•Explain core competencies and key work processes , and the associated operational performance measures and outcomes these produce for tracking daily operations  

2009 -AHCA/NCAL- Identifying and Improving Process Effectiveness

Ira M. Schoenberger, FACHCASenior Administrator

Baldrige Health Care Criteria Framework: A Systems Perspective- Core Competencies and Key Work Processes

While core competencies were introduced as an important concept in the 2007 Baldrige Criteria, their strategic significance was not fully exploited.

The Criteria questions probe the relationship of your core competencies to your organization’s mission, strategy, and sustainability.

Is your organization competent in the areas that will deliver its sustainability?

Baldrige Health Care Criteria Framework: A Systems Perspective- Core Competencies and Key Work Processes

Strategic advantages generally arise from either or both of two sources: (1) core competencies, which focus on building and expanding on an organization’s internal capabilities, and (2) strategically important external resources, which are shaped and leveraged through key external relationships and partnerships.

Key Work Processes Your key work processes (6.1b[1]) are your most

important internal value creation processes and might include health care service design and delivery, patient and stakeholder support, supply chain management, business, and support processes. Your key work processes are the processes that involve the majority of your organization’s workforce and produce patient and stakeholder value.

Key The term “key” refers to the major or most important

elements or factors, those that are critical to achieving your intended outcome. The Baldrige Criteria, for example, refer to key challenges, key patient and stakeholder groups, key plans, key work processes, and key measures—those that are most important to your organization’s success. They are the essential elements for pursuing or monitoring a desired outcome.

Your key work processes frequently relate to your core competencies, to the factors that determine your success relative to competitors and organizations offering similar health care services, and to the factors considered important for business growth by your senior leaders.

Core Competencies

The term “core competencies” refers to your organization’s areas of greatest expertise.

Your organization’s core competencies are those strategically important capabilities that are central to fulfilling your mission or provide an advantage in your marketplace or service environment.

Core competencies frequently are challenging for competitors or suppliers and partners to imitate, and they may provide a sustainable competitive advantage.

Core competencies may involve unique service offerings, technology expertise, a marketplace niche, or a particular business acumen (e.g., health care delivery start-ups).

Mission

The term “mission” refers to the overall function of an organization. The mission answers the question, “What is this organization attempting to accomplish?” The mission might define customers or markets served, distinctive or core competencies, or technologies used.

Examples of Core Competencies

The mission of the United States Air Force is to fly, fight and win …in air, space and cyberspace.

To achieve that mission, the Air Force has a vision of Global Vigilance, Reach and Power . That vision orbits around three core competencies: Developing Airmen, Technology-to-Warfighting and Integrating Operations. Core competencies and distinctive ...

Mercy Health Care System (MHS) core competencies are those areas of expertise that are critical to accomplishing the mission and vision. MHS’s senior leaders determine and reaffirm

MHS’s core competencies as part of the mission and vision review during the SPP. MHS’s core competencies include: 1) partnering with physicians to create and maintain an effective integrated healthcare delivery system; and 2) engaging employees and physicians using the Servant Leadership Philosophy and the COE model, which provide a balanced approach to patient focused care.

The integrated delivery system model has enabled growth and diversification of business lines, supporting the ability to effectively coordinate quality healthcare delivery across the continuum of care and supporting the mission, “to provide exceptional healthcare services resulting in healing in the broadest sense.” Partnering with physicians supports a collaborative focus on quality healthcare services and information sharing across the four core services. The integrated delivery model supports coordinated transitions between departments, providers, and care settings to ensure ….

Heritage Hall East Mission

It is the purpose of HHE to improve the lives we touch through the delivery of high quality health care and everyday compassion. The vision of HHE is to set the standard in nursing and rehabilitative care through clinical excellence and responsiveness to the unique needs of every patient we care for. We will be the recognized leader in clinical quality and customer satisfaction in our marketplace. Our organizational culture is defined by our core belief that patients and residents are the center of our work. Our employees are the vital link between HHE and our patients and residents. They are the service we provide, the product we deliver–they are our most valuable resource. Achievement of our vision comes only through the talents and extraordinary dedication they bring with them every day of the year. Our core values revolve around excellence in patient/resident care and an energized culture of change and learning for our staff—extending to the surrounding community. Our values include Care & Compassion for every life we touch, Respect & Appreciation for each other, Teamwork & Enjoyment in working together, Focus & Discipline on improving the quality of care, Creativity & Innovation to develop effective solutions and Honesty & Integrity in all dealings. The organization deploys these values through 1) innovative approaches for resident empowerment, 2) a highly participative management approach—which includes all levels of the organization, and 3) a coordinated focus on personal learning and career mobility. Our mission is conveyed to our residents, families and staff on an ongoing basis via written communication and direct contact. Our residents and families are informed and educated on our philosophy and mission prior to admission i.e. in the hospital or home, during the admission process and on an ongoing basis at care plan meetings, resident counsel meetings, and family meetings. All contract workers are orientated to our mission statement and expectations.

Examples of Mercy Health System core competencies and key processes

Operationalized-

Business

Clinical

Skilled and SatisfiedStaff

Customer Satisfaction

Mission

Core Competencies

Health Care Core Competencies based on their Mission and Vision statement and Core values.The focus is on Clinical, Business, Skilled andand Satisfied Staff Staff Excellence, and CustomerExcellence.

2.1b(1) Figure 2.1-3 Key Strategic Objectives, Goals Goals Time

Frames Short Term & Long Term Action Plans Performance Measures

/Indicators Key Strategic Objective: Clinical excellence Deficiency free in 2006. Jan’05

Sept’05 (survey window for 2006)

Maintain adequate staffing levels. Ensure 100% competencies of staff. Monitor and measure clinical outcomes monthly and quarterly.

Center pre survey DPH survey.

Patients will report consistent relief of pain

2005 On going education of staff through the pain collaborative. Pain collaborative meetings monthly or as needed. Pain champion who monitors and audits the quality measure tool.

Chart Audits Customer satisfaction data Audits reported to DON and CRC.

Fall rate will be at or below 15%

2005 Weekly fall rounds including assessments and interventions. Monthly fall meetings, early identification of fall risk patients. Root cause analysis as needed. Interdisciplinary teamwork.

COR reports Performance trends. Fall champion reports at morning meeting.

Pressure ulcers at or lower than 2%

2005 Weekly skin rounds, active participation of CNAs, use of pressure relieve and prevention devices, positioning rounds with rehab. Interdisciplinary teamwork.

COR reports. Reports from skin trends reported at morning meetings.

Weight loss less than 5% 2005 Patients residents weighed weekly. Interdisciplinary review of weekly weights.

COR reports. Reports from weight reported at morning meetings and medical director meetings..

Pain 4 or less than 4% 2005 Pain will be measured with vital signs on every patient or resident. Medical direct rounds on short stay unit weekly, Nurse practitioner in weekly.

COR reports. Reports of pain reported at morning meetings and medical director meetings..

Key Strategic Objective: staff excellence Maintain agency elimination.

FY 2005 Provide mentoring and coaching to new employees. Continue on site LPN program Market to schools of nursing by offering gerontology awards and educational programs for students.

Financial performance trends Monthly nursing PPD reports.

Increase retention by 1% (80.00%)

FY 2005 Develop an employee recognition Committee (FISH concept) Maintain on site career counseling and education for employees through Campus on a Campus Program.

Monthly retention and turnover report.

Reduce turnover by 2% annually

2005-2006 Management staff will interview every employee at time of exit. Data is collected and analyzed. Maintain on site career counseling and education for employees through Campus on a Campus Program.

Monthly retention and turnover report.

Maintain 100% competency in all general and specialty areas

2005 Increase the number of inservices offered. Maintain inservices for Respiratory, IV, Orthopedics and Amputee Add specialty inservicing for cardiac.

Competency reports to CQI committee.

Examples of Key Health Care Process from HHE Step 3- Key services and their major processes are determined through market need and evaluated against regulatory agencies that govern each process. The center is licensed as a skilled nursing facility to meet the needs of long-term care residents and short stay patients from our referral basis. We design our services around our stakeholders requirements keeping in mind our strategic objectives..

If we adhere to our key processes we provide delivers our core competencies and our strategic objectives: clinical excellence, excellence in customer care, staff excellence and business excellence By measuring our results and using our CQI process we continually improve our health care outcomes.

Figure 6.1-1 Health Care Processes

(1) Key Health Care Processes

(2) Key Requirements

(5) Key Performance Assessments and

Measures/Indicators Pre-admission screening, assessment and admission

- Ensure potential resident’s needs can be met by the center. -Admit residents on a schedule that meets the needs of the referral source. - Have available any special needs for equipment, etc. - Make a decision on all referrals with 1 hr. -Legal and financial agreements completed within 24 hours.

-Discharges from specialty programs -Referral source satisfaction results: Key loyalty measures. -DPH survey results -Customer satisfaction

Resident assessment and diagnosis (including lab testing, etc.) and care planning.

-Timely, thorough assessments completed within 24 hours Interdisciplinary care plan meetings held within 5-10 days.

-DPH survey results -JCAHO results

Pharmacy, medication administration

- Accuracy - Accurate documentation, immediately after administration.

DPH survey results JCAHO survey results Pharmacy expenses

Care delivery including treatments, ADLs, patient teaching.

-Adequate staff with clinical competence and skills. -Adequate equipment and supplies -Clear documentation

PPD nursing hours DPH survey results JCAHO results Customer satisfaction

Case Management -Appropriate utilization of facility services

-Average LOS -Financial performance -Days in AR

Discharge planning -Initiated on admission -Patient and family involvement -Community Service links

DPH survey results JCAHO survey results Customer satisfaction

i.

Sample of Trended Scorecard

Sample of Performance Score Board

Baldridge Criteria:How do you design your work systems?

How do you design your work systems?

Describe HOW your organization determines its CORE COMPETENCIES and designs its WORK SYSTEMS and KEY PROCESSES to deliver VALUE to PATIENTS and other CUSTOMERS, prepare for potential emergencies, and achieve organizational success and SUSTAINABILITY.

Within your response, include answers to the following questions:

6.1a. CORE COMPETENCIES

a(1) HOW does your organization determine its CORE COMPETENCIES?

What are your organization’s CORE COMPETENCIES and how do they relate to your MISSION, competitive or collaborative environment, and ACTION PLANS?

a(2) HOW do you design and INNOVATE your overall WORK SYSTEMS?

HOW do you decide which PROCESSES within your overall WORK SYSTEMS will be internal to your organization (your KEY work PROCESSES) and which will use external resources?

6.1b. Work PROCESS Design

b(1) What are your organization’s KEY work PROCESSES?

HOW do these KEY work PROCESSES relate to your CORE COMPETENCIES?

HOW do these PROCESSES contribute to delivering VALUE to PATIENTS and other CUSTOMERS, organizational success, and SUSTAINABILITY?

b(2) HOW do you determine KEY work PROCESS requirements, incorporating input from PATIENTS, other CUSTOMERS, suppliers, PARTNERS, and COLLABORATORS, as appropriate?

What are the KEY requirements for these PROCESSES?

b(3) HOW do you design and INNOVATE your work PROCESSES to meet all the KEY requirements?

HOW do you incorporate new technology, organizational knowledge, and the potential need for agility into the design of these PROCESSES?

HOW do you incorporate health care outcomes, CYCLE TIME, PRODUCTIVITY, cost control, and other efficiency and EFFECTIVENESS factors into the design of these PROCESSES?

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Resources

AHCA/NCAL Quality Award program requirements and application information (www.ahcancal.org).

Baldrige National Quality Program To order a free copy of the Baldrige Health Care Criteria for Performance Excellence:Tel: 301-975-2036Website: www.baldrige.nist.gov.

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More Resources

Books available at www.ahcapublications.org:• Conducting Satisfaction-Based Customer Surveys: A

Guidebook for Long Term Care Providers by Vivian Tellis-Nayak, Ph.D.

• Continuous Quality Improvement: Using the Regulatory Framework by Barbara Baylis

• Developing a Quality Management System: The Foundation for Performance Excellence in Long Term Care by Bernie Dana

• Quality Management Integration in Long-Term Care: Guidelines for Excellence by Maryjane Bradley and Nancy Thompson

Questions ????For more information...

Please contact:

Ira M. Schoenberger, FACHCASenior Administrator Heritage Hall West/Genesis Health Care61 Cooper StreetAgawam, Massachusetts 01001413-821-0750

ira.schoenberger@genesishcc.com