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11/29/2012
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IHI National Forum “Defining Moments”
M23: Baldrige Performance Excellence Program
Excellence is Every, Every, Every
December 2012
Orlando, FL
Experience Objectives
• Assess, compare, and contrast your
organization’s performance against that of
Baldrige role models and the Criteria for
Performance Excellence.
• Describe how the Baldrige Framework can be
used to create inspired cultures and
immediately improve performance
• Act on the Baldrige excellence roadmap.
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Presenters• Joel Ettinger, President and CEO, Category One Inc. and
Alumni Member of the Board of Examiners, Malcolm Baldrige National Quality Award
• Susan Hawkins, SVP, Performance Excellence, Henry Ford Health System
• Craig Deao, Research and Development Leader, StuderGroup
• Gary Yates, MD, SVP and CMO, Sentara HealthcareDr. Yates is the President of Healthcare Performance
Improvement, LLC a consulting company focused on improving healthcare reliability
What Will NOT Happen
• You will not understand all of it—it’s too
big
• We will not address all elements of the
Framework equally—it’s too big
• Know everything you need to do when
return to your worksite and colleagues—
it’s too big
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Criteria for Performance Excellence
Business Health Care Education
A disciplined approach to addressing key
patient/customer, stakeholder, and operational
requirements integrating cycles of refinement
and innovation
How Do You/We Know That…
• Effective leadership system is in place that assures sustainability, excellence, agility, relentless patient focus – even in economically difficult times
• Pervasive innovation is a key differentiator
• Strategic planning process produces appropriate stretch targets fully deployed
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How Do You/We Know That…
• Market data are valid/segmented to design/deliver products/services that people want/need
• The people we serve can easily access services
• Accurate satisfaction, loyalty, referral, & engagement determination systems exist
• Information systems are based on user needs and produce “actionable” information
How Do You/We Know That…
• Everyone has the knowledge they need to have to “ make” healthcare great
• Culture is optimal, work systems carefully designed, necessary skills secured, all workforce is proud, recognized, loyal, engaged
• New services are designed systematically with patient/customer, evidence-based input
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How Do You/We Know That…
• We provide, always, the finest error free medicine humanly possible
• We out-compete the competition in all important ways – care experience and research funding
• Our clinicians are magnificent members of the an amazing workforce that makes the health care
• All major processes are continually improved, waste eliminated everywhere
How Do You/We Know That…
• All key results based on Critical Success
Factors are measured, trended, compared to
competition and best-in-industry
• The approaches to work and improvement,
and innovation are systematic, deployed and
aligned on an enterprise-wide basis
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These Things Happen,
No Longer
The Baldrige Performance
Excellence Program
What are the Criteria?
“The leading edge of
validated management
practice”
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What are the Criteria?
• Expectations or requirements
• Structured approach to improvement
• Framework for a systems view of performance
management
• Based upon a set of core values
• A common language
Criteria Purposes
• Alignment of key components
• Go beyond conformance-to-standard to a
focus on excellence
• Facilitate communication and sharing among
all types of organizations
• Working tool for understanding and managing
performance improvement
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Criteria Key Characteristics
• Focus on results
• Are non-prescriptive and adaptable
• Support a systems perspective
• Support goal-based diagnosis
THE FRAMEWORK
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Four Harmonized Components
Simplified
• Organizational Profile– Who are we? What is important to us?
• Core Values– What do we believe in?
• Criteria– How do we do it
• Performance Differentiators– How well are we doing it? (results)
BALDRIGE: The Pursuit of Excellence
FEELING, THINKING, BEING, THEN DOING
Visionary Leadership
Patient-focused Excellence
Organizational and Personal
Learning
Valuing Workforce Members
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
ORG PROFILE & 7 CATEGORIES OF CRITERIACORE VALUES/CONCEPTS
PERFORMANCE DIFFERENTIATORS (ADLI)
How are our APPROACHES SYSTEMATIC?
How are our approaches fully DEPLOYED?
How does LEARNING and IMPROVEMENT
happen?
How is our work ALIGNED and INTEGRATED?
HOW DO YOU KNOW EMPOWERMENT
SO WHATWHAT ARE YOU THINKING
EVERY, EVERY, EVERY
HOW DOES INNOVATION
DISTINGUISH US
CORE COMPETENCIES
SEGMENTATION ENGAGEMENT
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The Comprehensive Excellence
Continuum
Right to
OperateOrg
Excellence
MI
TQM
TPS & Six
Sigma
JCAHO
ISO9000HFAP
CMS/State
Surveys
Other
Govt.
Surveys
Leadership/Customer
Driven
Compliance/QA/QC
Driven
Magnet
Maintain Innovation
DNV
Improvement
Accelerators
Pillar Framework
6-month EBL assessments
LEM
Stoplight Report
Support Service Survey
PCM
SG Portal
RED Strategy Planning Process
Virtual Tokens of Recognition
Service Guarantee
Leader Evaluation Process
Goal Cascade
Monthly Meeting Model
90-day Plans
Linkage grids
LDI
CDI
Peer Interviewing
30/90 day meetings
AIDET
Managing Up
highmiddlelow Performer
Conversations
Rounding on Employees
Leader Rounding for Outcomes
Hourly Rounding
Pre- and Post-Visit Calls
SG’’’’s Best Practices
Standardization AcceleratorsMust
Haves®
Performance
Gap
Objective
Evaluation
System
Leader
Development
Aligned Goals Aligned Behavior Aligned Process
Specific and interdependent practices that have
value to all businesses to create better places to
work & higher quality services for customers.
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World Class Quality
“ The most comprehensive list of actions to
achieve world-class quality is contained in the
Malcolm Baldrige Criteria. ”
Joseph Juran
Quality Progress
August, 1994
Respondents Who Used the CriteriaQuality Progress
Percent Answering
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The Framework Effectively Enables
• Sustainability
• Innovation
• An engaged workforce
• Significantly greater integrated physician
relationship
• Proactively address the more knowledgeable
customer
The Baldrige Effect
• Reduce cost, waste, errors – Less work, Better Work, More Accomplished
• Silos replaced by system integration and collaboration
• To better manage the future – health care reform, ACOs, declining reimbursement
• Improved performance in all key results
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The Baldrige Effect
• It creates the culture and context to EXECUTE
and FULLY DEPLOY Best Practices…
and, preferably…
• Better Than Best Practices—Intelligent Risk
and Innovation
2012 Award Recipients
• Lockheed Martin Missiles and Fire Control,
Grand Prairie TX
• Mesa Products, Tulsa OK
• North Mississippi Health Services
• City of Irving
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Manufacturing Award Recipients
• 3M Dental Division (1997)
• Armstrong Building Products Operations (1995)
• Boeing Airlift & Tanker Programs (1998)
• Cargill Corn Mill (2008)
• Clarke American Checks, Inc. (2001)
• Corning Telecommunications Products Division (1995)
• Eastman Chemical (1993)
• Honeywell Federal Manufacturing Technologies (2008)
• IBM Rochester (1990)
• Lockheed Martin Missiles and Fire Control (2012)
• Medrad (2003, 2010)
Manufacturing Award Recipients
• Milliken & Company (1989)
• Motorola CGISS (2002)
• Motorola, Inc. (1988)
• Nestle Purina Petcare (2010)
• Solar Turbines Inc. (1998)
• Solectron Corporation (1991
and 1997)
• Sunny Fresh Foods (1999, 2005)
• STMicroelectronics --
Region Americas (1999)
• Texas Instruments Defense
Systems & Electronics
(1992)
• Westinghouse Commercial
Nuclear Fuel Division (1988)
• Xerox Business Products &
Systems (1989)
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Service Award Recipients
• BI (1999)
• Boeing Aerospace Support (2003)
• Caterpillar Financial Services U.S. (2003)
• DynMcDermott Petroleum Operations (2005)
• Federal Express Corporation (1990)
• GTE Directories Corporation (1994)
• Merrill Lynch Credit Corporation (1997)
• Operations Management International, Inc. (2000)
• Premier, Inc. (2006)
• The Ritz-Carlton Hotel Company, L.L.C. (1992 and 1999)
• Xerox Business Services (1997)
Small Business Award Recipients
• Branch-Smith Printing Division (2002)
• Freese and Nichols (2010)
• Granite Rock Company (1992)
• Los Alamos National Bank (2000)
• Mesa Products, Inc. (2006, 2012)
• Midway USA (2009)
• Pal’s Sudden Service (2001)
• K&N Management (2010)
• Park Place Lexus (2005)
• PRO-TEC Coating (2007)
• Stoner, Inc. (2003)
• The Studer Group (2010)
• Texas Nameplate (1998, 2004)
• Trident Precision Manufacturing, Inc. (1996)
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Education Award Recipients
• Chugach School District (2001)
• Community Consolidated School District 15 (2003)
• Iredell-Statesville Schools (2008)
• Jenks Public Schools (2005)
• Monfort College of Business (2004)
• Montgomery City Schools (2010)
• Pearl River School District (2001)
• Richland College (2005)
• University of Wisconsin-Stout (2001)
Non-Profit Award Recipients
• City of Coral Gables (2007)
• City of Irving (2012)
• Concordia Publishing House (2011)
• US Army Armament Research, Development and Engineering Center (2007)
• VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (2009)
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Health Care Award Recipients
• Advocate Good Samaritan
Hospital (2010)
• AtlantiCare (2008)
• Baptist Hospital, Inc. (2003)
• Bronson Methodist Hospital
(2005)
• Heartland Health (2008)
• Henry Ford Health System
(2011)
• Mercy Health System (2007)
• Poudre Valley Health
System (2008)
• North Mississippi Medical
Center (2006)
• North Mississippi Health
Services (2012)
• Robert Wood Johnson (2004)
• St Luke’s Hospital (2003)
• Sharp HealthCare (2007)
• SSM Health Care (2002)
Schneck Medical Center (2011)
• Southcentral
Foundation(2011)
When are you too
busy to pursue
excellence?
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BALDRIGE: The Pursuit of Excellence
FEELING, THINKING, BEING, THEN DOING
Visionary Leadership
Patient-focused Excellence
Organizational and Personal
Learning
Valuing Workforce Members
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
ORG PROFILE & 7 CATEGORIES OF CRITERIACORE VALUES/CONCEPTS
PERFORMANCE DIFFERENTIATORS (ADLI)
How are our APPROACHES SYSTEMATIC?
How are our approaches fully DEPLOYED?
How does LEARNING and IMPROVEMENT
happen?
How is our work ALIGNED and INTEGRATED?
HOW DO YOU KNOW EMPOWERMENT
SO WHATWHAT ARE YOU THINKING
EVERY, EVERY, EVERY
HOW DOES INNOVATION
DISTINGUISH US
CORE COMPETENCIES
SEGMENTATION ENGAGEMENT
ORGANIZATIONAL PROFILE
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Organizational Profile
• Who are we?
• What’s important to us?
• What do our customers want? What does our workforce need?
• What are we really good at?
• What are our challenges and advantages?
SEVEN CATEGORIES OF CRITERIA
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• Values and expectations
• Ethical leadership
• Ensure sustainability
• Engage, empower, communicate
• Performance reviews, set direction
• Findings and improvement
• Effective Governance
• Improve leadership system
• Regulatory, legal, and ethical responsibilities
• Support of key communities
• Build community health
Category 1: Leadership
1.1
Senior
Leadership
1.2Governance
AndSocial Responsibilities
• Sustainability/blind spots
• Health care markets
• SWOT
• Technology and innovation
• Ability to execute plan
• Action plans and measures
• Financial resouces
• Agility
• Staff plans
• Performance projections
• Alignments of goals and actions
2.1
Strategy Development2.2
Strategy Implementation
Category 2: Strategic Planning
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Category 3: Customers Focus
• Identify and innovate services to meet/exceed expectations/attract new customers
• Deploy support services to entire workforce
• Build and manage culture/ relationships to increase customer engagement
• Listen and learn--actionable
• Manage complaints to increase engagement
• Determine satisfaction and engagement
• Use information to antcipaatefuture markets
3.1
Voice of the Customer
3.2
Customer Engagement
Category 4: Measurement, Analysis and Knowledge Management
• Performance Measurement
• Use of comparative data
• Analysis and communication of performance
• Translating reviews into improvement
• Making information available
• Managing organizational knowledge
• Data/information integrity and security
4.1
Measurement, Analysis and Improvement of
Organizational Performance
4.2
Management of Information, Knowledge, Information
Technology
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• Culture enrichment to secure high performance
• Workforce evaluation and recognition
• Empowerment, innovation, ideas
• Workforce and leadership learning and development
• Learning system
• Capability and capacity
• Recruit and retain
• Safe work environment
• Satisfaction determination and improvement
• Relationship to organizational performance results
5.1
Workforce Environment5.2
Workforce Engagement
Category 5: Workforce Focus
Category 6: Process Management
• Core Competencies
• Process requirements
• Work system and process design
• Delivering value
• Suppliers, partners, collaborators
• Emergency readiness
• Meeting requirements continuously
• In-process process measures--productivity, costs, cycle time and supplier performance
• Reducing inspections, rework
• Improving processes, reducing variation
6.1
Work Systems
6.2
Work Process
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PERFORMANCE DIFFERENTIATORS
Characteristics of Great Companies
• Know the right things to do
• Do the right things
• Do the right things well
• Do the right things well…ALL THE TIME.
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Performance Differentiators
Approach/Deployment
1. Approach--Systematic
• Approaches are repeatable
• Use data/information to enable evaluation, learning and improvement
2. Deployment--Full
• Extent to which systematic approaches are used by all appropriate work units
3. Learning/Improvement—Ongoing Cycles
• Evidence of fact-based systematic evaluation and improvement
• Organizational learning important to the achievement of critical success factors
4. Integration and Alignment
• Integration of plans, processes, information, resources, actions, results, analysis and learning throughout the organization
Approach and Deployment
• Approach
– A method or process
– Steps
– Ownership
– Repeatability
(systematic)
• Deployment
– The approach is
disseminated to all
places and people
– The approach includes
and/or considers all
segments
– What is your systematic
approach to
deployment?
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Learning, Alignment, and Integration
• Learning / Refinement
– Is the process effective?
– How do you know?
– What measures do you review?
– When are they reviewed?
– What is your systematic approach to learning, improvement, and innovation for this process?
• Alignment / Integration
– Do our systems and processes support and/or reinforce what matters?
– Do our systems and processes appropriately and effectively work together
Performance Differentiators
• Results:
– Current good or excellent results
– Results trended > three years show improving trends
– Trended results compared to industry performance
are at least good
– Trended results are best-in-industry, world-class
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CORE VALUES
Health Care Core Values
• Visionary leadership
• Patient-focused excellence
• Organizational and personal learning
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Health Care Core Values
• Valuing workforce members and partners
• Agility
• Focus on the future
• Managing for innovation
Health Care Core Values
• Management by fact
• Public responsibility and community health
• Focus on results and creating value
• Systems perspective
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Scoring Band Information
BandBand
NumberDescriptors
0-250 1
Early stages of developing and implementing approaches to Category
requirements. Important gaps exist in most categories.
251-350 2
Beginning of a systematic approach to the primary purposes of the Items,
but major gaps exist in approach and deployment in some Categories.
Early stages of obtaining results stemming from approaches.
351-450 3
A systematic approach to the primary purposes of most Items, but
deployment in some key Areas to Address is still too early to demonstrate
results. Early improvement trends in some areas of importance to key
requirements.
451-550 4
Effective approaches to many Areas to Address, but deployment in some
Areas is still at early stages. Further deployment, measures and results
are needed to demonstrate integration, continuity and maturity.
Scoring Band Information
BandBand
NumberDescriptors
551-650 5
A sound, systematic approach responsive to many of the Areas to Address with
a fact-based improvement process in place in key areas. No major gaps in
deployment, and a commitment to organizational analysis and learning.
Improvement trends and/or good performance reported for most areas of
importance.
651-750 6
Refined approaches, including key measures, good deployment and good results
in most Areas. Some outstanding activities and results clearly demonstrated.
Good evidence of continuity and maturity in many Areas. Basis for further
deployment and integration is in place, with a focus on industry analysis,
learning and sharing of best practices. May be “industry” leaders or
benchmark leaders in some Areas
751-875 7
Refined approaches, excellent deployment, and good to excellent
improvement and levels demonstrated in most Areas. Good to excellent
integration, with analysis. Learning, and sharing of best practices as key
management strategies. “Industry” leadership and some benchmark leadership
876-1000 8
Outstanding approaches, full deployment, excellent and sustained results.
Excellent integration and maturity, with analysis, learning and sharing of best
practices pervasive. National and world leadership.
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ResultsCategory One, Inc.
1.0 Leadership
1.1 Leadership System 70%
1.2 Company Responsibility & Citizenship 60%
2.0 Strategic Planning
2.1 Strategy Development Process 70%
2.2 Company Strategy 60%
3.0 Customer & Market Focus
3.1 Customer & Market Knowledge 65%
3.2 Customer Satisfaction & Relationship
Enhancement 70%
4.0 Information and Analysis
4.1 Selection & use of Information & Data 70%
4.2 Selection & Use of Comparative
Information & Data 55%
4.3 Analysis & Review of Company
Performance 50%
5.0 Human Resource Focus
5.1 Work Systems 70%
5.2 Employee Education, Training &
Development 60%
5.3 Employee Well-Being & Satisfaction 65%
6.0 Process Management
6.1 Management of Product & Service
Processes 65%
6.2 Management of Support Processes 55%
6.3 Management of Supplier &
Partnering Processes 70%
7.0 Business Results
7.1 Customer Satisfaction Results 58%
7.2 Financial & Market Results 60%
7.3 Human Resource Results 55%
7.4 Supplier & Partner Results 65%
7.5 Company-Specific Results 52%
Total Points: 612
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1.0 Leadership
1.1 Leadership System 48%
1.2 Company Responsibility & Citizenship 45%
2.0 Strategic Planning
2.1 Strategy Development Process 50%
2.2 Company Strategy 38%
3.0 Customer & Market Focus
3.1 Customer & Market Knowledge 40%
3.2 Customer Satisfaction & Relationship
Enhancement 37%
4.0 Information & Analysis
4.1 Selection & use of Information & Data 44%
4.2 Selection & Use of Comparative
Information & Data 35%
4.3 Analysis & Review of Company
Performance 45%
5.0 Human Resource Focus
5.1 Work Systems 50%
5.2 Employee Education, Training &
Development 50%
5.3 Employee Well-Being & Satisfaction 55%
6.0 Process Management
6.1 Management of Product & Service
Processes 49%
6.2 Management of Support Processes 50%
6.3 Management of Supplier &
Partnering Processes 40%
7.0 Business Results
7.1 Customer Satisfaction Results 44%
7.2 Financial & Market Results 46%
7.3 Human Resource Results 45%
7.4 Supplier & Partner Results 40%
7.5 Company-Specific Results 45%
Total Points: 448
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Year 4 to Year 5 Progress
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When it comes to Culture and Excellence
“Do or do not.
There is no try.”Yoda
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Percent of Patients Diagnosed
with Ischemic Stroke Receiving tPA
Saint Luke’s Hospital
BETTER
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•
• •
•53
•2 0 0 3 2 0 0 4 2 0 0 5 2 0 0 6 2 0 0 7 2 0 0 8 2 0 0 9 1Q 2011
•Transforming the Patient Experience: 2003 - 2011
•Patient Satisfaction Results - Percentile (Press Ganey)
•93 •91 •91
•88
•18
•29
•35
•77
•61 •63
•78
•54
•72
•77
•83 •80
•38
•18 •16
•100 •98 99 97
•80
•60
•40
•20
•0
•92
•89 •88
•82
•96 94
•95
•79
•60
•76
•83
•62
•38
•Outpatient Inpatient Emergency Amb Surg Conv Care
•52
•Results of Stakeholder Loyalty
•KAPE 110211
•Source: CompData
•Per
cen
t
•25%
•20%
•15%
•10%
•5%
•0%
• 20.5% 20.0%
•G S A M H o s p A H o s p B H o s p C H o s p D
•21.4%
•23.1% 23.4%
•GSAM Market Share For Overlapping Markets •(Overall IP)
•17.0% Increase
•25.6% Decrease
•7.4% Decrease
•2006 2007 2008 2009 Q3 2010
•6.9%
Decrease
•8.4%
Decrease
•57
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Inpatient Satisfaction
Outpatient Satisfaction
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Ambulatory Satisfaction
Emergency Department Satisfaction
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Home Health Satisfaction
Patient Satisfaction Starts
With Employee Satisfaction
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Customer-Focused Outcomes - HCAHPS
Customer-Focused Outcomes
Top Box Scores for Patient Satisfaction
8 years of consistent improvement
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Rate of Change:
SG Partners Improve Where Others
Decline
Source for National Benchmark: NACHR - JWT
Source for Best Practice: ANCC
Good
5.4%
12.9%
14.6%
Bronson Memorial Hospital: RN
Turnover
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Workforce-Focused Outcomes
Staff Voluntary Turnover
Workforce-Focused Outcomes
Physician Engagement Scorecard
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•
•55
•Physician Engagement and Relationship •Physician Engagement Survey Results
•Go
od
•Perc
entile
•Source: HealthStream •Top Decile
•56
NMMC Results
Measure Percentile
Employees 93rd
Physicians 99th
Patients 90th
Key Process Measures – Customer Satisfaction
Press Ganey 501+ beds
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BETTER
*SLH data represents best 5% of comparative group
*
Saint Luke’s Hospital
Net Days in Accounts Receivable
NMMC Results
Cumulative financial gains from
outcomes management of focused
DRG losers
Care-Based Cost Management:
Making the Business Case for Quality
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BETTER
Saint Luke’s Hospital
Admitting Wait Time
NMMC Results
Key Process Measures – Clinical Outcomes
Solucient 501+ bed, Case Mix Adjusted
Measure Below Expected
Mortality 22 %
Charges 37 %
Length of stay 13 %
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50% increase in PVHS discharges from 2000 to 2008
18% increase in Competitor discharges from 2000 to 2008
39% population growth in Competitor’s home county from 2000 to 2008
11% population growth in Larimer County from 2000 to 2008
Financial & Market Outcomes
Patient Discharges: 50% increase since 1st Baldrige
application
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Remaining Competitive
Hospital Charges
NMMC Results
Measure Percentile
FTE’s 14th
Total Labor Expense 9th
Charges per Discharge 8th
Operating Margin 90th
Total Margin 95th
Key Process Measures – Efficiency/Finance
Solucient 501+ bed, Case Mix Adjusted
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2005 Medicare per Capita Spending by Hospital Referral Region
Dartmouth Atlas data
When are you too
busy to pursue
excellence?
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Category One Inc.Redefining Excellence
Joel H. Ettinger
Josh H. Ettinger412-968-1015