“Finding Nemo”: Helping a Hospital

Establish Alignment

Eric Hung Le, Ph.D., MBA

Master Black Belt

Grace L. Duffy

Management and Performance Systems

Agenda

• The Healthcare Challenge

• The Outcomes

• The Journey

• Lessons Learned

Avg. Life Expectancy vs. Per Capita Spending (*)

(*) UC Atlas of Global Inequality, 2010

A story about a little fish

who believes he can make

a difference!

Metrics 2009 2010 % Improved

Gallup Survey –

Engagement Score

40th percentile 89th percentile 122%

Staff w/ Perfect

Attendance

13 31 138%

Staff Sick Calls 95 45 52%

Employee Giving

Campaign Participation

40% 89%

122%

Outcomes – The People

Engaged people drive …

Metrics 2009 2010 % Improved

Heart Failure Discharge

Compliance

58.8% 90.3% 54%

Anticoagulation Service –

Monitoring & Intervention

643 3746 482%

Pharmacists monitoring /

intervening on med. orders

received

6767 7872 16%

Unit-Based Pharmacist Model

(#interventions)

None

1,029/mo

1,848/mo

80%

Technician placed in the ED to

perform Med. Reconciliation

None 5,000 med.

Reconciliations

performed

Brand new

service

Outcomes – The Service

… excellent Service, which drives …

Metrics 2009 2010 % Improved

Physician Satisfaction 95.6 percentile 97.8 percentile 1%

Outcomes – Other Business Metrics

Metrics Budgeted 2010 Actual 2010 Variance

Pharmaceutical

Expenditures

$11.8 M $9.1 M $2.7 m

(23%)

Productivity 100% 122% 22%

… great business results!

Our Journey …

The Environment – The Pharmacy Department

• Provides pharmacy services to a 300-bed hospital

• No. of staff

– 1 director

– 2 managers

– 4 clinical pharmacists

– 25 pharmacists

– 25 technicians

• Education levels range from a HS degree to Doctorate

• 3 million doses dispensed a year

• Annual budget - $12 million per year

• 7x24 operation

Nursing

Physicians

Patients

Enabling Processes • Facilities / Equipment Management • Human Resources Management • Financial Management • Information Management

Strategic Planning

Pharmacy Education

Medication Management

Core Business Processes

Quality Control

Other OUs

VCU & Other

Schools

Dispense

Medications

Consults

Develop

Guidelines &

Protocols

Core Services Business Processes Partnership Customers

TJC /Rx Board ASHP Competitions Talent Pool Technology Government

Process Evaluation

External Forces

What Does The Pharmacy Do?

Organization Problems

• Lack of vision & direction

• Leadership being reactive

• Rapid expansion

• Rapid pace of changes

• Too many initiatives

• Work silos

• Information overload

• Poor performers

• Poor coordination of ops

• Staff conflicts

• Misplaced priorities

• “WIIFM” syndrome

• Lack of staff engagement

• “Clock-in Clock-out” mentality

• Process disconnects

Organization Problems (cont.)

Process Improvement at the Hospital

• Six Sigma deployment a few years earlier (2006)

– One Black Belt

– A handful of Green and Yellow Belts

– A few process improvements were initiated with good

results, but the culture has not changed

• Realization:

– Can’t sustain the gain, can’t make that big delta –

how do we “move the mass”?

– LSS concepts and tools are still not second nature –

how do we create a culture shift?

– Is there a more effective way to “connect” with

people at the core?

Employee commitment translates directly to

customer loyalty and profitability

10% Increase

Employee Commitment

7% Increase

Customer Loyalty

5% Increase

Profitability Drives Drives

The

Employee’s

Work

Experience

Employee

Commitment

Customer

Interaction

Areas

Corporate

Image

Customer

Loyalty

Customer

Interaction

Areas

Corporate

Image

Customer

Loyalty

Revenue,

Profits

and

Shareholder

Value

Drives Drives

(*)

How do we maintain a balance between gaining short-term

benefit and building long-term organization alignment?

The Right People Are Your Assets

(*) Manufacture Industry Benchmark Study, Deloitte 2000

Position Power vs. Organizational Influence

N=5 (C-suite)

Administrators

N= 30

Directors

N=1500

Employees

Most Corporate Training & Development Programs are

focused at the management and leadership levels

Can We “Move the Mass”?

Program Design Objectives

• Create the foundation to enable a cultural change – Front-

line staff alignment and teamwork

• Establish building blocks using the 3 R’s (Relate, Repeat,

and Reframe) framework

• Focus on incremental progress – avoid information

overload!

• Institute a mechanism to reinforce concepts learned

• “Unbundle” core Lean Six Sigma concepts and relate

them to what people see and do everyday!

Unless you change what you do,

you are staying where you are!

Achieving

Operational

Excellence

Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Dec.

Eff

icie

ncy &

Eff

ecti

ve

ness

“Sharpen The Saw” Series –

Align

“First Who, Then What”

Self-Assess

“ Put First Thing First”

“Start with the End in Mind”

Understand Data

Link Actions to Outcomes

Think Lean

Make processes work better

Understand Variations

Sustain

Holistic Approach to Work

(*)

(*) “The Seven Habits of Effective People”, by Steven Covey.

Coaching & Mentoring

Engaging Staff

• Co-create the vision

– Where are we going?

– What’s the impact?

– Share and learn

• Engage team members in meaningful and

noteworthy moments they’ve had

• Encourage shared responsibilities

• Nudge the team to move forward and make

progress

It takes lots of patience and practice!

Sustaining the Energy: What Makes it Stick?

• The value of being aligned and working as a team for front-line staff

• Very strong leadership who is committed to service excellence – Engage the staff

– Reinforce concepts learned and put into practice

• Concepts taught each month are reinforced and build on the previous month – Mandatory participation

– Same coach (1 voice)

– Consistent messages delivered each month

– Habit-changing

– “You’re never a prophet in your own land”

• Build on the 3 R’s (Relate, Repeat, Reframe)

With alignment, you can get to

your destination more

easily & quickly!

“Talent wins games,

but teamwork +

intelligence wins

championships”

Michael Jordan

Building a Championship Team

“The answer to the decade-long conundrum may

have little to do with investing in high-tech

equipment and evidence-based protocols.

Instead, improving patient outcomes may require

first investing in and focusing on the culture of the

organization itself.”

The Annals of Internal Medicine, March 2011

23

Building a Performance Culture

Q &A