Sherry Marshall

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Sherry Marshall
Integrating the Baldrige Business Model in
Healthcare A Focus on Measurement and
Process Management

• Vice President, Quality
• Saint Lukes Hospital of Kansas City

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Saint Lukes HospitalKansas City, Missouri
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Where We Came From
Saint Lukes Hospital

• Founded in 1882
• Articles of Agreement dated October 3, 1882
• Charity care was an important aspect of the
  agreement
• New hospital was designated a teaching institution

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Saint Lukes Hospital
Who We Are Today

• 582 beds
• 3186 employees
• 500 physicians
• Not for profit
• Tertiary care referral
• Protestant Episcopal Church
• Primary teaching hospital UMKC School of
  Medicine
• Level I Trauma Center
• Level III Neonatal care
• Centers of Excellence

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Mission
Saint Lukes Hospital
Committed to the highest levels of excellence in
providing health services to all patients in a
caring environmentdedicated to medical research
and education.
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Vision
Saint Lukes Hospital
The Best Place to Get Care,The Best Place to
Give Care
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The Best Place to Get Care
Saint Lukes Hospital
Most Preferred in Kansas City
NRC 1997, 1998, 1999, 2000, 2001, 2002, 2003,
2004
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The Best Place to Give Care
Saint Lukes Hospital
Our People Make the Difference

• That is why
• High retention
• High employee satisfaction
• Highly dedicated and engaged workforce

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What We Stand For
Saint Lukes Hospital

• Our Core Values
• Quality/Excellence
• Customer Focus
• Resource Management
• Team Work

Be the Best Identify/Analyze Problems High
Quality Corporate Compliance Courtesy/Respect Cust
omer Satisfaction Ethics/Confidentiality Celebrate
Diversity Cost Effective Flexibility Cooperation
Honest Communication Team Culture Recognize
Achievement
O R G A N I Z A T I O N A L E X C E L L E N C E
122 Years Serving Kansas City and the Region
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Saint Lukes HospitalOrganizational Milestones

• Received third Missouri Quality Award
• Site visit by MBNQA
• Third refinement of the Balanced Scorecard
• Deployed 90-Day Action Planning Process

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Saint Lukes HospitalOrganizational Milestones

• Developed and deployed process level scorecards
  in key areas
• Began preparation to achieve Nursing Magnet
  designation
• Selected as a Malcolm Baldrige National Quality
  Award recipient

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Agility Continuous Learning Innovation
Information Sharing
Saint Lukes Hospital
Leadership for Performance Excellence Model
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Saint Lukes Hospital
Performance Measurement
Balanced Scorecard

• Primary measurement tool

• 5 perspectives

• Financial
• Customer Satisfaction
• Growth Development
• Clinical and Administrative Quality
• People

• Key measures linked to strategy

• Operating Margin
• Overall Customer Satisfaction
• Profitable Market Share
• Patient Safety Index
• Retention

• Scoring criteria set by statistical methods and
  benchmarks

• Tracks overall organization performance

• Provides organizational alignment

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Saint Lukes Hospital
Performance Measurement
Balanced Scorecard Trend Charts
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Saint Lukes Hospital
Performance Measurement
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Physicians as Partners
Saint Lukes Hospital
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90-Day Action Plans
Saint Lukes Hospital

• Making it real for leaders
• Operating margin
• Patient Safety index
• Overall satisfaction
• Revenue growth
• Retention

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Saint Lukes Hospital
Performance Analysis
BSC Departmental Report Form

• One BSC measure from each perspective is selected
  (Strategic Focus Area SFA)
• Managers develop department 90-day action plans
  for each SFA

• Provides alignment of Hospital strategic plan at
  the department level
• Provides focus for managers
• Results reported monthly and trended over time

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Saint Lukes Hospital
Performance Analysis
BSC Departmental Report Form
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Performance Management Cycle
Saint Lukes Hospital

• Planning goal setting at start of the year
• Coaching through the year
• Review at the end of the year, with merit
  increase awarded

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Saint Lukes Hospital
Performance ManagementProcess by Core Value

• Shared Behaviors What is expected of me as an
  employee of Saint Lukes Health System?
• Job Specific Accountabilities What am I
  accountable for because of the job I hold?
• Personal Commitments What goals will I commit
  to for the coming year based on my own individual
  talents?

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Saint Lukes Hospital
Alignment of Strategy with the Performance
Management Process (PMP)

• Assure financial stability by SLH departments and
  services collectively achieving operating margin
  goal.
• Department Director Personal Commitment
• Assure financial stability of East 3 by meeting
  budgeted gross revenue and maintaining supplies,
  salaries and other expenses within 2003 budget.
  Measured with the monthly flex budget report.
• Registered Nurse I Personal Commitment
• Achieve 100 accuracy on charge entry and
  documentation measured by quarterly unit audits

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Saint Lukes Hospital
Managing and Improving Processes Process Level
Scorecards

• How do you know youve had a good day?

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Saint Lukes Hospital
Achieving Strategic Alignment Throughout the SLHS
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Saint Lukes Hospital
Why Process Level Scorecards?

• Recognition that all work is a process designed
  to meet customers needs
• Do we really understand how well our processes
  are working?
• Serves to link daily operations, in-process
  measures and BSC outcomes measures
• Used by process owners to monitor overall process
  performance

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Saint Lukes Hospital
Why Process Scorecards?

• MQA and Baldrige feedback
• SLH focus is on continuous improvement
• Processes are not well-defined, documented and
  identified in many areas
• Better definition of processes and better
  measurement of processes can yield even greater
  improvement opportunities

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Relationships
Saint Lukes Hospital
Organizational Scorecard
Process Scorecard
Provides Inputs
Enables Drill Down Into Processes
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Relationships
Saint Lukes Hospital

• Organizational Scorecard
• Is focused on key performance indicators
• Enables determination of organizational health
• Enables focus on improving in key areas
• Process Scorecard
• Defines the activities within processes and
  handoffs
• In-process measures identify key control data
  points
• Enables drill-down to areas affecting performance
• Outcomes of processes feed the Organizational
  Scorecard
• Becomes the foundation for process improvement
  activities

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Saint Lukes Hospital
ApproachDeveloping Process Level Scorecards

• Senior leaders identified key processes and
  process owners by balanced scorecard perspective
• Defined a plan for building a process level
  scorecard

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Level 1 Processes
Saint Lukes Hospital

• Perform Financial Management
• Satisfy Customers
• Enhance Growth and Development
• Provide Clinical and Administrative Services
• Manage Human Resources

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Level 2 Processes Manage Human Resources
Saint Lukes Hospital

• Hire staff
• Orient new employees
• Train staff
• Develop staff
• Motivate staff

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Level 3 Processes Motivate Staff
Saint Lukes Hospital

• Segment employees
• Determine employee satisfaction
• Recognize employees
• Provide and administer benefits and compensation
• Provide a safe work environment

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Process Scorecard Results
Saint Lukes Hospital
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Saint Lukes Hospital
Process Scorecard Results
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Saint Lukes Hospital
Process Scorecard Results
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Saint Lukes Hospital Process Scorecards

• Phase 1 Processes
• Manage Suppliers and Partners
• Admit Patients
• Initial Assessment of Patients
• Manage BSC Process
• Manage Hotel Services
• Reward and Recognize Employees

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Saint Lukes Hospital Process Scorecards

• Phase 2 Processes
• Manage Surgery Capacity
• Manage Inpatient Capacity
• Manage Facilities and Equipment
• Recruit New Staff
• Capture Accurate Transfer Admitting
• Information
• Manage Complaints

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Saint Lukes HospitalEnd Result

• Process scorecards provide useful sets of
  measures
• Allow us to take a proactive rather than a
  reactive approach to care/services we provide
• Allows us to take action based on fact-based
  evidence rather than anecdotal information
• Knowledge to develop additional scorecards
• Helps us to answer the question Are we meeting
  our customers needs?

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• So, Has the Baldrige Management Model Made a
  Difference?

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Organizational Rewards
Baldrige Business Model

• Improved Clinical Outcomes

Patients Receiving tPA Following Ischemic Stroke
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Baldrige Business Model
Organizational Rewards

• Improved Customer Satisfaction

Patient Satisfaction
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Baldrige Business Model
Organizational Rewards

• Sustained High Levels of Consumer Perception

NRC Perception Rankings vs. Top Competitors
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Baldrige Business Model
Organizational Rewards

• Improved Financial Performance

Days Cash on Hand
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Baldrige Business Model
Organizational Rewards

• High Levels of Employee Satisfaction

Employee Satisfaction
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Baldrige Business Model
Organizational Rewards

• High Employee Retention

SLH Retention
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Baldrige Business Model
Organizational Rewards

• Improved Productivity

Human Capital Value Added
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Saint Lukes HospitalSustaining Performance
Excellence
Lessons Learned

• Leadership drives and sustains the process
• Leadership at all levels is important
• More difficult to change the culture than to
  learn the tools
• Valuable team building experience
• Trust is extremely important

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Saint Lukes HospitalSustaining Performance
Excellence
Lessons Learned

• There are no quick fixes
• Must always focus on the customer
• Should never be satisfied with the present level
  of quality
• Decisions must be driven by data and compared to
  best
• Employees make it happen!

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Baldrige Business Model
Next Steps

• Study our feedback report
• Celebrate our strengths
• Prioritize our OFIs
• Use feedback to improve
• Continue to share what weve learned
• Continue to learn from others

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Baldrige Business Model
The Value

• Feedback, Feedback, Feedback!
• Criteria is the Best Way to Get Better, Faster
• Enhanced Our Internal Pride
• Positions Us Ahead of Our Competition
• Recognized as an Industry Leader
• Raises Healthcare Industry to Higher Levels of
  Performance

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Saint Lukes Hospital
Our People Make the Difference
They Are Our Competitive Advantage!
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Saint Lukes HospitalKansas City, Missouri
THE BEST PLACE TO GET CARE
THE BEST PLACE TO GIVE CARE!