Why Baldrige as a Quality Platform? Presented to: The Quality Colloquium On the Campus of Harvard University August 25, 2004 Robert J. Harriman, PhD V.P., Quality Improvement and Patient Safety Baptist Hospital, Inc. rharriman@bhcpns.org L. Craig Miller, M.D., FCCP Sr. V.P., Medical Affairs Baptist Health Care Pensacola, Florida cmiller@bhcpns.org 1
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Seven Categories of the Health Care Criteria 1. Leadership 2. Strategic Planning 3. Focus on Patients, Other Customers, and Markets 4. Measurement, Analysis, and Knowledge Management 5. Staff Focus 6. Process Management 7. Organizational Performance Results 3
Journey to Performance Excellence No Secrets Began in 1995 Commitment to Performance Excellence Benchmark Best Practices Customer Satisfaction Teams 4
Journey to Performance Excellence Real Time Accountability Non-Negotiable Negotiable Results Leadership Development Never Stop Learning 5
BAPTIST HEALTH CARE Culture of Quality FINANCIAL PILLARS OF EXCELLENCE PEOPLE SERVICE GROWTH QUALITY BALDRIGE CRITERIA FOR EXCELLENCE VISION INNOVATION VALUES SUPERIOR SERVICE STEWARDSHIP MISSION To provide superior service based on Christian values to improve the quality of life for the people and communities served TEAMWORK INTEGRITY 6
1. Leadership Senior Leadership Direction Empowerment, Innovation and Agility Key Performance Measures; Improving Leadership System & Effectiveness Support of Key Communities and Community Health 7
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Pillars of Operational Excellence 9
Key Components Achieving Extraordinary Levels of Service and Operational Excellence Mission Vision Values Employee Patient Satisfaction + Satisfaction + Leadership Development Actions that Support Service and Operational Excellence Hardwiring Success Standards of Performance Behavioral Based Interviewing Peer Interviewing Communication Boards Employee Forums Administrative Rounding Bright Ideas Reward & Recognition Service Excellence Teams Weekly Patient Satisfaction Tracking Scripting Patient Communication Boards Nurse Leader Rounding Nurse Discharge Calls Service Recovery Leadership Core Competencies Leadership Development Training Cascade Learning Daily Line Up Best Practice Sharing Systems of Accountability 90 Day Plan 360 Degree Feedback Pillars of Excellence Leader Report Cards CARE & BAR reports Performance Evaluation Satisfaction Feedback System 10
2. Strategic Planning Strategic Planning Process Process Considerations Action Plan Development/Deployment Short and Longer Term Action Plans 11
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Methods Used in Alignment of Strategic Planning 13
3. Focus on Patients, Other Customers and Markets Patient/Customer and Health Care Market Knowledge Patient/Other Customer/Market Segments Listening/Learning and Using Patient/Customer Requirements Patient and Other Customer Relationships and Satisfaction 14
Listening & Learning 15 Customer Snapshot L&L Activities
Listening and Learning Activities 16
Customer Snapshot 17
4. Measurement, Analysis and Knowledge Management Data Gathering/Alignment to Support Operations and Decision Making Information and Knowledge Management 18
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DATA BHI S SYSTEMATIC APPROACH INFORMATION (Alignment) KNOWLEDGE (Deployment) Solucient Action Solucient Explore Benchmarking Visits Bright Ideas CaduCIS Direct Feedback Staff and Partners EIS (Executive Information System) Employee Exit Interview Employee Forum Evaluation Form Employee Surveys Florida Cancer Data System HealthSource (24 hour call program) HIS (Hospital Information System) MIDAS (Medical Information Data Access System) Physician Action Line Press, Ganey and Associates Sperduto Teams TrendStar VHA Southeast Leader Performance Evaluation (y) 90-Day Action Plan (q) StopLight Report (q) BAR (Financial/H.R. Indicators) (m) CARE Report (Clinical Indicators) (m) Nursing Report Card (m) Responsibility Report (m) Productivity Report (bi-w) 360 0 Feedback Survey (bi-y) Patient Satisfaction Reports (w) HPAR (q) Physician Satisfaction Reports (y) Financial Statements (m) Board Reports (m) Financial Focus Packets (m) Traditions (Employee Orientation) Physician Orientation Serv-U (90 days following Traditions) Daily Line-Up (aka Baptist Daily) Daily Rounds Communication Boards Employee Forums Inside Baptist (Intranet) Standard of the Month Firestarter Meetings Department Head Meetings Baptist University Colleges of Performance Excellence College of Clinical Excellence College of Leadership Development Physician Leadership Development Medical Staff Meetings/Retreat Board of Directors Meetings/Retreat Informal, Intentional Deployment ACTION (Review/Refine) DASHBOARD This systematic approach reflects how, through fact-based management and extensive organizational learning and sharing, we align and integrate our performance with our organizational needs. This provides a strong foundation for use in refining and continually improving our performance. 21
5. Staff Focus Organization and Management of Work Effective Communication and Skill Sharing Staff Performance Management System Recruiting, Hiring Retaining Staff Staff Education, Training and Development Staff Well-Being and Satisfaction 22
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6. Process Management Key Health Care Services and Processes Process Performance Improvement Key Support and Business Practices 25
Service Design Process Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Conception Feasibility Approval Plan for Implementation Implementation Evaluation Idea Generation / Screening Concept Development Financial Productivity Cycle Tune Volume Regulatory Capital Sourcing Senior Leaders and, if necessary, Board Create a Team Develop Strategies and Goals Develop Action Steps Develop Monitoring and Evaluation Targets Develop Exit or Decline Strategy Execute Plan Evaluate and Monitor Actual Performance to Goals Develop Corrective Action Plans if necessary 26
EBCI Process 27
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7. Organizational Performance Results Health Care Results Patient/Other Customer-Focused Results Financial and Market Results Staff and Work System Results Organizational Effectiveness Results Governance and Social Responsibility Results 29
High Employee Morale 90 80 70 60 50 40 30 20 10 0 1996 1997 1999 2001 2003 Actual Industry Average Best in Class 30
Low Employee Turnover 17.0% 16.0% 15.0% 14.0% 13.0% 12.0% 11.0% 10.0% 2000 2001 2002 2003 31
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Patient Satisfaction Correlated to Employee Morale Patient Percentile 100 80 60 40 20 0 90 80 70 60 50 40 Employee Morale Mar Dec Sep Jun Mar Dec Sep Jun Mar Dec Sep BH %-tile BH Employee Morale 34
Baptist Hospital, Inc., Results Clinical Quality Pillar Pressure Ulcers % of ADC FY 98 FY 99 FY 00 FY 01 FY 02 FY 03 Actual Target Hospital Average Best in Class 35
Infection Prevention Results SINU Ventilator Related Pneumonia 12 10 8 6 4 SINU 2 0 2000 2001 2002 2003 36
IHI Critical Care Collaborative Cost Results 25 20 15 10 SINU Cost Hospital Cost 5 0 April May June July August 37
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Physician Satisfaction Survey Active Physicians (n=139) Overall Satisfaction with Primary Hospital Quality of Emergency Department Quality of Medical Records Quality of Laboratory Services Quality of Radiology Services Quality of Nursing Staff Top 2 Ratings 2001 2003 80%* 90% 67% 93% 78% 79% 82% 92% 80% 96% 75% 93% Quality of Pharmacy 82% 96% *Ratings of 4 or 5 (Completely Satisfied or Very Satisfied) 39
Outcome Profile at Baptist Hospital Standardize Variation % Diff from Predicted 1999 2003 3% 2 1 0-1 -2-3 Mortality Morbidity Complications Yr. 1999-2000: 12,253 IP Case Case Mix Index: 1.62 Yr. 2002-2003: 13,124 IP Case Case Mix Index: 1.72 Significant at 90% confidence level 40
Baptist Hospital, Inc., Results Financial Performance Pillar Net Days in Accounts Receivable Days 1999 2000 2001 2002 2003 BHI Moody's Medians 41
Baptist Hospital, Inc. Results Growth Pillar Net Patient Revenue 1999 2000 2001 2002 2003 BHI Moody's Medians 42
Summary Make Patient-Defined Quality and Value the Strategy Convey the Vision Measure Performance at the Whole- System Level Assure Cooperation across the Continuum 43
Conclusion In times of change the learner will inherit the earth while the learned find themselves wonderfully equipped to live in a world that no longer exists. Eric Hoffer (1902-83) 44