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What High Performers do Differently - Using Data to
Drive Change
Terry Grundy MBA Managing Director
Press Ganey Associates (Australia and New Zealand)
Traditional Approaches to Quality Improvement
TQM, CQI
Lean Thinking
Productive Ward
Process
Re-Design
Re-Engineering
High Performers Know It’s About Managing Behaviour
Process Improvement then Accelerates
The Most Significant Difference in Driving Change Through Data
High Performers Invest in their Leadership and Hold Leaders Accountable as Leaders
NOT as Clinicians
Press Ganey is the world’s largest provider of healthcare experience/satisfaction measurement services (now over 10,500 clients across 18 countries) with over 880 employees.
July 2012 Milestone: 310,000 surveys distributed every 24 hours, (65 million in 2012) – (185 million in 2013)
11 of the 15 Malcolm Baldrige Quality Award Winners: are PG Clients
14 of the 17 Honour Roll Hospitals: are PG Clients
240 of the 395 Magnet organisations: are PG Clients
Sample Australian Clients
OUTCOME FOCUSED DEFINITION
You can ask the cleaner what the hospital’s goals are, and whether they have been achieved? They will be able to tell you ………
“Vision without execution is h a l l u c i n a t i o n .” Thomas Edison
Employee Engagement
Patient Satisfaction
Doctor Engagement
Growth
&
Capacity Management
Funding Our Future
Health Outcomes
Advocate Good Samaritan Hospital – 2010 Baldridge Winner
High Performers = Balanced Scorecard Strategic Planning and Accountability
Service Quality People Finance Growth Community
Reduced claims
Reduced legal expenses
Reduced malpractice expense
Doctor Satisfaction
Patient Satisfaction
Improved clinical outcomes – decreased nosocomial infections
Reduced medically unnecessary days and delays
Reduced re-admits
Reduced medication errors
Reduced turnover
Reduced vacancies
Reduced agency costs
Reduced overtime
Reduced cost to orientate
Employee Satisfaction & Engagement
Improved operating income
Decreased cost per adjusted discharge
Improved debtors
Reduced accounts receivable days
Reduced advertising costs
Higher volume
Increased revenue
Decreased left without treatment in the ED
Reduced outpatient no-shows
Increased doctor activity
Increased Philanthropy
Provision of services to meet mission
Improved relationships & involvement with local communities
High Performers = Constantly Collect Data to Populate Metrics
Service
Patient Satisfaction
Goal: min xx% Percentile improvement needed xx%
Target: xx% recommend overall
Baseline: xx.x mean AMGA: Goal: x% improvement over baseline
Target: xx% percentile -main Campus Target: xx% percentile - RMP
People
Employee Satisfaction
xx% Improvement over 2 years
Reduce RN Turnover
Goal: xx% Reduction
Target: xx.x%
Current: xx.xx%
Quality Reduction of Patient Falls
Goal: xx% Reduction
Target: .xx/100 Pt. Days
Current: .xx/100 Pt. Days
ACE Inhibitor
Goal: x% Increase
Target: xx%
Current: xx%
Growth
New Patient Volume Growth
x%
Surgical Growth
Outpatient: x% Inpatient: x%
Financial
Operating Margin
Goal: x%
Reduction in Adjusted Cost/Day
TBD
On Time O.R. Starts
Target: xx% Current: xx%
The Cleveland Clinic: Top 4 Hospitals in the US since 1995
• 1,300 beds • 54,000 admissions • 3.7 million outpatient visits • 2,000 Doctors on staff
St Vincent’s Private Hospital Sydney
Balance Score Card
Alignment of Data to Individual Leaders
NOT JUST SPECIALTIES
Calvary Canberra Scoreboard
Showcase Outcomes to All
High Performers Showcase Their Outcomes For ALL
High Performers Provide the Evidence For Change
Savings of $1,230,000 in past 18months
85.1 84.5
83.6
82.0
86.6 87.7
85.2 84.7 83.7
82.1
92.9
88.7 88.6
83.0
81.4 80.9 81.0
83.9
86.4
83.5 83.6
81.2
79.2
91.8
84.7
88.1
77.0
79.0
81.0
83.0
85.0
87.0
89.0
91.0
93.0
95.0
YES
NO
Impact of Discharge Calls on Patient Perception 1 July 2010 – 30 June 2011 (16,000 inpatients)
Impact of Connecting With Discharge Phone Calls
Readmission Reduction
Source: South Carolina Academic Medical Center
Patients that received a post visit call
3 days after discharge had a lower
re-admission rate
High Performers Pursue Loyalty – Not Satisfaction
Zone of Affection
1 2 3 4 5 Very Very Poor Poor Fair Good Good
Zone of Indifference
Adapted from: Jones, T. and Sasser, E. Why Satisfied Customers Defect.
Harvard Business Review. November-December 1995. pp.88-99.
Zone of Defection
0.3% 0.7% 3.8% 27.2% 68.6% Top 5%
0.9% 1.4% 7.9% 39.4% 50.4% IP Benchmark
VALIDATE
High Performers
Trust Their Staff – But Check !!!!
Sometimes Usually Always
“But we're already doing it!"
Why Validation is the Key to Effective Practice Change
Checking execution is: not “sometimes” not “usually” but “always”.
“But we're already doing it!" Why Validation is the Key to Effective Patient-Centred Care
1. Validation through data and documentary evidence. Example: ongoing patient, doctor and employee surveying
2. Validation by the unit leaders (check with patients).
3. Validation by regularly assessing and discussing the outcomes on the unit.
4. Validation by external leaders (DON, quality manager or equivalent - check with patients).
5. Validation with the patient after discharge (through a discharge phone call).
6. Validate by turning the required behaviour into an annual competency, like other skill areas.
7. Follow-through – when behaviour does not meet the requirements, take action.
Leader Rounding on Patients Overall Patient Satisfaction
0
10
20
30
40
50
60
70
80
90
100
July
-04
Sep
t-04
Nov
-04
Jan-
05
Mar
ch-0
5
May
-05
July
-05
Sep
t-05
Nov
-05
Jan-
06
Mar
ch-0
6
May
-06
July
-06
Sep
t-06
Nov
-06
Jan-
07
Mar
ch-0
7
May
-07
July
-07
Sep
t-07
Service Training Began
Source: Advocate Good Samaritan Hospital, Downers Grove, IL, Beds = 303, Admissions = 17,486, measured by Press Ganey Associates, Inc.
Resistence to Process Change
Accountability Applied to Behaviour
Resistence to Accountability
Leaders Supporting High Performers
Acting on Low Performers
When Leadership Improves So Does Clinical Outcome
Thank You Terry Grundy MBA Managing Director Press Ganey Associates (Australia and New Zealand) [email protected]