“a quest for quality….the business case” chris boldt, operations vp steven chies, sr. vp for...
TRANSCRIPT
“A Quest for Quality….The Business Case”
Chris Boldt, Operations VPSteven Chies, Sr. VP for Operations
Benedictine Health System
2011 AHCA/NCAL Quality SymposiumFebruary, 2011
The Frequent Questions:
Why did BHS adopt quality process?
How did you achieve six (6) AHCA Gold Quality Awards?
Benedictine Health System - Today
• BHS owns and/or manages more than 70 LTC facilities on 40 campuses across 7 states
• BHS Profile▪ 4,000 NF Beds
▪ 2,000+ Housing with Services/ Assisted Living Suites
• 6,000+ Employees
Core Values
• Hospitality
• Stewardship
• Respect
• Justice
Vision
Creating Benedictine Living Communities where health, independence and choice come to life.
Creating a Quality Culture• Leadership…commitment, passion from the top• Foundational elements…mission, vision, values• The LTC Quality Story…and baggage!• The long, long run…
What do we know as factual?
• Perception of quality is poor• Demographics are changing• Dementia diagnosis is increasing• Boomers have different expectations• Governmental commitment is waning• Understanding of need is poor• Current product line is aging• Unexpected events will impact society• All politics and health care is local
Quality in Long Term Care
• The perception of the American public of the quality of care and quality of life in a “nursing home” is extremely poor.
• The vast majority of Americans do not want to go to a “nursing home”.
• They believe they are places we go to die and lose our independence and dignity.
What is the public perception?
• 95 % Question• Do you want to go to a nursing home?
Implications of Quality Perception:
• Guilt and Fear of individuals and families
• Demand for Quality Improvement
• Regulatory Reaction – More is Better
• Poor regulatory compliance – More Surveyors
• Media Coverage of poor compliance
• Poor compliance – litigation opportunities
• Greatest Generation (1905-25) 50 Million
• Silent Generation (1926-45) 35 Million
• Boomer Generation (1946-1964) 77 Million
• Xer Generation (1965-1982) 65 Million
• Millennium Generation (1983-02)80 Million
Implication of Demographics:• Fewer people….more competition
• Fewer tax payers….more competition
• More competition for client
• Product line need to meet expectations
• Need for process enhancement
Implications for Government Payment:
• Cannot rely on stable source• Personal Responsibility will prevail• Pay for Performance• Expectation of Improved Outcomes
Dr. Donald Berwick
• Challenge Providers to:▪ Reduce Resources by
10% without:• Single instance of harm
• Without rationing care
• Without excluding services
• Knowledge of Quality
• Understands Data
• Expectation of Performance
BHS Leadership Systems
• Solid Governance
• National leaders in long term care on staff
• Systematic meetings to share, learn and plan among all levels of employees
• BHS Leadership Institute
• Ongoing leadership communication
• Compliance and risk programs
Benedictine Framework for Performance Excellence
2 Strategic PlanningStrategic Planning and Deployment Model
3 Customer and Market Focus Satisfaction Surveys Compliant Management
4 Measurement and Analysis Dashboard
Staff Focus 5Service StandardsMission and Values Survey
Process 6ManagementP-D-C-A Care Processes Support Processes
Organizational Results 7 Dashboard
1Values-Centered
LeadershipHospitality•Stewardship
Respect•Justice
.
http://www.quality.nist.gov/HealthCare_Criteria.htm
Drivers Systems Results .
People
Operations
Results:• Health Care• Patient Satisfaction• Financial/Market• Staff & Work System• Organizational Effectiveness• Governance/Social Responsibility
Measurement, Analysis & Knowledge Management
Leadership
StrategicPlanning
Customer Focus
1
2
3
4
5
6
7
Operational Improvement• The theory sounds great…but
• How does it get to the bed side?
• How do you determine improvement?
• How do you sustain the improvements?
BHS Strategic Planning
• Strategic Challenges• Strategic Objectives• Goals• Focus Areas
▪ Care ▪ Service▪ People▪ Finance▪ Growth
BHS Vision andDirection
Strategic Objective &
Corp. Action Plans
FacilitySpecific
Goals
FacilityAction Plans
Employee Goal
BHS Board and SMT
BHS SMT and Corporate Directors
Participating Organizations
Departments and Teams
Employee Focus
BHS Alignment Model
BHS Strategy Development and Deployment Model
Focus
Where are we now?Where do we need to
go?How will we get there? How are we doing?
Who >Governance / Leadership
Governance / Leadership Leadership and Staff Leadership and Staff
When > Annually Annually Annually Quarterly
Internal and External Analysis
BHS Corporate Strategic Objectives SWOT
Vision,
Facility StrategicObjectives and Goals
Determine action plans,resources, accountability and Metrics/Action Plan Goals
Action Plans
Quarterlyreviewof progress and Performance
Results
Align Execute Review
Strategy Deployment
• Adoption of “Focus and Execute” a web-based application
• Tracking of progress of Action Plans▪ Team
▪ Open access
▪ Remote management - Webinar
• Continuous review of progress on Action Plans
BHS Facility “Focus and Execute” Plan
BHS Quality Performance Excellence
• The Mission and Core Values are the basis
• Led by President/CEO
• All 6 SVP are Lead for a Baldrige Category
• Quality Director ▪ Supports and coordinates
▪ Provides training
BHS Customer Service Standards
• Based upon the Core Values of the organization
• Behavioral expectations for all staff
• Self-evaluation of performance by each employee at annual evaluation
• Performance Management System
BHS Service Recovery
• Service Recovery is bringing a customer back from the brink of defection – and doing so in a timely fashion to the customer’s satisfaction.
• The ART of Service Recovery▪ A = Acknowledge▪ R= Resolve▪ T= Trend
Customer Satisfaction Surveys
• Nursing Facility▪ Newly Admitted Resident▪ Resident▪ Family – MyInnerview
• Assisted Living▪ Tenant - MyInnerview▪ Family- MyInnerview
• Housing▪ Tenant - MyInnerview
LTC Family "Recommend to Others"
506070
8090
100
YR 1 YR 2 YR 3 YR 4SGHRC MIV Goal
Good
BHS Facility Example
BHS Dashboard
• Internal IT system
• Current performance on key strategic measures
• Trend performance
• Best practice performance identified
Care – Percent of PainGood National Average BHS System Median Target
Best Practice Quartile Opportunity for Improvement Quartile
Finance – Operating Cash Flow Margin
Good BHS Operating Cash Flow Margin Median Target Best Practice Quartile Opportunity for Improvement Quartile
Current Structures for Performance Review
BHSBoard
StrategicPerformance
Team
Regional Operations
Facility Quality Council
Pillar Metrics 15 Measures
Senior leaders OVP, & CD
Pillar Metrics & PP
CEO, Board and SVP
Res
ults
Strategy
Facility Functioning 30 measures
Administrator,QMC, DON, and
other
OVP & Regional Consultants
Pillar Metric, PP& other metrics
BHS Facility Example
7.4-1 Overall Employee Satisfaction
012345
YR 1 YR 2 YR 3 YR 4SGHRC BHS Target
Good
Employee Performance Management
• Developed by a team of team from corporate office and facilities
• Common Job Descriptions across all sites▪ Behavioral based
• Supervisory training
• Self evaluation including self-evaluation of performance compared to the Customer Service Standards.
Business Systems
Support Systems
Resident&
TenantsCustomer Facing Systems
BHS Key Systems and Processes
Process Improvement – P-D-C-A
Plan
Check
Act
Do
42
PDCA aka• Shewhart Cycle• Deming Cycle
PDCA Improvement Example
“Bottom Line Value:”
• Organizational Focus• Clear/Crisp Strategic Direction• Alignment throughout the System• Enhanced Management Processes and Systems…
Consistent Performance• Customer Focus…Enhanced Satisfaction• Strong Financial Performance• Committed, Energized Workforce• Measurable Results!
• “The problems that exist in the world today cannot be solved by the level of thinking that created them.”
• Albert Einstein
