Visit the Heathcare Division Web site at www.asq.org/health

Building A Better Healthcare System

Your Pace of Improvement is Critical to Reducing Risk
How fast is your organization improving your Healthcare System and results? I recommend healthcare organizations include the pace of improvement in their risk management assessments if they are not already doing so. If your organization is not improving faster than the national average, your financial resources are at risk. When healthcare organizations are not financially sound, it is difficult to have an engaged workforce, and it is harder to have consistent, safe, and effective patient care practices or a safe working environment.

Improvement Models Help Leaders Integrate Whole
System Improvement Faster and More Consistently
In the United States, a small number of healthcare organizations are experiencing improvement rates that are much faster than the average. How are they doing this? Our research shows that these organizations’ senior leaders are investing in improvement and are using one or more models to drive and integrate improvement across the entire healthcare system.

For example, ThedaCare, Seattle Children’s, Park Nicolett, Avera McKennan, and Virginia Mason have chosen Lean and the Toyota Production System as their model. Others use the Baldrige Criteria for Performance Excellence. To date, 11 healthcare organizations have received the Baldrige Award. Their results, summarized in my last column¹, show a much faster pace of improvement and higher performance in clinical outcomes; patient satisfaction; and financial, market, process, and leadership results. Some are an order of magnitude better than lower performing healthcare organizations. And, the Lean and Baldrige models are synergistic.

Senior leaders have the organizational and positional power to make performance excellence a success. They must set directions, create a patient focus, establish and communicate clear and visible values, and set high expectations. Only leadership can focus the organizational culture on excellence and establish a pace of improvement that overcomes risk. ²  

Improvement Models Apply to Healthcare Organizations of all Types and Sizes
To date, all of the Baldrige healthcare recipients have been large organizations. However, the framework and principles are universally applicable. HomeLife in Kalamazoo, Michigan is using the Baldrige framework to significantly improve mental health services. Caris Healthcare is using it to significantly improve hospice care in Tennessee. Madonna Living Community of Rochester, Minnesota has used the ACHA Quality Award Criteria (based on the Baldrige Criteria) to significantly improve nursing home and assisted living care. VA hospitals can use the Baldrige-based Carey Award Criteria. Qualis Health in Washington is using Baldrige to improve the quality of healthcare delivery and healthcare outcomes for individuals and populations across the nation.

Lean is also being used in a wide range of healthcare settings from large healthcare settings to doctors’ offices. By focusing on patient-centered processes, called value streams, organizations are removing waste, which simultaneously improves patient satisfaction and reduces costs.

Tahoe Forest Health System Applies Performance Improvement
and Innovation to Achieve Unique Results
I’ve had the opportunity to work with senior leaders at the Tahoe Forest Health System (TFHS) to review their progress on their excellence journey.  Some lessons learned may benefit your organization.

TFHS began its excellence journey in 2005 after leaders attended a California Award for Performance Excellence (CAPE) conference. They began incorporating the Baldrige framework as the basis for improvement. TFHS senior leaders also invested in mapping and defining the health system’s core service delivery processes. This helped identify areas of improvement related to patient flow and handoffs between processes where most waste and problems occur. Performance excellence initiatives also helped change the culture to one that focuses on the horizontal processes rather than the vertical organizational structure. As a result, when there is a problem, leaders focus first on the process involved. They find themselves asking, “What is our process? Was it followed? Do we need to change it? Or do we need to retrain someone on the process?”

When people ask, “Why Baldrige?” Bob Schapper, CEO, replies, “My answer is simple: key financial indicators equivalent to A- bond ratings from Wall Street, infection rates far below the national average, maintaining a patient satisfaction rating, reported by Press Ganey, in the top 10 percentile for inpatient, ambulatory surgery and emergency care against a variety of peer groups, and incredible community engagement. That’s why we are involved with Baldrige.”

To help accomplish these results in an efficient manner, senior leaders have aligned the organization around five foundations: quality, service, people, finance, and growth. These are the same pillars popularized by the StuderGroup and used by almost every Baldrige healthcare recipient. What is unique at TFHS is that the five-member, publically elected Board of Directors has aligned its governance committees around the same five foundations.

TFHS has deployed Performance Excellence Boards, which align every department’s key measures and improvement action plans with the five foundations. The Boards are used as a mechanism to communicate what is most important to improve with key stakeholders and staff. When action plans are completed, the results are summarized in an Accomplishments Log. This helps senior leaders round and recognizes teams for accomplishments. These Boards also make a strong impression on local business leaders and representatives from other healthcare organizations when they tour the hospital.

TFHS excels in community engagement. Senior leaders have established community-based Advisory Boards and Foundations to provide counsel on community needs and to help research and investigate innovative approaches. These Advisory Boards also accelerate the pace at which innovative services are introduced. One example is the creation of a locally-based Cancer Center. Through discussions with community leaders and surveys, TFHS leaders learned that there was a desire for a local cancer center so patients would not have to drive to Reno or Sacramento for chemotherapy treatments. A Cancer Advisory Board comprised of local community members was formed to engage the community in the development process. The members of the Advisory Board, along with TFHS leaders, benchmarked 12 other cancer centers nationally to guide the design of the new cancer center. The Center was intentionally designed to provide patients with both physical and emotional comfort, and patients were involved in decisions. In one decision, various models of chemo chairs were brought in, and a focus group selected the best chair. To increase convenience and reduce waiting times for laboratory results, a small laboratory was located on site. With this attention to detail and patient service, the demand continues to grow. The Cancer Advisory Board is used as a model for other innovations that provide services to the community. Community engagement leads to community ownership of programs and services at TFHS. With community ownership, philanthropic support naturally follows.

TFHS has recently been recognized by UC Davis as the only “Rural Center of Healthcare Excellence” for its innovative approaches and excellent results. TFHS was also one of the first recipients of the Pathways to Excellence recognition from the American Nurses Credentialing Center (ANCC).

Reduce Your Risk Through Building a Better Healthcare System
Will Rogers wrote, “You may be on the right track, but if you are not moving fast enough, you will get run over.” In the competitive world of healthcare, especially with the potential impact of healthcare reform, most organizations do not have the luxury of waiting to implement performance excellence. Start today in selecting the most appropriate model for building a better healthcare system, and begin implementing it effectively and efficiently. Otherwise, you are putting your organization at risk — financially, competitively and from the standpoint of patient outcomes.

References

1. Bodinson, G. (2009). Healthcare organizations get “healthier” using the Baldrige system for performance excellence. Patient Safety & Quality Healthcare, 6(6), 62.
2. Bodinson, G. (2005, November). Change healthcare organizations from good to great. Quality Progress, 22-29.
   

Glenn Bodinson
ASQ Healthcare Division Editor
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Greetings from the Chair

No-Wait ED Webinar Series
Learn how six emergency departments have transformed their service delivery systems using a variety of proven methods. The six-part recorded webinar “No-Wait EDs — This Is How We Do It” will be available in mid February for $349. For more information, visit, www.iienet2.org/SHS. The series is a partnership of IIE/SHS and ASQ/HCD.

World Conference
May 23–26 in St. Louis
The May 23rd Division meeting will be led by Joe Fortuna, the incoming chair for the Healthcare Division. Every division member is invited. We plan a call-in capability for those of you who will not be able to attend in person.

Laura Kinney and her team have created a great healthcare track for the Conference. Stop at the HCD booth to say “hi!” Ask how you can help out the division in the upcoming year. Remember, this is YOUR division.

Let’s continue to “Build a Better Healthcare System” together. Keep an eye on our web site, www.asq.org/health, for more details of the web series and updates on our Washington