Transcript A Quest for Quality….The Business Case
“A Quest for Quality….The Business Case”
Chris Boldt, Operations VP Steven Chies, Sr. VP for Operations Benedictine Health System 2011 AHCA/NCAL Quality Symposium February, 2011
The Frequent Questions:
Why did BHS adopt quality process?
How did you achieve six (6) AHCA Gold Quality Awards?
Benedictine Health System Today
• BHS owns and/or manages more than 70 LTC facilities on 40 campuses across 7 states • BHS Profile ▪ ▪ 4,000 NF Beds 2,000+ Housing with Services/ Assisted Living Suites • 6,000+ Employees
Core Values
• • • • Hospitality Stewardship Respect Justice
Vision
Creating Benedictine Living Communities where health, independence and choice come to life.
• • • •
Creating a Quality Culture
Leadership…commitment, passion from the top Foundational elements…mission, vision, values The LTC Quality Story…and baggage!
The long, long run…
What do we know as factual?
• • • • • • • • • Perception of quality is poor Demographics are changing Dementia diagnosis is increasing Boomers have different expectations Governmental commitment is waning Understanding of need is poor Current product line is aging Unexpected events will impact society All politics and health care is local
Quality in Long Term Care
• • • The perception of the American public of the quality of care and quality of life in a “nursing home” is extremely poor.
The vast majority of Americans do not want to go to a “nursing home”. They believe they are places we go to die and lose our independence and dignity.
What is the public perception?
•
95 % Question
• Do you want to go to a nursing home
?
Implications of Quality Perception:
• • • • • • Guilt and Fear of individuals and families Demand for Quality Improvement Regulatory Reaction – More is Better Poor regulatory compliance – More Surveyors Media Coverage of poor compliance Poor compliance – litigation opportunities
• Greatest Generation (1905-25) 50 Million • Silent Generation (1926-45) 35 Million • Boomer Generation (1946-1964) 77 Million • Xer Generation (1965-1982) 65 Million • Millennium Generation (1983-02)80 Million
Implication of Demographics:
• • • • • Fewer people….more competition Fewer tax payers….more competition More competition for client Product line need to meet expectations Need for process enhancement
• • • •
Implications for Government Payment:
Cannot rely on stable source Personal Responsibility will prevail Pay for Performance Expectation of Improved Outcomes
Dr. Donald Berwick
• • • • Challenge Providers to: ▪ Reduce Resources by • • • 10% without: Single instance of harm Without rationing care Without excluding services Knowledge of Quality Understands Data Expectation of Performance
BHS Leadership Systems
• • • • • • Solid Governance National leaders in long term care on staff Systematic meetings to share, learn and plan among all levels of employees BHS Leadership Institute Ongoing leadership communication Compliance and risk programs
Benedictine Framework for Performance Excellence Organizational Results 7
Dashboard
2 Strategic Planning
Strategic Planning and Deployment Model
Process Management
P-D-C-A Care Processes Support Processes
6 Staff Focus 5
Service Standards Mission and Values Survey
1 Values-Centered Leadership
Hospitality •Stewardship Respect•Justice .
3 Customer and Market Focus
Satisfaction Surveys Compliant Management
4 Measurement and Analysis
Dashboard
http://www.quality.nist.gov/HealthCare_Criteria.htm
Drivers Systems Results .
2 1 Leadership Strategic Planning 5
Peopl e Operations
6 3 Customer Focus 4 Measurement, Analysis & Knowledge Management 7
Results:
• Health Care • Patient Satisfaction • Financial/Market • Staff & Work System • Organizational Effectiveness • Governance/Social Responsibility
Operational Improvement
• • • • The theory sounds great…but How does it get to the bed side?
How do you determine improvement?
How do you sustain the improvements?
BHS Strategic Planning
• • • • Strategic Challenges Strategic Objectives Goals Focus Areas ▪ ▪ ▪ ▪ ▪ Care Service People Finance Growth
BHS Alignment Model BHS Vision and Direction Strategic Objective & Corp. Action Plans Facility Specific Goals BHS Board and SMT BHS SMT and Corporate Directors Participating Organizations Facility Action Plans Departments and Teams Employee Goal Employee Focus
BHS Strategy Development and Deployment Model Focus Align Execute Review
Where are we now?
Internal and External Analysis BHS Corporate Strategic Objectives SWOT
Who > When > Governance / Leadership Annually
Where do we need to go?
Vision, Facility Strategic Objectives and Goals
How will we get there?
How are we doing?
Determine action plans, resources, accountability and Metrics/Action Plan Goals Quarterly review of progress and Performance
Governance / Leadership Annually
Action Plans
Leadership and Staff Annually
Results
Leadership and Staff Quarterly
Strategy Deployment
• • • Adoption of “Focus and Execute” a web based application ▪ ▪ ▪ Tracking of progress of Action Plans Team Open access Remote management - Webinar Continuous review of progress on Action Plans
BHS Facility “Focus and Execute” Plan
BHS Quality Performance Excellence
• • • • The Mission and Core Values are the basis Led by President/CEO All 6 SVP are Lead for a Baldrige Category Quality Director ▪ ▪ Supports and coordinates Provides training
BHS Customer Service Standards
• Based upon the Core Values of the organization • • Behavioral expectations for all staff Self-evaluation of performance by each employee at annual evaluation • Performance Management System
BHS Service Recovery
• Service Recovery is bringing a customer back from the brink of defection – and doing so in a timely fashion to the customer’s satisfaction.
•
The ART of Service Recovery
▪ ▪
A = Acknowledge R= Resolve
▪
T= Trend
Customer Satisfaction Surveys
• • • Nursing Facility ▪ ▪ ▪ Newly Admitted Resident Resident Family – MyInnerview Assisted Living ▪ ▪ Tenant - MyInnerview Family- MyInnerview Housing ▪ Tenant - MyInnerview
BHS Facility Example
BHS Dashboard
• • • • Internal IT system Current performance on key strategic measures Trend performance Best practice performance identified
Care
–
Percent of Pain
National Average BHS System Best Practice Quartile Median Target Opportunity for Improvement Quartile Good
Finance
–
Operating Cash Flow Margin
BHS Operating Cash Flow Margin Best Practice Quartile Median Target Opportunity for Improvement Quartile Good
Current Structures for Performance Review
CEO, Board and SVP Senior leaders OVP, & CD OVP & Regional Consultants Administrator, QMC, DON, and other BHS Board Strategic Performance Team Regional Operations Facility Quality Council Pillar Metrics 15 Measures Pillar Metrics & PP Pillar Metric, PP & other metrics Facility Functioning 30 measures
BHS Facility Example
Employee Performance Management
• Developed by a team of team from corporate office and facilities • • • Common Job Descriptions across all sites ▪ Behavioral based Supervisory training Self evaluation including self-evaluation of performance compared to the Customer Service Standards.
BHS Key Systems and Processes
Business Systems Customer Facing Systems Resident & Tenants Support Systems
Process Improvement – P-D-C-A Act Plan
PDCA aka • Shewhart Cycle • Deming Cycle
Check Do
42
PDCA Improvement Example
“Bottom Line Value:”
• • • • • • • • Organizational Focus Clear/Crisp Strategic Direction Alignment throughout the System Enhanced Management Processes and Systems… Consistent Performance Customer Focus…Enhanced Satisfaction Strong Financial Performance Committed, Energized Workforce Measurable Results!
•
“The problems that exist in the world today cannot be solved by the level of thinking that created them.”
• Albert Einstein
Contact Information
• 763-689-1162