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Pathway to Performance Excellence

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Not for Profit Council: NASVH is a member ... 'Get a Vision' Exercise. 3 minutes total. Work individually or as a group from the same facility ... – PowerPoint PPT presentation

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Title: Pathway to Performance Excellence


1
Pathway to Performance Excellence
NASVH 2009 Summer Conference Asheville, NC
  • Bernie Dana, LTC Management Consultant
    Associate Professor of Business, Evangel
    University, Springfield, MO BDanaMQM_at_sbcglobal.ne
    t
  • Cheryl Maitland, Administrator, Oregon Veterans
    Home, The Dalles, OR CherylM_at_oregonveteranshome.c
    om
  • Melissa Temkin, American Health Care Association,
    Washington, DC mtemkin_at_ahca.org

2
About AHCA
  • A non-profit federation of state affiliates that
    represent more than 10,000 non-profit and
    for-profit nursing and assisted living facilities
    that care for more than 1.5 million elderly and
    disabled individuals nationally, including
    veterans.
  • AHCA currently represents 25 of state veterans
    homes nationwide.
  • AHCA represents the largest number of not for
    profit nursing facilities nationwide over 2,500
    facilities.
  • 2nd largest health care PAC at average 1 mil per
    year.

3
AHCA Support State Veterans Homes
  • Legislative and Regulatory Advocacy
  • In-depth education Annual convention and other
    events
  • National Quality Recognition

4
Legislative and Regulatory Advocacy
  • Over 80 full-time regulatory, legislative,
    research and other staff based in Washington, D.C.
  • 5 full-time lobbyists
  • VA liaison works on issues that affect state
    veterans homes and civilian homes that serve VA
    beneficiaries
  • Not for Profit Council NASVH is a member
  • Committee structure addresses the broad spectrum
    of LTC issues quality, HIT, life safety,
    disaster preparedness, etc.

5
Educational Opportunities
  • Annual Convention
  • Over 70 sessions in 13 focus areas, including
    quality, care practice, workforce and leadership
    issues
  • Keynotes Cal Ripken, Jr. and Dr. Bob Arnot
  • October 4-7, McCormick place in Chicago
  • Annual Quality Symposium February 9-10, 2010 at
    the Marriott Baltimore Waterfront
  • Congressional Briefing June 8-9, 2010

6
Pathway to Performance Excellence
  • Bernie Dana
  • Cheryl Maitland

7
Program Objectives
8
The Need and the Opportunity
  • Rising costs cannot be fully offset by increasing
    revenue
  • Regulatory compliance does not increase customer
    satisfaction
  • Inconsistent performance causes employee
    dissatisfaction
  • Traditional management systems are reactive
    rather than proactive and visionary
  • Person-centered culture change will not be
    sustained without systems change

9
There is a Better Way!
  • Act on a vision for what can be
  • In all situations, lead by example
  • Let customer expectations define the quality
    standard
  • Engage and empower employees
  • Develop a quality management system to sustain a
    focus on performance
  • Develop a structure to fulfill the quality
    journey
  • Commit to continuous learning and growth

Source Mapping the Road to Quality Results,
Olson, Dana, and Ojibway, Provider, Apr 2005
10
Leadership and Culture Change
  • Create a vision for performance excellence
  • Change to systems thinking
  • Its the system how organizations approach
    getting things done
  • Does caring and compassion trump system thinking?
  • Systems create behaviors
  • My people wont do what your people do
  • 85 of people problems are systems problems

11
Sharing the Right Vision
  • Paradigm shift needed compliance vs. customer
  • Grasp your current reality
  • Commit to innovation
  • Vision sharing takes time and new system
  • New language
  • New tools
  • Engage all in CQI
  • LTC research found common theme they chose to
    act on a vision for what can be.

12
How Vision Developed
  • New leadership young or from other professions
  • Education programs
  • Pioneer Network, Eden Alternative, etc.
  • Quality award program and similar models
  • Never from regulatory change or survey enforcement

13
Get a Vision Exercise
  • 3 minutes total
  • Work individually or as a group from the same
    facility
  • Develop a headline that you would like to see
    about your community in 5-7 years
  • Headline should reflect a measurable result (i.e.
    Veterans Home staff satisfaction at 96 --
    highest in nation)
  • Write on handout

14
The Philosophical Principles of Quality
Management
  • Quality is meeting or exceeding customer
    expectations.
  • Quality is everyones job.
  • Quality is systems and statistical thinking.
  • Quality is continuous learning and improvement.
  • Quality requires effective leadership.

15
Definition of LTC Quality Is...
  • The totality of service features and
    characteristics that meet or exceed customer
    needs and expectations.1
  • Requires the provider to
  • Comprehend individual and collective expectations
  • Provide services and facilities that meet
    expectations
  • Achieve a high level of performance and
    reliability in systems and processes used to
    deliver services

1Source Defining Quality in Long Term Care,
Dana, Provider, Aug 2004
16
An Essential Measure of Quality Is
  • Customer Satisfaction
  • Customers may not always know what is best for
    them but they have right to be fully informed,
    respected, and in control of decisions regarding
    their service.

17
Customer
  • External Customer Ultimate user of the service
  • Internal Customer Anyone we hand off work to
    within the organization

18
Customers View of Quality (Kano)
  • What comes first?
  • Shift in expectations

19
Customer Realization Challenges
  • We care a lot, but then assume we know what is
    best
  • Learn to differentiate key customer groups
  • Empower staff to respond
  • Recognize every encounter as a quality moment for
    the customer

20
Remove Blame from the System
  • Get the right people on the bus
  • Believe that everyone wants to do a good job and
    have fulfillment from their work
  • Write personnel policies to encourage your best
    rather than to control your worst
  • Confront poor performance when it happens rather
    than at the annual evaluation
  • Build trust by response, fairness, transparency
  • Learn to ask why instead of who when
    something goes wrong
  • Train staff how to continuously improve their
    work

21
Empowerment
  • Parameters and Empowerment

Parameters set by vision, goals and resources to
maintain the focus on improvement and alignment
with organizational purpose
  • Employees are EMPOWERED when they
  • Know what is expected of them
  • Have the skills and resources to meet
    expectations
  • Receive continuous feedback to know how they are
    doing
  • Can adjust work processes to achieve desired
    result

22
Most Important Exercise
  • 2 minutes total
  • Meet with someone next to you
  • Identify the three most important individuals or
    groups of employees

23
The Managers
  • Gallup research People leave managers, not
    organization
  • Managers not effective employees not effective
  • LTC managers selected from ranks for work skills,
    loyalty, and compliance

24
Managers Need Development
  • Basic management skills
  • Communication styles
  • Conflict resolution
  • Performance evaluation
  • Coaching
  • Team meeting skills, idea generating tools,
    consensus building tools, process management,
    improvement tools

25
Systems View of Quality
Design Quality
Performance Quality
26
Cost of Quality
  • Prevention Cost - Activities designed to prevent
    poor quality
  • Appraisal/Inspection Cost - Assessing conformance
    to a standard
  • Failure Cost - Correcting non-conformance to a
    customers requirement
  • Cost increases as problem gets closer to customer


27
Does Inspection Work?
Do both of the lines have an equal amount of bend
in them?
  • Dependent on the inspectors and their paradigms
  • Managers add inspection steps when something goes
    wrong

28
Classifying Work
  • Value-Added Work - External customer sees benefit
  • Required Work - Needed to keep organization
    operating
  • Rework - Something was not done properly the
    first time
  • Wasted Work - Not required and no value
  • No Work - Authorized leave/waiting time

20 15 30 10 25
29
Do We See the Opportunity?
  • Waste and Rework Cost
  • Number of full-time equivalent employees
    100
  • Average annual hours worked by each employee
    1,950
  • Total hours worked annually
  • Estimated rate of waste and rework (20)
    .2
  • Total waste and rework hours
  • Average hourly pay rate (including benefits)
    12.00
  • Total cost of waste and rework

195,000
39,000
468,000
30
Process and System
  • Process - Interrelated work activities producing
    a specific outcome
  • System - A combination of related processes
  • Process characteristics
  • Can be divided into a series of tasks
  • Tasks can be put into order
  • Performance can be measured
  • Need standardized process

31
Variation
  • Two Basic Kinds of Variation
  • Common Cause Variation
  • predictable and inherent in all processes
  • Special Cause Variation
  • not predictable
  • often unsatisfactory
  • assignable to a cause should be investigated

32
Example of Process Variation
  • Sample food temperatures of meal entrees over a
    10 day period from two facilities
  • Average is the sameare both processes performing
    the same?

33
Organize for Quality
  • Performance accountability continues with
    day-to-day leadership structure

34
Process Management Cycle

35
Selecting a Process to Improve

Team?
36
Keep Score that Matters
  • Performance is everything
  • Efforts will earn you sympathy
  • Compassion doesnt cover up poor results
  • If not getting results, change something
  • Know key success factors, then
  • Learning to measure quality is not easy

BHAGs ? Strategies ? Action Plans ? Feedback
37
Principles of Measurement
  • Measure the process, not the person
  • Measure to improve, not to blame
  • Keep simple, understandable, believable,
    accurate, and useful
  • Measure performance against a customer-focused
    standard
  • Measure the key process indicators
  • Make comparisons meaningful (best, not average)

38
Is Alarm Disconnected?
We have disconnected the alarm on chronic
quality failures because the failures are so
familiar and expected that we no longer are
surprised or even offended by them.
Dr. Joseph Juran
39
The Tools of Quality Management
40
Nature of Problems
  • Problem Any situation/issue that separates you
    from your mission, vision, and goals
  • Two primary categories
  • Strategic problems - organizational performance
    gaps
  • Process problems - work process failures
  • Responsibility for problems
  • Management responsible for all strategic problems
    and all process problems if
  • process handed down or tweaked by management
  • employees are not empowered to correct

41
Key Root Cause Concepts
  • Ask why rather than who
  • Ask why at least five times
  • Investigate the facts

42
Find the Root Cause
  • Problem 1 Resident and daughter upset that
    expensive slip purchased for mother had
    returned from laundry in frayed condition.
  • Symptoms - Clothing damaged
  • - Laundry chemical costs increased
  • Why Expensive booster chemical being added
    to every load
  • Why Laundry staff feel it is need to
    prevent rewash
  • Why Laundry supervisor directed
  • Why Vendor had not provided training.
  • Why Administrator did not include
    laundry supervisor in
  • decisions and got too busy
    to schedule training
  • Solution Provide training, develop
    measurements, empower

43
Develop a CQI Methodology
  • Helps create objectivity
  • Can be adjusted to fit your QMS
  • Provides a roadmap to solving problems
  • Requires discipline to follow steps
  • Everyone needs to be trained to use it

44
Sample CQI Methodology
  • Identify the process and the customers
    requirements
  • Collect and analyze process data
  • Describe the current process (flowchart)
  • Select opportunities to improve and determine
    root causes
  • Develop and implement potential solutions
  • Hold the gains

45
PDSA Cycle of Improvement
1. What are you trying to change? What idea are
you testing? What will you measure? Plan your
change.
4. Revise plan/retest. Spread/expand test.
Implement change on a larger scale
PLAN
ACT
DO
STUDY
3. What happened? Summarize what you learned.
2. Pilot your test. What were the results?
Document the results.
46
Display and Analysis
  • Learn to use the right tools to measure, analyze
    information and data

47
Models of Quality Management
  • Baldrige National Quality Award Program
  • State Quality Awards
  • Six Sigma, Lean Enterprise, Etc.
  • AHCA/NCAL National Quality Award Program

48
(No Transcript)
49
Steps Toward Mature Processes
(1) Reacting to Problems
  • Characterized by activities mostly responsive to
    immediate needs or problems rather than by
    processes
  • Goals are poorly defined

50
Steps Toward Mature Processes
(2) Early Systematic Approaches
  • Beginning stages of using operating processes
    with repeatability, evaluation, improvement, and
    coordination
  • Strategy and quantitative goals are being defined

51
Steps Toward Mature Processes
(3) Aligned Approaches
  • Systematic processes in place that are regularly
    evaluated for improvement
  • Learning from processes shared
  • Organizational units are coordinated
  • Processes address well defined strategies and
    goals

52
Steps Toward Mature Processes
(4) Integrated Approaches
  • Systematic processes in place that are regularly
    evaluated for change and improvement in
    collaboration with other affected organizational
    units
  • Efficiencies across units sought and achieved
    through analysis, innovation, and sharing
  • Processes and measures track progress on key
    strategic and operational goals

53
AHCA/NCAL Quality Award
  • Step 1 - Commitment Organizational Profile with
    mission and demonstration of ability to improve
    (5 pages met/not met no IJ)
  • Step 2 Achievement Address how core values of
    quality are embraced with good results (18 pages
    team of examiners No IJ and 3 year weighted
    average above state)
  • Step 3 Excellence Address all of Baldrige
    criteria with superior results 55 pages team of
    master examiners, No IJ and 3 year weighted
    average above state)

54
Benefits of Quality Award Model
  • Develops providers ability to improve services
    and internal processes
  • Peer and public recognition as a quality champion
  • Examiner feedback identifies strengths and
    opportunities for improvement
  • Creates disciplined learning curve
  • Webinars and other support resources available

55
Benefits of Quality Award Pathway
  • Begins change in thinking
  • Gives focus to the real customer
  • Requires continuous learning at all levels
  • Creates pride/celebration in achievement Requires
    long term commitment
  • Creates shift in management style

56
QUESTIONS?
57
Resources
  • Multiple resources for quality improvement listed
    at AHCA website http//www.ahcancal.org/quality_
    improvement/quality_first_initiative/Pages/QF_Tool
    sResources.aspx
  • Developing a Quality Management System The
    Foundation for Performance Excellence in Long
    Term Care, Dana, AHCA revised 2008 (Order through
    AHCA bookstore listed at above website)
  • Guidelines for Developing a Quality Management
    System (Free download) http//www.ahca.org/quality
    /qf_qms_guidelines.pdf
  • A Guide to Nursing Facility Performance Measures
    (also for MR/DD providers) (Free download)
    http//www.ahca.org/quality/qf_nf_perform_measure.
    pdf
  • Good to Great, Collins, HarperCollins, 2001
  • First, Break All the Rules, Coffman and
    Buckingham, Simon and Schuster, 1999
  • Zapp! Empowerment in Healthcare, Bynam, Random
    House, 1993
  • The Deming Management Method, Walton, Perigee
    Books, 1986
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