SSM Health Care

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SSM Health Care

• Baldrige As a Business Model in SSM Health Care

Paula J. FriedmanCorporate Vice
PresidentSystems Improvement Adventist
HealthLeadership Conference
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Questions

• How many of your employees have read the Baldrige
  criteria?
• How many understand it?

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Session Objectives

• Provide an understanding of Baldrige as a
  business model in achieving exceptional health
  care
• Provide concrete examples to operationalize
  concepts

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The MBNQA

• Nations top quality award
• Recognizes performance excellence
• Framework to systematically improve an
  organization

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SSM Health Care Facilities
SSM Health Care St. Louis Cardinal Glennon
Childrens Hospital St. Joseph Health Center St.
Joseph Health Center West DePaul Health
Center St. Joseph Hospital St. Marys Health
Center SSM Rehab Managed Care Organization Physic
ian Organization SSM Home Care
SSM Health Care of Wisconsin St. Clare Hospital,
Baraboo WI St. Marys Care Center St. Marys
Hospital Medical Center
Blue Island, IL St. Francis Hospital Health Center
Maryville, MO St. Francis Hospital Health
Services
SSM Health Care of Oklahoma St. Anthony
Hospital Bone Joint Hospital
Centralia, IL St. Mary's Hospital
Mt. Vernon, IL Good Samaritan Regional Health
Center
Jefferson City, MO St. Marys Health Center Villa
Marie Skilled Nursing Facility
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SSM Health Care

• 21 hospitals, three nursing homes, physician
  practices, home care, information center other
  services
• 2.4 billion in assets
• 23,000 employees, 5,000 physicians, 5,000
  volunteers
• Approximately 150,000 admissions and 1.1 million
  outpatient visits

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How We Did It

• You must maintain unwavering faith that you can
  and will prevail, regardless of the difficulties,
  and at the same time, have the discipline to
  confront the brutal facts of your current
  reality.
• Jim Collins

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How We Did It

• Faith
• Leadership commitment
• CQI Culture
• Baldrige criteria (1995)
• The vision that we could be a great organization

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Up Here, We Go By Results!
A story about a priest and a taxi driver who went
to heaven
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What flavor this month?
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The Way We Were ...

• Not striving to improve every day in every way
• Satisfied with the status quo
• Ready to rebel at the next wonderful new thing
• Needed Focus

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Constancy of Purpose
Inspiring themes are not enough to ensure the
genuine pursuit of excellence.
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The Five Principles of CQI

• Patients and other customers are our first
  priority
• Quality is achieved through people
• All work is part of a process
• Decision-making by facts
• Quality requires continuous improvement

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Refined CQI Implementation Plan
MBNQA
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Early Learnings

• Trained more people than needed
• Didnt tie team work to strategic financial
  plan
• No urgency about achieving results

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Getting to the Next Level

• Rapid-cycle improvement
• State quality award criteria
• modeled on Baldrige

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Organizational Profile Environment,
Relationships, and Challenges
2 Strategic Planning
5 Staff Focus
1 Leadership
7 Organizational Performance Results
3 Focus on Patients,Other Customers, And
Markets
6 Process Management
4 Measurement, Analysis, and Knowledge Management
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Criteria Categories

• Leadership
• Strategic planning
• Focus on patients, other customers and markets
• Information and analysis
• Staff focus
• Process management
• Organizational performance results

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Organizational Profile Environment,
Relationships, and Challenges
2 Strategic Planning
5 Staff Focus
1 Leadership
7 Organizational Performance Results
3 Focus on Patients,Other Customers, And
Markets
6 Process Management
4 Measurement, Analysis, and Knowledge Management
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Leadership Criteria Recap

• Set, communicate and deploy organizational
  values, directions.
• Balance the needs of patients and other
  customers.
• Create an environment for empowerment, innovation
  and learning.
• Ensure public responsibility above minimum
  standards.

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Know the Goal

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SSMHCs Leadership Philosophy Expectations

• Superior results in clinical, operational and
  financial performance
• Fact-based decision-making
• Involvement and shared accountability
• Customer focus
• Information sharing
• Developing people

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Gaps in Current Reality

• 1998 Began year long process to rearticulate
  mission
• Involved 3,000 employees at all levels of
  organization and at every entity
• 1999 New mission statement

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Our Mission
Through our exceptional health care services, we
reveal the healing presence of God.
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Define it
Love the mission statement ...
By the way, how do you define exceptional?
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Characteristics Of Exceptional Health Care
Services
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Leadership Learnings

• Define whats important to you as an organization
• Communicate it in meaningful ways to your key
  stakeholders
• Define expectations for leaders

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Organizational Profile Environment,
Relationships, and Challenges
2 Strategic Planning
5 Staff Focus
1 Leadership
7 Organizational Performance Results
3 Focus on Patients,Other Customers, And
Markets
6 Process Management
4 Measurement, Analysis, and Knowledge Management
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Strategic Planning Criteria Recap

• Strategic Financial Planning Process
• Develop entity goals action plans that align
  with systems goals
• Deploy goals action plans throughout facility
  to all employees
• Select use comparative and benchmark data to
  set goals

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Strategy Deployment Alignment
Mission
Exceptional Health Care Services
Network Plan
Entity Plan
Department Plan
Employee Goals
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Key Strategic Challenges

• Our key strategic challenges are
• Patient safety
• Nursing shortage
• Increasing financial pressures, including
  capital investment costs and declining
  reimbursement
• Growing customer expectations

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Strategic Planning Tools

• Strategic Financial Planning Process
• Minimum data set
• External internal assessments
• Competitive assessment
• Comparative data
• Scenario planning
• HR planning
• Performance indicator reports
• Passport Goal Posters

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• Deploying the Plan

• Departmental Posters
• Passport Program

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Plan Alignment
Entity Level
IP Loyalty
Drivers or KCRs
Pain Mgmt.
Response
Department Level
Call light response
Meds. Del. W/in X min. of order
Pain assessed per pain scale
Individual Level
I will ask if there is anything else 100 of
time
I will respond in X min.
I will assess 1X/shift/pt
I will respond in X minutes
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Strategic Planning Tools

• Comparative Data
• Competitive Data
• Information from other organizations/sources on
  relative performance
• Benchmark Data
• Best practice
• Best in class performanceUsed to set goals and
  objectives to assess performance level

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Strategic Planning Learnings

• Link whats important to you as an organization
  in your SFPP
• Achieve cascading alignment in goal setting
• Address strategic challenges
• Integrate plan with HR and suppliers
• Communicate it in meaningful ways to your key
  stakeholders

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Organizational Profile Environment,
Relationships, and Challenges
2 Strategic Planning
5 Staff Focus
1 Leadership
7 Organizational Performance Results
3 Focus on Patients,Other Customers, And
Markets
6 Process Management
4 Measurement, Analysis, and Knowledge Management
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Patients, Other Customers Markets Criteria
Recap

• Understand requirements, expectations and
  preferences of all customers.
• Monitor and analyze satisfaction data
• Systematically build relationships with customers

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Patients, Other Customers Markets Key
Questions

• Whom do you serve?
• What do they want from you?
• How do you know?

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Patients, Other Customers Markets

• Key Customers
• Patients their families (IP, OP, ED, HC, LTC)
• Key Partners
• Physicians
• Key Staff
• Employees
• Other Stakeholders
• Payors
• Suppliers/Vendors

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Patients, Other Customers Markets Leadership
Role

• Monitor and analyze satisfaction data
• Examine what drives satisfaction
  dissatisfaction
• Build relationships with customers
• Use complaint management process as another
  listening learning post

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Impact Analysis
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Key Customer Requirements
Good
Source Physician Satisfaction Survey
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Inpatient Loyalty
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Patients, Other Customers Markets Learnings

• Clarity around definition of customer
• Customer segmentation
• Better use of listening and learning posts
• Standardized complaint management process

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Organizational Profile Environment,
Relationships, and Challenges
2 Strategic Planning
5 Staff Focus
1 Leadership
7 Organizational Performance Results
3 Focus on Patients,Other Customers, And
Markets
6 Process Management
4 Measurement, Analysis, and Knowledge Management
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Information Analysis Criteria Recap

• Establish good measures of effectiveness for
  action plans
• Closely monitor performance results
• Analyze performance data
• Look for correlations
• Identify key drivers of results
• Select use benchmarks/comparative data

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Performance Management Process
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Cascading Indicators
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Performance Indicator Report
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Information Analysis Learnings

• Balanced set of measures
• Measure whats important
• Monitor what you measure
• Use of in-process measures
• Do it real time anticipate changes
• Use comparative data
• -If you want to be the best, then compare
  yourself to the best

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Organizational Profile Environment,
Relationships, and Challenges
2 Strategic Planning
5 Staff Focus
1 Leadership
7 Organizational Performance Results
3 Focus on Patients,Other Customers, And
Markets
6 Process Management
4 Measurement, Analysis, and Knowledge Management
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Staff Focus Criteria Recap

• Develop HR plan Recruit/Retain
• Motivate staff to contribute to full potential,
  to develop learn, to be innovative and creative
• Provide education, training work design that
  supports goals action plans

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Challenge Nursing Shortage

• By 2010, its estimated there willbe a shortage
  of 1 million nurses.

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Response Shared Accountability

• Places authority with nurses

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Shared Accountability Nursing Turnover as of
August
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Systemwide Nursing Turnover
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Systemwide Employee Turnover
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Leadership Development Process
Conduct 360 Feedback
Compare Feedback to Expectations
Complete Review Process
Develop Next Years Plan
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Staff Focus Learnings

• Integration with Strategic Planning
• Preparing the organization to address human
  resource issues
• Evaluation of effectiveness
• Recruitment
• Hiring
• Training

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Organizational Profile Environment,
Relationships, and Challenges
2 Strategic Planning
5 Staff Focus
1 Leadership
7 Organizational Performance Results
3 Focus on Patients,Other Customers, And
Markets
6 Process Management
4 Measurement, Analysis, and Knowledge Management
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Process Management Criteria Recap
Health Care Delivery Processes
Business Processes

• Physicians
• Suppliers

• Admit
• Assess
• Treat
• Discharge

Support Processes

• Finance
• Human Resources
• Facilities Management
• Information Systems

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Health Care Process Care Delivery Model
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Health Care Process Examples

• Care Delivery/Treatment
• Lab Accuracy, Timeliness
• Repeat Rates, TAT, Satisfaction Survey
• Pharmacy Accuracy
• Dangerous Abbreviations, ADE
• Surgical Service Competence, Communication
• SS Infection Rate, Periop Mortality, Family
  member communication

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ED LoyaltySt. Joseph Health Center, St. Charles
Direction of arrow Good
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CQI Model Process Design Approach
Plan
Do
Check
Act
Plan
Identify Opportunity
Conceptual Design
Standard- ization
Implement New Process
Future Plans
Analysis
Results

• Team members?
• Process to design?
  
• Why process chosen?
• How links to SFP?
• Identify benchmarking opportunities

• What other changes could improve process?
• How can team improve to work more effectively in
  the future?

• Initial results meet or exceed customer needs?
• Results demonstrate new process' ability to meet
  or exceed customer needs?

• Methods to be used to make new process permanent?
• How can team's work be shared with others across
  the system?

• Implement new process
• How to change process if not meeting customer
  needs?

• How design to avoid problems?
• How can the impact of problems on customers be
  reduced?
• Indicators designed into process to measure
  performance?

• Customers' expected outcomes?
• "Best way" to meet customer needs?
• Research from other organizations?

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Clinical Collaboratives

• Teams meet, compare data
• Goal realize 50 improvement within six months
• Improve the quality and value of patient care
• Create a network of clinical experts
• Foster organizational learning

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Achieving Exceptional Safety of Orders With
Dangerous Abbreviations
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Process Management Learnings

• Importance of clearly identifying your key health
  care, business and support processes
• Better involvement of suppliers in improving key
  processes
• Clearly link key processes to customer
  expectations

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Organizational Profile Environment,
Relationships, and Challenges
2 Strategic Planning
5 Staff Focus
1 Leadership
7 Organizational Performance Results
3 Focus on Patients,Other Customers, And
Markets
6 Process Management
4 Measurement, Analysis, and Knowledge Management
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Results Criteria Recap

• Patient/Customer Satisfaction
• Financial and Market
• Staff and Work System Results
• Organizational Effectiveness

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Overall Operating Margin
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Organizational Performance Results Learnings

• Define measure what is important
• Measure for effectiveness
• Set monitor in-process (leading) outcomes
  (lagging) indicators
• Identify drivers to process improvement to
  continuously improve results

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What We Learned

• Six major learnings
• Baldrige criteria is a business model
• Focus on whats truly important
• Measure what we say is important
• Measure for effectiveness, not activity
• Use comparative data to set goals
• Institute a consistent deployment process

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Benefits of Baldrige

• Focus clarity
• Who What - How
• Discipline - systematic approach to improvement
• A D - R
• Measurement orientation
• Overall Process-level
• Effectiveness versus activity

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Implementing A Quality Culture
We are, or become, those things which we
repeatedly do. Therefore, excellence can become
not just an event, but a habit.
Albert Einstein
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SSM Health Care 2002MBNQA Recipient
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Contact Information
E-mail Baldrige_at_ssmhc.com
Paula J. Friedman Corporate Vice President
Systems Improvement [phone] Paula_Friedman
_at_ssmhc.com