Leadership Workshop - Leading Out of the Mess
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Transcript of Leadership Workshop - Leading Out of the Mess
Leading Out of the Mess
Roger L. ChaufournierExecutive DirectorCSI Solutions, LLC
September 2009
Michigan Primary Care Association
Fall 2009 Annual Conference
Objectives of the Workshop
1) Understand how to utilize a leadership Framework to drive improvement in the organization
2) Understand best practices of leadership in driving organizational change
Overview Chapel Road Case Study
Framework for Leadership
Leading Transformation
Bringing it All Home: Next Steps
CHAPEL ROAD HEALTH CENTER
Chapel Road Health Center
Single site FQHC located in an urban environment
Leadership turned over List of challenges to overcome
What are your impressions of this organization?
Common Leadership Practices
Reactive vs. Proactive Blame the people Throw people or policies at the problem Gimmicks
Slogans/campaignsNew Policies/Approval Process & SignaturesReorganizationsUse of extrinsic motivation (carrot and stick)
All Leadership Approaches Work! Autocratic-Top Down-Controlling
Hands Off
Team based
But certain leadership principles lead to higher levels of performance ….
“Hardly a competent workman can be found who does not devote a considerable amount of time to studying just how slowly he can work and still convince his employer that he is going at a good pace. Under our system a worker is told just what he is to do and how he is to do it. Any improvement he makes upon the orders given to him is fatal to his success.”
Frederick Taylor
“We trained hard...but it seemed that every time we were beginning to form up into teams we would be reorganized. I was to learn later in life that we tend to meet any new situation by reorganizing; and what a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency and demoralization.”
Who do you think said this and in what era did they live?
Peter Drucker“Every few hundred years in the history of Western society a transformation takes place. The transformation transcends all aspects of society; the government, the schools, the values, religion, culture, etc. The transformation is not sudden, but takes place over a 50 year or more period. The transformation is so profound that the children born in that era can not comprehend the time in which their parents were born and in which their grandparents lived.”
Transformational Leadership Problem Solving: System Focused not People
Focused Strategic vs. Reactionary Focus on Quality as a Business Strategy Measurement and Feedback as a driver for change Leadership as a system; continuous reflection and
improvement Build organizational capacity for excellence
Small Group Dialogue
What would you do to right the ship? What role should the Chief Medical Officer
Play? If you were the CEO, what would you do? How can the CEO best work with the
Medical Director to develop a game plan?
Baldrige Health Care Criteria for Performance Excellence FrameworkA Systems Perspective
4Information and Analysis
6Process
Management
2StrategicPlanning
5StaffFocus
1Leadership
3Focus on Patients,Other Customers,
and Markets
Organizational Profile:Environment, Relationships and Challenges
Malcolm Baldrige National Quality Award
7Organizational
Results
Peter Drucker’s Effective Executive: Eight Practices
1. They ask “what needs to be done”2. They ask “what is right for the enterprise”
3. They develop action plans4. They take responsibility for decisions5. The take responsibility for communicating
6. The focus on opportunities rather than problems7. They run productive meetings8. They think and say “we” rather than “I”
Give the executive the
knowledge they need
Convert the knowledge into effective action
Ensure that the whole organization feels responsible and
accountable
PULL
PUSH
1. Set Direction: Mission, Vision and Strategy
3. Build Will• Plan for Transformation• Set Aims/Allocate Resources• Measure System Performance• Provide Encouragement• Make Financial Linkages• Learn Subject Matter• Work on the Larger System
5. Execute Change• Use Model for Improvement for Design and Redesign• Use Change Leadership Model• Review and Guide Key Initiatives• Spread Ideas• Communicate results• Sustain improved levels of performance
Make the status quo uncomfortable
Make the future attractive
Leadership for Transformation
2. Establish the Foundation• Reframe Operating Values
• Build Improvement Capability
• Build Relationships
• Develop Future Leaders
• Personal Preparation
• Choose and Align the Senior Team
4. Generate Ideas• Read and Scan Widely, Learn
from other Industries/Disciplines• Benchmark to Find Ideas• Listen to Customers• Invest in Research
&Development• Knowledge management• Understand Organization as a
System
IHI 2003
Leadership
Build will through a clear vision people want to buy into
Communicate Clear system level metrics Clear system priorities Empower staff to move the dots Align organization and remove barriers
Strategic Leadership
Clear vision and mission Constant Fingerprinting of the vision Set a limited number of core strategic
drivers-the vital few System of accountability
Quality Initiatives Must be Broad Enough and Deep Enough to Move the Big
Dot
Organization message: this year, patients will not acquire catheter-related bloodstream infections, surgical site infections, or ventilator-associated pneumonia
Organization message: this year, patients will not acquire catheter-related bloodstream infections, surgical site infections, or ventilator-associated pneumonia
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IOM aim: Care should be safe
IOM aim: Care should be safe
JHHS-level goal: patients will not be infected as a result of being in our hospital
JHHS-level goal: patients will not be infected as a result of being in our hospital
Projects (often cross-departmental): CABG surgical site infection initiative, ICU catheter initiative, laminectomy initiative, etc.
Projects (often cross-departmental): CABG surgical site infection initiative, ICU catheter initiative, laminectomy initiative, etc.
Each absolutely MUST have clear metrics:
you manage what you measure. If you don’t
capture the data, develop a way
JHM Strategic Priority: Clinical excellence
JHM Strategic Priority: Clinical excellence
Source: Richard Davis, Ph.D. Johns Hopkins Medicine
Aligning Workto your Business Imperative
Community Health HealthHealth Center CenterAssessment Strategic Plan QI Plan &
MonitoringSystem
Priorities forParticipation inImprovement Projects andPriorities for Spread
Collaborative TeamEstablished
PlanAct Do Study
Cycles
PlansForSpreadBased on SuccessfulPDSA
Mon
thly
mea
sure
s
ImprovedHealthCenterPerformance• lower cost• > clinical outcome• >patient & staff satisfaction
Update the plan
Information Management and Analysis Set of system level measures for the
organization They focus on “moving the dots” Information is available to front line work
force Data driven decision making
SJHS Performance Metrics Balanced High level Linked to
trended run and control charts
Indicator-specific comparative rates (green circle)
Adds focus to “move to the outside circle”
Some successes22
04/10/23
Dashboards
© 19 99 Arthu r Ande rsen. All rig hts re served .
Informed decisions through the use of appropriate and timely data
KQI_ending-063004.pdf
Source: Richard Davis, Johns Hopkins Business of Medicine Program
Work Process Management
Put people to work on building the better mouse trap
Use change methods to drive improvement
Empower staff with the tools to study and improve work
Drive the improvement efforts
Every Leader Needs a Toolkit of Improvement Methods To Lead ChangeImprovement Methods: PDSA PICOS/Lean Six sigma (DMAIC) AIM Kaizen Reengineering
These tools are specific to the improvement task at hand.
All have similarities in approach: applying the scientific method to improvement: defining, measuring and testing
Value Stream Mapping Phases
Preparation
Current State
Future State
Planning
Agreeing on what process to study, how to map it and who will participate.
Agreeing on a well understood map of the current situation.
Agreeing on a shared vision of a lean future state.
Agreeing on how to implement the future state vision
Adapted from Lean Enterprise Institute
Pre-Registration / RegistrationReimbursement Received
Bills Processing
Chart Coded
Chart Collected
Discharge Order Written
Clinical Documentation Improvement
Patient Care Rendered
Medical Record / Encounter Form Created
The Johns Hopkins HospitalRevenue Recovery Initiative
Revenue Cycle
Denials Management
Late Charge Management
Standards Identified(selected examples....) 98% overall accuracy rate of registration 90% competency rate of registration staff 100% of claims include referral/auth. 95% insurance verification and precert. 90% TOS payments collected/counseled Reduce denial rate Increase patient satisfaction
Standards to guide PICOS groups
PICOS Groups Redesign Registration Processes Key metrics for each group
Vision for new processes
Action items Short Term: implement immediately after workshop Long Term: implement over 12 months while group
continues to meet
Revenue Recovery Revenue Recovery AccomplishmentsAccomplishments
Activity Baseline FY00 FY01 FY02 FY03 FY04 FY05 (Q2)
Competency Scores 65% 80% 90% 92% 91.4% 92.5% 93.5% Admin. Denial Rate 1.4% 1.4% 1.4% 1.4% 1.4% 2.0% 1.7%
Clinical Denial Rate 2.3% 1.7% 2.0% 2.0% 1.8% 1.8% 1.8%
TOS Collections $13.8m $17.5 $8.7m* $10.1m $8.6M $9.5M $4.4M Collection Rate 85.6% 87.4% 87.5% 88.1% 88.6% 89.3% 87.9% Days in A/R 118 96 75 61 56.3 50.6 53.7
Late Charges 9% 4% 4% 3% 2.6% 3.1% 2.5%
Cumulative Revenue FY00 – FY05 = $98,000,000
Work Force Management
Create an environment that breeds success
Recruit great people Train and empower the work force Recognition as a driver or performance Building “Good to Great” cultures
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What Leads to Intrinsic Motivation? Control over the variables Feedback The ability to make a contribution and
succeed Variation Recognition
Make work like a Nintendo game!
Role of Recognition
The Carrot Principle Gostick and Elton 2007 200,000 employee ten year study Frequent, variable, meaningful praise tied to:
Goal SettingCommunicationTrustAccountability
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Recognition Formula Annual expenditures $1000 per employee or 2%
of payroll Every 7 days thank for free (hand written note,
verbal, email) 4-6 /year above and beyond wards ($100-$2000 $100 annually- 2 times per year event award $200 year Service Awards (90 day;1 yr;3 yr;
5yr;10yr; every five year thereafter
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Empowerment
How do you build an empowered organization? Philosophy Delegated authority Training Monitoring Communication Reinforcement Celebration
BRINGING IT ALL HOMEWhat do I do now?
Bring it All Home-Key Points
Leadership can be viewed as a system A framework can help you improve your
leadership system Each Domain of the Framework has
principles and best practices you can learn to master
You should maintain a continuous learning environment
Action Planning
What three steps can you take upon return? (new concepts you want to explore)
What next step do you need to do to continue your learning journey?
Where to find more information Malcolm Baldrige National Quality Award IHI.org Monograph: The Seven Leadership Leverage
Points Built to Last; Jim Collins and Jerry Porras. First, Break All the Rules: What the World’s Greatest
Mangers Do Differently, Marcus Buckingham and Curt Coffman
The Leadership Challenge, James Kouzes and Barry Posner
The Carrot Principle Gostick and Elton 2007