Performance Excellence Process - Horizon Health Network

Horizon HealtH network and tHe Performance excellence Process

overviewapril 2013

2HORIZON HEALTH NETWORK

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message from tHe ceo and Board cHair

A year ago, Horizon Health Network (Horizon) became one of the first six critical partners in the government’s newly established Performance Excellence Process. This results-oriented, long-term business approach and our role in its implementation are discussed in this report.

This new process came at a time when Horizon was already working with its facilities and programs to set new goals for the future. Knowing that there were more fiscal challenges ahead, the Performance Excellence Process would allow Horizon to determine where improvements could be made to save money and increase the quality of care that it provides.

Horizon is committed to sustaining accessible, high-quality health care for our communities and has made it a priority to immediately reduce spending in smart, efficient ways. The goal is to align health-care costs with the national average by 2017, which will save more than $167 million from the budget.

Thanks to the hard work of our staff and physicians, a number of initiatives have already shown promising results for cost savings and increased public satisfaction. We are proud of the accomplishments we can share with you and will continue to do so as we implement new process improvements that further strengthen our health-care system.

John McGarryPresident & CEO

W. David Ferguson Board Chair


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PartnEr FOr SuCCESS 4

PrOCESS IMPrOvEMEnt 5

SEttInG PrIOrItIES 6

PErFOrManCE EXCELLEnCE LEaDErSHIP 7

PrOJECt aCHIEvEMEntS 8

rEPOrtInG On PErFOrManCE EXCELLEnCE 10

aBOut HOrIZOn HEaLtH nEtWOrK 11

aPPEnDIX

LEAN SIX SIGMA PROCESS IMPROVEMENT A-2

STRATEGY MAP AND BALANCED SCORECARD A-3

LEAN SIX SIGMA - BLACK BELT DESIGNATION A-5

PROCESS IMPROVEMENT FACILITATORS/BLACK BELTS A-6


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Partner for success

In March 2011, our provincial government launched ‘Government Renewal’, with the goal of increasing efficiency and accountability, streamlining administration, adopting better business practices and making continuous improvements within government. To this end, government established the Performance Excellence Process.

Horizon Health Network was one of the six initial critical partners in the development and execution of the Performance Excellence Process. In 2012, seven additional partners began to adopt the Performance Excellence Process. However, to date Horizon Health Network is the only health partner integrating the Performance Excellence Process into its business development planning.

Other partners include: • Department of Environment and Local Government

• Department of natural resources

• Department of Transportation and Infrastructure

• Department of Finance

• Service new Brunswick

• Department of agriculture, aquaculture and Fisheries

• Department of Education and Early Childhood Development

• Department of Justice and Attorney General

• Department of Post-Secondary Education, Training and Labour

• Department of Public Safety

• Department of Social Development

• the new Brunswick Internal Services agency

This new process came at a time when Horizon Health Network was already working with its facilities and programs to set new goals for the future. The expectation was that the implementation of formal process improvement methodologies would increase efficiencies, provide cost savings and increase the public’s satisfaction with services.

To be chosen to participate in the Performance Excellence Process, Horizon Health Network had to demonstrate:

• Organizational leadership and readiness

• Human resource capacity and competencies

• Potential return on investment from process improvement efforts and initiatives


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Process imProvement

The Performance Excellence Process is a results-oriented, long-term approach to the way the government and Horizon Health Network do business. It utilizes several best practice methodologies including a Strategy Map, Balanced Scorecard and Lean Six Sigma process improvement. Many of these best practices are already being used by other health authorities across Canada and in the United States.

Using process improvement tools, Horizon Health Network is able to accurately assess its progress by using defined measurables. It has identified process improvement teams to work on carefully selected projects that align with our Strategy Map, as well as with the strategy of the Government of New Brunswick. This long-term approach ensures Horizon Health Network will be ready to meet fiscal challenges and still provide quality patient care.

HOW PERFORMANCE EXCELLENCE WORKS

PRIORITIZE: Performance Excellence starts with a strategic vision. The provincial government has articulated its vision - a stronger economy and an enhanced quality of life, while living within our means – through the development of an annual Strategy Map. The Map outlines improvement priorities and serves as a communication tool to articulate government’s focus year after year. Horizon Health Network produced its own Strategy Map which supports the government’s vision as well as its own mission – care for people, educate, innovate, and foster research.

EXECUTE: This is the opportunity to put the strategy into action, which begins with identifying projects and aligning them with the strategic objectives in the Strategy Map. In order to understand the progress being made, objectives will be measured using a Balanced Scorecard. Horizon Health Network uses formal process improvement methodologies (Lean Six Sigma) to become more efficient and improve service to its patients.

ENABLE: Enabling a culture of performance excellence refers to Horizon Health Network’s ability to foster people readiness, information readiness and a culture of performance excellence. By supporting its staff and ensuring they have the tools they need to provide quality service, Horizon Health Network is creating a culture of performance excellence.


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setting Priorities

The Strategy Map is a strategic plan, and not an operational plan. That means the map is all about where to focus improvement efforts within the organization. It does not reflect all day-to-day operations of the organization. The map is updated annually to outline new improvement priorities for the year ahead.

This tool ensures that stakeholders have a clear vision of Horizon Health Network’s direction, as well as its specific objectives.

Citizens

Financial

Internal Processes

Enablers

People Readiness

Performance Excellence Culture

A stronger economy and an enhanced quality of life, while living within our means.VISION2015

GNB Mission: Providing quality services to support a prosperous, fair and just society for New Brunswick.

Horizon Values: Compassion – RespeCt – integRity – CollaboRation – exCellenCe – sustainability - innovation

Information and Technology Readiness

Horizon Mission: Care for People, Educate, Innovate and Foster Research

Develop and align leadership talentto drive execution

of Horizon strategy

access relevant, timely and quality

information

leverage technology to improve health

care delivery

Develop a culture of performance excellence aligned

with gnb strategy

“provide access to necessary programs and services”

Deliver programs and services that meet quality and safety standards prioritize, optimize and

improve processes

achieve budget targets

“provide value for mytax dollars”

Horizon Strategy Map 2013 - 2014

promote healthy lifestyles for citizens

Final March 20, 2013


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Performance excellence leadersHiP

An Alignment Champion is the individual responsible for the implementation of the Performance Excellence Process within a government department or organization.

At Horizon Health Network, our Alignment Champion is Nancy Roberts, Corporate Director, Performance. nancy works directly with the Government of new Brunswick Office of Strategy Management and Alignment Champions from other government departments to ensure Horizon Health Network’s Performance Excellence Process is aligned with the province’s strategic goals.

Nancy previously held the position of Vice President of Planning and Professional Services for the South-East Regional Health Authority; prior to her position in senior management she was a practicing pharmacist with The Moncton Hospital and served as Director of Pharmacy Services.

A Process Improvement Facilitator is a full time practitioner of Lean Six Sigma process improvement. Certification is required as a Lean Six Sigma Black Belt, based on the approved standards. Process Improvement Facilitators or Black Belts receive support, guidance and coaching from a Certified Lean Six Sigma Master Black Belt.

The term Black Belt refers to a level of Certification within Lean Six Sigma. An individual certified as a Black Belt receives extensive training in the tools of Lean Six Sigma, and leads complex projects. Black Belts are project leaders, skilled in the use of statistical methods and the Lean Six Sigma methodology.

Lean Six Sigma – Project HierarchyMaster

Black BeltAlignment Champion

Process Improvement

Facilitator

SubjectMatter Experts

Process Owner

Core Team

Project Champion


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ProJect acHievements

Performance Excellence Process projects are categorized by strategic theme. The following are recent achievements of the Performance Excellence Process and other process improvement initiatives at Horizon Health Network:

A Stronger Economy• Horizon Health Network has more than 200 health and life science researchers

working in a variety of specialties across the province. The Research Office actively pursues public/private partnerships at the local, regional and national level, to grow the capacity of its programming.

Enhanced Quality of CareStandardization, based on best practices, leads to consistent service quality and improved patient care and safety.

• 17 per cent increase available surgery time for Orthopedic Joint Replacement at the Dr. Everett Chalmers Regional Hospital.

• Application of national benchmarks to the frequency of drug testing at the Moncton Methadone Clinic ensures safe, quality care and the target is to save $75,000 annually Horizon-wide.

• The turnaround time for urgent lab tests results to be delivered to the Emergency Room at the Saint John Regional Hospital has decreased by more than 50 per cent – going from 30 minutes to 13 minutes. This was done by optimizing the use of the pneumatic tube.

• Reduction of wait times from 25 weeks to less than four weeks in

Echocardiography at the Saint John regional Hospital. this 84 per cent reduction in wait time was achieved by using process improvement tools and initiatives.

• Bed-side ordering for In-Patient Food Services at the Miramichi regional Hospital has resulted in patients consuming 30 per cent more calories, and has reduced leftovers by 40 per cent.

• Expanded Telehomecare across Horizon, increasing the number of monitors from 44 to 172. This enables Extra-Mural nurses to provide in-home support to patients with chronic conditions, such as Congestive Heart Failure and Chronic Obstructive Pulmonary disease, resulting in fewer emergency room visits and hospital admissions.


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Living within our meansThe Performance Excellence Process allows Horizon Health Network to ensure mechanisms are in place to identify opportunities to prioritize, optimize and improve service delivery. Staff are encouraged to find more efficient ways to provide services to handle the growing demand on existing resources. For instance, Horizon Health network has:

• reduced overtime costs by over $1.2 million throughout Horizon Health Network by reviewing and adjusting staffing requirements in key areas.

These and other projects are part of Horizon Health Network’s Balanced Scorecard. The Scorecard is a strategic planning and management tool that is used extensively in business, industry, government and non-profit organizations worldwide. It is a framework that translates the organization’s mission and vision statements and strategic objectives into a comprehensive set of performance measures that can be quantified, appraised and reported on.

Some projects currently underway include:

• Complete tasks in parallel, and eliminate non-value added tasks to allow the opportunity for more Orthopedic Surgeries to be completed at The Moncton Hospital during the same amount of time.

• Improve the supply chain process in Neuroscience Operating Room procedures at the Saint John Regional Hospital to increase efficiency.

• Improve room set-up and turnover to develop greater efficiency within Cardiac Operating Rooms at the Saint John regional Hospital.

• review Oncology Medication Disposal procedures throughout Horizon Health Network to enhance staff safety, minimize risk to the environment, and preserve stock in the face of medication shortages.

• Standardize Nursing Staff Levels to ensure greater patient care by reducing variability in unit coverage.

• Improve scheduling process to reduce overtime and improve wait times in the Ultrasound Department at the Moncton Hospital.


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rePorting on Performance excellence

Horizon Health Network’s President and CEO, Horizon Health Network’s Executive Management Team, and the Alignment Champion, are responsible for the successful implementation of the Performance Excellence Process. Horizon Health Network must report regularly on the results of its process improvement efforts to the Office of Strategy Management at the Government of New Brunswick.

To ensure Horizon Health Network staff are informed as to the progress made through process improvement, the Executive Management Team and the Alignment Champion report to Horizon Health Network’s Leadership Advisory Council which is made up of senior management.

In addition, Horizon Health Network’s internal newsletter and intranet site feature project updates and offer resources to all staff in order to develop a culture of performance excellence and encourage ongoing process improvement.

Process improvement (Lean Six Sigma) has a vocabulary all its own. Acronyms like DMAIC, SIPOC, SOMIA may seem confusing. As may ‘value stream mapping’ and ‘waste walks’. But these are the tools and methods that enable process improvement to happen in any organization.

Like a carpenter knows his tools, so too do Horizon’s Process Improvement Facilitators and they are there to guide managers and staff on how to implement the right tools for the job. Resources and training opportunities are available to staff so that they may learn more about the process improvement and recognize opportunities for performance excellence in their own areas.


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aBout Horizon HealtH network

Horizon Health Network is located in New Brunswick and is Atlantic Canada’s largest health authority with expertise in diverse areas of health and community services. Horizon Health Network includes 12 hospitals and over 100 facilities, clinics and offices providing medical services ranging from acute care to community-based health services to patients across New Brunswick, northern Nova Scotia, and Prince Edward Island.

Horizon Health Network has provincial responsibilities for tertiary health care and unique provincial programs, such as the new Brunswick Heart Centre, nB trauma Program, the Provincial Child Adolescent Psychiatry Unit, the Operational Stress Injury Clinic and the Stan Cassidy Centre for Rehabilitation.

Horizon Health Network offers all of its services in both English and French and serves a large and diverse First Nations population through its First Nations Liaison Committee, which includes nine First Nations communities. Horizon Health Network’s strategic vision focuses on research, innovation, education and health and wellness and is home to Dalhousie Medicine New Brunswick’s education program.

The organization has an operating budget of approximately $1.1 billion and includes 13,000 staff, 1,000 physicians, 4,600 volunteers, 18 auxiliary and alumnae organizations and 20 foundations.

For more information contact:Communications & Community Relations, Horizon Health Network155 Pleasant Street, Miramichi, New Brunswick EIV 1Y31(506) 623-5541 or [email protected]

aPPendix: Process imProvement Quick facts & ProJect summaries

A-2 HORIZONHEALTHNETWORK

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lean six sigma Process imProvement

Since its inception in 2008, Horizon Health Network has practiced a culture of process improvement.

Formal process improvement methodologies refer to Lean Six Sigma practices, a business management practice that focuses on increasing customer satisfaction while eliminating the waste and variation from processes. It’s a result-oriented approach that uses data to drive improvement decisions and to sustain the change within the organization. Lean Six Sigma practices have been adopted by governments, health-care authorities, and major private sector organizations throughout North America.

Lean Six Sigma projects follow a five step process called by its acronym – DMAIC. DMAIC stands for the following:

Define: customer needs and drivers of satisfaction are stated, the process to be improved is identified, and the project charter is created with measurable targets and quantitative savings

Measure: establishes baseline and target performance of the process, defines the inputs/output variables of the process, validates the data to be used, and uses the project teams and subject matter experts to identify potential causes to the problem as outlined in the project charter

Analyze: uses data to validate the key process inputs that affect the process outputs

Improve: identifies the improvements to optimize the process and eliminate/reduce defects and variation

Control: documents, monitors, and provides visual tools for sustaining the gains made by the process improvements


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strategY maP and Balanced scorecard

A Strategy Map is a blueprint for describing, measuring and aligning an organization’s focus. It provides the link between strategy formulation and implementation, and is used to clarify strategies and communicate them to all employees.

The Horizon Health Network’s Strategy Map aligns with the Government of New Brunswick’s map. Their map lays out how government wants New Brunswick to be different in three years. It has three specific themes:

• a stronger economy;• an enhanced quality of life; while• Living within our means

Horizon Health Network’s map follows this same vision and aligns its goals to it with specific objectives. The map is all about where to focus improvement efforts. It is a tool that ensures that Horizon has a clear vision of the government’s direction, as well as its specific objectives and targets.

It is also how Horizon Health Network will identify key internal processes that will drive strategic success and align investments in people and technology. It is a strategic plan, not an operating plan. It does not reflect all day-to-day operations of Horizon.

The Strategy Map is updated annually to identify new improvement priorities for the year ahead.

Below is the 2013-2014 Strategy Map for Horizon Health Network.

Citizens

Financial

Internal Processes

Enablers

People Readiness







Develop and align leadership talentto drive execution

of Horizon strategy

access relevant, timely and quality

information


care delivery

Develop a culture of performance excellence aligned

with gnb strategy

“provide access to necessary programs and services”

Deliver programs and services that meet quality and safety standards prioritize, optimize and

improve processes

achieve budget targets



promote healthy lifestyles for citizens

Final March 20, 2013


contentsHorizon Values: Compassion – RespeCt – integRity – CollaboRation – exCellenCe – sustainability - innovation

2012 - 2013Horizon Health Network Balanced Scorecard

Strategic Theme: A stronger economy Measures:

Partner to grow health and live sciences research infrastructure Number of new research agreements

Strategic Theme: Enhanced quality of life Measures:

Effectively deliver priority services Improved control for those living with Diabetes (HgA1C)

Hospital readmission rate within 30 days ( for Mental Health)

Hospital readmission rate within 28 days (for Congestive Heart Failure)

Percentage of high priority patients who received surgery within the targeted timeline - (Category I and II)

Ensure access to services that meet primary needs Admission rate per 100,000 of Ambulatory care sensitive conditions (Preventable hospitalization)

Compliance to accountability benchmark for salaried family physicians and Nurse Practitioners (shadow billing)

# of days difference between Average length of stay and Expected length of stay (national standard)

# of high priority clients on community Mental Health wait list beyond 90 days

Access to appointment at Community Health Centres & Health Clinics (days wait to 3rd next available appointment)

Champion and promote healthy lifestyles for citizens Smoking quit rate at six months

Strategic Theme: Living within our means Measures:

“Provide value for my tax dollars” Overtime hours as percentage of total hours worked

Meet or underspend expense budget Ratio of actual to budgeted (funded) expenditures

Meet or exceed revenue budget commitments Horizon generated revenue for grants

Prioritize, optimize and improve service delivery Dollars saved through cost elimination and cost control (specific budget reductions)

Dollars saved by continuous improvement

Cost per weighted case for Miramichi Regional Hospital

Enablers (HR, IT, Performance Excellence Culture): Measures:

Develop process improvement competencies Number of full time process improvement employees per 1000 employees

Engage, develop and retain leaders Employee Engagement Survey

Number of people who have completed management leadership development program

Deliver relevant, timely and quality information Number of eHealth projects that improve information delivery for clinical, support or administrative services

Leverage technology to improve health care delivery Number of eHealth of projects that strategically leverage existing technologies

Develop a culture of performance excellence aligned with GNB strategy

Performance Excellence Maturity Index

Number of paid sick leave days

# recommended action items completed to meet national standards for health-care

% scorecard initiatives/ action plans (SOMIA) on track

Based on the Strategy Map, a framework that translates an organization’s strategy into a set of objectives and measures is developed. This is called a Balanced Scorecard and aligns the organization to the identified objectives and measures through its planning and control processes. The Balanced Scorecard allows the project team to measure their progress in meeting objectives.

Below is the Strategy Map and Balanced Scorecard used in 2012-2013.

Citizens

Financial

Internal Processes

Enablers

People Readiness







partner to grow health and life sciences research infrastructure

Develop process improvement competencies

engage, develop and retain

leaders

Deliver relevant, timely and quality

information


care delivery

Develop a culture of performance excellence aligned with gnb

strategy

“effectively deliverpriority services”

ensure access to services thatmeet primary health needs

Champion and promote healthy lifestyles for citizens

prioritize, optimize and improve service delivery

meet or exceed revenue budget commitments

meet or under spend expense budget




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lean six sigma - Black Belt designation

The term Black Belt refers to a level of certification within Lean Six Sigma. An individual certified as a Black Belt receives extensive training in Lean Six Sigma, and leads complex projects. Black Belts are project leaders, skilled in the use of statistical methods and Lean Six Sigma methodology.

Black Belts must have strong interpersonal communication and facilitation skills, perseverance, a curiosity to understand how things work and why, an ability to lead teams at various levels within an organization, and the ability to work with senior levels.

Horizon Health Network has six certified Black Belts who hold the position of Process Improvement Facilitators. a Process Improvement Facilitator generally reports to department/organizational Alignment Champions and receive support, guidance and coaching from a Master Black Belt.

The Lean Six Sigma Master Black Belt role can be varied depending on the process improvement maturity of the organization and the number of Black Belts but may:

• Develop and implement the formal process improvement structure and reporting mechanisms within an organization or department.

• Coach and mentor Lean Six Sigma practitioners, to achieve maximum results on projects.

• Ensure that Process Improvement Best Practices are shared across the organization effectively.

• Ensure organization/department projects are aligned to strategy. • Monitor projects to ensure they are on time and on track. • Collect and report on total process improvement results.

LEADING IN PERFORMANCE EXCELLENCE – Jennifer Kikkert, Regional Lead, Business Process Management

Jennifer Kikkert is the regional Lead of Business Process Management for Horizon Health Network. Jennifer also works with the Executive Council Office of GNB with the Office of Strategy Management, assisting in the implementation of the Performance Excellence Process within the Departments of Social Development and Justice & Attorney General.

Over the last 12 years, Jennifer has held a number of positions in the health-care industry, as well as the health-care vendor industry, including Senior Software Engineer, Application Support Analyst, and Business Analyst. Her educational background includes a Bachelors of Arts (Honours) degree from the University of New Brunswick, an Applied Information Technology diploma, Process Mastery Certification from the Hammer & Co program and has completed the Lean Six Sigma Black Belt Certification from the College of Extended Learning, University of New Brunswick. Jennifer is currently training as a Master Black Belt.


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Process imProvement facilitators/Black Belts

Melinda HansonMelinda Hanson is based in Saint John. Melinda has spent the past 11 years working as an environmental professional. She has lead many change and improvement projects in various settings including community, research and most recently in an industrial setting. Melinda received her Six Sigma Green Belt Certification in 2009 and has a bachelor’s degree in Biology, and a technology diploma in Environmental Science. She is currently studying for her MBA. Originally from Saskatchewan, Melinda has been living in Saint John for last 11 years and is excited to be part of the Horizon Health network team.

Nick HughesNick Hughes is based in Miramichi. Nick started his career in the aviation industry as a maintenance engineer in the united Kingdom, working on both civil and military aircraft. Nick relocated with his Canadian wife, first to Vancouver and for the last 16 years to Miramichi. Over the last 20 years, Nick has worked in the forest products industry and industrial construction industry, implementing numerous continuous improvement projects in the positions of Technical Director and Continuous Improvement Manager. Nick holds a master’s degree in Business Administration and a Project Management Professional designation.

Josée LeBel Josée LeBel is based in Moncton. She started her career in the food industry as a plant engineer where she was mainly responsible for managing capital expenditure projects and various process/efficiency improvement projects. She was then trained as a Six Sigma Black Belt with Brunswick News where she led multiple process improvement projects in diverse departments such as administration, customer service and operations. She was also responsible for numerous White Belt trainings and was also a coach for several Green Belt projects. Most recently, Josée applied her knowledge and skills as Casino Operations Manager for Spielo, a video lottery terminal supplier. There, in addition to leading an offsite team through a cultural change, she was also managing multiple government clients through contract deliverables. Josée has a bachelor’s degree in Industrial Engineering from l’Universite de Moncton. Josée says that she is thrilled to bringing her experience and knowledge to Horizon Health Network.


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Process imProvement facilitators /Black Belts

Christine McDonald Christine McDonald is based in Saint John. Chris has spent most of her career in Cape Breton, Nova Scotia in various procurement, transportation and logistic roles in neutraceutical and pulp and paper manufacturing operations. In her most recent role, she was a Lean Six Sigma Black Belt at NewPage Corporation in Port Hawkesbury, N.S., where she led several process improvement projects in areas of manufacturing and transactions. Chris holds a degree in Business Administration, a Strategic Supply Chain Management Program Designation, and a Canadian Institute of Traffic and Transportation Designation. Chris relocated to Saint John with her family in October of this year and is thrilled to be working at Horizon Health Network.

Steve Savoie Steve Savoie is based in Moncton. Steve has worked in the food industry for his entire career, though in a variety of fields, from laboratory work and process improvement to quality assurance and food safety. Over the last nine years, Steve worked for Maple Leaf Foods mostly in process improvement roles such as a Six Sigma Analyst and then as a Black Belt. For the last three years, Steve has been in a corporate food safety role and was the Quality Assurance/Food Safety Manager at Maple Leaf Foods’ Moncton plant. Steve holds a master’s degree in Food Microbiology, a post graduate diploma in Food Safety/Quality and a bachelor’s degree in Biology. He is certified as a Six Sigma Green Belt Coach and a Six Sigma Black Belt. Steve is thrilled to be putting his process management experience to work with Horizon Health Network’s team, and has recently accepted a new position within the organization.

Mark Stairs Mark Stairs is based in Fredericton. Mark started his career in the forest industry where he worked in Process Improvement as a Lean Six Sigma Black Belt. Mark has more than 11 years of experience in leading change and process improvement projects. He has spent the past eight years in the gypsum manufacturing industry as a Continuous Improvement Manager, including three years as Plant Manager, where he led significant cultural change in continuous improvement. His educational background includes a bachelor’s degree in Forestry and Environmental Management from the University of New Brunswick. Mark recently accepted a new role at Horizon Health network where he may use his training to even greater advantage.

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Performance Excellence Process - Horizon Health Network