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Using Baldrige to Create High Performance
August 15, 2012
William A. Conway, M.D.Senior Vice President and Chief Quality Officer, Henry Ford Health System
Chief Medical Officer, Henry Ford Hospital
Henry Ford Health System Core Services:
Four acute med/surg and two behavioral health hospitalsHenry Ford Medical Group– 32 Medical Centers– 1200 physicians & scientists
2200 private physicians1500 MD & DO physician traineesHealth Alliance PlanLarge Post Acute Services Division
Henry Ford Health System
Other Statistics (annual):
24,000 employees102,000 admissions to 2200 beds418,000 ED visits3.2 million office visits88,000 surgeries
Seven Years of Learning
Conduct Scenario Planning & Develop Strategic Objectives
Develop & Prioritize Strategic Initiatives
Develop Action Plans & Set Targets
COMMUNITY PURCHASERS
PATIENTSReview Organizational
Performance
Affirm MVV & Environmental Assessment
Conduct Scenario Planning & Develop Strategic Objectives
Develop & Prioritize Strategic Initiatives
Develop Action Plans & Set Targets
COMMUNITY PURCHASERS
PATIENTS
COMMUNITYCOMMUNITY PURCHASERSPURCHASERS
PATIENTSPATIENTSReview Organizational
Performance
Affirm MVV & Environmental Assessment
HFHS Board of Trustees
Performance Council
Business Unit Leadership Teams
Executive Cabinet
Pillar Teams
HFHS Board of Trustees
Performance Council
Business Unit Leadership Teams
Executive Cabinet
Pillar Teams
Organizational Framework Leadership
Core Competencies Innovation Care Coordination Collaboration
Vision Transforming lives and communities through health and wellness – one person at a time.
People Service Quality & Safety
Growth Research & Education Community Finance
THE HENRY FORD EXPERIENCE
System Values Respect for people High Performance Learning & Continuous Improvement Social Conscience Each Patient First
Mission To improve people’s lives through excellence in the science and art of health care and healing.
Strategic Patient/ Performance & Staff Safe & Reliable AccountabilityPlanning Customer Focus Knowledge Management Focus Process Focus for ResultsOrganizational Framework Leadership
Core Competencies Innovation Care Coordination Collaboration
Vision Transforming lives and communities through health and wellness – one person at a time.
People Service Quality & Safety
Growth Research & Education Community Finance
THE HENRY FORD EXPERIENCE
System Values Respect for people High Performance Learning & Continuous Improvement Social Conscience Each Patient First
Mission To improve people’s lives through excellence in the science and art of health care and healing.
Strategic Patient/ Performance & Staff Safe & Reliable AccountabilityPlanning Customer Focus Knowledge Management Focus Process Focus for Results
“The Henry Ford Experience” 7 Pillars of Performance
4.27 = 90th Percentile
4.08 = 75th Percentile
Good
HFHS Employee Engagement
Community Giving
People
ServiceGood
HFHS IP Top Box Likelihood to Recommend (Press Ganey)
Good
6062646668707274767880
'05 '06 '07 '08 '09 '10 8/11 YTD
'10 '10
ED Likelihood to Recommend (Press Ganey)
Ambulatory
SEM 75th %ile
SEM 90th %ile
Good
Growth
GoodHFHS Revenue
HFHS Inpatient Market Share
10%
11%
12%
13%
14%
15%
16%
17%
18%
19%
2005 2006 2007 2008 2009 2010 2011
Good
Quality
76 7774
81 82
74
8083
79
84 8581
65
40
45
50
55
60
65
70
75
80
85
90
Mgt actions show safety is a priority
We are encouraged to speak up I would feel safe as a patient here
Staff feel free to question those with more authority
HFHS Culture of Safety Survey2006 ‐ 2012 Comparison of Percent Favorable
(4 ‐Agree and 5 ‐ Strongly Agree)
2006 2008 2010 2012 AHRQ 75th Percentile 2012 AHRQ 90th Percentile 2012
30
35
40
45
50
55
60
1.5
1.6
1.7
1.8
1.9
2
2.1
2.2
2.3
2.4
2004 2005 2006 2007 2008 2009 2010 2011 YTD
HFH
S Harm
Events Per 1,000 Acute Care D
ays
System
Mortality Ra
te
HFHS Harm Events and Hospital Mortality Rate Trends
HFHS Mortality HFHS Harm AHRQ Nat'l Safety Index
Insulin Protocol SSIwork
Sepsis Protocol
IHI 100K Lives UTI
WHOSurgical Checklist
DVT
Hi‐Risk Med Management
Infection Prevention
‐25%
‐40%
‐27%Variable Cost Savings 2010 $1.9M HFH
31%
35%
CMS-17% / 6 years
HFHS
NRC Best Overall Quality vs. Competitors
Finance
$(40,000)
$(20,000)
$‐
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$140,000
2004 2005 2006 2007 2008 2009 2010 2011*
Ope
rating
Income
Fiscal Year(*DMC not included due to acquisition by Vanguard)
System Operating Income(Dollars in Thousands)
HFHS Competitors' Average
Philanthropy Cash Donations
Mission, Vision, and Values
MissionTo improve people’s lives through excellence in
the science and art of health care and healing
ValuesEach Patient First Respect for PeopleHigh Performance A Social ConscienceLearning and Continuous Improvement
Former Vision StatementTo put patients first by providing each patient the quality of care and comfort we
want for our families and ourselves.
Leveraging Core CompetenciesInnovation – Discovering and applying new knowledge in techniques, technology, processes, services, and structures
– Clinical Research & Technology– Facilities – Services and Access Points– Processes
Care Coordination – Proficiency in coordinating care across the continuum, teams
Partnering/Collaborating – Relationship- building with stakeholders, community, interdisciplinary
Community SupportEconomic Driver
$5.82 billion in direct/indirect economic benefitsLive MidtownNeighborhood development
Community LeaderServe in leadership roles in key organizations, such as Detroit Chamber of Commerce, Detroit Convention & Visitors BureauLeadership volunteer hours exceed 12,000 annuallyCommunity benefit 78%, $400M
Sustainability Through…
Workforce culture
Relentless focus on improvement
Accountability for results – ongoing performance reviews are standard agenda items
Succession planning & leader development
Patient safety culture
Created Performance Council and New Leadership Processes
Feedback showed incomplete strategic planning steps, deployment, and alignmentMany performance targets – and results – remained the “responsibility” of a few vs. everyoneEvaluated all current leadership teams: membership, roles and responsibilities, meeting frequency, and perceived effectivenessCreated a “picture” of our Leadership SystemLaunched the new HFHS Performance Council
HFHS Leadership System
Performance CouncilComprised of leaders of every Business Unit, pillar team, and key Corporate areaCharged with overseeing the Strategic Planning Process and Organizational Performance ReviewProvides clear direction and decision making process to those seeking approval of or input to projects, policies, and initiatives (clarifies role of all leadership teams)
HFHS Board of Trustees
Performance Council
Business Unit Leadership Teams
Executive Cabinet
Pillar Teams
Other Changes to HFHS Leadership System
Created an Enterprise Risk Council with System-level goals:– Develop and execute/oversee HFHS’s approach to Enterprise Risk
Management (ERM)– Ensure ERM strategies are integrated into the overall strategic plan.– Short-term: Identify top five risk areas that require enhancements to
controls or processes to adequately mitigate/prepare for the risk. Integrate these into the current strategic planning process in 2011/12
– Long–term: Identify a full-scope, repeatable Enterprise Risk assessment process
Reinforced System-wide teams, accountable to Performance Council, to provide broad inputs and greater spread
Improved Strategic Planning and Implementation
Multiple refinements to the Strategic Planning Process– New processes focused on the criteria – New common vocabulary:
• Strategic Objectives• Strategic Initiatives• Action Plans• Performance Targets
– Aligned the strategic planning and budgeting processes
– Clear expectations for aligned action planning
Conduct Scenario Planning &
Develop Strategic Objectives
Develop & Prioritize Strategic Initiatives
Develop Action Plans & Set Targets
COMMUNITY PURCHASERS
PATIENTSReview Organizational
Performance
Affirm MVV & Environmental Assessment
Cascading Strategic Initiatives Pillar/SO
Key Organizational Performance Measures*
2012 – 2014 System Strategic Initiatives [Owner]
Cascade to BUs
All Pillars Improvement in Key Performance Measures
Baldrige Journey (learning, sharing, & improvement, both internally and externally) [BLT]
YES
Turnover; employee wellness (HRA lifestyle)
Develop a competent, agile workforce positioned to transition as patient and business unit needs fluctuate
YES
Engagement survey mean Develop a high-performance, highly-engaged workforce YES
People: National Leader in healthcare employee’s engagement and wellness
Leadership positions filled inside; diversity of candidate pools
Continue succession planning for key leadership positions YES
Transform the satisfaction and engagement of our customers through a consistent service-centric culture
YES Service: Best-in-class service among U.S. healthcare organizations
Top Box Likelihood to Recommend; HCAHPS Scores Redesign, elevate, and humanize the customer experience. YES Readmission % Reduce readmissions at all facilities
YES
Overall harm No Harm Campaign (2011-2013 )
YES
Quality & Safety: National leader in delivering safe, reliable, high quality, & highly coordinated care Project Helios milestones Clinical Transformation leveraging Epic System YES
Continue IT system enhancements at HAP and in provider system As applic.Continue physician alignment strategies, including HFMG recruitment and HFPN membership expansion.
As applic.
Develop HFHS Business Model (optimal geographic presence, clinical program mix, and business mix)
As applic.
Growth: Dominant health system in MI
Net Revenue – steady state and new strategic growth; Inpatient Admissions and market Share; HAP Members
Continue service line development in chosen areas As applic.
Research: Nationally preferred clinical research partner
External research funding from all sources
Strengthen research & education affiliation with WSU Medical school; including joint research building.
As applic.
Education: Leading independent academic medical center
Trainee readiness to practice without supervision
Strengthen affiliation with WSU and MSU Medical schools to retain MI trained physicians; Continue to Integrate Medical Education System-wide.
As applic.
Improve access to care/services for the under/uninsured As applic. Improve healthcare equity and reduce disparities As applic.
Community: National leader in community health advocacy and involvement
Community Benefit $ Establish Wellness Center of Excellence, community health needs
assessment and outreach As applic.
Finance: Financial strength to fund strategic plan
Net Operating Income; Cost per Unit (case mix index-adjusted admission)
Drive down System cost per unit through local and System tactics, sharing, and spread through expense and utilization management.
YES
Strategic Plan identifies:
Alignment between Strategic Objectives, Key Performance Measures (and targets), and Strategic Initiatives
Clear identification of owners
Clear accountability for strategy cascade starts at PC
All business units must create and share an action plan that shows alignment to System initiatives as well as “local” strategic initiatives, all organized by the 7 pillars
Pillar teams or other System teams also create and share action plans
Targets for next three years for each System performance measure (reported throughout year on System Dashboard)
Engaging Workforce Through Communications
Structure: CEO led, all PR staff integrated, link to Pillars
Process: Consistent, repetitive messaging Multimedia, multi-tactic
Employee champions: service, safety, equityEngage Face-to-Face:
Town Halls, Leadership Rounds, Huddles,multiple recognitions
Huddles
Inclusive and Transparent Performance Measurement
New Metrics Committee:– Comprised of operational, financial, and pillar leaders – Provide oversight and expertise to pillar teams and the
Performance Council on definition, display (dashboards), comparisons, and analysis of organizational performance
New HFHS Analytics department to drive information and knowledge management System-wideTransparency of results for greater knowledge transfer and better future planning
Transparency and Accountability at each Business Unit
INITIATIVES ACTION(S) Overall(R,Y,G)
LOOKING FORWARD(NEXT OPR)
PC SUPPORT NEEDED?
No Harm Campaign
•Achieved almost 50% reduction in Employee Harm rate through focused efforts of Safety Champions and Huddle Boards. • Continue focus on CAUTI, Med Harm, Communication Failures and Specimen Labeling
RED
• Sustain employee harm improvements• Continue focus on communication (see below)• Host HFWBH Quality Expo in Jan. 2012
NO
Care Team Communication
• Conducted an A3 Workshop with staff and patients focused on “Creating and individualized, team-based plan of care developed in collaboration with patients”
YELLOW
• Focused teams to tackle root causes and “baby A3s” including creation of common care plan, consult process improvement• Implement proposal for Clinical Lean Team with dedicated time to advance this effort and develop the front-line expertise to problem solve
• Support and possible participation from key medical group physicians
Process Improvement Culture
• Implementing plan for Performance Excellence Team •Conducted first 2012 Strategic Planning session SLT to identify HFWBH Performance Objectives in line with System Objectives
GREEN
• Rollout team plan• Refine and validate HFWBH Performance Objectives and engage all leaders and front-line staff in defining the work needed in order to achieve the objectives.
•Finalization of HFHS objectives
INITIATIVES ACTION(S) Overall(R,Y,G)
LOOKING FORWARD(NEXT OPR)
PC SUPPORT NEEDED?
No Harm Campaign
•Achieved almost 50% reduction in Employee Harm rate through focused efforts of Safety Champions and Huddle Boards. • Continue focus on CAUTI, Med Harm, Communication Failures and Specimen Labeling
RED
• Sustain employee harm improvements• Continue focus on communication (see below)• Host HFWBH Quality Expo in Jan. 2012
NO
Care Team Communication
• Conducted an A3 Workshop with staff and patients focused on “Creating and individualized, team-based plan of care developed in collaboration with patients”
YELLOW
• Focused teams to tackle root causes and “baby A3s” including creation of common care plan, consult process improvement• Implement proposal for Clinical Lean Team with dedicated time to advance this effort and develop the front-line expertise to problem solve
• Support and possible participation from key medical group physicians
Process Improvement Culture
• Implementing plan for Performance Excellence Team •Conducted first 2012 Strategic Planning session SLT to identify HFWBH Performance Objectives in line with System Objectives
GREEN
• Rollout team plan• Refine and validate HFWBH Performance Objectives and engage all leaders and front-line staff in defining the work needed in order to achieve the objectives.
•Finalization of HFHS objectives
Leadership Competencies & Standards: Aligned to Baldrige
40% of Leader and Staff evaluations tied to leader/team standards
Incentives aligned with organizational goals
Patient/Customer Focus
Strategic Planning
Accountability for Results/Execution
Staff Focus
Process Management/ Focus on Safety
Performance Analysis & Knowledge Management
Leadership
Patient/Customer Focus
Strategic Planning
Accountability for Results/Execution
Staff Focus
Process Management/ Focus on Safety
Performance Analysis & Knowledge Management
Leadership
Team Member Standards
From Customer Satisfaction To Customer Engagement
The 10 Team Member Standardsof Excellence
Keep the “face of the customer”at the forefront everyday
Huddles
Mandatory Service TrainingEffective communication AIDET
How Do We Design and Improve? HFHS Model for Improvement (MFI)
Customer Needs &
Engagement
Plan
DoCheck
Actd
EmployeeEngagement
d = Debrief and evaluate effectiveness of improvement methods and tools
Continuous Improvement & Innovation
Key Process Focus
InpatientOutpatientEmergency Dept.Community CareServicesCHP
Health Plan (HAP)Research & Education
Access to ServicesAssessment, Planning and Care DeliveryPatient Education, Transition and Care Coordination
Member Health Status ImprovementPublication of Research, Acquisition of FundingEducation
Environment & Supply Chain Mgmt.Financial Mgmt.Information Mgmt.Workforce Mgmt.
SafeTimely
Efficient & EffectiveEquitablePatient-
Centered
Our Work Is Designed to Serve Each Patient First
“Each patient and customer is the center of our universe, the guest in our home, the reason we are here.”
InpatientOutpatientEmergency Dept.Community CareServicesCHP
Health Plan (HAP)Research & Education
Access to ServicesAssessment, Planning and Care DeliveryPatient Education, Transition and Care Coordination
Member Health Status ImprovementPublication of Research, Acquisition of FundingEducation
Environment & Supply Chain Mgmt.Financial Mgmt.Information Mgmt.Workforce Mgmt.
SafeTimely
Efficient & EffectiveEquitablePatient-
Centered
Our Work Is Designed to Serve Each Patient First
“Each patient and customer is the center of our universe, the guest in our home, the reason we are here.”
Work System & Key Process – Focus on “Each Patient First”
Inventing - R&D Piloting Spreading Fully Deployed
Depression – Impact Model in PCTC
PCTC RN Care Management
Gestational Diabetes Diabetes Self Management Educ.
Childhood Obesity PCTC Tel-Assurance Pediatric MH Special Needs Patients
Smoking Intervention Program
Back Pain for BCBSM Diabetes Support Group Facilitation
Depression In Primary Care
Anti-coagulation clinics
Panel Managers Health Engagement Visits
E-Visits Weight Management
OPD Discharge Process DocSite to OptimEyes E-Messaging Wound Care
DocSite Performance Reports
HAP/HEDIS P4P bonus for staff
DocSite use during visit Cardiac Rehab
Quality Bonus Lipid Clinic E-Prescribing
Clinical Program Culture Change Process Redesign
Patient-Centered Medical HomeProcess Change Workplan
Lessons LearnedEssential for senior leaders to drive, support and actively participate in Baldrige improvements
– CEO commitment and involvement– Leaders as Champions, Category Co-leads
The Baldrige Framework has to be integrated into everyday business – not a separate project – to build sustainable improvementsThe writing (and associated self-evaluation) generates as much learning as the feedback reportsSpread the knowledge – build examiner competency across the organization (we started at the State level)It’s OK to use the “B” word – builds common understanding Winning does not mean perfection
Clarify and communicate: award or strategy?and
2012: The Journey Continues
Key System-wide priorities based on examiner feedback and pre-/post-visit self-assessments:
– Refine our approaches for identifying and spreading improvements, innovations, and best practices; learn from others at Quest
– Continue to communicate and connect System goals and current performance, opportunities, and responsibilities to individuals and front line teams; refine strategic planning process steps to hard- wire “tight-loose-tight”
– Re-evaluate and re-align key processes, owners, and measures at all business units and work systems
We’re Henry Ford,
We Can
