Sharp HealthCare’s Baldrige
Journey Keeping the Drive Alive
February 2011
Reflection
The one thing all famous authors, world
class athletes, business tycoons,
singers, actors, and celebrated
achievers in any field have in common
is that they all began their journeys
when they were none of these things.
Yet still, they began their journeys.
Mike Dooley
Performance Measurement
Linkage and Alignment
Strategic
Enterprise
Planning
Work&Systems
Deployment
Process Management
Seven Step Process
Performance
Improvement
Processes
Performance Measurement
Data Analysis, Prioritization
Dashboards, Report Cards
Comparative Data Selection
Annual Targets and Goals
Output, Input and In-Process
Metrics
S
U
P
P
L
I
E
R
S
What we require of
our suppliers
Inputs
In-process
Metrics
Process
Requirements and
Feedback
What customers require
of our process
Outputs
Requirements and
Feedback
C
U
S
T
O
M
E
R
S
Sharp’s Project Prioritization
Criteria
Weight
Alignment with strategy
9
Resource availability
9
Data Complexity
1
Scope / Change Management
Complexity
3
Management of Information
Resources
• Common Enterprise IS / Single Signon
• Standardized IT Products
• Intranet
Data, Information and
Knowledge Management
Inputs
Patients
Employee
s
Suppliers
Others
I
P
▪ Clinical Information Systems
▪ Sharp University
▪ Communication Plan
▪ Workforce & Leadership Development
▪ Organizational Learning Tools
▪ Succession Planning and Exit Interviews
▪ P&Ps, Protocols, Standard Orders
▪ Best Practice Sharing Process
Requirements and
Feedback
O
C
Custome
Outputs
S
Supplier
s
rs
Patients
Employees
Suppliers
Others
Requirements and
Feedback
Technology
Sharp’s Communication Plan
Culture of Inquiry, Innovation, and Sharing – Driven by Senior Leaders
Data, Information and
Knowledge Management
• The communication plan represents an
interwoven network of sharing intra-entity
forums
• Three types of cross-system forums
– Centrally structured
– Entity-based structure with system
collaboration
– Hybrid of central and entity-based structure
Core Competency
Strategically important capabilities that provide an
advantage in your marketplace … they frequently
are challenging for competitors to imitate and
they provide a sustainable advantage.
Work Systems –
Key Work Processes
Enterprise Work Systems
Emergency Care
Home Care
Hospice Care
Inpatient Care
Long-term Care
Mental Health Care
Outpatient Care
Primary/Specialty
Rehabilitation
Urgent Care
Key Health Care Work Processes
Screening
Admission Registration
Assessment/Diagnosis
Treatment
Discharge/Education
Each work system is comprised of each key work process.
Key Health Care Processes
Process
Key Requirements
Process Measures
Screening
Safe, Timely
Blood sugar, Cholesterol, Cancer
screening, Glucose levels
Admission/
Registration
Safe, Timely
Patient satisfaction, Accredited, Privacy,
Door to Doctor
Assessment
and Diagnosis
Safe, Evidence-based,
Efficient, Timely
Patient satisfaction, Skin care, Stroke care,
LVF, CAP O2
Treatment
Safe, Evidence-based,
Efficient, Timely,
Patient-centered,
Equitable
Glycemic control, AMI Beta Blockers, CAP
antibiotics, Cancer, Treatment measures)
Discharge/
Education
Safe, Patient-centered,
Timely
AHRQ Patient Safety, AMI mortality,
Bariatric program, Smoking cessation
Key Business &
Support Processes
Process
Key Requirements
Process Measures
Revenue Cycle
Timely, Accurate
EBITDA, Days in AR, Billing Cost, Payment
Strategic
Planning
Timely, Accurate
Net Revenue, Market Share, Growth
Key Suppliers
and Partners
Efficient, Accurate,
Timely, Satisfaction
Provider Survey, Denials
Supply Chain
Management
Timely, Accurate,
Efficient, Safe
Pharmacy Turnaround, Sales Outstanding,
Automated Orders
Work Force
Management
Timely, Accurate,
Customer-centered,
Safe
Retention, EOS, Nursing satisfaction, Perf.
appraisal, Overall turnover, Vacancy
Knowledge
Management
Timely,
Safe, Accurate
Internal promotion, Training expenditure,
Out of network, Critical Values
SIPOC (forward) and
COPIS (backward)
S
U
P
P
L
I
E
R
S
What we require of
our suppliers
Inputs
In-process
Metrics
Process
Requirements and
Feedback
What customers require
of our process
Outputs
Requirements and
Feedback
C
U
S
T
O
M
E
R
S
Performance Improvement
Processes
Team
Resource
Management
Workforce and
Leadership Development
Process Design and
Improvement
Process Management
Strategic Planning & Deployment Process
Team
Improvement
Individual
Improvement
Process
Improvement
• Scorecard
• Dashboard
• Strategic Plan
DMAIC 12-Step Process
to Discover the Best Solution
12. Spread the improvement
11. Control the process
C
10. Fully implement
9. Select a solution and pilot it
D
1. Define context of problem/process
and select a project
2. Define the customer(s)
and their needs
3. Define and
understand the process
4. Define the right metrics
and targets
8. Identify and manage risks
I
7. Identify the ideal state and
possible solutions, apply
innovative tools
5. Measure the process M
6. Analyze cause and effects
A
Change Acceleration Process (CAP)
to Process People Through Change
Leading Change
Creating A Shared Need
Shaping A Vision
Mobilizing Commitment
Current
State
Transition
State
Improved
State
Making Change Last
Monitoring Progress
Changing Systems & Structures
Critical Success Factors
Deployment of Performance
Improvement Processes
•
•
•
•
•
•
•
•
Executive commitment, clear strategy
Initial priority: Financial ROI
Expert training & mentoring
Cross functional team of Black Belts
Rigorous structure
Accountability for results
Communication plan
Alignment with rewards
ED Length of stay FY 2011
ED LOS Time Intervals
SMH OPE Time Interals (Average)
Triage to ED Bed
MD to DC Order
DC Order to Exit
21 20 19
Oct-Dec '10
Minutes
Arrive to Triage
Aug-Sept '10
24 25 19
Feb-May '10
24
48
July-Nov 09
24
54
0
120
38
126
18
ED Bed to MD
39
132
24
42
138
100
42
200
300
400
500
600
700
SMH IPE Time Interals (Average)
Arrive to Triage
MD to Admit Order
Unit Bed to Exit
Triage to ED Bed
Admit Order to Case Mgr
23 420
135
2210
Aug-Sept '10
22 519
142
42
64
14
78
Minutes
Oct-Dec '10
ED Bed to MD
Case Mgr to Unit Bed
20 18 20
Feb-May '10
144
24 24 24
July-Nov 09
0
10
150
100
70
20
200
182
84
300
216
400
500
600
700
Six Sigma
Rapid Action Project
PFS Call Center
Customer Service Department Average Speed of Answer (Minutes)
14
12
21
13
10
14
8
7
26sec.
6
4
0
2
2
1
0.43
2007
2010
0
2005
Goal
Abandonment Rate (%)
40
25
30
20
20
%
23.0
1.4%
15
10
10
0
6.5
5
4.3
1.4
0
2005
Goal
2007
2010
System Quality Goal
Adding Baldrige Criteria
to the Journey
•
•
•
•
•
Criteria consistent with vision
External independent review and feedback
Expect focused progress on The Sharp Experience
Unanimous support of senior leaders
Not another project/change/cultural transformation – A
tool set to guide/accelerate progress
• Mark the milestones of progress along The Sharp
Experience
Baldrige Criteria and Discipline
Deployed Via
Quarterly Leadership Development
•
•
•
•
•
•
•
Leadership
Strategic Planning
Focus on Patients, Customers, Markets
Measurement, Analysis, Knowledge Management
Workforce Focus
Process Management
Results
Early Baldrige Activity 2003
• Assessor training - State
– 30 leaders across system
– Assessed current state
•
•
•
•
One day training on writing the application
Established a project leader
Identified Category Leads
Set a schedule for draft to state program
Early Baldrige Activity 2004
• First application submitted to state
• Had Baldrige Examiner read it just
before submitting
• Had limited understanding of
nuances of application writing
• Sent two leaders to State
examiner training
• Site Visit Prep- meeting in a bag
• Earned State site visit
The Journey: 2004 CAPE
Strengths
• Sharp Experience – Culture of Empowerment
• Pillars of Excellence
• Strategic Planning Process
• Atmosphere of Open Communication
Opportunities for Improvement (OFI’s)
• Early stages of Process Management (we didn’t know process)
• Sharp Health Plan not included as part of the system
• Organizational Learning lacks a Systematic Approach
• Some stakeholders – not integrated
• No Succession Planning Process
• Lack of Segmented data -target markets
Complaint
Management
In •general,
some
good things going on but not really process focused.
learning curve
on “how”
versus “what”.
• Little to Steep
no benchmarking,
Missing
results
Baldrige Activity 2005
•
•
•
•
Changed project leadership
Shifted some Category Leads
Had benefit of two examiners
Developed synopsis of 2004
feedback report
• Leaders set priorities for areas
to focus
• Resubmitted to state program
The Journey: 2005 CAPE
Strengths
• Strategic Planning Process
• The Sharp Experience – empowerment
• Rapid Change Methods
• A Collaborative Culture – leaders
• Innovation
• Measurement – collect and analyze information
OFI’s
• Knowledge Management, Succession Planning – need a process
• Lack Measurable processes for some high-level functions – ethics
• Lack Cycles of Improvement to Strategic Planning Process
• Complaint Management
• Missing some key results and competitor comparisons
• Segmentation Missing
In general, getting to some processes but weak in cycles of improvement
and results
Baldrige Activity 2006
• Senior leaders prioritized areas of
focus from executive brief of
feedback
• Decided to apply to NMBQA and
state program (!)
• Shifted some category leads
• Engaged a consultant to review
Category 7 (weakest scoring area)
• Focused on revisions in Category 7
• Earned a national site visit!
The Journey: 2006 CAPE
and Baldrige
Strengths
• Visionary leadership
• Comprehensive Strategic Planning Process
• Patient-focused excellence as part of The Sharp Experience
• Systematic approach to performance measurement and
improvement
• Systematic approach to personal and organizational learning
• Culture of empowerment aligned with mission, vision and
values.
• Focus on Patient Safety
Lots of processes in place and well deployed, great culture of
empowerment but delivering average results.
The Journey: 2006 CAPE
and Baldrige
OFI’s
• Systematic process for Best Practice Sharing – system wide
• Systematic process for Knowledge Management, Complaint
Management
• Suppliers/Partners – systematic approach
• Results Marginally Better than Average
• Retention Plans not developed/deployed
• Different Performance Levels Across Sharp’s Entities
• Declining Patient Satisfaction Results
Baldrige Activity 2007
• Senior leaders prioritized areas of
focus from executive brief of
feedback
• Applied to MBNQA
• Shifted some category leads
• Consultant reviewed process flows,
application and did mock site visit
• Organizational stressors: Magnet
visit, CPOE go-live, building projects
The Journey: 2007 Baldrige
Strengths
• Visionary Leadership
• Strategic Planning Process
• Patient Focused Excellence
• Actualizing vision of Best Place to Work, Best Place to
Receive Care
• Senior leader communication
• Alignment with Pillars
• System-wide review of performance metrics
• Availability of data and information
• Workforce engagement and enrichment
• Core Competency – The Sharp Experience
• Performance tools
• Excellent results for inpatient care
Much work yet to be done, the journey will never end.
The Journey: 2007 Baldrige
OFIs
• Systematic improvement of systems
• A systematic process for innovation
• Improve governance process
• Succession planning systematic
• Link key process and customer requirements to day to
day metrics
• Organize Work Systems around Sharp Experience
• Align and integrate Human Resource plans to the
strategic objectives
• Some results not sustained i.e. patient satisfaction
• Engage/enrichment process for physicians
• Unfavorable trends at certain hospitals
Site Visit Preparation
• Communication across system
– Meeting in a Bag, same message as The Sharp Experience
– Website: slides, documents, updates, schedule
– Point person at each site to coordinate rooms/personnel
• Document preparation
– Everything mentioned in application
– Segmentation
•
•
•
•
Schedule for site visit
Command Center
Interviews – who should participate?
Lessons learned
I AM Sharp HealthCare