ASQ Healthcare Division Newsletter
January / February 2010
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
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