is there a roadmap for transformation? · bidmc market position national data from leapfrog shows...
TRANSCRIPT
Is there a Roadmap
for Transformation?
Alice Lee Vice President, Business Transformation
Beth Israel Deaconess Medical Center
Continuous Improvement in Healthcare: A Roadmap for Transformation
Cleveland Clinic
November 12, 2012
Beth Israel Deaconess
Medical Center
Boston, MA
116 Years in Business
649 Licensed Beds
Teaching & Research
Affiliate of Harvard Medical School
Inpatient, Outpatient, Emergency Services
10,000+ Employees & Physicians
Yearly Gross Revenue of Over $1.6 Billion
Network of Affiliates and Partnerships
BIDMC Market Position National data from Leapfrog shows that among US and MA hospitals, BIDMC ranks tops
for high quality and lower cost
This is an extremely strong competitive advantage
We are here
2011:
Can we stay here?
Where am I?
Where am I going?
Why am I on this journey?
In the beginning…
Traditional
“Results Focused”
Blunt force improvement – form of stability
“To RIE or not RIE…”
• Lean as a religion?
Were we “successful”?
We were making measurable improvements & senior management was satisfied:
Why make a change?
How do these wins connect to the goals? Do I only do improvement
work if it is scheduled?
We helped 4 managers with gemba
consultations, how can we help 450?
FY06 FY07 FY08
Lean Program Financial Improvement
* BIDMC's Fiscal Year begins October 1st
Target
Millions
$0
# o
f St
aff
Trai
ne
d
Lean Participation at BIDMC
Basic 1 RIE >1 RIE Cumulative* BIDMC's Fiscal Year begins October 1st
FY05 FY06 FY07 FY08* BIDMC's Fiscal Year begins October 1st
Event Based model
Traditional
Where do we go from here?
Hire point Consultants
Do Nothing
Focus on Tools (Rote learning
vs thinking)
Multiple Paths…
Where do I go now?
Norm says go to Japan
Where do we go from here?
How did my thinking evolve?
We needed:
• to set a direction & focus
• to be disciplined & avoid distractions
• total participation
• to strive towards:
o Easier
o Better
o Faster
o Cheaper
= True North
Where do we go from here?
If we know where we are and where we are headed
– What is the gap? What are the barriers?
Think of True North as a spot on the horizon that you and
your company will be heading towards, one that will bring
you the full benefits of e2 (everybody, everyday).
- GBMP
Traditional
Transitional
“Game Changer”
Participation!
Engage leaders to own the lean journey
Traditional
Transitional
…But how?
Leadership Participation
Common Understanding
• Know why & what’s my role
• Common language of improvement
• Principles AND thinking
See problems
Solve problems
Teach & Coach others
Horizontal
Ver
tica
l
Foundations
Know Why
Management
Leaders’ Role
Countermeasures
Know How
True North Alignment Hierarchy of Improvement
Difference between “Being there vs. Getting there”
See Waste
Favorable Environment
Idea Systems
Develop more Problem Solvers
Practice
Problem Solving
Learn to See
Lean Leadership Development
Physician & administrative leaders learn
together
Leaders go to where the work is done to understand
current conditions
Build Relationships
Cs
VPs
Directors
Managers
Staff
Operations Physicians
Learn to lead differently together
+ Chairs
Chiefs
Directors
Attendings
Trainees
Develop all Senior Leaders
& Directors
Cs
VPs
Directors
Managers
Staff
Operations Physicians
Tension = Deep Learning
+ Chairs
Chiefs
Directors
Attendings
Trainees
Ownership = Diffusion
Operations Physicians +
Leaders develop their spheres of influence (10,000 people)
Develop all Senior Leaders
& Directors
Cs
VPs
Directors
Managers
Staff
Chairs
Chiefs
Directors
Attendings
Trainees
Early Transformation
Traditional
Transitional
Transformational
Start to run the business differently
How are we running the business differently?
CEO – COO – CFO
Vice Presidents
Physician Chiefs
Administrative & Clinical Directors
Managers & Supervisors
Medical Education
Capital Decisions
Develop formal
partnerships with vendors
Hiring Process
Embedding CI capabilities within key
depts
Planning Process
Supports need to publish
Space Design
Aligned Planning Process
4 pages
Compilation of vice presidents’ goals
FY10 Annual Operating Plan
Aligned Planning Process
Plan on a page
Parallel process creating the goals of our 3 missions
Migration from individuals drafting topical goals to broader, shared goals
FY11 Annual Operating Plan
Aligned Planning Process
Migration back to more specific goals
Introduction of a horizontal goal
Introduction of multiyear goals
FY12 Annual Operating Plan
Aligned Planning Process
Fewer goals
Relevant goals to every employee & physician
Reflection guided True North revision
Inclusive process for leaders of the 3 missions resulting in an integrated set of goals
Alignment to our strategic plan
FY13 Operating Plan
Value =
FY13 Annual Operating Plan
Improve the Health & Well-Being
Of Patients, Families, Employees & Physicians
Through Innovative Clinical Care, Education, & Research
SystemAdvance as a system of care
CostContinuously improve our
ability to adapt to changes in the healthcare environment
Maximize efficient utilization of resources:• Staff• Equipment &
supplies• Space• Diagnostic tests &
treatment
Clinical Care
Education
Research
PeopleEngage and develop our people every day
Fiscal Year 2013Operating Plan
True North
Grow and enhance a market-leading system of care…
…that delivers the highest value…
…by creating and sustaining a culture of continuous improvement…
…through engagement, development, and support of our employees, physicians, patients & families
Owner/ Date
9/7/12DRAFT
9/10/12DRAFT(People Team)
9/11/12DRAFT(Quality Team)
9/12/12 DRAFT (Ext Aff Team)
9/13/12 DRAFT
(Fin PerfTeam)
9/19/12DRAFT(MEC)
9/24/12FINAL
Ops Council
QualityEnsure reliability
• Implement processes that measurably decrease harm/defects
• Improve reliability through standardization
• Measurably improve patient & family experience
&
• Develop, standardize, improve transitions among sites of care
• Respond effectively to the needs of our network and affiliates
• Achieve optimal alignment between physicians & hospitals
• Enhance wellness and safety
• Promote & support a culture of service excellence and continuous improvement
• Optimize & support learning & development
Do we select, develop & retain
the right talent to lead
& thrive in our
environment?
90,000 Applications Annually
2,200 Hired Annually
Competency Assessment
Talent Selection
Competency Progression Map
Core Values
Work Style
Interpersonal Style
Thinking Style
Leadership Style
Findings/Results
Standardization
Quality
Satisfaction
Productivity
• Suggested interview questions provide fuller picture
• Minimize legal risk in hiring process – standardized approach vs. subjective
• Improve the predictive nature of the selection process
• Managers meet better fit candidates
• Reduce 90 day & 6 month turnover = 0%
• Applicant Feedback – Easy and reflects positively on BIDMC; “Allows you to see me as a person, not just a piece of paper” – Applicant quote
• 235 hired using assessments with 83% either Good or Very Good Fits
• 20,000 assessments taken w/ 84% pass rate; 16% fail rate – eliminates 10 weeks of resume review time of poor fit candidates annually
• Decrease time to fill
Is there a roadmap for
Transformation?
Traditional
Transitional
Transformational
Conflicting missions
Healthcare reform
Compliance & regulatory
Leadership changes
Presidential Election
How do you handle those things that could
impact the survival of your journey?
Build flexibility & agility
Processes – operations, support, organizational learning
Workforce – current & incoming
Leadership – transform the business
Partners – universities, vendors, suppliers
Structures – physical, management structure, organizational plan
Purpose: Promote skills to survive & thrive in an unknown future and to proactively manage change and align our systems & structure to support our direction & goals
Innovation
Diffusion
Systems
• Think differently to solve longstanding problems
• See beyond the problem edges
• Adaptive vs. adoptive thinking
• Learn together with deep understanding of each others’ perspective & our systems
• Shift mindset by practicing new ways of thinking
• Mobilization of resources (ownership: we see, we feel, we change)
• Holistic thinking vs. just the end goal
• Create management systems that can adjust to unpredictable, dynamic conditions
• Create closed loop systems
Business Transformation at BIDMC
Thank you!
Are we there yet?