Achieving Strategic Results

Institute for Healthcare Improvement 1

Achieving Strategic Results

Pete Knox Executive Vice President

Chief Learning & Innovation Officer Bellin Health, Green Bay WI

Salt Lake City, Utah - March 2013

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How Did Bellin Do It? “If your organization lacks a method to define and maintain standard “daily” work on core processes, you won’t be able to hold the gain-- no matter what your method of improvement.”

From what I can see from the outside, the management system at Bellin has a systematic way to drive improvement, connected to management of work at multiple levels of the organization. Without this structure, little chance of good performance over time (though heroic efforts can work episodically!)

“What the editorial does not describe is Bellin’s management structure and capability to execute changes that supports the accomplishments described in the piece. It seems to me that outsiders often tell a story based on what is relatively easy to use - - e.g. clinics in the work place -- vs. the hard and harder-to-see work to build effective management systems that you and your colleagues have accomplished at Bellin. Source: Kevin Little, Ph.D.

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What Features/ Functions Should

Our Products Have?

What Should We Make?

How Will We Make It?

What Do We Need to Improve/ Redesign?

Do People Buy Our Products?

Products and Services

SYSTEM OF PRODUCTION

SYSTEM OF MEASUREMENT

Is It Made Well?

SYSTEM OF IMPROVEMENT

SALES MARKETING

- Market/Customer Knowledge - Organizational Knowledge

ORGANIZATIONAL STRUCTURE

ALIGNMENT AND DEPLOYMENT

ROAD MAP

BRANDS

Strategic Position

SYSTEM OF LINKED MEASURE

OFFERED / CHOSEN

“ VOICE OF THE MARKETPLACE ”

External Focus

“ VOICE OF THE CUSTOMERS ” External Focus

High Performance Health Care Model

The Business of Health Care

© Knox 2000

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“ VOICE OF THE PROCESS ” Internal Focus

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© Pete Knox

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Strategic Clarity

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Analysis of Gap-Finance Model

Strategic Alignment and DeploymentCascading of Aims and Improvement

AIMS 1-3-5 yrSYSTEMSystem Improvement Plan

BRANDBrand Improvement Plan

DEPARTMENTQuality in Daily Work

INDIVIDUALIndividual Improvement Plan

AIMS 1-3-5 yr

AIMS 1-3-5 yr

AIMS 1-3-5 yr

MISSION /

VISION

Strategies

Strategies

Strategies

Strategies

Strategic Results

Production System Capability

SP

RE

AD

SP

RE

AD

A P

S D

A P

S D

A P

S D

A P

S D

A P

S D

A P

S D

A P

S D

A P

S D

A P

S D

A P

S D

A P

S D

A P

S D

A P

S D

A P

S D

A P

S D

A P

S D

Portfolio of

Projects

Current Performance

120 Day Cycle

Impact

Feasibility

120 Day Cycle

Impact

Feasibility

120 Day Cycle

Impact

Feasibility

120 Day Cycle

Impact

Feasibility

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Achieving a 4%

operating margin.

Current modeling

requires 4-5%

reduction in

operating

expenses annually.

(approx. 12M annual

reduction)

Goal: All areas of

organization meeting

adjusted cost to

produce targets

Managing total labor and benefit cost

Asset management

Managing supply and service costs

Process efficiency – standardized

work flows

Managing productivity

Operating Margin Driver Diagram

Engage front line staff & physicians

Allowances

Chris

Jacquelyn

John

Jim

Jim

Jacquelyn

Jacquelyn


The System of Production

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The Production System

Knowledge

of the

Individual

Connected Personal Experience Individual

Health &

Life Goals

SYSTEM OF PRODUCTION Designing a Connected Personal Experience Across the Continuum

H Q

$

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Anatomy of the Production System

Five different views

1 Product across the continuum

2. Functional or Operational area

3. Department

4. Individual

5. Large Scale Commonality

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Knowledge

of the

Individual


Health &

Life Goals

Five Views of the Production System

1 Continuum

2 3 4

*

Wellness/

Prevention

Acute

Care

Community

Health

H Q

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After

Care

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Education

Support

Group

EMS

ED

PT, OT,

ST F/U

Specialty

Care

Hospital

Stay

Seamless Connections

Collective Patient Experience

All Phases of Stroke Care Are Linked

Multi-Specialty

Stroke Clinic PCP/

Prevention

Post Hospital

IRD, SNF

Home

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Product Across the Continuum – Stroke

Key Results

1. The American Heart Association/ American Stroke Association has awarded Bellin

Memorial Hospital on February 27th, 2012 as a “Get with the Guidelines Stroke Silver Plus

Achievement Award Hospital”.

(Bellin will be recognized at the International Stroke Conference February 2013.)

Target Stroke –DTN 6/11 or 55% in 2011 and so far 3/5 DTN less than 60 minutes January through

May 2012

2. Implementation of TIA observation Unit in the Emergency Department- (Studies have shown that early initiation of treatment can reduce the risk of early recurrent stroke by 80%.

Up to 40% of people who have experienced a TIA will go on to have a stroke.)

─ 122 patients underwent evaluation using the TIA observation unit.

Of these 122 patients, only 3 (2.5%) patients were readmitted for stroke in the next 6 months.

3. 16 of these 122 (13.1%) patients were diagnosed with stroke during their TIA work-up.


4. Stroke Prevention: May 2011- April 2012 Results ─ Prior to use of the TIA observation unit, 7 of 51 (13.7%) patients discharged with a diagnosis

of stroke had been seen in the ED in the previous 6 months with stroke-like symptoms

─ After implementation of the TIA observation unit, 7 of 119 (5.9%) patients discharged with a diagnosis of stroke had been seen in the ED

That is a 57.1% reduction in stroke readmission at 6 months. Of these, 4 (57.1%) had not completed the work-up during their previous ED visit.

Conclusions

Rapid evaluation and treatment of TIA through an ED-based TIA observation unit substantially reduces the risk of readmission for stroke

Product Across the Continuum – Stroke

Key Results (cont’d)

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Key Innovations

• As Nursing focuses on high quality and improved safety, patient experience and financials are positively impacted

• 12 Standard Production Platforms ─ Bar coding

─ Bedside Report

─ Staffing guidelines/Acuity measures/ Nurse Compass/Optilink

─ Similar technology (Standard pumps, beds, vocera..etc)

─ Multidisciplinary rounding, Nurse & Physician Rounding

─ Standardized room- white boards

─ SBAR communication

─ Hourly rounding

─ CDR’s (Coding and Documentation Nurses)

─ Informatics-streamlining documentation

─ Follow up Phone Calls

─ Video Monitoring


Functional/Operational Area - Nursing

Key Result: Core Measures

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Key Result: Days Between

Serious Safety Events


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Key Result: HCAHPS

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Key Result: Nursing Satisfaction

Over 5 Years


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Key Result: Growing Volumes-

Controlling Expenses

Gross Patient Revenue & Total Operating Expenses

$-

$10,000,000

$20,000,000

$30,000,000

$40,000,000

$50,000,000

$60,000,000

$70,000,000

$80,000,000

$90,000,000

$100,000,000

FY 2006 FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 Annualized 2012

Gross Revneue Total Expenses

Adjusted Patient Days

38,000

39,000

40,000

41,000

42,000

43,000

44,000

45,000

46,000

FY 2006 FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 Annualized

2012

Adj Pt Days

Gross Patient Revenue & Total Expenses Per Adjusted Pateint Day

$-

$500

$1,000

$1,500

$2,000

$2,500

FY 2006 FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 Annualized

2012

Revenue per Adj Pt Day Expense per Adj Pt Day

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Quality in Daily Work Steps

1. Define your purpose

2. Identify your key internal/external customers

3. Identify the needs and expectations of your key customers

4. Define your key products

5. Identify your key processes

6. Identify your suppliers and what you need from them

7. Identify how well your key processes are performing

8. Determine what you need to be improving

9. Define your approach to a disciplined improvement cycle with your area

10. Define how you tell your story to customers

11. Determine how you will continually enhance the culture within your team


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Department/Unit - Therapy

Key Results

• FOTO: Functional Change Measures: Target 50%; Actual 72%

• Cost to Produce: Goal: $31; Actual $30

• Decreased cancellation and no show rate: Goal: 12%; Actual 10%

• FOTO: Patient Satisfaction scores improved from 90% to 97.82%

• 3rd Available improved from 3.5 days to 1.8 days

• Revenue increased by 10% one year and over 12.5% the next year

• 10% increase in Patient Volume

• We expanded our geographical reach to Primary Care Clinics from 7 locations to 15 in over 3 years: 25.5% increase in patient volume to the clinics

• Individual Productivity: Goal @ 24 units per therapist; Actual 24

• Employee Engagement: Goal at 4.1; Actual 4.4

Knowledge

of the

Individual


Health &

Life Goals

Redesign Case Study: Commonality

H Q

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Wellness &

Prevention

Acute

Care

After

Care

Community

Health

Commonality Plan

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Commonality - Aftercare/Transitions

Defining Key Measures

• Defining Measures and Metrics on Quality, Cost and Experience

• Measurement Examples:

─ Patient Experience Results

─ Reducing Readmissions

─ Identifying Clinical Risk Levels

─ Identifying Patient Motivation Levels

─ Discharge Bundle: Teach Back, Follow up Visits, Follow Up Phone Calls, Medication Reconciliation, After-Visit Summary

─ Increasing the use of Home Health Visits

Readmission Rate – 9%

System of Measurement

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VISION

The System of Measurement will provide

direction and structure for organizational

measurement that influences strategy and

supports the ongoing performance and the

improvements and innovations of our

production system.

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Wellness/

Prevention

Acute

Care

After

Care

Community

Health

System of Linked Measures

The Five Views of Measurement

Large Scale Commonality

Product Across the Continuum

Team

Individual Individual

Team


Team


Team

Individual Individual Individual

Collective Personal Experience

Op

era

tion

al &

S

yste

m S

up

po

rt

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2

3

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DESIRED OUTCOMES

• The System of Measurement should lead to an

organization that has:

─ Visual Displays of data throughout the organization

─ Conversations and discussion about measurement

─ A key set of measure linked to strategic objectives

spanning the depth and breadth of the organization

─ A combined leadership team who discusses the

linked measures when assessing performance

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System of Measurement

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System of Improvement

Managing Organizational Energy

• Lots of activity

• Few results

• Fully utilized capacity

• Many results

• Low activity

• Few results

• Empty capacity

• Limited/mixed results

Fully Utilized

Non

Aligned Aligned

Under Utilized

The Sweet Spot of

organizational energy

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Market/Sales Alignment

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We know that a cancer diagnosis can be overwhelming and with it

can come a host of concerns and decisions that have to be made.

For most people there is an immediate need for information and a

desire to be “doing something”. We want to help you make sure the

information you’re getting is accurate and helpful so that you can

move through each step of the decision-making process in control

and on your teams.

This isn’t about rushing . . . It’s about responding.

There is nothing more frightening than being told you have cancer.

Unless it’s being told you have cancer and then being told nothing at

all for days. . . Even weeks. At The Cancer Team, we’re committed

to treating you with dignity and respect by first making sure that you

aren’t left alone with your fears. From the beginning, The Cancer

Team member will work together to respond and include you in the

process of developing a treatment plan.

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Cultural Alignment 6

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Scorecard

High Performance

Culture

Key Drivers

Leadership Development

People Platforms

Quality Improvement

Organizational

(Strategic) Learning

Wage, Benefit and

HR Related Policies

Reward/Recognition

Recruitment & Acclimation

to the Culture

*Preceptor/Mentor

Individual

Attributes of

High Performance

Culture

Pride in

Organization

High

Engagement

Highly

Empowered

Contributes to Strategy

Act Like

You’re an

Owner -

Stewardship

Individual

Professional

Growth

Effective

Leadership

Highly

Productive

Performance

Individual Accountability

Effective

Communications

Creates

Patient

Satisfaction

Team Player

Promotes a

Culture of

Safety

Innovative

Thinking

Evaluation Methods

*Individual Scorecards

*Performance Feedback

Positive

Interdisciplinary

Relationships

High Quality

Work

Performance

Champions

Mission

Vision

Values

Professional/Personal

Development

Strategy Execution

High Performance Culture Model

Mission

Vision

Values

Performance

Engagement

Employee

Health &

Safety

Retention

Healthy

Lifestyle

High

Personal

Satisfaction

Future Sustainability

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SUMMARY

• Kevin is right.

─ It does require a comprehensive management system

that aligns the organization and deploys strategy to all

levels of the organization

• A lot of activity is not a replacement for a

comprehensive management system

• It is hard – it builds over time

• The whole system view is critical

• What is your comprehensive management system

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Thank you!

All rights are reserved. Copyrights for the materials used in this booklet owned by Bellin

Health and its affiliates. The use and/or reproduction by any means of any information

contained in this booklet without the written permission of Bellin Health is strictly prohibited.

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Achieving Strategic Results