Tools for Achieving Operational Excellence in Healthcare Organizations Presented by Kevin Gilson, Associate Consultant Theseus Professional Services, LLC

Tools for Achieving Operational Excellence in Healthcare Organizations

Tools for Achieving Operational Excellence in Healthcare Organizations

Presented by

Kevin Gilson, Associate Consultant

Theseus Professional Services, LLC

http://www.theseuspro.com

at the LifeSpan Annual Conference

May 10, 2007

Presented by

Kevin Gilson, Associate Consultant

Theseus Professional Services, LLC

http://www.theseuspro.com

at the LifeSpan Annual Conference

May 10, 2007

May 10, 2007 Theseus Professional Services, LLC 2

AgendaAgenda

Introduction What is Operational Excellence? What can Operational Excellence

contribute to your organization? MBNQ Program criteria as a tool for

achieving Operational Excellence Case Studies

Introduction What is Operational Excellence? What can Operational Excellence

contribute to your organization? MBNQ Program criteria as a tool for

achieving Operational Excellence Case Studies


IntroductionIntroduction

Why should you be interested in operational excellence or performance excellence?

What’s in it for You? What is the current trend in health care

quality programs?

Why should you be interested in operational excellence or performance excellence?

What’s in it for You? What is the current trend in health care

quality programs?


In 1998 the Milbank Memorial Fund asked:

In 1998 the Milbank Memorial Fund asked:

Why has health care lagged behind other sectors of the economy in quality improvement?

Why have clinical quality improvement efforts apparently failed to move the sector quality?

How do we enlist physicians and other health professionals to work on meaningful improvements in the quality of health care?

How will changes in the expectations and behavior of consumers and patients affect quality?

What will be required to transform health care into a sector capable of delivering quality care and constantly improving care?

Why has health care lagged behind other sectors of the economy in quality improvement?

Why have clinical quality improvement efforts apparently failed to move the sector quality?

How do we enlist physicians and other health professionals to work on meaningful improvements in the quality of health care?

How will changes in the expectations and behavior of consumers and patients affect quality?

What will be required to transform health care into a sector capable of delivering quality care and constantly improving care?


Is it Complicated?Is it Complicated?

Applies to everyone regardless of size Large multi-facility organization 30 bed facility 6 bed facility

Its not rocket science Doesn’t come from a planet far, far away

Is either free or materials cost under $10

Applies to everyone regardless of size Large multi-facility organization 30 bed facility 6 bed facility

Its not rocket science Doesn’t come from a planet far, far away

Is either free or materials cost under $10


Health Care’s ChallengesHealth Care’s Challenges

Your organizations are facing: Demands for higher levels of quality Escalating costs

More expensive procedures and medications More debilitating disease conditions Constraints on reimbursements by CMS, Medicare, Medicaid

and payers - trying to hold the line on cost Regulatory issues from CMS, states and payers

Marketplace challenges - increased competition Challenges are getting more complex

Your organizations are facing: Demands for higher levels of quality Escalating costs

More expensive procedures and medications More debilitating disease conditions Constraints on reimbursements by CMS, Medicare, Medicaid

and payers - trying to hold the line on cost Regulatory issues from CMS, states and payers

Marketplace challenges - increased competition Challenges are getting more complex


Case Study - ClientCase Study - Client

Consultation: Write a Quality Plan to implement Continual Quality Improvement What we did:

Developed method for conducting an assessment Assessed organization Identified strengths and opportunities for

improvement (OFI) Suggested next steps Jointly developed a Plan with management input

Consultation: Write a Quality Plan to implement Continual Quality Improvement What we did:

Developed method for conducting an assessment Assessed organization Identified strengths and opportunities for

improvement (OFI) Suggested next steps Jointly developed a Plan with management input



What we found: Organization - 250 full-time personnel Financial reporting comprehensive Key business processes not known Absence of key process metrics

“Gut feel” was predominant metric Some customer survey information No basis for CQI - problem areas unknown

What we found: Organization - 250 full-time personnel Financial reporting comprehensive Key business processes not known Absence of key process metrics

“Gut feel” was predominant metric Some customer survey information No basis for CQI - problem areas unknown



What they need to do: Understand key processes and programs Develop metrics and goals Manage this data to identify CQI opportunities

Quality Councils - upper and middle management Data display for decision-making Implement a Corrective Action process

Teams to implement CQI

What they need to do: Understand key processes and programs Develop metrics and goals Manage this data to identify CQI opportunities

Quality Councils - upper and middle management Data display for decision-making Implement a Corrective Action process

Teams to implement CQI



Variability - the EnemyVariability - the Enemy

What is Variability? Dr. Deming: Constancy of Purpose Characteristics:

Differences among people Differences among patients or clients Differences in the way the same service is

rendered by the same or different people Differences in the way relatives or concerned

parties perceive service delivery

What is Variability? Dr. Deming: Constancy of Purpose Characteristics:

Differences among people Differences among patients or clients Differences in the way the same service is

rendered by the same or different people Differences in the way relatives or concerned

parties perceive service delivery


Variability and HealthcareVariability and Healthcare

Care is great - but only on day shift This home is great - but the last one….. The person who answers the phone in the

afternoon has answers We want nurse “X” to work with our mother

Are broken processes responsible

for this variability?

Care is great - but only on day shift This home is great - but the last one….. The person who answers the phone in the

afternoon has answers We want nurse “X” to work with our mother

Are broken processes responsible

for this variability?


Aspects of VariabilityAspects of Variability

Variability: Costs money Expends time (hidden costs) Ineffective health care delivery Patient safety issues

Can result in costly recoveries from errors Extended stays in higher level of care Lawsuits or mediation

Variability: Costs money Expends time (hidden costs) Ineffective health care delivery Patient safety issues

Can result in costly recoveries from errors Extended stays in higher level of care Lawsuits or mediation


Definition of Operational (Performance) ExcellenceDefinition of Operational

(Performance) Excellence No one definition

Consultants usually define OE in terms of their consulting philosophy

Six Sigma, TQM, Lean, Toyota Production System Baldrige National Quality Program

Health Care Criteria for Performance Excellence

Used by the Maryland Performance Excellence Award program

No one definition Consultants usually define OE in terms of

their consulting philosophy Six Sigma, TQM, Lean, Toyota Production System

Baldrige National Quality Program Health Care Criteria for Performance

Excellence Used by the Maryland Performance

Excellence Award program


Components of OEComponents of OE

OE emphasizes: Process

Systems thinking or perspective Patient-focused excellence Valuing staff and partners input

Results Managing by fact Focus on the future - agility Visionary leadership

OE emphasizes: Process

Systems thinking or perspective Patient-focused excellence Valuing staff and partners input

Results Managing by fact Focus on the future - agility Visionary leadership


Evaluating OEEvaluating OE

Baldrige (MBNQA) components Leadership Strategic Planning Focus on Patients, Other Customers, and Markets Measurement, Analysis and Knowledge Management Workforce Focus Process Management Results

Baldrige (MBNQA) components Leadership Strategic Planning Focus on Patients, Other Customers, and Markets Measurement, Analysis and Knowledge Management Workforce Focus Process Management Results



MBNQAMBNQA

Leadership Visionary leadership

How senior leaders guide and sustain your organization - create sustainability

Organizational governance - vision and values Create and promote a culture of patient safety Communicate organizational performance with a

focus on action - performance measures Governance and social responsibility

Leadership Visionary leadership

How senior leaders guide and sustain your organization - create sustainability

Organizational governance - vision and values Create and promote a culture of patient safety Communicate organizational performance with a

focus on action - performance measures Governance and social responsibility


MBNQAMBNQA

Strategic Planning Strategy development

What is your process? What are your Key Strategic Objectives?

Strategy deployment Action plans Key performance measures/indicators Actions based on reviews and fact

“Act on Fact”

Strategic Planning Strategy development

What is your process? What are your Key Strategic Objectives?

Strategy deployment Action plans Key performance measures/indicators Actions based on reviews and fact

“Act on Fact”


MBNQAMBNQA

Focus on Patients, Other Customers, and Markets Determine requirements, needs, expectations

and preferences of customers Voice of the customer

Current health care service needs Customer satisfaction and loyalty

Focus on Patients, Other Customers, and Markets Determine requirements, needs, expectations

and preferences of customers Voice of the customer

Current health care service needs Customer satisfaction and loyalty


Case Study - VoCCase Study - VoC

Assessment of needs All stakeholders have:

Requirements - what must occur Regulations - CMS, state, local jurisdiction Medical requirements for the best quality of life Patient/family requirements

Needs - would be nice if it occurs Desires of patient or other customers

Expectations - unexpressed requirements Failure to deliver on expectations = requirement failure

Assessment of needs All stakeholders have:

Requirements - what must occur Regulations - CMS, state, local jurisdiction Medical requirements for the best quality of life Patient/family requirements

Needs - would be nice if it occurs Desires of patient or other customers

Expectations - unexpressed requirements Failure to deliver on expectations = requirement failure


Case Study - VoCCase Study - VoC

Gathering requirements, needs, expectations Mom is in your care Daughter lives in Iowa and is a senior citizen Neither has really thought through the issues

of Mom in assisted living Limited resources

Gathering requirements, needs, expectations Mom is in your care Daughter lives in Iowa and is a senior citizen Neither has really thought through the issues

of Mom in assisted living Limited resources


Voice of CustomerVoice of Customer

Category Requirements Needs Expectations

Patient (Mom) Medication Comfort Mobility

Physical Therapy Diet Environment

Patient Safety Activity Personal Care

Relative (Daughter)

Take care of Mom Visit Mom Environment

Control expenses Comfort Personal Care

Limited visits Crisis notification Information


MBNQAMBNQA

Measurement, Analysis and Knowledge Management Performance measurement Performance analysis, review and

improvement Management of information resources Data, information and knowledge

management

Measurement, Analysis and Knowledge Management Performance measurement Performance analysis, review and

improvement Management of information resources Data, information and knowledge

management


MBNQAMBNQA

Workforce Focus Workforce enrichment Workforce and leader development Workforce capability and capacity Workforce climate

Workforce Focus Workforce enrichment Workforce and leader development Workforce capability and capacity Workforce climate


MBNQAMBNQA

Process Management Design of work systems

Core competencies Work process design with patient safety view Emergency readiness Systems thinking point of view

Work process management Work process improvement (CQI)

Process Management Design of work systems

Core competencies Work process design with patient safety view Emergency readiness Systems thinking point of view

Work process management Work process improvement (CQI)


Case Study - SSMCase Study - SSM

SSM Healthcare System First health care organization to receive a site

visit in the MBNQA program Started CQI program in large multi-state health

care system in 1990 Established focus on management process

redesign to achieve bottom-line results Focus on process from customer viewpoint

85% of breakdowns are poorly designed processes 15% are people issues

SSM Healthcare System First health care organization to receive a site

visit in the MBNQA program Started CQI program in large multi-state health

care system in 1990 Established focus on management process

redesign to achieve bottom-line results Focus on process from customer viewpoint

85% of breakdowns are poorly designed processes 15% are people issues



Two important views: System thinking Application of the MBNQA criteria

Writing the application Feedback from Examiners

First recognition 1999 Missouri Quality Award

Two important views: System thinking Application of the MBNQA criteria

Writing the application Feedback from Examiners

First recognition 1999 Missouri Quality Award



Systems Thinking - 5 principles Openness - behavior of living systems can only be

understood in the context of their environment Purposefulness - why do people do what they do? Multidimensionality - complementary relationship

between parts Emergent property - success, failure as measures Counterintuitiveness - actions may produce an

undesired and opposite result

Systems Thinking - 5 principles Openness - behavior of living systems can only be

understood in the context of their environment Purposefulness - why do people do what they do? Multidimensionality - complementary relationship

between parts Emergent property - success, failure as measures Counterintuitiveness - actions may produce an

undesired and opposite result


MBNQAMBNQA

Results Health care outcomes Patient and other customer outcomes Financial and market outcomes Workforce-focused outcomes Process effectiveness outcomes Leadership outcomes

Results Health care outcomes Patient and other customer outcomes Financial and market outcomes Workforce-focused outcomes Process effectiveness outcomes Leadership outcomes


Case StudiesCase Studies

One assisted living applicant in 2006 Household of Angels Assisted Living

MPEA application was used to help the organization focus on quality improvement

Awarded Certificate for application Plans on continuing to utilize MPEA and Examiner

feedback to focus improvement efforts

One assisted living applicant in 2006 Household of Angels Assisted Living

MPEA application was used to help the organization focus on quality improvement

Awarded Certificate for application Plans on continuing to utilize MPEA and Examiner

feedback to focus improvement efforts


Tools of Operational ExcellenceTools of Operational Excellence

Malcom Baldrige National Quality Program http://www.quality.nist.gov Download free criteria and survey

Goal QPC Memory Joggers http://www.goalqpc.com Under $10 Memory Joggers for:

Quality tools - Memory Jogger II The Team Memory Jogger

Malcom Baldrige National Quality Program http://www.quality.nist.gov Download free criteria and survey

Goal QPC Memory Joggers http://www.goalqpc.com Under $10 Memory Joggers for:

Quality tools - Memory Jogger II The Team Memory Jogger

http://www.quality.nist.gov/

http://www.goalqpc.com/

http://www.quality.nist.gov/

http://www.goalqpc.com/


More ToolsMore Tools

Maryland Performance Excellence Award Program (MPEA) http://www.mpea.umd.edu Inexpensive workshops on creating an application

and using the criteria Examiner training program - free Annual celebration

American Society for Quality, Baltimore http://www.asqbaltimore.org or www.asq.org Local quality experts, monthly meetings

Maryland Performance Excellence Award Program (MPEA) http://www.mpea.umd.edu Inexpensive workshops on creating an application

and using the criteria Examiner training program - free Annual celebration

American Society for Quality, Baltimore http://www.asqbaltimore.org or www.asq.org Local quality experts, monthly meetings

http://www.mpea.umd.edu/

http://www.asqbaltimore.org/

http://www.asq.org/

http://www.mpea.umd.edu/


http://www.asq.org/


ReferencesReferences Developing a Quality Management System, American

Health Care Association, 2005 Improving Health Care, Case Studies from Leading

Practitioners, GOAL QPC, 2006 CQI and the Renovation of an American Health Care

System, Ryan and Thomson, ASQ Press, 1998 The Nun and the Bureaucrat, Savary and Crawford-

Mason, CC-M Publications, 2006 (also a DVD) www.managementwisdom.com

Medical Quality Management Sourcebook, 2000 Edition, Faulkner and Gray, 1999

System Thinking, Managing Chaos and Complexity, J. Gharajedaghi, Butterworth Heinemann, 2006

Developing a Quality Management System, American Health Care Association, 2005

Improving Health Care, Case Studies from Leading Practitioners, GOAL QPC, 2006

CQI and the Renovation of an American Health Care System, Ryan and Thomson, ASQ Press, 1998

The Nun and the Bureaucrat, Savary and Crawford-Mason, CC-M Publications, 2006 (also a DVD) www.managementwisdom.com

Medical Quality Management Sourcebook, 2000 Edition, Faulkner and Gray, 1999

System Thinking, Managing Chaos and Complexity, J. Gharajedaghi, Butterworth Heinemann, 2006

http://www.managementwisdom.com/

http://www.managementwisdom.com/


IOM ConferenceIOM Conference

IOM Forum on the Science of Healthcare Quality Improvement and Implementation: Implementation Science Methods Workshop, 24-25 May 2007, Irvine, California. (http://www.iom.edu/CMS/3809/38607/39184.aspx).

Topics for discussion include: 1. What methods should be used to research quality improvement

in health care? 2. What, as shown through research, are reliable quality

improvement strategies that can be spread now? 3. What lessons can be leveraged from other industries? 4. How can we address barriers to various research methods,

such as funding, ethics, and publication?

IOM Forum on the Science of Healthcare Quality Improvement and Implementation: Implementation Science Methods Workshop, 24-25 May 2007, Irvine, California. (http://www.iom.edu/CMS/3809/38607/39184.aspx).

Topics for discussion include: 1. What methods should be used to research quality improvement

in health care? 2. What, as shown through research, are reliable quality

improvement strategies that can be spread now? 3. What lessons can be leveraged from other industries? 4. How can we address barriers to various research methods,

such as funding, ethics, and publication?


In ConclusionIn Conclusion

Thank you for considering looking at your organization through the lens of Organizational Excellence

Apply for the Maryland Performance Excellence Award Application writing workshop May 22nd

Questions? Look for this presentation on these websites:

http://www.asqbaltimore.org http://www.theseuspro.com

Thank you for considering looking at your organization through the lens of Organizational Excellence

Apply for the Maryland Performance Excellence Award Application writing workshop May 22nd

Questions? Look for this presentation on these websites:

http://www.asqbaltimore.org http://www.theseuspro.com


http://www.theseuspro.com/


http://www.theseuspro.com/


Backup MaterialBackup Material


Components of OEComponents of OE

Core values and concepts (MBNQA) Visionary leadership Patient-focused excellence Organizational and personal learning Valuing staff and partners Agility Focus on the future Managing for innovation Management by fact Social responsibility and community health Focus on results and creating value Systems perspective

Core values and concepts (MBNQA) Visionary leadership Patient-focused excellence Organizational and personal learning Valuing staff and partners Agility Focus on the future Managing for innovation Management by fact Social responsibility and community health Focus on results and creating value Systems perspective

Documents

Tools for Achieving Operational Excellence in Healthcare Organizations Presented by Kevin Gilson, Associate Consultant Theseus Professional Services, LLC