Creating Sustainable Organizations
Sherry Martin
HIV Quality of Care Advisory Committee
September 13, 2012

Improving Quality in the Face of
Change
• Is change real; is health reform real?
• Why consider using the Baldrige approach?
• What are the common factors that lead to high performance?

The roots of reform
46 million people without health insurance cost increases that are bankrupting the country

2011 2020
NHE: $ 2.7 Trillion NHE: $4.6 Trillion
Per capita: $8,650 Per capita: $13,708
GDP 17.7% GDP 19.8%
CMS, Office of the Actuary, July, 2011

Health Affairs, September 3, 2012

We must become :
• More effective - use of evidenced-based practices
• Eliminate overuse and underuse
• Scale up prevention services
• More efficient – cut out waste
• Streamline cinic processes
• Reduce turn-around-times; wait times
• Safer – eliminate errors
• Eliminate delays in medication access
• Reduce suicides
• More patient- focused – methods to reach specific patients
• Increase access to care
$750 Billion in unnecessary health spending in
2009 alone

What Is the Answer?
THE PERFORMANCE IMPROVEMENT
IMPERATIVE
“Health care delivery organizations should develop organizational cultures that encourage continuous improvement by incorporating best practices, transparency, open communication, staff empowerment, team work, and that align incentives..
The imperatives are clear and the changes are possible ”
IOM, Sept. 2012

Baldrige Performance Excellence Program
WHAT IS IT?
• Formal recognition of US organizations from the President
• Established to promote performance excellence and sharing of successful practices
• Administered by National Institute of
Standards and Technology
• Formerly, the Baldrige National Quality
Program

Integrated management approach that results in:
• Delivery of continually improving value to the patient, including effective health care outcomes
• Improved delivery processes, more efficient and timely
• Organizational learning

• Hospitals using Baldrige are 6x more likely to be among the 100 Top Hospitals
– More than 27% are Baldrige users
– Only 3% of non-Baldrige users are listed
– Outperform the other top hospitals in every metric used to determine list
– Outperform the other top hospitals on CMS core measures

The Baldrige Program
HOW DOES IT WORK?
• Structured self assessment tool, that enables an organization to:
– Identify challenges and barriers to achieving their mission/vision
– Develop strategies and action plans to overcome
– Determine whether their approaches used to run the organization are achieving results
– Collect, analyze and use data effectively
– Align the organization to achieve sustained results

The Self Assessment Core -
THE CRITERIA
• Structured questions that enable you to analyze how you manage your work processes and the associated results
• Applicable to any size or type of healthcare facility
• Non-prescriptive – they don’t tell you how to establish your infrastructure or processes

Baldrige 2011-2012 Criteria Categories
• Leadership
• Strategic Planning
• Customer Focus
• Measurement, Analysis and Knowledge
Management
• Workforce Focus
• Process Management
• Results

Criteria Example
LEADERSHIP
• How do senior leaders create an environment for organizational performance improvement, the accomplishment of your mission and strategic objectives , innovation, and organizational agility?
• How do senior leaders take an active role in reward and recognition programs to reinforce high performance and a customer and business focus?

Criteria Example
STRATEGIC PLANNING
• What are your key strategic objectives and the timetable for accomplishing them?
• How do your strategic objectives achieve the following?
– Address your strategic challenges and strategic advantages
– Capitalize on your core competencies and address the need for new core competencies
– Enhance your agility to adapt to sudden shifts in your market or regulatory conditions

Criteria Example
CUSTOMER FOCUS
• How do you listen to patients and families and other customers to obtain actionable information? How do your listening methods vary for different customers .
• How do you determine patient satisfaction and engagement? How do your measurements capture actionable information for use in exceeding your patients’ expectations?

Criteria Example
MEASUREMENT, ANALYSIS AND KNOWLEDGE
• How do you select, collect, align and integrate data and information for tracking daily operations and overall organizational performance, including progress relative to strategic objectives and action plans? How do you use this data to support organizational decision making ( at the front line)
• How do you use organizational performance review findings to develop priorities for continuous improvement and opportunities for innovation

Key Excellence Factors
Leadership/Strategic Planning
• Systematic setting and communication of direction, values and aggressive goal setting
• Role modeling by all leaders of values
• Strong work process alignment with strategy
• Demonstrated accountability and transparency
• Clear focus on plan execution and agility
Goonan, K, et al. Journey to Excellence, 2009

How Sharp Aligned the Organization
Sharp Health Care – 2007 Baldrige Winner

Schneck Medical Center – 2011 Baldrige Winner

Key Excellence Factors
Customer Focus
• Plethora of methods to listen to patients and other customers
• Identification of patient requirements and subsequent action plans
• Sound decision making
• Transparency of operations and results
Goonan, K, MD; Journey to Excellence, 2009

Southcentral Foundation – 2011 Baldrige Winner

Key Excellence Factors
Measurement and KM
• Consistent use of fact-based decision making
• Collection of actionable data
• Consistent use of multiple aligned and interlinking measures
• Wide deployment and accessibility of data and information
Goonan, K, MD; Journey to Excellence, 2009 .

Key Excellence Indicators
Process Management
• Well-designed work systems and key business and support processes
• Strong focus on work systems and key processes that deliver customer value and organizational success and sustainability
• High levels of quality designed into key services
Goonan, K,MD: Journey to Excellence, 2009

Sharp Health Care Processes
Sharp Health Care – 2007 Baldrige Winner

• Healthcare - outcomes related to core business
• Customer focused – satisfaction
• Workforce-focused – engagement
• Process management – efficiency, cycle time
• Leadership – accomplishment of strategic plans to achieve mission

Criteria Examples
RESULTS
• What are your current levels and trends in key measures or indicators of health care outcomes that are important to and directly serve your patients and stakeholders?
• How do these results compare with the performance of other organizations with similar offerings
• What are your current levels and trends in key measures of operational performance of your work processes, including productivity and cycle time…

Key Excellence Factors
Results
• Excellent results that fully address health care outcomes, strategy and action plans, customer requirements, workforce needs, financial status
• Beneficial levels compared to credible benchmarks
• Beneficial trends
• Goonan, K, MD: Journey to Excellence, 2009

• LEVEL – your current level of performance – enables you to compare performance with benchmarks and establish targets to achieve
• TREND – the rate of your performance improvement - enables you to determine whether your interventions are working

Southcentral Foundation – 2011 Baldrige Winner

Baldrige Self Assessment
SUCCESS FACTORS
• Comprehensive – evaluates all aspects of an organization
• Fact-based , objective assessment
• Systematic – evaluates approach, deployment and effectiveness ( results)
• Identifies key opportunities on which to focus to achieve the mission
• Operates in the organizational background

Baldrige Assessment
IS IT A TOOL FOR US?
• Requires:
– Data and information to answer the criteria questions
– Consensus around key identified opportunities on which to focus
– Improvement initiative cycles
The Result
Improved Quality in a Changing Environment
SUSTAINABILITY

Goethe