1. Being remarkable from the boardroom to the bedside

    March 31, 2017 by ahmed

    HILL-COUNTRY

    Originally posted on Blogrige by Dawn Marie Bailey

    “Remarkable” means extraordinary, uncommon, worthy of notice or attention, unusual.

    Would you use that word to describe your place of work? How about your hospital? Now imagine how much more confidence you would have in your health care provider if it had proven itself to be extraordinary or remarkable.

    Baldrige Award recipient Hill Country Memorial continues to work toward being remarkable every day, with continuous improvements in the care it provides and in all areas of its operations.

    At the upcoming 29th Annual Quest for Excellence® Conference, Dr. James R. Partin, chief medical officer at Hill Country Memorial, will be presenting on the hospital’s “journey from good to remarkable” and on how other organizations might learn to make their operations remarkable, too.

    In a virtual interview, Partin shared with me Hill Country Memorial’s journey.

    What makes Hill Country’s journey remarkable?

    I think what makes Hill Country’s journey remarkable is the focus on improvement at all levels of the organization; from the boardroom to the bedside, each individual is committed to providing the highest quality of care and service to our patients and community. Another key has been our ability to integrate Baldrige into our day-to-day operations. We don’t “do Baldrige,” but rather we look at our processes and determine how we can revise/improve them to meet the Baldrige Criteria [found within the Baldrige Excellence Framework] and improve performance.

    Can you share an example of your success along the journey?

    One of our biggest successes along the journey was in the deployment of our strategic plan. We integrated this deployment into our cascade of strategic goals through department goals to support the strategic targets and individual employee quarterly coaching plans; these plans address how each employee implements action plans to help his/her department achieve departmental goals that roll back up to achievement of strategic goals.

    Another success is our implementation of the Strategic Breakthrough Improvement (SBI) Process. This process includes 90-day, interdisciplinary, organizational-level improvement teams that work on strategic action plans. Through the SBI and cascading goal processes, we have improved achievement of strategic targets from approximately 50% annually to 85% annually.

    What are your top tips for using Baldrige resources to support such a journey?

    • Don’t make Baldrige another thing you are doing. Rather, look at your processes and determine how you can improve them to address the Baldrige Criteria.
    • Share results with all stakeholders. Let people know how the work they are doing is helping the organization achieve its goals.
    • Involve physicians in improving key processes within the organization.

    What else might participants learn at your conference session?

    The most striking example of how Hill Country Memorial has continued to use the Baldrige Excellence Framework is in the Strategic Development Deployment Process. We continue to use the process and timeline to define our strategy annually for managing our strengths and improving our weaknesses to meet the changing health care environment, increasing competition, and the ever-changing payment models.

    What are a few key reasons that organizations in your sector can benefit from using the Baldrige Excellence Framework?

    The Baldrige framework

    • provides an organizational approach to improvement that is balanced;
    • helps an organization focus on key results and the processes that support those results, really honing in on important improvement opportunities; and
    • uncovers gaps/opportunities that staff may not know existed in the organization.

  2. When kindness and compassion are part of a disruption

    October 31, 2016 by ahmed

     

    Originally posted on blogrige by Dawn Marie Bailey

    If you are dissatisfied with your health care, can you get some money back? And if a health care organization was giving a money-back guarantee, how would you feel about its willingness to stand behind its services?

    The article “It Pays to be Kind at Geisinger” describes an interesting new model at Geisinger Health System in Danville, Pa., for which Baldrige Award recipient AtlantiCare is now part. Since August 2016, Geisinger has paid more than $400,000 in refunds to patients “whose experiences and expectations were not met with kindness and compassion.” Under the ProvenExperience initiative, patients can request refunds, from as little as $1 to more than $2,000, if they are dissatisfied with their hospital experience.

    “The effort is to do it right for every patient every time,” said System President and CEO Dr. David Feinberg in the article. “Just like any legitimate or ethically sound business, you back your product. Except I think the stakes are higher. You want to reduce human suffering and promote good health. That’s a pretty important product.”

    According to the article, he added, “The way I see it, if you go into Starbucks and you’re not happy with your order, they don’t sip your latte and argue that they made it correctly. They just take care of you on the spot. . . . What matters to me is that every patient is satisfied with their treatment and so I started thinking, ‘What is our guarantee? What is our refund?’”

    This initiative is a disruptive event for the organization. As Feinberg says in the article, “We need to be disruptive to move the practice of providing a great patient experience forward and so the decision was made to give unsatisfied patients their money back.”

    The Baldrige core value Organizational Learning and Agility supports disruptive events that can be triggered by innovative technologies or service introductions, economic upheaval or stress, major weather events, or social or societal demands.

    Such an initiative may not be right for your organization, but have you thought about what disruption might change things in a beneficial direction for you?

    For this health care organization, I see the ProvenExperience approach being supported in item 3.1 Voice of the Customer within the Baldrige Excellence Framework (Health Care), which includes the Baldrige Health Care Criteria for Performance Excellence. This item is all about determining patient and other customer satisfaction and engagement, including (1) how listening methods differ among types of patients and other groups and (2) how measurements capture actionable information that can be used for securing patients’ engagement in the long-term. From the article, we don’t have information on what feedback the organization received from its patients and other customers to lead to the approach, deployment, learning, or integration of the ProvenExperience process, but we can deduce that it might certainly be part of a step toward securing patients’ engagement in the long-term.

    An organization embarking on an approach to secure patient and customer loyalty and engagement might also check out Criteria item 1.1 Senior Leadership that considers the importance of creating a workforce culture that delivers a consistently positive experience for patients and other customers and that fosters customer engagement. Such a culture would be absolutely necessary to ensure that every patient or customer experience is met with kindness and compassion.

    In addition, the Baldrige core value Patient-Focused Excellence and Organizational Learning and Agility supports such an approach and provides guidance on what an organization may need to consider to be successful:

    Your patients and other customers are the ultimate judges of your performance and the quality of your health care services. Thus, your organization must consider all features and characteristics of patient care delivery . . . and all modes of customer access and support that contribute value to your patients and other customers. Such behavior leads to patient and other customer acquisition, satisfaction, preference, and loyalty; positive referrals; and, ultimately, the ongoing success of your business. . . . An additional factor is your organization’s management of patient and other customer relationships, which helps build trust, confidence, and loyalty.

    So what disruption might spur your organization or your industry to consider a new way to secure customers’ long-term engagement and loyalty?


  3. A “Best Place to Work” with a culture of caring

    October 19, 2016 by ahmed

     

    Originally posted on Blogrige by Christine Schaefer

    It may not surprise anyone that Baldrige Award-winning Sutter Davis Hospital is on the 2016 list of “Best Places to Work in Health Care” recognized by Modern Healthcare. The 2013 Baldrige Award recipient has made its “Culture of Caring” the foundation for excellent results in all key areas. In fact, the high-achieving hospital considers its Culture of Caring to be its core competency.

    Following are highlights from the profile of Sutter Davis Hospital on the Baldrige Performance Excellence Program’s website:

    • The Culture of Caring is reinforced through senior leaders’ dedication to safe patient care, an engaged workforce and the community. Annual goals and action plans create accountability for the delivery of a consistently positive patient experience. This accounts for the hospital’s solid clinical quality ratings and outcomes and its strong position as a preferred place to work and practice medicine.
    • Sutter Davis Hospital demonstrates high standards for work and process efficiency. For example, the average door-to-doctor time in emergency has decreased from 45 minutes in 2008 to 22 minutes in 2012, well below the California benchmark of 58 minutes.
    • An organizational focus on people is reflected in Sutter Davis Hospital’s employee satisfaction and engagement scores, which exceed the top 10 percent of marks in a national survey database. Physician satisfaction shows sustained improvement over the past three years, increasing from 80 percent to 90 percent, and attaining Press Ganey top 10 percent performance in 2011 and 2012.
    • Measures of workforce climate at Sutter Davis Hospital exceed targeted goals of Sutter Health (the parent organization). Employees have rated workforce health, safety and security at 100 percent from 2008 to 2012. Employee perceptions of safety exceed national top 10 percent benchmarks as measured in the hospital’s annual Culture of Safety survey.

    How Sutter Davis Hospital builds an effective and supportive workforce environment and engages its workforce to achieve a high-performance work environment (the basic requirements of category 5 of the Baldrige Health Care Criteria for Performance Excellence) are described in a summary of the organization’s 2013 application for the Baldrige Award, which is publicly available on the Baldrige Program website.

    As that document indicates, benefits for Sutter Davis Hospital employees have included discounted daycare, tuition reimbursement, employee discounts at health clubs and amusement parks—and health insurance that expanded to include pet insurance and identity theft coverage based on employee feedback

    In the following excerpt, Sutter Davis Hospital (SDH) describes five approaches supporting its winning culture:
    Organizational Culture. SDH fosters an organizational culture characterized by open communication, high performance, an engaged workforce and ensures our culture benefits from the diversity of our workforce via the following mechanisms:

    1. CULTURE OF CARING classes: Quarterly, all new workforce members at SDH attend the CULTURE OF CARING class. This four-hour class orients new employees to the Sutter Davis Difference, including the Mission, Vision, and Values (MVV), STANDARDS OF BEHAVIOR, professionalism, patient satisfaction, and key resources for the workforce.
    2. Just Culture: The Just Culture process was instituted after receiving the results from our Culture of Safety survey. The Just Culture Algorithm systematically allows us to identify needed process improvements, hold employees accountable for their choices while at the same time encouraging an open learning culture. It shifts the focus from errors and outcomes to system design and behavioral choices.
    3. Round the Clocks: In order to further deploy the Sutter Davis Difference and MVV to all workforce members and to ensure SDH is communicating at all levels; the ATeam schedules quarterly Round-the-Clocks to meet with the workforce. All shifts are visited in Round the Clock meetings, during which the A Team focuses on rewarding and recognizing success, engagement and communicating key messages. In addition, volunteers receive information at least semiannually through the Volunteer Update Meeting.
    4. Interdisciplinary Practice Councils (IPCs): The IPCs allow the workforce to contribute their diverse ideas, skills and abilities to improve the workforce and patient’s experience. Open communication in the IPCs creates a work environment that promotes respect, sharing common goals, and having a voice in patient care and work environment decisions.
    5. All Staff Assembly: As a cycle of improvement, SDH began inviting all workforce members, to an annual All Staff Assembly. In a three-hour session designed to be informative, engaging, inspiring and entertaining, A Team members deploy messages related to the Sutter Davis Difference, the MVV, the Strategic Planning Process, the DASHBOARD and PILLAR performance.

  4. Bringing a systems approach to U.S. population health

    September 20, 2016 by ahmed

     

    Originally posted on BlogrigeB by Christine Schaefer

    Our proposed framework would improve how we monitor and manage health for the U.S. population. Essentially, it translates the Baldrige framework to address U.S. population health.”, Julie Kapp

    Every year a new cohort of Baldrige Executive Fellows gains intensive knowledge about leading organizations to excellence through cross-sector, peer-to-peer learning hosted at the sites of Baldrige Award recipients. Every Baldrige Fellow completes a capstone project as part of the executive leadership program.

    A paper on the capstone project of Julie M. Kapp, MPH, PhD, a 2014 Baldrige Fellow, is being published this month in Systems Research and Behavioral Science. Kapp is an associate professor in the Department of Health Management and Informatics at the University of Missouri School of Medicine in Columbia, MO.

    Following is an interview of Kapp about the publication of the Baldrige-based approach to U.S. population health.

    What inspired your capstone project?

    This publication A Conceptual Framework for a Systems-Thinking Approach to U.S. Population Health was inspired by the work I have done up to this point in my career within the health care sector, as well as within the education sector and with community-based organizations.

    In my past role as the executive director of the Partnership for Evaluation, Assessment, and Research at the University of Missouri in St. Louis, I met with dozens of community-based organizations that were putting their passions to work for the greater good of the St. Louis area. At that time, within the St. Louis area, 4,076 organizations were registered with the Internal Revenue Service as tax-deductible charitable organizations. Those organizations span sectors and multiple programmatic areas, such as education, public health, crime prevention, mental health, and community development. Many work with area school districts or to improve economic stability.

    Despite the vast number of organizations actively focused on such issues in and around struggling areas of St. Louis, much work needs to be done to strengthen their capacity, readiness, and use of strong evaluation planning and evidence-based decision making to ensure effective results for the betterment of the region.

    This challenge isn’t specific to St. Louis, and a movement around the country encourages a collective impact approach. This has been defined as the commitment of cross-sector organizations toward a common goal, with five conditions for success identified as (1) a common agenda; (2) a backbone support organization; (3) mutually reinforcing activities; (4) shared measurement systems; and (5) continuous communication (see J. Kania and M. Kramer, Stanford Social Innovation Review, 2011).

    The more deeply I became involved—and after I transitioned to my current role at the School of Medicine at the University of Missouri in Columbia—the more I came to believe that the five conditions listed above for collective impact are not enough. To improve the effectiveness of how community-focused organizations address health and other issues, we must change their funding requirements. To change their funding requirements on a broad scale requires change at the federal level. Therefore, what is required is a systems approach. This is a key way in which my proposed framework reflects the Baldrige Excellence Framework.

    What were the milestones of your project? Did you receive any key feedback from sharing your capstone progress with other Baldrige Fellows?

    The entire experience was exceptionally beneficial. The chemistry and collegiality among our cohort of Baldrige Fellows elevated the experience even further. I learned so much from each of them, and from the leadership—Bob Fangmeyer [Baldrige director], Harry Hertz [Baldrige director emeritus], Bob Barnett [Baldrige Fellows executive in residence], and Pat Hilton [Baldrige Fellows program manager].

    Dr. Steven Kravet, president of Johns Hopkins Community Physicians, co-authored the paper, contributing his physician’s perspective as well as his perspective as another Baldrige Fellow.

    What is your vision for how this capstone project is improving/has improved something significant at your organization? Could you please describe any results or impacts so far?

    Our proposed framework would improve how we monitor and manage health for the U.S. population. Essentially, it translates the Baldrige framework to address U.S. population health, with two overarching recommendations: (1) drive a strategic outcomes-oriented, rather than action-oriented, approach by creating an evidence-based, national reporting dashboard; and (2) improve the operational effectiveness of the workforce.

    The current infrastructure is fragmented and misaligned. A 2013 National Research Council and Institute of Medicine report identifies how the United States has for decades lagged behind our high-income peer countries on a number of health indicators, including life expectancy. To reduce this U.S. health disadvantage through system-level change, we must begin to align and integrate and be able to visually display health and health care organizations’ shared metrics; allocated dollars on shared metrics; programs and activities on shared metrics; progress reports on shared metrics; and evidence-based and effective practices on shared metrics.

    With the publication of this framework, I hope to distribute it to as many key stakeholders that impact U.S. health as possible, including researchers, leaders of federal agencies, national organizations, and legislators. It is relevant to the secretary of the U.S. Department of Health and Human Services; Agency for Healthcare Research & Quality; Centers for Disease Control and Prevention; National Research Council; U.S. Surgeon General; AcademyHealth; National Academies of Sciences, Engineering, and Medicine; Centers for Medicare and Medicaid Services Innovation Center; state government organizations; and nonprofit organizations and foundations, among others. Next steps include beginning to operationalize the framework at the local, state, and federal levels.

    We can’t afford not to consider an aligned and integrated systems-thinking perspective for improving U.S. population health.

    What were your key learnings from the Baldrige Fellows program?

    Baldrige opened my eyes to alignment and integration, a systems approach, and feedback loops. Those concepts were apparent during our group’s visit to Advocate Good Samaritan Hospital in Downers Grove, Illinois [a 2010 Baldrige Award recipient]. It was so helpful to see what excellence looks like in operation. Good Samaritan Hospital also really brought home the message for me that having the right leadership is everything.

    The ideas that are part of the Baldrige framework are really helpful. But the real learning and growing comes when you have to do the hard work of answering the questions in addressing your particular challenge.

    Could you please share a few insights you gained from delving into the Baldrige framework during the Baldrige Fellows sessions that you can use for the benefit of your own organization?

    Yes. First, make sure you have a clear vision and can communicate it. The “why” is our reason for being. It motivates us each day.

    Second, the difference between success and failure is in the “how.”

    Third, being transparent in sharing data and action plans and progress on metrics goes a long way to build trust in an organization’s leadership and confidence in a process.

    Finally, stay the course. Don’t lose faith.

    Could you please describe the value/benefits you see of the Baldrige framework to your sector?

    Health care organizations are familiar with the Baldrige framework [which includes the Health Care Criteria for Performance Excellence], but it is not used widely enough. And as of now, the discipline and implementation of approaches to U.S. population health are not reflecting the Baldrige framework. I hope our paper provides those involved with U.S. population health a framework to use to move forward.

    With the 2010 Patient Protection and Affordable Care Act initiatives, the country is moving in the direction of integrating these two sectors, which is extremely challenging to do without an overarching framework. I have not yet seen anyone else [but the Baldrige Program] provide such an applied, operational framework that essentially addresses the how, the process.


  5. A bold vision for community health: Use framework to align resources, improvements

    July 31, 2016 by ahmed

     

    Originally posted on Blogrige by Dawn Bailey

    Teenage pregnancy, obesity/lack of physical activity, drug use, and student drop-out rates are all issues on which Baldrige Award recipient Charleston Area Medical Center Health System (CAMCHS) has been working directly with its community for more than 20 years, said Brenda Grant, chief strategy officer. However, such efforts to improve the population’s health weren’t always focused or forward thinking (i.e., systematic), she added during a June 2016 HealthDoers Learning Lab on Collaborative Leadership: Part III, from Population Health to Healthy Communities.

    Through her health systems’ work with the Baldrige Excellence Framework, Grant said she became aware of the Communities of Excellence 2026, a nonprofit organization that is adapting the Baldrige framework for use by whole communities “to achieve and sustain the highest quality of life for their people” and to give such community efforts a framework for improvement and alignment.

    “I have seen the Baldrige framework help us become a better organization by answering and responding to the questions [in the Baldrige Criteria within the framework] and making sure we have strong approaches to deployment, learning, and integration,” said Grant, “so I am excited about the framework being established for communities of excellence and really think that could be a guide for us as we move into the future for our community.”

    Grant said CAMCHS’s involvement in population health started by looking at the needs in the community and developing programs around those needs. In 1994, a steering committee called the Kanawha Coalition for Community Health Improvement was formed to include other county hospitals, the United Way, the school system, behavioral and family health organizations, churches, and many others. The committee’s mission is to identify and evaluate community health risks and coordinate resources. But Grant said when they started the coalition for improvement, they realized that reacting to problems was really the process for how problems would be addressed.

    “There were a lot of different people working on problems but not really in a coordinated manner,” she said. Now, the committee is moving through early systematic approaches to aligned approaches using a community needs assessment, which includes random telephone surveys, focus groups for low-income and minority populations, and targeted surveys, as well as forums where the community identifies the top issues. Using available data, the committee then comes up with 10–15 community priorities. At a community forum, education is provided on those topics, random voting is conducted, and the community selects the issues for work groups to pursue.

    Rick Norling, retired CEO of Baldrige Award recipient Premier, Inc., said such work in the community reinforces “the value of a collaboratively generated community strategic plan to pull all of these efforts together as community-based priorities.” He added that health care organizations increasingly need to move toward partnering with their communities not just for compliance but for improving population health.

    “I personally believe [a community health needs assessment and implementation strategy] can be a powerful driver for improving the health of our communities, so that’s why I really want to focus on taking the work that we’re currently doing and moving it even in a more substantial manner,” said Grant. “We have a long history of trust, working with the community. But the potential is still there to be a powerful driver for health. That’s why . . . the Baldrige journey has really been helpful for us. . . . One of the core values of Baldrige is a systems perspective that talks about managing all parts of your organization as a unified whole to achieve your mission. And that really was helpful to us internally as we looked at health care transformation.”

    Norling defined population health management as building a partnership among a health care system and members of a community. The best hospitals and health systems, he said, are building a strategy of becoming population health managers.

    “To pursue population health management, the sites of care go well beyond a traditional health system, all the way to the family home, a key site of care,” he said. “Retail pharmacy, minute clinics, grocery stores, wellness centers, senior housing, they bring a whole new dimension of complexity to the systems of care required and the need for much more collaborative leadership.”

    Norling said the Communities of Excellence (COE) criteria have been created in conjunction with the Baldrige Performance Excellence Program and are currently being piloted in communities. The first pilot is Live Well San Diego, which has been adopted by the San Diego County Board of Supervisors as its strategic plan, said Norling; over 150 community organizations have become Live Well partners, agreeing to collaborate and with the county health and human services department organizing the effort. Norling said the criteria are being implemented and improved concurrently.

    Live Well San Diego’s performance will be enhanced by adopting the criteria, and feedback from attempting to adopt those criteria will provide us feedback to improve them, said Norling, adding that other community pilots are taking place around the United States.

    “I think what’s happening in San Diego County is a pretty exciting example of what this kind of systems thinking in a community can create,” Norling said. “It would seem that hospitals and health systems should be active participants, if not the leaders in this journey, and the culture of health requires this kind of broad perspective.”

    Added Stephanie Norling, managing director, Communities of Excellence 2026, “The COE framework really represents the next logical iteration in the current population health movement. CAMCHS is a great example of a health system’s journey from clinical care to population health, and the addition of a systems-based, community-wide framework is really the next step in achieving the kind of breakthrough results we need for our communities and their residents.”

    In regards to results, which are part of any Baldrige assessment, the COE framework also brings with it the element of measurement, something new to many community initiatives. “[Baldrige] provides the opportunity for us to have the framework to respond to questions that will make us a better community. It will also help us with results,” said Grant. “One of the things that we struggle with is how do you measure community health improvement, how do we know that we really are improving. . . . Having a group of communities to benchmark [that are using the COE framework] would just be invaluable to us in the future.”