“A Quest for Quality….The
Business Case”
Chris Boldt, Operations VP
Steven Chies, Sr. VP for Operations
Benedictine Health System
2011 AHCA/NCAL Quality Symposium
February, 2011
The Frequent Questions:
Why did BHS adopt quality process?
How did you achieve six (6) AHCA
Gold Quality Awards?
Benedictine Health System - Today
• BHS owns and/or manages
more than 70 LTC facilities
on 40 campuses across 7
states
• BHS Profile
▪ 4,000 NF Beds
▪ 2,000+ Housing with Services/
Assisted Living Suites
• 6,000+ Employees
Core Values
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Hospitality
Stewardship
Respect
Justice
Vision
Creating Benedictine
Living Communities
where health,
independence and
choice come to life.
Creating a Quality Culture
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Leadership…commitment, passion from the top
Foundational elements…mission, vision, values
The LTC Quality Story…and baggage!
The long, long run…
What do we know as factual?
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Perception of quality is poor
Demographics are changing
Dementia diagnosis is increasing
Boomers have different expectations
Governmental commitment is waning
Understanding of need is poor
Current product line is aging
Unexpected events will impact society
All politics and health care is local
Quality in Long Term Care
• The perception of the American public of the
quality of care and quality of life in a “nursing
home” is extremely poor.
• The vast majority of Americans do not want to
go to a “nursing home”.
• They believe they are places we go to die and
lose our independence and dignity.
What is the public perception?
• 95 % Question
• Do you want to go to a nursing home?
Implications of Quality Perception:
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Guilt and Fear of individuals and families
Demand for Quality Improvement
Regulatory Reaction – More is Better
Poor regulatory compliance – More Surveyors
Media Coverage of poor compliance
Poor compliance – litigation opportunities
• Greatest Generation (1905-25) 50 Million
• Silent Generation (1926-45) 35 Million
• Boomer Generation (1946-1964) 77 Million
• Xer Generation (1965-1982) 65 Million
• Millennium Generation (1983-02)80 Million
Implication of Demographics:
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Fewer people….more competition
Fewer tax payers….more competition
More competition for client
Product line need to meet expectations
Need for process enhancement
Implications for Government
Payment:
• Cannot rely on stable source
• Personal Responsibility will prevail
• Pay for Performance
• Expectation of Improved Outcomes
Dr. Donald Berwick
• Challenge Providers to:
▪ Reduce Resources by
10% without:
• Single instance of harm
• Without rationing care
• Without excluding services
• Knowledge of Quality
• Understands Data
• Expectation of Performance
BHS Leadership Systems
• Solid Governance
• National leaders in long term care on staff
• Systematic meetings to share, learn and plan
among all levels of employees
• BHS Leadership Institute
• Ongoing leadership communication
• Compliance and risk programs
Benedictine Framework for Performance Excellence
Organizational Results
7
2 Strategic Planning
Dashboard
Process
Management
Strategic Planning and
Deployment Model
1
6
Values-Centered
Leadership
P-D-C-A
Care Processes
Support Processes
Hospitality•Stewardship
Respect•Justice
3 Customer and
Market Focus
Satisfaction Surveys
Compliant Management
.
Staff Focus
5
Service Standards
Mission and Values Survey
4 Measurement and Analysis
Dashboard
http://www.quality.nist.gov/HealthCare_Criteria.htm
Drivers
Systems
Results
.
7
1
5
Leadership
2
Strategic
Planning
3
Customer
Focus
Peopl
e
Operations
6
Results:
• Health Care
• Patient
Satisfaction
• Financial/Market
• Staff & Work
System
• Organizational
Effectiveness
• Governance/Social
Responsibility
4
Measurement, Analysis &
Knowledge Management
Operational Improvement
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The theory sounds great…but
How does it get to the bed side?
How do you determine improvement?
How do you sustain the improvements?
BHS Strategic Planning
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Strategic Challenges
Strategic Objectives
Goals
Focus Areas
▪
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▪
Care
Service
People
Finance
Growth
BHS Alignment Model
BHS
Vision and
Direction
BHS Board and SMT
Strategic
Objective &
Corp.
Action Plans
BHS SMT and Corporate Directors
Facility
Specific
Goals
Participating Organizations
Facility
Action
Plans
Departments and Teams
Employee
Goal
Employee Focus
BHS Strategy Development and Deployment Model
Focus
Where are we now?
Internal and
External
Analysis
BHS
Corporate
Strategic
Objectives
SWOT
Align
Where do we need to
go?
Vision,
Facility
Strategic
Objectives and
Goals
Execute
How will we get there?
Review
How are we doing?
Determine
action plans,
resources,
accountability
and
Metrics/Action
Plan Goals
Quarterly
review
of
progress
and
Performance
Action Plans
Results
Who >
Governance /
Leadership
Governance / Leadership
Leadership and Staff
Leadership and Staff
When >
Annually
Annually
Annually
Quarterly
Strategy Deployment
• Adoption of “Focus and Execute” a webbased application
• Tracking of progress of Action Plans
▪ Team
▪ Open access
▪ Remote management - Webinar
• Continuous review of progress on Action
Plans
BHS Facility “Focus and Execute” Plan
BHS Quality Performance Excellence
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The Mission and Core Values are the basis
Led by President/CEO
All 6 SVP are Lead for a Baldrige Category
Quality Director
▪ Supports and coordinates
▪ Provides training
BHS Customer Service Standards
• Based upon the Core Values of the
organization
• Behavioral expectations for all staff
• Self-evaluation of performance by each
employee at annual evaluation
• Performance Management System
BHS Service Recovery
• Service Recovery is bringing a customer back
from the brink of defection – and doing so in a
timely fashion to the customer’s satisfaction.
• The ART of Service Recovery
▪ A = Acknowledge
▪ R= Resolve
▪ T= Trend
Customer Satisfaction Surveys
• Nursing Facility
▪ Newly Admitted Resident
▪ Resident
▪ Family – MyInnerview
• Assisted Living
▪ Tenant - MyInnerview
▪ Family- MyInnerview
• Housing
▪ Tenant - MyInnerview
BHS Facility Example
BHS Dashboard
• Internal IT system
• Current performance on key strategic
measures
• Trend performance
• Best practice performance identified
Care – Percent of Pain
 National Average  BHS System  Median  Target
 Best Practice Quartile  Opportunity for Improvement Quartile
Good
Finance – Operating Cash Flow Margin
 BHS Operating Cash Flow Margin  Median  Target
 Best Practice Quartile  Opportunity for Improvement Quartile
Good
Current Structures for Performance Review
BHS
Board
OVP &
Regional
Consultants
Administrator,
QMC, DON, and
other
Strategy
Senior leaders
OVP, & CD
Strategic
Performance
Team
Regional Operations
Facility
Quality Council
Pillar Metrics
15 Measures
Results
CEO, Board
and SVP
Pillar Metrics
& PP
Pillar Metric, PP
& other metrics
Facility
Functioning
30 measures
BHS Facility Example
Employee Performance Management
• Developed by a team of team from corporate
office and facilities
• Common Job Descriptions across all sites
▪ Behavioral based
• Supervisory training
• Self evaluation including self-evaluation of
performance compared to the Customer
Service Standards.
BHS Key Systems and Processes
Business Systems
Customer Facing Systems
Support Systems
Resident
&
Tenants
Process Improvement – P-D-C-A
Act
Plan
Check
Do
PDCA aka
• Shewhart Cycle
• Deming Cycle
42
PDCA Improvement Example
“Bottom Line Value:”
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Organizational Focus
Clear/Crisp Strategic Direction
Alignment throughout the System
Enhanced Management Processes and Systems…
Consistent Performance
Customer Focus…Enhanced Satisfaction
Strong Financial Performance
Committed, Energized Workforce
Measurable Results!
• “The problems
that exist in the
world today
cannot be
solved by the
level of
thinking that
created them.”
• Albert Einstein
Contact Information
• Chris.boldt@bhshealth.org
• Steven.chies@bhshealth.org
• 763-689-1162