Creating a Different Future Through the Pursuit of Performance - - PowerPoint PPT Presentation

Pattie Skriba, Vice President Business Excellence

Creating a Different Future Through the Pursuit of Performance Excellence

February 2018

▪ Part of Advocate Health Care – One of the Top 15 health systems ▪ Faith-based – UCC & ELCA ▪ 300-bed community hospital (15,500 admissions) ▪ 1,600 associates, 900 physicians & 500 volunteers ▪ Level I Trauma Center (44,000 ED visits) ▪ Advanced Perinatal Services (1,800 births) ▪ Clinical strengths: Cardiology, Neurosurgery, Surgery, Emergency, Trauma, High-risk Obstetrics

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Advocate Good Samaritan Hospital

Advocate Good Samaritan Hospital

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In November 2010,

Advocate Good Samaritan Hospital was recognized with a Malcolm Baldrige National Quality Award, joining 100 other businesses, including 17 from health care, to have received this award since 1988.

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BUT GOOD SAMARITAN’S QUALITY WASN’T ALWAYS SO GOOD

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▪ Physician satisfaction was mixed ▪ Quality that was generally perceived as good ▪ Nursing Care seen as ‘uneven’ ▪ Patient satisfaction that was at best mediocre ▪ Quality medical staff of mostly ‘splitting’ physicians ▪ Technology and facilities that were increasingly perceived as slipping behind ▪ Associate satisfaction that was pretty good, but not exceptional ▪ A PHO that was struggling financially

Good Samaritan – True To Its Name – A “GOOD” Hospital

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In a Highly Competitive Market

Good Samaritan Hospital

PSA 1 (50% of admissions) PSA 2 (25% of admissions) SSA

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Why Companies Don’t Become Great

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Good is the enemy of great. And that is

• ne of the key reasons why we have so

little that becomes great. The vast majority of companies never become great, precisely because the vast majority become quite good – and that is their main problem.

• - Jim Collins (from Good to Great)

Change Versus Transformation

▪ CHANGE is about doing or having something better, different, or more with what is already possible or already exists. ▪ TRANSFORMATION is about doing what isn’t currently possible, unless or until, you change how you are BEING.

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Organizational Transformation Requires Transformational Leadership

▪ Achieve breakthrough improvement versus incremental change ▪ Make happen what would not have happened without their leadership

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Rationales for Organizational Transformation

Mission Rationale

▪ To make good on our promise to be ‘a place of healing’

Operational Rationale

▪ To create a framework for inspiring and integrating our efforts to build loyal relationships and provide great care

Strategic Rationale

▪ To differentiate ourselves and ensure future success by becoming the best place for physicians to practice, associates to work and patients to receive care

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2004

An Intentional Decision to Create a Different Future

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Moving from Good to Great

Key Steps in Transformation

• 1. Establish an inspiring vision and enroll

leaders– create ownership

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Establishing An Inspiring Vision

To provide an exceptional patient experience marked by superior health outcomes, service and value

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To BE the best place for physicians to practice, associates to work and patients to receive care

Leaders Must Go First

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▪ Leaders must first enroll themselves in the vision before others will follow. ▪ “What you are passionate about foretells your future.” (Kaiser) ▪ “Leaders get the behavior they exhibit and tolerate.” (Jim Collins)

Leadership’s Greatest Opportunity

“Changing behavior is less a matter of giving people analysis to influence their thoughts than helping them to see a truth to influence their feelings…”

• - John Kotter, The Heart of Change

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Creating Ownership

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▪ To create alignment and ownership, the Leader must routinely enroll others in the WHY of the strategy or project – context is decisive. ▪ We enroll and lead others through

• communication. Communication is the action of

Leadership. ▪ The leader’s job is to enroll, inspire and engage

• thers to voluntarily and passionately do what

the leader is asking them to do. Achieving compliance is not enough.

Key Steps in Transformation

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• 1. Establish an inspiring vision and enroll

leaders– create ownership

• 2. Create alignment and transparency to drive

improvement focus

Alignment Creates Possibility For Success

“The most successful companies, across all industries, have a cohesiveness of purpose, unity of effort, and clarity of direction that are created and driven by their leadership.”

• - Stephen Beeson MD, Sharp Healthcare

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ONE OF THE JOBS OF LEADERS IS TO MAKE AN ALIGNED AND INTEGRATED PICTURE THAT CAN BE UNDERSTOOD AND EMBRACED

Our Need for Alignment and Integration

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A BALANCED COMMITMENT TO EXCELLENCE

Associate Engagement Patient Satisfaction Physician Engagement Growth Funding Our Future Health Outcomes

A Plan to Shape Our Future

Launched Moving From Good to Great (G2G)

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Create Alignment through Cascading of Goals

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Advocate Goals / Strategy GSAM ET Determines Preliminary Goals & Targets Goal Deployment Worksheet Completed GSam Strategy Regulatory Directors Provide Input into Goals/Targets Goals/Targets Finalized Goals: Online Tracking System Organizational and Department Action Plans Created Goals Assigned to Frontline, Action Plans Defined Performance Boards

Creating Transparency

Distributed to over 300 Leaders Monthly

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Key Steps in Transformation

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• 1. Establish an inspiring vision and enroll

leaders– create ownership

• 2. Create alignment, ownership and

transparency to drive improvement focus

• 3. Deploy evidence-based practices

2005-06: Path to Achieving Operational Excellence

Deeper Deployment of Evidence-based Practices

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Leadership Development Institutes (LDIs) Goal Alignment & Accountability System Pillar Boards Leader Rounding (Associates & Physicians) Thank You Notes Physician Bookmarks Behaviors of Excellence Peer Interviewing High / Solid / Low Conversations (HSL) 5 Fundamentals of Service (AIDET) Hourly Rounding Discharge Call Manager

30% 52% 18%

Engag gaged Not t Engag gaged Activel ely y Dise seng ngag aged ed

U.S. Employee Engagement: 2016* (Gallup)

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“start not with “where” but with “who”… get the right people on the bus in the right seats and the wrong people off the bus… stick with that discipline no matter how dire the circumstances.”

Evidence-Based Practice: Peer Interviewing

Evidence Based Practice: HSL Build Culture: Differentiate Low, Solid, High Performance

to Move the Performance Curve

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L H S

By 2006, The G2G Transformation Had Achieved Breakthrough Results

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20 40 60 80 100 120

Outpatient Satisfaction

5.48 3.29

1 2 3 4 5 6 2004 2005 2006

2.70 2.62 0.85

1 2 3 2004 2005 2006

ICU Central Blood Stream Infections

Per 1,000 Device Days

0.73 0.65 0.63

0.30 0.35 0.40 0.45 0.50 0.55 0.60 0.65 0.70 0.75 0.80 2004 2005 2006

Mortality Index (Actual/Expected)

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ICU Ventilator-Associated Pneumonia

Per 1,000 Device Days

2006: At a Crossroad…

• G2G journey led to:

– Operational Excellence – Superior Outcomes – Cultural Transformation

• With Vision & Values

as our moral compass, we asked …

Innovator

MVP

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How will we achieve repeatable excellence?

A Culture of Compassionate Service

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Key Steps in Transformation

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• 1. Establish an inspiring vision and enroll

leaders– create ownership

• 2. Create alignment, ownership and

transparency to drive improvement focus

• 3. Deploy evidence-based practices
• 4. Foster a process-honoring culture

What You Don’t Know That You Don’t Know = Baldrige Opportunity

KNOW THAT YOU KNOW KNOW THAT YOU DON’T KNOW

DON’T KNOW THAT YOU DON’T KNOW

Baldrige Opportunity

“What You Know – and You Know That You Know” “What You Don’t Know – and You Know That You Don’t Know” “What You Don’t Know – and You Don’t Know That You Don’t Know”

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The Baldrige Criteria Framework

Key Steps in Transformation

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• 1. Establish an inspiring vision and enroll

leaders– create ownership

• 2. Create alignment and transparency to

support the vision

• 3. Deploy evidence-based practices
• 4. Foster a process-honoring culture
• 5. Fully deploy a performance improvement

approach

Box 1: Problem Statement Box 4 Root Cause Analysis Box 7: Completion Plan Box 2: Current State Box 5: Solutions Box 8: Confirmed State Box 3: Ideal State Box 6: Rapid Experiments Box 9: Insights

PLAN PLAN PLAN PLAN PLAN DO DO STUDY ACT

GSAM’s Performance Improvement Approach: PDSA-A3

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Create a community of problem-solvers

Key Steps in Transformation

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• 1. Establish an inspiring vision and enroll leaders–

create ownership

• 2. Create alignment, ownership and transparency

to drive improvement focus

• 3. Deploy evidence-based practices
• 4. Foster a process honoring culture
• 5. Fully deploy a performa improvement nce

approach

• 6. Build Loyal Relationships – the foundation to

accomplishment

Stakeholder Satisfaction

Stakeholder Partnership & Loyalty Created A Shift In View Regarding Stakeholders

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From To

The Breadth of Relationship

RESULTS RELATIONSHIPS

Accomplishment Triangle

ACTIONS OPPORTUNITIES POSSIBILTIES

Relationships Are the Foundation for Accomplishment

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The Breadth of Relationship RESULTS ACTIONS OPPORTUNITIES POSSIBILITIES RELATIONSHIPS

Relationships Are the Foundation for Accomplishment

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Identifying Our Core Competency of ‘Building Loyal Relationships’

with

Patients & Families Physicians Associates Volunteers

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Ambulatory Surgery

93th 90th

Emergency Department

Outpatient

72th 99th 80-89th 99th

Convenient Care

Inpatient

Building Loyal Relationships

80th

(2017)

LOYAL RELATIONSHIPS DRIVE BREAKTHROUGH RESULTS

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0% 5% 10% 15% 20% 25%

GSAM Hosp A Hosp B Hosp C Hosp D

Percent

Source: CompData

25.6% Decrease 7.4% Decrease 6.9% Decrease

17.0% Increase

8.4% Decrease

Results of Loyal Relationships

GSAM Market Share For Overlapping Markets Overall Inpatient: 2006-2011

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Transforming Our Patients’ Experience (2003-2017)

18 18 54 38 72 80 90 93 99

20 40 60 80 100

Outpatient Inpatient Emergency Amb Surg Conv Care

Patient Satisfaction Percentile (Press Ganey)

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

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20 40 60 80 100 20 40 60 80 100 Rate of Improvement Performance

Creating a Culture of Patient Safety

100th Percentile for Patient Safety Source: Thomson Reuters 2004-2008

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0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 0.80 0.90 1.00

JAN-12 MAR-12 MAY-12 JUL-12 SEP-12 NOV-12 JAN-13 MAR-13 MAY-13 JUL-13 SEP-13 NOV-13 JAN-14 MAR-14 MAY-14 JUL-14 SEPT-14 DEC-14 MAR-15 MAY-15 JULY-15 SEPT-15 NOV-15 JAN-16 MAR-16 MAY-16 JULY-16 SEPT-16 DEC-16 MAR-17 MAY-17 JULY-17 SEPT-17 NOV-17

MORTALITY INDEX (OBSERVED/EXPECTED)

ROLLING 12 MONTHS

GOOD

GSAM Mortality Index

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Approximately 276 Patients Walk Out of GSAM That Were Not Expected To Live 90th Percentile

0.87

Top 10% In American Hospitals

0.79

Jan 2012 Dec 2017

National Recognition for Excellence

2009, 2011 - 2016

2008 through 2016

2012 through 2018 2006 through 2018 GSAM Health & Wellness Center 2017

Rev 01/31/2018

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All of Us Face Challenging Times

“The dominant pattern of history isn’t stability, but instability and disruption. Those

• f us who came of age amidst stable

prosperity in the second half of the 20th century would be wise to recognize that we grew up in a historical aberration. …instability is chronic, uncertainty is permanent, change is accelerating, disruption is common, and we can neither predict nor govern events. … there will be no “new normal.” There will

• nly be a continuous series of “not normal”

times.”

Final Thoughts…

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Sustaining Performance Excellence in a Continual Series of ‘Not Normal Times’ Requires…

A Conscious Choice… & Discipline

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“Greatness is not a function of circumstance. Greatness, it turns out, is largely a matter of conscious choice, and discipline. We are not imprisoned by our circumstances. We are not imprisoned by the luck we get or the inherent unfairness

• f life. We are not imprisoned by crushing setbacks, self-

inflicted mistakes or our past success. We are free to choose, free to become great by choice.”

• - Jim Collins (from Great By Choice)

Because… we never forget the real purpose of our work….

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May your holiday be decorated with the most precious of gifts & your New Year rich with love.

Happy Holidays from Joe, Nicole & Jack Stevens

B

lessed.

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Th Thank ank You

• u

Pattie Skriba, VP-Business Excellence Advocate Good Samaritan Hospital Downers Grove, Illinois Pattie.skriba@advocatehealth.com