Transcript Improving Quality through Evidence

Derek M. Larkin, JD, MBA
CEO Boston IVF
1. Understand the basic principles of evidence-based management
2. Witness the application of evidence-based management through reporting
3. Be able to create systems that foster evidence-based management
4. Be able to create a culture of continuous improvement
No conflicts to disclose.
1. Demand Evidence – look for supporting data
2. Examine Logic – look for faulty cause & effect reasoning
3. Encourage Experimentation – test viability of proposed strategies
4. Reinforce Continuous Learning – expand knowledge & increase
reliable evidence with which to make decisions
“the conscientious, explicit and judicious use of current best evidence in making
decisions about the care of individual patients.” Dr. David Sackett
1
Pfeffer, Jeffery, Sutton, Robert. (2006). Evidence-Based Management. Harvard Business Review. January, 2006.
 GOAL: Go from Data Driven Decision Making to Evidence Based Management
 GOAL: Go from Data Driven Decision Making to Evidence Based Management
HONEST, OBJECTIVE ASSESSMENT OF WHAT WORKS
EXPOSE DANGEROUS HALF TRUTHS & ASSUMPTIONS
MAKE SMART DECISIONS ON THE MOST RELEVANT ISSUES
The great tragedy of science is the slaying of a beautiful hypothesis by an ugly fact.
- Thomas H. Huxley
Increase or decrease our cycle price?
Establish a satellite office?
Offer partnership to our physician?
Extend our lease or move?
Implement a shared risk program?
Hire a new physician?
Increasing Time Pressure
ADVANTAGES:
• Produces solutions
to unfamiliar
problems
• New solutions
may have wider
application
DISADVANTAGES:
• Requires time
• Untested solutions
• Difficult under
stress
1http://davetgc.com/Decision_Making.html,
ADVANTAGES:
• Compares
alternatives
• Can be justified
• Often successful
DISADVANTAGES:
• Requires time
• Affected by stress
• May be costly
• Analysis paralysis
March 16, 2014.
ADVANTAGES:
• Good for novices
• Can be rapid if
the rule applies
and is known
• Easy to justify
DISADVANTAGES:
• Time consuming
• Rules may not
apply (out of
date, irrelevant)
ADVANTAGES:
• Very Fast
• Requires little
thought
• Workable option
• Useful in routine
situations
DISADVANTAGES:
• Experience
required
• May be difficult
to justify after
 Narrative Bias: There is no perfect transmission of information through people.
 The cumulative pregnancy rates above represent total pregnancies from total patients in cycle.
 There seems to be an inverse relationship between the increase in cumulative pregnancy rates
and a decrease in the number of cycles per new patients.
 This data when plotted in an XY Scatter plot graph shows a linear relationship with an R-
Square value of 0.9696.
• In 2004 – 2,372 patients yielded 3,480 cycles.
• In 2008 it would take about 1,000 more patients (3,445) to yield 3,480 cycles.
• If we conservatively estimate a 1% increase in cumulative success rates
through 2010, it would take about 500 more patients just to yield the same
number of cycle starts we had in 2007.
• If the cumulative pregnancy rates were to jump another 10% in four years,
we would likely see the total cycle starts drop below 2,000 – or to a point of
equilibrium where IUI:IVF ratio limits cycle starts.
• Therefore, patient attraction and retention needs to be a strategic focus if
Boston IVF is to maintain market leadership. Further, smart business
expansion will also accomplish this goal.
Are You Part of the Problem?1
 Stop treating old ideas as if they were brand-new.
 Be suspicious of “breakthrough” ideas and studies.
 Celebrate and develop collective brilliance.
 Emphasize drawbacks as well as virtues.
 Use success (and failure) stories to illustrate sound practices,
but not in place of a valid research method.
 Adopt a neutral stance toward ideologies and theories.
1
Pfeffer, Jeffery, Sutton, Robert. (2006). Evidence-Based Management. Harvard Business Review. January, 2006.
Critical Self-Analysis:
90% of people believe they
are in the top 50% when it
comes to looks, intelligence,
charisma and artistic ability.
 Business Performance Measurement (BPM) systems provide:
 Insight into different units of the company
 Align different levels of analysis
 Drive synergies between different units
 Allows the organization to recognize its competitive advantage – and strategize
 Coherence among performance metrics and scorecards throughout organization
 BPM Frameworks
 Balanced Scorecard1
 Economic Value Added
 Activity-based costing
 Quality Management
 Total Quality Management (TQM)
 LEAN/Six Sigma
 European Foundation Quality Management (EFQM)
ISO 9001:2008
 Customer Value Analysis
1
Kaplan, Robert S. & Lamotte, Gaelle. (2001). The Balanced Scorecard and Quality Programs. Balanced Scorecard Report. March 15, 2001.
ISO 9001:2008 Principles
Customer focus
Leadership
Involvement of People
Process Approach
System Approach to
Management
Continual Improvement
Factual Approach to
Decision Making
Balanced Scorecard Principles
Customer Perspective
Financial Perspective
Internal Business
Perspective
Learning & Growth
Perspective
6 PRINCIPLES OF LEAN1
1
1.
Attitude of continuous improvement
2.
Value creation
3.
Unity of purpose
4.
Respect for the front-line workers
5.
Visual tracking
6.
Flexible regimentation
Toussaint, John S., MD, Berry, Leonard, PhD, The Promise of Lean in Health Care. Mayo Clinic Proceedings. January, 2013
Employee
Satisfaction
Survey
VIP Team
Planning
Implementation
Patient
Satisfaction
Survey
Administrative
Leadership
Team
Implementation
OB/GYN
Satisfaction
Survey
Sales &
Marketing Team
Implementation
Understand the movement of information through your organization.
CEO = 40,000 ft.
“Patients come first.”
Manager = 15,000 ft.
“Patients come first.
Collect the money.”
Staff = 1,000 ft.
“Collect the money.”
Corporate Disconnect:
Patients come first = nebulous
Collect the money = actionable
When your corporate disconnect
reaches your patients, you have a
problem.
Blue Ocean Leadership, April 2014:
SLOW
FAST
“Just 30% of employees are actively committed to
doing a good job. According to Gallup’s 2013 State
of the American Workplace report, 50% of employees
merely put their time in, while the remaining 20% act
out of their discontent in counterproductive ways,
negatively influencing coworkers, missing days and
driving customers away because of poor customer
service.”
Annual Performance
Appraisal
Performance
Professionalism
Attitude
Compliance
Initiative
Company
Performance Bonus
% to Budget
Forecast, accounts for
market conditions
Contribution
(full-time v. part-time)
Team work
Business knowledge
Tenure
Hire attitude and teach skills, don’t hire skills and think you can teach attitude.
Who?
Look down the
ladder for the
solution.
What?
Look up the
ladder for the
cause.
1. Form an executive committee
2. Become data-driven and measure the important things
3. Create feedback systems for ongoing management
4. Implement BPM and process improvement systems
5. Communication. Accountability. Reward.