Rural Hospital Performance Excellence & Baldrige · 2014-04-21 · • Rural Hospital Performance...
Transcript of Rural Hospital Performance Excellence & Baldrige · 2014-04-21 · • Rural Hospital Performance...
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Rural Hospital Performance
Excellence & Baldrige
600 East Superior Street, Suite 404 I Duluth, MN 55802 I Ph. 800.997.6685 or 218.727.9390 I www.ruralcenter.org
Terry Hill
Senior Advisor for Rural Health Leadership and Policy
National Rural Health Resource Center
Bob Schapper
Chief Executive Officer
Tahoe Forest Hospital District
November 2013
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Purpose
The National Rural Health Resource Center is a nonprofit organization dedicated to sustaining and improving health care in rural communities. As the nation’s leading technical assistance and knowledge center in rural health, The Center focuses on five core areas: • Performance Improvement • Health Information Technology • Recruitment & Retention • Community Health Assessments • Networking
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Tahoe Forest Hospital District
Bob Schapper, CEO
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Blueprint Sources
• Remaining Relevant: Rural Hospitals’ Challenge, Louisiana Hospital Association, 2012
• Rural Policy Research Institute (RUPRI), U of Iowa
• Rural Hospital Performance Improvement Project (RHPI)
• Federal Office of Rural Health Policy (ORHP)
• National Rural Health Association (NRHA)
• 2011 CAH Quality Leadership Summit
• 2012 CAH Financial Leadership Summit
• 2013 CAH Performance Excellence Summit
• 2013 Top 100 CAHs, iVantage Health, 2013 Survey
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Quality Leadership Summit 2011
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Current Health Care Business Model
Based on volume, The more you do, the
more money you make
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It’s Changing!
Triple Aim
• Better health
• Better care
• Lower cost
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Patient Value =
Quality + Service
Cost
= Patient Value
Future Health Care Business
Model Based on Patient Value
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The Challenge:
Crossing the Shaky Bridge
Source: http://www.flickr.com/photos/67759198@N00/2974261334/sizes/o/in/photostream/
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Definition of Framework
“A framework for getting people, processes and resources aligned and moving in the same direction. The ultimate goal is to achieve strategies that benefit the customer and the bottom line and that result in organizational excellence.”
-National Rural Health Resource Center
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Top Reasons for
Strategic Frameworks
1. Creates an organized process for leading and driving change
2. Creates a culture that supports change
3. Enables a broad-based systems approach
4. Supports quality reporting that drives improvement
5. Opportunity to document where you have been and where you want to be
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Top Reasons for Strategic
Frameworks and Evaluation
6. Opportunity to know where you are right now and make mid-course corrections
7. Aligns people, processes and resources
8. Links individual department operations to organizational strategy
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Baldrige Performance
Excellence Framework
A systems based
management tool to align focus on quality
and performance
A blueprint for rural hospitals
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• Developed in 1987 in response to a crisis in US competitiveness
• $24.6 billion savings on $120 million cost
− That’s a 200:1 ratio
• Health care added as new criteria in 2002
• 20 million copies downloaded in 2010
Baldrige Performance
Excellence Framework
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Why Use Baldrige?
• 2011 study:
− 820:1 economic return in terms of cost savings, customer satisfaction, and financial gain (revenue)
• Hospitals using Baldrige are 7 times more likely to be in the Thompson Reuters Top 100 than those that do not use it
Source: Performance Excellence Network, www.performanceexcellencenetwork.org
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Baldrige Award Winners
• Henry Ford Health System (2011) − http://www.youtube.com/watch?v=nn-U11GeCu8&list=PL914FB9D44BF49C14
• North Mississippi Health Services (2012) − http://www.youtube.com/watch?v=rRgdRP2U-2o&list=PL914FB9D44BF49C14
• Schneck Medical Center (2011) − http://www.youtube.com/watch?v=eTePfr0bHxE&list=PL914FB9D44BF49C14
• Alaska Native Tribal Health Consortium (2012) − http://www.anthctoday.org/
Source: Performance Excellence Network, www.performanceexcellencenetwork.org
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A Framework for Excellence
Results
Results
Measurement, Analysis, and Knowledge Management
Strategic Planning
Drivers
Leadership
Customer Focus
Core Work
Operations Management
Workforce Focus
Source: Performance Excellence Network, www.performanceexcellencenetwork.org
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1. Boards must understand and support
2. Leaders and managers must understand and support
3. Primary care providers must be a part of leadership
Leadership
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4. Strategic planning must be dynamic and ongoing
5. Use a systems framework for planning to ensure a holistic approach
6. The plan must be communicated organization-wide
Strategic Planning
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It’s Complicated!
“Even small health care institutions are complex, barely manageable places. Large health care organizations may be the most complex organizations in human history.”
- Peter Drucker
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Strategic Planning
“If you don’t know where you are going, any road will get you there.”
- Lewis Carroll, Author
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The Hospital’s Risk of
Not Changing
“Healthcare ‘markets’ are now being redefined; shifting from purchasing service units to
purchasing quality outcomes. Importantly, quality care is increasingly defined in both personal and
population perspectives.”
“This developing redefinition of healthcare needs to be reflected in rural provider strategic planning.
It is a great opportunity for rural health.”
Source: “Population Health Improvement & Rural Hospital Balanced Scorecards: A Conversation,” Tim Size, David Kindig, & Clint MacKinney
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Partners, Patient Care
Coordination & Communities
7. Measure and publicly report patient satisfaction and excel at customer service
8. Partner with larger systems or rural networks
9. Partner with other types of providers in the service area
10.Engage and educate the community to encourage use of local health and wellness services
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Partnerships to Consider
• Other rural hospitals (network)
• Large health systems (telehealth)
• Accountable Care Organizations (ACOs)
• Long-term care and home health providers
• Drug stores
• Mental health
• Business/economic development
• Public health
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CAH Formula for Success
Do
llars Profit Zone
Loss Zone
Service Volumes
Cost
Revenue
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Why Migration Happens
• Physician referrals out of areas
• Negative perception of local hospital
• Lack of knowledge/understanding of local services
• Inconsistent customer service and quality
• Lack of innovative ways to engage the community
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Migration Reversal Strategies
• Community health assessment
• Physician/hospital partnerships
• Proactive plan to change community perceptions
• Strategic community alliances
• Customer service programs
• Upgraded marketing/communication tools and messages
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Population Health: What Can Rural
Hospitals Do Now?
• Initiate a hospital employee wellness program
• Create a community health council
• Hold community meetings
• Do effective community marketing
• Hospital leaders speak at community meeting
• Plan for community care coordination
• Plan for chronic disease management
• Plan for population health data analysis
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Performance Management Tools
• Studer Principles and Pillars
• Lean Management
• Balanced Scorecard
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Measurement, Feedback,
& Knowledge Management
11. Use a strategic framework to manage information and knowledge
12. Evaluate strategic process regularly and share information organization-wide
13. Gather and use data to improve health and safety of patients in the service area
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CAH Data Collection:
Strategic Purpose
• Hospitals make significant investments in collecting data for regulatory or accreditation purposes, which limits value
• The goal is to push the Effort Curve to the right
Action Steps
Data Analysis
Data Reporting
Data Collection
Data -------------Information
Typical Effort
Desired Effort
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Demystifying the BSC
What it is:
1. A way of expressing and measuring your hospital’s strategy
2. A way of linking hospital operations to that strategy
3. A way of monitoring and comparing hospital performance
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Demystifying the BSC
What it is NOT:
1. A magic bullet that will automatically “fix” every problem
2. Just another benchmarking project that generates meaningless data
3. Something that will exist without commitment and effort
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Understanding the
Balanced Scorecard
“A successful Balanced Scorecard program starts with a recognition that it is not a
metrics project…
IT’S A CHANGE PROCESS”
Robert Kaplan, Balanced Scorecard Collaborative’s Government Summit, Sept. 2004
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Balanced Scorecard Perspective
Perspective Key Questions
Financial As financial stakeholders, how do we intend to meet the goals and objectives in our hospital mission statement?
Customer As customers of our hospital’s services, what do we want, need, or expect?
Internal Business Processes
As members of the hospital Staff, what do we need to do to meet the needs of our various customers?
Learning and Growth What type of culture, skills, training, and technology are we doing to improve in order to support our key processes?
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Balanced Score Card
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Strategy Map
• A graphical depiction of your strategy
• Shows how the elements of the strategy relate to one another
• The “blue print” of your strategy
• The key to successful Balanced Scorecards
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Finance
As financial stakeholders,
how do we intend to meet
the goals and objectives in
the facility's Mission
Statement?
Service &
Community
Quality
(Processes)
People (Infrastructure)
As customers of the facility's
services, what do we want,
need or expect?
As members of the facility’s
staff, what do we need to do to
meet the needs of the patients
and healthcare community?
As an organization, what
type of culture, skills,
training and technology are
we going to develop to
support our processes?
Improve Efficiency Increase Revenue
Margin to Fund Mission
Excellent Customer Service
Employer of Choice
Leadership Development Culture of Excellence
Progressive Technology
Expansion of Services
Community Wellness
Collaboration Inform & Educate Community
Continuous
Performance Improvement
Customer Safety
Capture Market Share
Older Adult Services Outpatient Services Primary Care Services
EXAMPLE HOSPITAL Strategy Map Mission: XYZ Hospital is committed to providing exceptional healthcare as we promote wellness, restore health, and provide comfort to people of all ages
and in every stage of life.
Vision: To challenge ourselves to consistently exceed expectations by providing the best healthcare based on a balanced pillar approach encompassing service,
quality, finance, people, community, and growth. Through teamwork increased profitability, targeted growth, and strong leadership, we will create a medical
center that will be the new standard thus achieving the highest level of satisfaction for customers, providers, and employees.
A B
D
C
M
N
E
J
J
H D
K
F G
I H
N
I
G
L
E F
J
K
Growth As an organization, what
services must we grow to
achieve our mission?
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The Map Should Reflect Your “Personality”
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Example of Part of a Rural Hospital Strategy Map
Hospital Mission
Financial Perspective
Customer Perspective
Internal Process Perspective
Learning & Growth Perspective
Grow revenues from existing market
Optimize physician’s use of hospital services Improve Patient
Satisfaction
Meet practice needs of medical staff
Support professional development
Measure
Measure Measure
Measure
Initiatives
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Performance Measurement Statistics:
Patients and Community
Q4 ’01 Year End ’01
Patient satisfaction: % recommend
85.0% 93.0%
% claims denied: medical necessity
9.0% 7.8%
ER/Urgent Care wait times (minutes)
34 36
Unplanned Returns to ER
3.2% 2.7%
PATIENTS AND
COMMUNITY
Patient Satisfaction: %
Recommend85% 93%
GOAL - At least 88% of inpatients and outpatients would
recommend hospital based on their experience; Specify factors that
contributed to performance.
% Claims Denied:
Medical Necessity9.0% 7.8%
GOAL - 6.5% or fewer of claims based on charges; Specify factors
that contributed to performance.
ER/Urgent Care Wait
Times34 36
GOAL - 35 minutes or fewer from registration to physician exam ;
Specify factors that contributed to performance.
Unplanned Returns to
the ER3.2% 2.7%
GOAL - 5% or fewer ER visits result in an uplanned visit to the ER;
Specify factors that contributed to performance.
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
Q1-0
0
Q2-0
0
Q3-0
0
Q4-0
0
Q1-0
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1
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2
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2
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2
-
10.0
20.0
30.0
40.0
50.0
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0
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0
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1
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0%
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40%
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80%
100%
120%
Q1-0
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Q1-0
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Q3-0
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Q4-0
2
Exceeded Target
0.0%
1.0%
2.0%
3.0%
4.0%
Q1-0
0
Q2-0
0
Q3-0
0
Q4-0
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Q1-0
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14. Develop a workforce that is change ready and customer / patient focused
15. Have an intense focus on staff development and retention
Workforce & Culture
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Studer Principles
• Commit to excellence
• Measure the important things
• Build a culture around excellence
• Create and develop great leaders
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Studer Principles
• Focus on employee satisfaction
• Build individual accountability
• Align behaviors with goals and values
• Communicate at all levels
• Recognize and reward success
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Efficient Processes
16. Develop efficient business processes and maximize revenue cycle management
17. Continually improve quality and safety processes
18. Use techniques such as Lean to improve both efficiency and quality
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Lean Management
Based on the Toyota Production System
• Focus on customer value and waste elimination
• Intradepartmental teams continually improve hospital processes
• Lean is really all about effective problem solving
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What Does Lean Buy Us?
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Time Improvement Example
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Continuous Improvement Cycle
Defined Strategies
Define Performance
Metrics
Identify Improvement Opportunities
Execute Initiatives
Measure and Monitor
People
Technology/ Infrastructure
Strategy Map
Monitor Scorecard
Improvement Initiatives
Assessment Balanced Scorecard
LEAN
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Process Management and
Quality Reporting
“At best, Electronic Health Records can hardwire quality.”
-Darlene Bainbridge, President, D.D. Bainbridge & Associates, Inc.
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19. Publically report and communicate outcomes internally and externally
20. Document value in terms of cost, efficiency, quality, satisfaction, and population health
Documentation of Value
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We are in this Together
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“Even if you’re on the right track, you’ll get run over if you just sit there.”
-Will Rogers
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Terry Hill
Senior Advisor for Rural Health
Leadership and Policy
National Rural Health Resource Center
600 East Superior Street, Suite 404
Duluth, MN 55802
(218) 727-9390 ext. (232)
Bob Schapper
Chief Executive Officer
Tahoe Forest Hospital District
10121 Pine Avenue
Truckee, CA 96160
(530) 582-3480