics

*External Consultant Hourly Charge, $200-$500/hr(References on external consultant hourly charges)

S&P Estimated Hourly Consulting Expense* $80-$90(Includes salary and benefits for all analysts, S&P leadership, and support staff and appropriate overhead expenses)

% S&P Consultant Time Dedicated to Projects 90%

Examples of Additional S&P Projects with Quantitative Impact

Examples of Projects with Quantitative Examples of Projects with Quantitative ImpactImpact

Overall 2 FTE reduction/day, $24,000 Overall 2 FTE reduction/day, $24,000 (cost savings for printing)(cost savings for printing)

EMR Auto Dismiss of Clinical EpisodesEMR Auto Dismiss of Clinical Episodes

Optimize patient itinerary length Optimize patient itinerary length --overall reduction of 1,200 hours/monthoverall reduction of 1,200 hours/month

Neurology Appointment DurationNeurology Appointment Duration

*$79,800,000 *$79,800,000 (potential cost avoidance)(potential cost avoidance)Barcode Medication ChartingBarcode Medication Charting

$680,000 $680,000 (cost savings)(cost savings)Cardiac Cath Lab Consolidation ProjectCardiac Cath Lab Consolidation Project

$600,000 $600,000 (cost savings)(cost savings)Transportation Expense ManagementTransportation Expense Management

$500,000 $500,000 (revenue enhancement)(revenue enhancement)Gonda 3 Process Improvement projectGonda 3 Process Improvement project

$500,000 $500,000 (cost savings)(cost savings)PPI enabled through Patient PortalPPI enabled through Patient Portal

$180, 000 $180, 000 -- $200,000 $200,000 (cost savings)(cost savings)Waste Expense ReductionWaste Expense Reduction

Significant revenue loss avoidanceSignificant revenue loss avoidanceMayo Rochester & MHS ICDMayo Rochester & MHS ICD--9 to ICD9 to ICD--1010

Improved on time arrivals from 66% to Improved on time arrivals from 66% to 96%96%

Surgical AM AdmissionsSurgical AM Admissions

50% reduction in cycle time50% reduction in cycle timeACTION: Cancer Center Clinical Trials ACTION: Cancer Center Clinical Trials IntegrationIntegration

Quantitative Annual Impact Quantitative Annual Impact Project DescriptionProject Description

*One study found that each preventable Adverse Drug Event that took place in a hospital added about $8,750 (in 2006 dollars) to the cost of the hospital stay.” (IOM – Preventing Medication Errors; July 2006)

3.6 3.6 –– S&P Qualitative S&P Qualitative AdvantageAdvantage

•• ““End to EndEnd to End”” Consulting Consulting –– Providing Services from project initiation Providing Services from project initiation through final execution/implementationthrough final execution/implementation

•• Knowledge Retention Knowledge Retention –– Knowledge from completed projects is retained Knowledge from completed projects is retained at Mayo and subsequently leveragedat Mayo and subsequently leveraged

•• Improved Consulting Cycle TimesImproved Consulting Cycle Times –– Internal consulting staff are Internal consulting staff are positioned to expedite turnaround on project deliverablespositioned to expedite turnaround on project deliverables

•• Relationship Credibility Relationship Credibility –– LongLong--term relationships lead to improved client term relationships lead to improved client understanding, buy in and commitment understanding, buy in and commitment

•• Objective/integrative institutional perspective Objective/integrative institutional perspective –– Strategic, operational Strategic, operational and healthcare business experience allows staff to provide broadand healthcare business experience allows staff to provide broadinstitutional perspectivesinstitutional perspectives

•• Commitment to the Mayo Vision Commitment to the Mayo Vision –– An internal consulting group An internal consulting group understands the value and is committed to the institutional Missunderstands the value and is committed to the institutional Mission and ion and Vision Vision

•• Networking with External Expertise Networking with External Expertise –– An institutional resource with the An institutional resource with the knowledge and expertise to effectively benchmark with external knowledge and expertise to effectively benchmark with external organizations.organizations.

4.2 Education and Professional 4.2 Education and Professional Development Development

ActivityActivity Year end 2009Year end 2009% of % of core trainingcore training modules completed by staffmodules completed by staff 54%54%

% of % of advanced trainingadvanced training modules completed by staffmodules completed by staff available 2010available 2010

# of S&P staff who attended conferences # of S&P staff who attended conferences 1717

# of abstracts/presentations/poster presentations # of abstracts/presentations/poster presentations 2727

# of manuscripts submitted/articles published# of manuscripts submitted/articles published 77

# of adjunct faculty at external academic institutions# of adjunct faculty at external academic institutions 33

# of staff who have Mayo Quality Fellow certification# of staff who have Mayo Quality Fellow certification 99

S&P sponsored the Mayo Clinic Conference on Systems Engineering S&P sponsored the Mayo Clinic Conference on Systems Engineering and and Operations Research in HealthcareOperations Research in Healthcare

Questions?Questions?

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