Duke University HospitalBest Practice Sharing

Presented by:

William C. Burton

Associate Vice-President, Performance Services

Duke University Health System

February 21st, 2018

Topics for Today

• Background

• Journey

• Sharing of Best Practices

Duke University Hospital…

• 957 licensed beds

• Main campus (3 million sf)– Duke North inpatient bed tower

– Duke Cancer Center

– Duke Medicine Pavilion

– Duke South Clinics

– Eye Center

– Children’s Health Center

• Off Campus– Ambulatory Surgery Center

– Adult Bone Marrow Transplant

– ~25 primary and specialty care

clinics

• Largest employer in Durham Co.– Second largest employer in NC

A Period of Strong Growth

Volume Statistics 2014 2015 2016 2017 % Growth

Average Daily Census 743 783 789 821 10.5%

Discharges, Obs., and OP in Bed 49,607 52,421 51,181 52,461 5.7%

Case Mix Index 2.30 2.41 2.42 2.47 7.8%

Surgical Cases 38,220 40,055 39,781 40,664 6.4%

Emergency Department Visits 66,860 70,701 74,914 76,763 14.8%

Specialty Visits (PDC) – Total Visits 1,266,357 1,363,429 1,609,326 1,651,966 30.4%

Specialty Visits (PDC) – New Pt. Visits 223,081 242,027 278,703 283,576 31.5%

Primary Care Visits (DPC total visits) 560,944 614,480 647,084 691,037 23.1%

OP Imaging (MRIs and CTs) 80,712 88,240 94,190 99,331 23.1%

Unique patients (DUHS) 620,301 665,911 724,211 745,304 20.2%

Cath Cases (including EP & Peds) 7,334 7,646 7,871 8,569 16.8%

About Performance Services

Performance Services – Functional Structure

AVP PS

Improvement Services

PMO

Care Redesign

Lean

Operational Support

Service Lines

Ambulatory

Hospitals

Clinical Depts

Medicine

Surgery

OB/GYN

Pediatrics

Quality

Surgical Improvement

P4P Programs

Quality Improvement

Reputation

Patient Experience

Survey Process

Star Ratings

Improvement Support

Infrastructure and Analytics

PS Websites,

Scorecard System, Advanced Tools

Data marts & Application

Development

Duke Lifepoint

Supply chain Analytics

Workforce Analytics

Infection Prevention Analytics

Workforce and Productivity Mgmt

Labor Budgeting

Position Mgmt

Labor Management

Process

Comparative Resources

Vizient

Action OI

2016Baldrige Site Visit

CSU Structure: Since 1997

• Patient care services are grouped according to Clinical Service Units (CSUs), which is an operational structure that aligns physicians, staff and administration to DUH priorities.

• Co-lead by Vice-President, Medical Director, & Associate Chief Nursing Officer, as deployed– Heart

– Oncology

– Musculoskeletal

– Neurosciences and Psychiatry

– Transplant

– Emergency Services

– Med/Surg/Critical Care

– Perioperative Services

– Women’s and Children’s

– Ambulatory Practice

Primary and Secondary Service Areas

Key Strengths

• Recognized nationally for Leadership and Strategy

categories

• Strategic Planning Process:

– Systematic and engages all key stakeholders

– Allows for organizational agility

– Identify organizational priorities

– Facilitates workplan development

• Performance Management System:

– Integrated into the SPP to support selection of BSC measures

and targets to achieve organizational priorities

– Alignment across the organization

LeadershipKey Strength: Integrated Leadership System

• Defines priorities and

targets

• Establishes accountability

• Monitors progress and

supports the development

of tactics and workplans

• Integrates key

organizational processes

Best Practice Sharing Topics

Strategy Development & DeploymentKey Strength: Systematic Planning Process

• Designed to achieve

alignment of goals through

workplans and our

performance measurement

system

• Workplan execution

supported by labor

management and financial

planning processes

DUH Blueprint for Success

Strategic Planning Process supports our Blueprint for Success:• Validates our MVV• Engages key internal and

external stakeholders• Prepares for and supports

the execution of transformational change

• Identifies priorities for PI and focused innovation

• Revised based on feedback

DUHSStrategic Priorities

Environmental/ Risk Assessment

Quality & Patient Safety Plan

Current Performance

Healthcare Reform

ExternalFeedback (The

Joint Commission, Magnet, Baldrige)

Duke Health Priorities

• Utilize internal and

external inputs

• Review input from

all key stakeholder

groups

• Align to overall

organizational

goals & objectives

• Include

comprehensive

analysis of risk

Strategy DevelopmentKey Strength: Evaluation of Key Inputs

Strategy DeploymentKey Strength: Alignment of Organizational Goals

• Aligns organizational goals

and objectives from the

BOD to the workforce

• Links to the pay for

performance program at all

levels to align expectations

• Aligned with and across

Health System

Employees

Operational Units (Service Lines, Departments)

System Entities and Clinical Departments (Hospitals, Ambulatory, Home Health,

Outpatient Services)

Duke University Health System

DukeHealth – Advancing Health Together

Performance Measurement:• BSC Process• Alignment

Duke’s Balanced ScorecardKey Steps

Define Organizational

Priorities

Identify Measures of

Success

Set appropriate

targets

19

Dec 2017

Jan 2018

Feb2018

Mar 2018

Apr2018

Finalize Actual Targets

Apr. 18 – Jun 6

Jan. 17 – Apr. 18Strategy & Initial Measure

Recommendations

Dec. 1 – Jan. 17

FY18 BSC Development Timeline

DUHS Ops

Jun. 6Jan. 17

DUHS Ops DUHS OpsApr. 18

May2018

Jun2018

Research Benchmarks & Develop Target Methodology

• Targets aligned to benchmarks

• Established at the Executive level with Board approval

• Aligned and integrated through the Strategic Planning Process

Key Improvements:• Centrally managed reporting• Annual process and integration across DukeHealth• Linkage to Board priorities • Integration into management processes

Performance Monitoring:• Tools• Processes

DUH Balanced Scorecard

The FY17 BSC application contains:

• 450+ active scorecards

• Over 7000 measure/scorecard combinations

• Published monthly• Available to all levels of

leadership

DUH Balanced Scorecard

DUH Balanced Scorecard

Duke’s Performance Review Sessions

• Senior leadership drives the hospital’s performance

relative to the established Balanced Scorecard targets

through the Performance Review

• Every Service Line rotates through a performance review

session on a quarterly basis (four times per year per

service line)

• The presentation schedule is set at the beginning of

each calendar year

28

Attendance at Duke’s Performance Review Sessions

• Senior leader performance review committee members– Chief Executive Officer

– Chief Medical Officer

– Chief Nursing Officer

– Chief Financial Officer

– Chief Pharmacy Officer

– Chief Human Resources Officer

– Senior Director, Performance Services

• Progress and updates provided by CSU leadership – Vice President

– Medical Director

– Associate Chief Nursing Officers, Clinical Operations Directors and Nurse Managers

29

Follow-up Memos from

Performance Review

Sessions

We are a better organization because of our

Journey

• Systematic Organizational Planning:

– Developed and formalized our annual planning process using

criteria as the framework

• Included integration with physician leaders

– Implemented systematic workplan development and deployment

• Enhanced staff engagement:

– All staff event and the blueprint for success

– Alignment of EJRs to organizational priorities and BSC goals

– 3D PI stories

– Redesign of our Mission and Vision

– Communication processes related to key initiatives

• Enhanced Knowledge Management:– 3-D portal

• Now over 300 stories in inventory

– 3-D sharing day

• Improved Measurement Systems:– Deployment of scorecards to all levels of the organization

– Alignment with organizational planning process and priorities

– Measure selection, target setting and benchmarking

• Integrated and Aligned Performance Improvement

Approach– 3D Model

– 3D Champions

– Expanded Toolkit

We are a better organization because of our

Journey

Thank You

Questions