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1000 Lives Improvement hosted Katherine Gottlieb, CEO of Southcentral Foundation, to discuss how they transformed a system of care in Anchorage, Alaska, and how their lessons could help in transforming healthcare in NHS Wales.
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Katherine Gottlieb, MBA, DPS (h.c.), President/CEO
Steve Tierney, MD, Medical Director – Quality Improvement
Michelle Tierney, MPA, MA, Vice President Organizational Development and Innovation
Kevin Gottlieb, DDS, Vice President Resource and Development and Chief of Staff
Copyright © 2011 Southcentral Foundation. All Rights Reserved.NOTICE: Unless otherwise indicated, this work represents copyrighted material protected by United States and international law. This work may not be used, reproduced, downloaded, disseminated, published, transferred or transmitted, in whole or in part, in any form or by any means, electronic or mechanical, including photocopying, recording or information storage and retrieval, except with the express written permission of the publisher. This work may not be edited, altered, or otherwise modified, in whole or in part, except with the express written permission of the publisher.
Describe the customer-owned and relationship based Southcentral Foundation Nuka System of Care
Understand a different way of thinking about healthcare
Answer questions
Objectives
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
SCF Board of Directors
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Government recognized that:If the people receiving the health service are involved in the decision making processes, better yet, if they own their own health care – programs and services have a potential for enhancement and the people and their health statistics will improve.
Indian Self-Determination and Education Assistance
Act 1975
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Unfriendly and rude staffGuinea pig for new doctorsCustomers waited for everything
• Long waits for scheduled appointments• Four- to six-hour waits common Long waits on
phone, pharmacy, everywhere Inconsistent treatment Risky place to go
The Drive to Change
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Customers frustrated – waiting, impersonal, paternalistic, crowded, unfriendly
Clinical staff frustrated – too many people, not enough time, no personal relationships, too many demands
Management frustrated – lots of unhappy people, hard to motivate staff, poor financial performance, challenging facilities
Everyone Was Frustrated …
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Alaska Native people were given this choice and we chose to assume the responsibility for our own health care
• Change everything• Total redesign• With our choices and values
Our Choice
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Southcentral Foundation uses the term customer-owner instead of:
• Patient• Client • Customer
Customer-owner
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Governing board Advisory committees Elders Council Focus Groups Annual Gathering 24- hour hotline Community gatherings Personal interaction
with employees
Satisfaction surveys Comment cards
Customer Focus Key Improvements
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Vision A Native Community that enjoys physical, mental, emotional and spiritual wellness
Mission Working together with the Native Community to achieve wellness through health and related services Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Key PointsShared ResponsibilityCommitment to QualityFamily Wellness
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Relationships between customer-owner, family and provider must be fostered and supportedEmphasis on wellness of the whole person, family and community (physical, mental, emotional and spiritual wellness)L ocations convenient for customer-owners with minimal stops to get all their needs addressedAccess optimized and waiting times limitedTogether with the customer-owner as an active partnerIntentional whole-system design to maximize coordination and minimize duplicationOutcome and process measures continuously evaluated and improvedNot complicated but simple and easy to useServices financially sustainable and viable Hub of the system is the familyInterests of customer-owners drive the system to determine what we do and how we do itPopulation-based systems and servicesServices and systems build on the strengths of Alaska Native cultures
Operational Principles
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Alaska
At 591,000 square miles, Alaska is as wide as the lower 48 states and larger than Texas, California and
Montana combined.
San Francisco
Charleston
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
• 64,000 Customer-owners• 54,000 Anchorage and Valley• 10,000 55 villages
• Employees• 1982: Fewer than 100• 2013: About 1,600
• Operating Budget• 1982: $3 million• FY 2013: $227 million
From 1982 to 2013…Operating Budget
1982 FY 2013
$3m
$227m
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Why Listen to Our StoryWhy Listen to Our Story
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
• Utilization– 75% decrease in hospital admissions since 1999– 71% decrease in hospital days per 1000 since 1999 – 36% decrease in outpatient visits per 1000
customer-owners
• Clinical quality– Level 3 NCQA Patient Centered Medical Home – 75 or 90 percentile for HEDIS outcome measures
o Diabetes o Cancer o Cardiovascular disease
Measures of Success
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Customer-owner satisfaction• Overall 93%
Employee satisfaction• Overall 94% • Response rate 95%
Employee Turnover • 10.8%
Baldrige National Quality Award - 2011
Measures of Success
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Whole system transformation
Behavioral Health• Fireweed• PCC
BURT Denaa Yeets’ TRAILS and FASD The Pathway Home Quyana Clubhouse Dena A Coy
• Residential• Outpatient• Willa’s Way
Behavioral Health Service McGrath Behavioral Health Clinics
Therapeutic Family Group Homes• Cottonwood• Rendezvous• Cleveland
Alaska Womens Recovery Project (AWRP)
Access To Recovery (ATR)
SCF Programs and Services
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Compliance Data Services Organizational Development Development Center Human Resources Quality Assurance Research Nuka Institute
SCF Programs and Services
Tribal Relations and Village Initiatives
Traditional Healing Clinic Planning Grants Communications &
Public Relations RAISE Programs Elder Program Seattle Office Board Support Corporate Office
Support
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Dental (ANMC and Fireweed) Facilities General Counsel Information Technology Special Assistant Program Budget Planning and
Management Contracts Financial Operations Patient Accounts Payroll Reimbursement
SCF Programs and Services
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Office of the President• Divisional structure
Executive and Tribal Services, Medical Services, Behavioral Health, Resource and Development and Organizational Development and Innovation
• Line Authority Functional committee structure
• 4 areas of focus to get to high performance Operations– effective day to day operations Quality Assurance– compliance with standards etc. Process Improvement– improving systems and structures Quality Improvement– improving clinical and educational
services
Organizational Structures
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Then and Now …
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Then and Now …
Copyright © 2011 Southcentral Foundation. All Rights Reserved.