Driving Quality Performance - Chi Solutions, Inc. · Driving Quality Performance Quality Symposium...
Transcript of Driving Quality Performance - Chi Solutions, Inc. · Driving Quality Performance Quality Symposium...
©2006 Chi Solutions, Inc. Proprietary and Confidential.
Driving Quality PerformanceQuality Symposium September 27, 2006
Earl Buck
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Leaders of Quality – A SampleBusiness
Lord KelvinW. Edwards DemingJoseph JuranPhilip CrosbyMalcolm BaldridgeTaiichi OhnoJim WomackMikel Harry
Health CareJames WestgardGeorge LundbergJohn Bernard HenryRay GambinoBrent JamesMichael LaposataDennis O’Leary
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“Quality” definedQuality is “a state in which the customer and
provider realize value entitlement in every aspectof the business relationship” Mikel Harry, PhD
CustomerNeed P
ProviderService
ValueExchange
Cost
Defects
Time
Price
Quality
Delivery
Product
Service
Capacity
Capability
“We are not in the business of quality,we are focused on the quality of our business”
Creation of VALUE is key
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System of Management – Organizational View
Reference: In part from Mikel Harry, Ph.D.
Individuals People Metrics Knowledge, Skills, Commitment, Roles
Efficacy Metrics CTVs, Customer Satisfaction, Yield, On-timeOperations
Financial Metrics Growth, Profit, Market ShareBusiness
Capability Metrics S.D., DPMO, CTQs, Tolerance, VariationProcesses
• “systems approach” requires labs to look beyond our four walls• requires us to consider more than technology, science, analysis• can’t separate quality from financial performance• satisfied people satisfied customers satisfied owners complete value stream
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Value =(Quality) (Service)(Financial Benefit) X (People)
Clinical Quality andBusiness Excellence Customer Service
Expense PerformanceRevenue PerformanceMargin ManagementCapital Generation
Work Culture
Internal Focus Customer Focus
Value Focus
Learning and Growth Focus
Value Proposition - Clinical Laboratory ServicesBalanced Scorecard becomes the tool to manage “value”
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Total Testing Process – Our historical focus
What Test to Order
OrderIdentify Patient/SampleCollect SpecimenAccession SpecimenTransport Specimen
Prepare SpecimenAnalyze
Release ResultTransmit Result
Interpret Result
Pre-pre-analytic
Pre-Analytic
Analytic
Post-Analytic
Post-post-analytic
Where defects occur?
32-75 %
4-32 %
9-55 %
?Ref: “Patient Safety Hits the Laboratory Industry: Early Findings from the CDC”, Ana K Stankovic, MD, PhD
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Quality Focus – Must go beyond walls of lab
“What do I need to maintain my health, diagnose my
illness, or help me get better?”
PATIENT
“What do all these tests mean and why won’t
anyone tell me?”
Post-post-analytic“What do the results
mean?”
Pre-pre-analytic“What to order?”
Pre-analytic Analytic Post-analytic
WITHIN LAB
PROVIDER
Customer?
Payor
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Is Quality Really An Issue?In its “The State of Health Care Quality 2005”, the National Committee
for Quality Assurance says“Good news….quality of health care for many Americans
continued to improve in 2004….the improvements of the past decade.…have saved thousands of lives and billions of dollars”
“Bad news….this positive trend ….seriously threatened….workers shifted to new health plans that don’t measure/report on quality….widespread, unexplained variation in clinical practice is contributing to critical ‘quality gaps’….consumers do not have access to the kind of objective information they need to make informed decisions about their care”
Quality GapAvoidable deaths 39-83K/year & avoidable medical cost $2.8-$4.2BSuboptimal care 83.1M sick days & $13.5B lost productivityMajority of Americans still rely on family/friends to determine quality of providers, hospitals, health plans
Artor
Science?
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What do other quality groups say?IOM – Institute of Medicine
“Advisor to the nation to improve health”Much work related to health care quality & patient safetyRecent reports or projects
Medication errors, Emergency care, Traumatic brain injury, Childhood obesity, Cancer, Breast Imaging, etc.Adolescent health, Human oocyte donation for stem cell research, medication errors, etc.Nothing focused on clinical laboratory
The only report specific to lab is “Medicare Laboratory Payment Policy: Now and in the Future” published in 2000Does the lack of attention to lab mean there is no perceived problem with lab quality or does it mean we’re not visible/valued enough to be an important focus?
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Where does the lab fit into this picture?70-85% of all healthcare intervention requires laboratory data or information assess, diagnose, monitor status or healthcare or susceptibility to specific disease
60-65% of clinical data repositories information is comprised of clinical and anatomic pathology data
Pharmacy and laboratory generate the highest number of transactions within healthcare – tremendous focus on pharmacy error today, only incident specific focus on lab industry
Laboratory is mission critical to healthcare, but not viewed that way by our colleagues or the public, and not valued that way
Change is coming…. “recognizing the critical importance of laboratory services, the Joint Commission has designated the laboratory as an ‘essential’ hospital service. This designation has elevated theimportance of the laboratory’s compliance status in determining the overall accreditation status of the hospital”
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What about lab quality?Inside the laboratory industry, we’ve become more sophisticated in our quality methods and statistical tools, but still lag behind other industries in our failure ratesPublic events create intense focus followed by government intervention (CLIA88, Corporate Integrity Agreements-90’s, GAO Report 2006)“Hospitals move to cut dangerous lab errors”,
Wall Street Journal, June 20, 2006, Laura LandroGAO Report oversight weaknesses undermine federal standards
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JCAHO Comments on Lab Quality“Many clinical diagnoses and most patient clinical management arebased on the results of laboratory tests, yet attention to the level of quality in hospital laboratories is often eclipsed by other quality concerns within the larger organization”
“Organizational leaders…adopt a ‘systems approach’….based on engineering and quality control principles”
“Requires retrospective…..and prospective….analyses to identify and eliminate risks….in processes….before adverse events can occur”
“Safety-focused learning environment…only develops when the organization’s managerial and clinical leaders work collaboratively and deliberatively to create it”
“personnel standards currently required by CLIA are insufficient to adequately protect patients and the public health”
Testimony of Dennis O’Leary, M.D., President, JCAHO before Congress, June 27, 2006
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Quality Improvement Opportunity
Do we think there is opportunityto improve on quality in the laboratory industry?
Is there any doubt!!
“The only way to eat an elephant
is one bite at a time”
But … are we making sufficient progress, or do we need a profound intervention to create a quality breakthrough?
00.10.20.30.40.50.60.70.80.9
1
What future action do we take?
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Keys to Success: Quality ImprovementRequirements to create quality breakthrough:
1. Driving Need2. Executive Leadership3. Breakthrough Goals4. Defined Resources5. Functional Infrastructure6. Support Systems7. Organizational Will8. Improvement Events9. Capable People10. Compelling Big Ideas11. Implementation Focus12. Operational Freedom
Mikel Harry, PhD
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First, “breakthrough” specificsPerformance Improvement – next generation
Real-time information and management reports
People – new skills and responsibilities
Patient outcomes – the need to know the ultimate value we bring to our customers
Balanced Scorecard – a tool to drive the breakthrough strategy
Industry accountability for making necessary improvements
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Performance ImprovementAdopt third generation Six Sigma
1st generation = defect reduction2nd generation = cost reduction3rd generation = value creation (incorporates LEAN)
Use LEAN to improve single process elements or work cells via repeated Kaizen events
Use Six Sigma to attack the more complex process issues
Must commit the $$ upfront to get the ROI
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LEANCreated by Ohno @ ToyotaFocus is defining value and eliminating both
waste (“muda”) and expenseKaizen event = understand current state, define
future state, improve the processMost times create the performance metric during
this process and monitor improvement after the event over timeRepeat, repeat, repeat – a single Kaizen event will
not improve your laboratory operation significantly
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Six Sigma Credo
We don’t know what we don’t knowWe can’t act on what we don’t knowWe won’t know until we measureWe don’t measure what we don’t valueWe don’t value what we don’t measure
-------------------------------------------------------------------Focused on value creation, but heavily dependent on statistical analysisIntent is to reduce variation
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Cost of Quality based on performanceThe cost of “quality” activities in any organization inrelation to the prevalence of defects is:
• 3σ = 25-40% of revenue• 4σ = 15-25% of revenue• 5σ = 5-15% of revenue• 6σ = < 1% of revenue
Mikel Harry, PhD
“Methods that provide 6 Sigma performance can be easilymonitored with only 1 or 2 control measurements, whereas methods with 5 Sigma performance require 2 or 3 control measures and methods having 4 Sigma performancerequire 4 or more control measurements”
http://www.westgard.com/essay72.htm
Lab Industry Today?
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Move toward “real-time” managementRetrospective management allows too much
opportunity for undetected failure
IT capability today can support the need for data and information feedback quickly
LEAN/Six Sigma requires data
On-line analytic processing (OLAP) cube is Six Sigma tool
Here is an example of a tool that works
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MAST - Improving Laboratory Operations Through Reporting
DashboardsService TAT
Sales ProductionManagement
Send-outs
Utilization AM TATModify Behavior
“Management Accountability, Staffing & Service Tracker”
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PeopleNew skill sets and expertise are needed in the lab of the future
LEAN/Six Sigma – must educate staff across all levelsMedical Technologist Clinician – working with providers and patients to improve the value of outcome to patientsClinical Laboratory Quality Manager – now a graduate program
Needs a team of dedicated staff and leadershipAutomation Operation and ManagementDatabase management and mining – real-time needs and outcomes
research
A renewed focus on personal accountability is required for work within the lab and work within healthcare
People are the most important asset we have
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Patient Outcomes & Lab Services“You don’t know if you’ve created a best practice in your laboratory until you connect that practice with patient outcome”
Lee Hilborne, M.D., Ph.D.
“So who cares about the impact of laboratory testing on patient outcomes? I think patients care….want to get good care….what to pay a reasonable price for it”
David Wilkinson, M.D., Ph.D.
“The Impact of Laboratory Practice on Patient Outcomes”, 1995 Institute: Frontiers in Laboratory Practice Research, David Wilkinson, MD, PhD“Using patient outcomes to screen for clinical laboratory errors”, Winkelman JW & Mennemeyer MA, Clinical Laboratory Management Review, 1996 Mar-AprPatient Safety is one focus of outcomes and a growing body of
knowledge within the lab industry
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Balanced ScoreCard - “Cause & Effect”
ProcessCycle Time
EmployeeSkills
CustomerLoyalty
ProcessQuality
ROCE
On-timeDelivery
Financial
Customer
IInternal/Business Process“Quality”
Learning & Growth“People”
ref: Kaplan & Norton
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Balanced Scorecard impact on Value Creation
Quality Customer
PeopleFinance
Value Proposition – we must grow this space
Balanced Scorecard forces us to focus on more than finances!
Can “Quality” be astand-alone attribute?
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Lab Industry Led BreakthroughAs an industry, we agree there is opportunity for
improvement
Forces outside the industry do not seem focused on the broad need for improvement – other than the government on an interim basis
We have struggled to collaborate within the industry (although we are making progress), so how do we learn to speak with common purpose?
IQLM or some other way?
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IQLMInstitute for Quality in Laboratory Medicine
AgendaCreate an independent public-private partnership that speaks broadly for laboratory medicineDemonstrate laboratory’s role in systematic improvements in health carePromote evidence-based laboratory practices that lead to improvements in quality, effectiveness and safetyProvide a forum for collaboration for laboratory and clinical partners in health careSupport research in design and delivery of effective laboratory services
From Presentation at CLMA ThinkLab 06
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Keys to Success: Quality ImprovementRequirements to create quality breakthrough:
1. Driving Need2. Executive Leadership3. Breakthrough Goals4. Defined Resources5. Functional Infrastructure6. Support Systems7. Organizational Will8. Improvement Events9. Capable People10. Compelling Big Ideas11. Implementation Focus12. Operational Freedom
Mikel Harry, PhD
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Driving Quality Improvement1 - Driving Need
Healthcare quality in the U.S. needs improvementLaboratory industry performance does not equal performance of many in the manufacturing industryWe want to perform better
2 - Executive LeadershipExecutives/leaders can make significant progress in the current healthcare environment
3 - Breakthrough GoalsImprove the performance of the lab industry by 1.5 Sigma in the next 10 yearsImprove your lab organizations performance by 2.0 Sigma in the next 10 years
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Driving Quality Improvement4 - Defined Resources5 - Functional Infrastructure6 - Support Systems
--------------------------------------------------------------Must demonstrate early successes with LEAN to show ROI to justify additional resourcesMust change thinking about IT resources to move toward real-time feedback and management reportsMust commit to allowing personnel to focus on improving quality – it cannot be a management program onlyMust spend $$ on needs that may not be considered lab focused today
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Driving Quality Improvement7 - Organizational Will9 - Capable People12 - Operational Freedom
----------------------------------------------------------------Leadership must champion the cause and enhance the underlying organizational will to seek the highest level of improvementTrain new experts needed to support this even if there is a staffing issueEmpower those who know the processes best and provide them the time and support to make improvements
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Driving Quality Improvement8 - Improvement Events10 - Compelling Big Ideas11 - Implementation Focus
-----------------------------------------------------------------Goal = be the best, exceed patient expectations, know how you impact patient outcomesFocus on expanding your quality tool kit, bring LEAN/Six Sigma to bear, learn from other industries if necessaryDo one improvement exercise, then repeat on a continuing basisQuality improvement becomes the number one goal for your organization and drives all else
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Application of Breakthrough Strategies
The four case studies being presented this afternoon willdemonstrate how leaders in our industry have appliedstrategies that are creating breakthrough impact fortheir organization………………
Thank you!