High-Performance Healthcare:

1
High-Performance Healthcare

• By
• Dr. Tony Lybarger

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Seven Practices of Successful Organizations

• Employment Security
• Selective Hiring of New Personnel
• Self-managed Teams Decentralized Decision
  Making
• Comparatively High Compensation Contingent on
  Organizational Performance (Pay-for-Performance)
• Extensive Training (60 hours --- My Number)
• Reduced Status Distinctions Barriers, including
  Parking, Dress, Language Office Arrangements
• Extensive Sharing of Financial Performance
  Information Throughout the Organization

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A Journey From Where You Are to High-Performance

• As managers we manipulate resources in pursuit
  of organizational success. The probability of
  organizational success increases if that success
  is defined in a way that we understand, can
  explain to employees and is measurable.
• This is a two-part Webinar with three
  assignments. Today 1 we will review the
  characteristics of a High-Performance
  Organization (HPO), 2 there will be a three
  week break during which you can/will compare the
  performance of your organization to that of a HPO
  and 3 on 10/28/08 (my 47th wedding anniversary)
  we will come back together to review and discuss
  the results of your comparison.
• I would like for you to share as much of your
  comparison as possible with me before the
  10/28/08 Webinar. Obviously, your name and the
  name of your organization will not be revealed.
  During the second Webinar we will discuss your
  findings and talk about management strategies for
  resolving performance gaps between where you are
  and HPO (where you want to be).
• Your participation will either strengthen or
  weaken this effort.

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Creating Change How Do We Proceed?

• It seems (at least to me) there are two ways to
  organizationally approach the change process
• 1 Deal with each challenge (trauma or
  opportunity) in isolation.
• 2 Create a high-performance healthcare
  organization that is fundamentally healthy and
  capable of reacting assertively to all types of
  challenges and traumas as a normal part of the
  business cycle.
• What do you think?

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Three Questions

• What to Change?
• What to Change to?
• How to create that Change?

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What to Change?

• Administrative and organizational practices at
  XXXX that are not in alignment with
  characteristics of a high-performance healthcare
  organization.

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What to Change to?

• A High-Performance Healthcare Organization (HPO).

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What is a High-Performance Organization?

• A high-performance healthcare organization is
  excellent in so many areas of operation that it
  consistently outperforms most of its competitors
  for extended periods of time (sustainable
  competitive advantage).

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Characteristics of High-Performance Organizations

• Strategic Approach
• 1 Organizations philosophy statement is
  consistent with its strategy.
• a XXXXs core values (5) are represented in the
  strategic plan.
• 2 Managers and employees know what they need
  know about the organizations strategy in order
  to do their jobs.
• a All employees have access to the strategic
  plan and understand the role they play in
  achieving strategic goals.
• 3 Organization-wide performance measures match
  the organizations strategy.
• a XXXX identifies 10 preferred work behaviors
  (PWBs) which if exhibited correctly and
  consistently by employees (Hardwired) increases
  the probability of achieving strategic goals.
• 4 Employees act in ways that are consistent
  with the behaviors needed to execute the
  strategic plan.
• a 90 of XXXX employees exhibit PWBs correctly
  90 of the time.
• b All XXXX employees consistently do what they
  say they will do.

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Characteristics of High-Performance Organizations

• Customer Approach
• 1 The organization believes that they exist
  primarily to serve their customers.
• 2 The organization strives to be the best in
  their region at providing a high-quality service
  to their customers.
• a 95 - 99 of customers rate their interaction
  with XXXX as excellent.
• 3 The organizations assesses and determines its
  customers future needs.
• 4 The organization exceeds customer
  expectations.
• a 95 of all customers rate the quality of
  their interaction with XXXX as excellent after
  discharge.
• b 95 of customers are satisfied with their
  wait time for service.
• c 95 of customers (random sample/20 per day)
  surveyed during their hospital stay are
  satisfied with their care.

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Characteristics of High-Performance Organizations

• Leadership Approach
• 1 Everyone is clear about the organizations
  performance expectations.
• a 95 of XXXX employees can verbalize their
  PWBs.
• 2 Executive Management, Department Managers
  Supervisors walk the talk.
• a BS walks and behavior talks.
• 3 Employees believe that their behaviors affect
  the organization.
• a Employees of XXXX act like owners rather than
  renters.
• 4 HPOs had more innovative HR than
  Low-Performance Organizations (LPOs).
• a HRs first priority is employee and patient
  satisfaction rather than compliance with
  regulations.
• 5 Management promotes the person who has the
  best skills and knowledge to do the job.
• a Executive Management, Department Managers
  Supervisors at XXXX create organizational equity.
  Employees (all) get what they deserve.
• b HP employees receive rewards substantially
  different from LP employees.
• c LP employees are coached (one strike),
  transferred (two strikes) or (three strikes)
  fired.
• 6 Employees are comfortable with being able to
  express disagreement with the organizations
  policies and practices.
• a Executive Management, Department Managers
  Supervisors at XXXX create a Culture of
  Execution which honors open and honest
  communication (Robust Dialogue).
• b Crap sometimes roles uphill.
• c Executive Management wants to know what we
  do worst.

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Characteristics of High-Performance Organizations

• Processes Structures
• 1 The organization places the highest priority
  on meeting customer needs.
• a Profit comes from service rather than service
  from profit.
• 2 The organizations views information as
  something to be shared rather than hoarded for
  the purpose of power and control.
• a Executive Management, Department Managers
  Supervisors share information freely.
• 3 The organization, as a result of its focus on
  customer satisfaction, is more likely to use
  state-of-the-art customer-relationship
  technology.
• 4 Performance measures are leveraged to drive
  clarity and focus throughout the organization.
• a Information is gathered and disseminated
  related to employee performance and customer
  satisfaction.

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Characteristics of High-Performance Organizations

• Values Beliefs
• 1 Most employees (85) think the organization
  is a good place to work.
• a 10 of employees (LPOs) are uncomfortable
  with XXXX.
• b 5 (very LPO) dont like XXXX at all.
• c What is a good place to work?
• 2 Employees tend to be loyal to the facility
  and they tend to participate in the
  organizations social events.
• a 80 of invited employees attend XXXX
  sponsored social events.
• 3 The work environment fosters cohesiveness,
  loyalty and readiness to change. Employees tend
  to be treated with dignity and respect and the
  employees treat the organization the same way.
• 4 Employees and supervisors have more freedom
  to use their own discretion related to changing
  procedures and processes to improve outcomes.
• a Employees are allowed to take risks and fail,
  within reasonable limits, without fear.
• b Every employee, within reasonable limits, is
  a decision maker.

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What is a Good Place to Work?

• I would like for each of you to answer this
  question. As a part of the two-step Webinar,
  please e-mail your definition to me.

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Fortune 2008100 Best Places to Work

• 10 Methodist Hospital (Houston)
• Last year Methodist added a new program called
  No One Dies Alone, in which employees volunteer
  time with terminal patients
• 78,746 average hourly annual pay
• 88,972 average annual salaried
• 11 hours of training per year (07)
• 11 turnover

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100 Best Places to Work 18

• OhioHealth (Columbus)
• Rewards everything customer service, community
  service, stars of the month perfect attendance
• 77,175 average hourly annual pay
• 108,143 average annual salaried
• 103 hours of training (07)
• 8 turnover

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100 Best Places to Work 45

• Childrens Healthcare of Atlanta
• Provides backup care for children, elders pet
  insurance
• 58,139 average hourly annual pay
• 43,286 average annual salaried
• 20 hours of training (07)
• 9 turnover

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100 Best Places to Work 49

• Griffin Hospital (Derby, Conn.)
• Over 580 other hospitals have visited to learn
  how Griffin provides exceptional patient service.
  There were 6,691 applications for 180 open
  positions
• 10 turnover
• Average annual salaried not available
• 68, 640 average annual hourly pay
• 110 hours of training a year (07)

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100 Best Places to Work 59

• Mayo Clinic (Rochester, Minn.)
• Hire for Life is the HR goal, and it seems to
  be working --- 17 of the workforce has been
  there 20 or more years
• 31 hours of training (07)
• 5 turnover
• Annual pay information not available

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100 Best Places to Work 75

• Southern Ohio Medical Center (Portsmouth)
• Hospital provides home-based medical care
  engages all employees in care giving. Even
  housekeepers are urged to ask patients how they
  can be of help.
• 82,077 average annual salaried pay
• 58,407 average annual hourly pay
• 4 turnover

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100 Best Places to Work 76

• Arkansas Childrens Hospital (Little Rock)
• They have invested more than17 million in wages
  increases since 2001
• 62,860 average annual salaried pay
• 61,266 average annual hourly pay
• 8 turnover

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100 Best Places to Work 80

• Healthways (Nashville, Tenn.)
• This disease-management company provides walking
  trails, bikes for rent, and easy-to-locate
  stairways for exercise
• 82,613 average annual salaried pay
• 63,545 average annual hourly pay
• 13 turnover

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100 Best Places to Work 85

• Lehigh Valley Hospital Health Network
  (Allentown, Pa.)
• Employees pay nothing for healthcare and get
  bonuses tied to patient satisfaction scores
  financial performance.
• 60,043 average annual hourly pay.
• 69,256 average annual salaried
• 88 hours of training (07)
• 7 turnover

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100 Best Places to Work 94

• Baptist Health South Florida (Coral Gables)
• Offers employees adoption aid (just increased
  from 4,000 to 10,000), three child care centers
  nursing retention bonuses
• 11 turnover
• 16 hours of training (07)
• 67,406 average annual hourly pay
• 89,100 average annual salaried

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100 Best Places to WorkHealth Care

• 10 Methodist Hospital System
• 18 OhioHealth
• 45 Childrens Healthcare of Atlanta
• 49 Griffin Hospital
• 59 Mayo Clinic
• 75 Southern Ohio Medical Center
• 76 Arkansas Childrens Hospital
• 80 Lehigh Valley Hospital
• 94 Baptist Health South Florida

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Summary of High-Performance Characteristics

• XXXXs core values (5) are represented in the
  strategic plan.
• All employees have access to the strategic plan
  and understand the role they play in achieving
  strategic goals.
• XXXX identifies 10 preferred work behaviors
  (PWBs) which if exhibited correctly and
  consistently by employees increases the
  probability of achieving strategic goals
• 90 of XXXX employees exhibit PWBs correctly 90
  of the time
• All XXXX employees consistently do what they say
  they will do.
• 99 of customers rate their interaction with XXXX
  as excellent.
• 95 of all customers rate the quality of their
  interaction with XXXX as excellent after
  discharge.
• 95 of customers are satisfied with their wait
  time for service.
• Customers (random sample) are surveyed for level
  of satisfaction during their hospital stay.
• 95 of XXXX employees can verbalize their PWBs
• BS walks and behavior talks.
• Employees of XXXX act like owners rather than
  renters.
• HRs first priority is employee and patient
  satisfaction rather than compliance with
  regulations.

27
Summary of High-PerformanceCharacteristics

• Executive Management, Department Managers
  Supervisors at XXXX create organizational equity.
  Employees (all) get what they deserve.
• HP employees receive rewards substantially
  different from LP employees.
• LP employees are coached (one strike),
  transferred (two strikes) or (three strikes)
  fired.
• Executive Management, Department Managers
  Supervisors at XXXX create a Culture of
  Execution which honors open and honest
  communication (Robust Dialogue).
• Crap sometimes roles uphill.
• Executive Management wants to know what we do
  worst.
• Profit comes from service rather than service
  from profit.
• Executive management, Department Managers
  Supervisors share information freely.
• Information is gathered and disseminated related
  to employee performance.
• 80 of invited employees attend XXXX sponsored
  social events
• Employee satisfaction surveys show that 85 of
  employees say XXXX is a good place to work.
• 10 of employees (LPEs) are uncomfortable with
  their relationship with XXXX.
• 5 of employees (VLPEs) dont like PCMC at all!
• Employees are allowed to take risks and fail,
  within reasonable limits, without fear.
• Every employee, within reasonable limits, is a
  decision maker.
• High-performance healthcare organizations have
  competent Department Managers.

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Culture and High-Performance in Healthcare
Organizations

• Hospitals with the best business practices (in
  particular, leadership and operational
  effectiveness) had the best workplace culture
  (employee satisfaction, loyalty, engagement
  retention).
• Hospitals with the best workplace cultures had
  the highest patient satisfaction/loyalty scores.
• Hospitals with the highest patient
  satisfaction/loyalty scores were financially more
  successful than the average hospital and
  exhibited the best community stewardship.

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Culture and High-Performance in Healthcare
Organizations

• The numbers dont lie Healthcare providers who
  earn high marks for the caliber of their
  organizational and department culture rank
  highest on overall performance outcomes and
  financial success.
• Hospitals with the best business practices (in
  particular, leadership and operational
  effectiveness) had the best workplace culture
  (employee satisfaction, loyalty, engagement and
  retention).
• Hospitals with the best workplace cultures had
  the highest patient satisfaction/loyalty scores.
• Hospitals with the highest satisfaction/loyalty
  (employee) scores were financially more
  successful than the average hospital and
  exhibited the best community stewardship.

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Department Managers High-Performance

• Organizational researchers, for 50 years, have
  found the most important relationship within any
  organization is the one between the employee and
  her immediate supervisor.

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Department Managers Healthcare Organizations

• Overall, the study found three macro drivers of
  performance that contributes most to a satisfied,
  loyal and engaged workforce.
• 1 Confidence in, and performance of executive
  leadership. (People with Offices in the Executive
  Suite)
• 2 Front-line manager capability and
  performance. (Department Managers)
• 3 The degree of patient focus within the
  organization.

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The Trifecta IndexLeadership s Performance

• Job Satisfaction I am satisfied with my job.
• Organizational Loyalty I am willing to
  recommend my organization to friends as a great
  place to work.
• Professional Engagement I see my profession in
  a positive light and encourage others to consider
  my career.
• Effective front-line leadership contributes to
  higher job satisfaction, loyalty and professional
  engagement.

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Front-Line Management Employee Retention

• My manager or immediate supervisor is effective
  at retaining good staff.
• My manager or immediate supervisor seems to care
  about me.
• My manager or immediate supervisor is receptive
  to staff (my) suggestions.
• When front-line managers are respected and
  effective, employees tend to want to stay with
  their organization for longer periods of time.

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Front-Line Leadership Patient Satisfaction

• There is a positive relationship between
  effective front-line leadership performance (as
  evaluated by staff) and increased patient
  satisfaction.

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Front-Line Manager Performance Budget Targets

• Departments led by ineffective performing
  front-line managers missed budget projections by
  an average of 8.3.
• Departments led by somewhat effective front-line
  managers missed budget targets by an average of
  6.7.
• Departments led by effective front-line managers
  missed budget targets by an average of .4
• Departments led by highly-effective front-line
  managers consistently hit their projected budget
  targets.

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Department Managers Performance

• High-performance healthcare organizations have
  competent Department Managers.

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Can Your Organization Change? YES!

• People dont think themselves into a new way of
  acting. People act themselves into a new way of
  thinking. (Ex 89)
• Identify PWBs --- then reward employees who
  exhibit those behaviors correctly/consistently
  and coach, transfer or fire those employees that
  dont.
• The foundation for changing behavior is linking
  rewards to performance and making that linkage
  transparent. (Ex 92)
• If you, the leaders, at XXXX reward and promote
  people that Execute, the end result will be a
  Culture of Execution. (Ex 92)

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How To Create Change

• People dont think themselves into a new way of
  acting. People act themselves into a new way of
  thinking. (Ex 89)
• Tell people what results you expect.
• Discuss how to get those results.
• Reward people for getting those results.
• For those people coming up short, provide
  coaching, withdraw rewards, move them to other
  jobs or fire them.
• (EX 86)

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Best Hospitals 2008Characteristics

• Index of Hospital Quality (IHQ) The IHQ
  describes the interrelationships between 1
  structure, 2 process and 3 outcomes.
• 1 Structure refers to resources related
  directly to patient care. Examples of structural
  measures include intensity of nursing staffing,
  availability of desirable technologies and
  patient services.
• 2 Process of care delivery encompasses
  diagnosis, treatment, prevention and patient
  education.
• 3 Outcomes relates to mortality.

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Best Hospitals in America2008

• 1 Johns Hopkins Hospital (Baltimore
• 2 Mayo Clinic (Rochester)
• 3 Ronald Reagan UCLA Medical Center
• 4 Cleveland Clinic
• 5 Massachusetts General Hospital
• 6 New York-Presbyterian Univ Hospital
• 7 Unvi of California San Fran Med Center
• 8 Duke University Med Center (Durham)
• 10 Hospital of the Univ of Pennsylvania
• 10 Univ of Washington Med Cnter (Seattle)

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Best Hospitals in America2008

• 12 Barnes-Jewish Hospital (St. Louis)
• 13 Univ of Michigan Hosps (Ann Arbor)
• 14 Univ of Pittsburg Med Center
• 15 Vanderbilt Univ Med Cnter (Nashville)
• 16 Stanford Hosps Clinics (Stanford)
• 17 Univ of Chicago Medical Center
• 18 Cedars-Sinai Med Center (Los Angeles)
• 19 Yale-New Haven Hospitals (New Haven)

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References

• Fortune 2008 Best Places to Work
• Execution by Larry Bossidy Ram Charan
• How to Build a High-Performance Organization
  American Management Association
• The Connection Between Organizational Culture and
  Performance in Healthcare Organizations
  Healthcare Performance Solutions
• U.S. News Best Hospitals 2008
• Hardwiring Excellence by Quint Studer
• The Baptist Health Care Journey to Excellence by
  Al Stubblefield

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Dr. Tony LybargerContact Information

• Phone [phone]
• Fax [phone]
• E-mail tlybarge_at_yahoo.com