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Achieving MayoAchieving Mayo’’s Value Equation:s Value Equation:The Role of Systems and The Role of Systems and
ProceduresProceduresAIMC Health Care WorkshopAIMC Health Care Workshop
April 28, 2010April 28, 2010
Sharon Gabrielson, BS, MASharon Gabrielson, BS, MASection Head, Systems and ProceduresSection Head, Systems and Procedures
Mayo Clinic, Rochester, MNMayo Clinic, Rochester, MN
Group ExerciseGroup Exercise
•• What do your customers value?What do your customers value?
Group ExerciseGroup Exercise
•• How do you know what your How do you know what your customers value?customers value?
The Mayo Clinic ValueThe Mayo Clinic ValueEquationEquation
Value =Quality
(Outcomes, Safety, Service)
Cost
Value increases when quality is improvedand when cost is decreased
OverviewOverview
•• Mayo Organization/Systems and Mayo Organization/Systems and Procedures OverviewProcedures Overview
•• Systems and Procedures as a Value Systems and Procedures as a Value Add to Mayo ClinicAdd to Mayo Clinic
•• Recruitment, On boarding, RetentionRecruitment, On boarding, Retention•• Quantifying the Value AddQuantifying the Value Add
Mayo Clinic in FloridaMayo Clinic in Arizona
Mayo Clinic in Rochester
Physicians and scientistsPhysicians and scientists 3,6493,649Allied health staffAllied health staff 48,91348,913Residents and fellowsResidents and fellows 2,2712,271Total personnelTotal personnel 54,83354,833
Mayo Clinic Mayo Clinic ––February 2010February 2010
7
Primary Value: The needs of the patient come firstMission: Mayo Clinic will provide the best care to every patient every day through
integrated clinical practice, education, and researchVision: Mayo Clinic will be the premier patient-centered academic medical organization
Satisfy Our Patients Achieve Mission-Advancing Financial Performance
Improve and Demonstrate Quality, Safety, Service, and Value
Attract, Develop, and Retain the Best People
Mayo Clinic Strategic PlanMayo Clinic Strategic PlanMayo Clinic Strategic Plan
•• Achieve the highest levels of patient service Achieve the highest levels of patient service and satisfactionand satisfaction
•• Demonstrate Mayo Clinic as the choiceDemonstrate Mayo Clinic as the choicedestination medical centerdestination medical center
•• Achieve operating margin targetAchieve operating margin target•• Achieve sufficient and stable sourcesAchieve sufficient and stable sources
of funding for Research and Educationof funding for Research and Education
•• Achieve the highest levels of quality care and safetyAchieve the highest levels of quality care and safety•• Develop highDevelop high--value care models targeted to specific patient populationsvalue care models targeted to specific patient populations
•• Improve staff satisfaction, training, retention, Improve staff satisfaction, training, retention, and recognitionand recognition
•• Increase diversity of all staffIncrease diversity of all staff
•• Strengthen leadership developmentStrengthen leadership development•• Establish a culture of innovation and discoveryEstablish a culture of innovation and discovery
VISI
ON
EXEC
UTI
ON
PRIO
RIT
IES
QualityQualityIntegrationIntegration
Science ofHealth Care Delivery
Science ofHealth Care Delivery
IndividualizedMedicine
IndividualizedMedicine
01-15-08
Systems and ProceduresSystems and Procedures
•• Internal business consulting group at Mayo Internal business consulting group at Mayo •• Objective resource with a focus on applying a Objective resource with a focus on applying a
systems approach to the design, systems approach to the design, development, and implementation of development, and implementation of solutionssolutions
•• Strong business knowledge, systems Strong business knowledge, systems engineering, analytical, process improvement engineering, analytical, process improvement and execution skillsand execution skills
S&P Staff Education/BackgroundS&P Staff Education/BackgroundS&P Staff Education/Background
•• Industrial EngineeringIndustrial Engineering•• Business AdministrationBusiness Administration•• Operations Research/Systems Operations Research/Systems
EngineeringEngineering•• Healthcare AdministrationHealthcare Administration•• Public HealthPublic Health•• MD, PhD, Nursing, Operations, MD, PhD, Nursing, Operations,
Finance, etc.Finance, etc.
Systems and Procedures Systems and Procedures –– Adding Adding Value to Mayo ClinicValue to Mayo Clinic
•• Case StudyCase Study--What Customers ValueWhat Customers Value•• 2008 Internal and External customer 2008 Internal and External customer
surveyssurveys•• Common themes surrounding our Common themes surrounding our
services, on boarding, skill sets, tools services, on boarding, skill sets, tools and methodologies, competition from and methodologies, competition from other internal groupsother internal groups
•• How do we leverage these value How do we leverage these value drivers to increase the value of our drivers to increase the value of our service to our customers and enhance service to our customers and enhance MayoMayo’’s businesss business
Redesign Around ValueRedesign Around Value
•• Standardize the way we workStandardize the way we work•• Define our business lines and servicesDefine our business lines and services•• Develop an S&P consulting model Develop an S&P consulting model •• Invest in orientation, training, & Invest in orientation, training, &
continuous educationcontinuous education•• Create a portfolio of tools, processes Create a portfolio of tools, processes
methodologies, best practices methodologies, best practices •• Leverage what we do bestLeverage what we do best
•• End to end solutionsEnd to end solutions•• ObjectiveObjective•• Trusted partnerTrusted partner
Business Line and ServicesBusiness Line and Services
• Business Strategy and Planning• Business assessment• Business case analysis• Facilities planning• New product/services
•• BuBusiness Strategy and Planningsiness Strategy and Planning•• Business assessmentBusiness assessment•• Business case analysisBusiness case analysis•• Facilities planningFacilities planning•• New product/servicesNew product/services
Business Line and ServicesBusiness Line and Services
• Business Process Engineering• Re engineering• Process improvement• Workflows• Optimization through simulation
modeling/analytics
•• Business Process EngineeringBusiness Process Engineering•• Re engineeringRe engineering•• Process improvementProcess improvement•• WorkflowsWorkflows•• Optimization through simulation Optimization through simulation
modeling/analyticsmodeling/analytics
Business Line and ServicesBusiness Line and Services
Business Transformation Business Transformation •• Current to future stateCurrent to future state•• Resource managementResource management•• Change managementChange management•• Organization transformationOrganization transformation•• Solution implementation/executionSolution implementation/execution
RecommendSolutions
RecommendSolutions
ImplementSolutions
ImplementSolutions
AnalyzeInformation
AnalyzeInformation
CloseEngagement
CloseEngagement Discover,
Diagnose &Gather Data
Discover,Diagnose &Gather Data
EstablishPartnership
EstablishPartnership
Consulting ModelSystems & Procedures
The consulting model is comprised of 9 core elements: 3 Integrated process groups which support, enhance, and enable the 6 sequential stages.
Each element and IPG consists of key principles, tools/techniques, and critical steps
©2010 Mayo Foundation for Medical Education and Research (MFMER)
Create lasting value for
Mayo Clinic, our patients &
our staff
IPG: Managing Change
IPG: Communicating
IPG: Knowledge Sharing
Close Engagement
RecommendSolutions
AnalyzeInformation
Discover, Diagnose & Gather Data
EstablishPartnership
Implement
Consulting ModelDay 2
Consulting ModelDay 2
FacilitationTechniques
Consulting ModelDay 2
Consulting ModelDay 2
Consulting ModelDay 2
Consulting ModelDay 2
ObservationalResearch
FacilitationTechniques Benchmarking
SystemsThinking
Problem‐SolvingTools
Decision Support&
Data AnalysisBenchmarking
Committee Navigation
ManagingProjects in S&P
BalancedScorecard
CustomerFeedback
Consulting ModelDay 1
ManagingProjects in S&P
Change Management
Consulting ModelDay 1
Crucial Conversation®
HR class
Negotiation Skills&
Techniques
Consulting ModelDay 1 More coming in EPD Phase 2
EPD Delivery Framework
RecommendSolutions
ImplementSolutions
AnalyzeInformation
CloseEngagement
Discover,Diagnose &
GatherData
EstablishPartnership
Createvalue
RecommendSolutions
ImplementSolutions
AnalyzeInformation
CloseEngagement
Discover,Diagnose &
GatherData
EstablishPartnership
Createvalue
RecommendSolutions
ImplementSolutions
AnalyzeInformation
CloseEngagement
Discover,Diagnose &
Gather
EstablishPartnership
Create value
RecommendSolutions
ImplementSolutions
AnalyzeInformation
CloseEngagement
Discover,Diagnose &
GatherData
EstablishPartnership
Createvalue
RecommendSolutions
ImplementSolutions
AnalyzeInformation
CloseEngagement
Discover,Diagnose &
GatherData
EstablishPartnership
Createvalue
RecommendSolutions
ImplementSolutions
AnalyzeInformation
Discover,Diagnose &
GatherData
EstablishPartnership
Createvalue
CloseEngagement
Integr
ated Pro
cess Gro
ups
Recruitment, On boarding, Recruitment, On boarding, RetentionRetention
RecruitmentRecruitment
•• Rigorous processRigorous process•• Telephone screeningTelephone screening•• In person interviewIn person interview
•• Submission of written workSubmission of written work•• PresentationPresentation•• Behavioral interviewBehavioral interview•• Case studyCase study
On boardingOn boarding
•• Competency Assessment to analyze Competency Assessment to analyze competency gaps (incorporate AIMC competency gaps (incorporate AIMC assessment tool)assessment tool)
•• Training curriculum Training curriculum •• aligned with the 6 stage project aligned with the 6 stage project
consulting model and its 3 core consulting model and its 3 core integrated process groupsintegrated process groups
Education and Professional Education and Professional Development (EPD) ProgramDevelopment (EPD) Program
•• The goal of this program is to:The goal of this program is to:•• Obtain greater consistency in Obtain greater consistency in
project approach and consultant project approach and consultant skill levelsskill levels
•• Introduce the tools, processes, Introduce the tools, processes, and methodologies to analysts for and methodologies to analysts for use in the front line workuse in the front line work
•• Provide continuous learning Provide continuous learning environment environment --retention factorretention factor
DecisionSupportMethods
AdvancedTeam Skills
Forecasting& ModelingTechniques
Advanced Portfolio
Management
SE/ORMethods
AdvancedResearchMethods
OrganizationTransformation
Methods
Business Intelligence& Analytics
S&P Ed &
S&P Ed &
PD Program
PD Program
RelationalDatabase Use
Mathematical Modeling
Of Systems
S&P ConsultingModel
DS/DAMayo CommitteeSystem Navigation
StaffingModel Designs
& Uses
Managing ProjectsIn S&P
Business Strategy & Development
ObservationalResearch
Software & ToolSelection/Approval/
Implementation HealthcareBusiness
Environment
IndustrialEngineeringTechniques
Benchmarking
The MGPs
IT at Mayo
ChangeManagement
Knowledge Sharing
Problem-SolvingTools
Human FactorsEngineering
Library Resources& Services Prototyping
FacilitationTechniques
Balanced Scorecard
Healthcare Finance
SystemsThinking
Customer Feedback
Strategic Thinking& Business Planning
Emerging Technologies
Negotiation
Workflow Optimization
Organizing, Delivering & Presenting Information
Patient ExperienceAt Mayo Clinic
Value Creation& Value Engineering
Publishing
MeetingFacilitation
TeamSkills
BusinessWriting
ComputerBasics
PresentationSkills
CommunicationSkills
InterpersonalSkills
HRNEO
AdministrativeOrientation
ComputerBasics
UnitHeads
IT SystemsNon-EMR
Intro toClinical
Systems
S&P1-DayNEO
Mentors
November 11, 2009
Quantifying Value AddQuantifying Value Add
•• MetricsMetrics•• Key performance indicatorsKey performance indicators•• Aligned with the Mayo Clinic Aligned with the Mayo Clinic
Strategic PlanStrategic Plan
23
Primary Value: The needs of the patient come firstMission: Mayo Clinic will provide the best care to every patient every day through
integrated clinical practice, education, and researchVision: Mayo Clinic will be the premier patient-centered academic medical organization
Satisfy Our Patients Achieve Mission-Advancing Financial Performance
Improve and Demonstrate Quality, Safety, Service, and Value
Attract, Develop, and Retain the Best People
Mayo Clinic Strategic PlanMayo Clinic Strategic PlanMayo Clinic Strategic Plan
•• Achieve the highest levels of patient service Achieve the highest levels of patient service and satisfactionand satisfaction
•• Demonstrate Mayo Clinic as the choiceDemonstrate Mayo Clinic as the choicedestination medical centerdestination medical center
•• Achieve operating margin targetAchieve operating margin target•• Achieve sufficient and stable sourcesAchieve sufficient and stable sources
of funding for Research and Educationof funding for Research and Education
•• Achieve the highest levels of quality care and safetyAchieve the highest levels of quality care and safety•• Develop highDevelop high--value care models targeted to specific patient populationsvalue care models targeted to specific patient populations
•• Improve staff satisfaction, training, retention, Improve staff satisfaction, training, retention, and recognitionand recognition
•• Increase diversity of all staffIncrease diversity of all staff
•• Strengthen leadership developmentStrengthen leadership development•• Establish a culture of innovation and discoveryEstablish a culture of innovation and discovery
VISI
ON
EXEC
UTI
ON
PRIO
RIT
IES
QualityQualityIntegrationIntegration
Science ofHealth Care Delivery
Science ofHealth Care Delivery
IndividualizedMedicine
IndividualizedMedicine
01-15-08
Mayo Clinic Rochester Systems & ProceduresMayo Clinic Rochester Systems & Procedures
Financial Performance
Improve and Demonstrate Quality, Safety, Service, and Value
Attract, Develop, and Retain the Best People
Customer Service
1.1 Overall Customer Satisfaction1.2 Project Requests (clinical, research, education, administration)
4.1 Staff Satisfaction• Key Drivers for Overall Satisfaction and
Discretionary Effort
3.2 Strategic Partnerships
4.3 Staff Demographics• Turnover Rate • Diversity Rate4.4 Leadership Development/
Succession Planning• Staff Prepared • Internal Hires
3.1 Alignment with MC or MCR Strategic Priorities
3.3 Committee Assignments Institutional Departmental
4.2 Education and Professional Development
• Staff Development & Training • Scholarly Activity
Improve and Demonstrate Quality, Safety, Service, and Value
IntegrationIntegrationQuality &Quality &SafetySafety
Science ofScience ofHealthcare DeliveryHealthcare Delivery
IndividualizedIndividualizedMedicineMedicine
Primary Value: The needs of the patient come first.Mission: Systems and Procedures will partner with our Mayo Clinic colleagues to achieve the best patient experience through objective, innovative, and integrative business consulting. Vision: Systems & Procedures will be Mayo Clinic’s premier business consulting team.
2.1 Projects with Expense Reduction, Efficiency, Revenue Growth2.2 Estimated Project Duration
3.4 Support for MayoTransformation Initiatives
1/1/09-12/31/09
3.5 S&P Quantitative Metrics
3.6 S&P Qualitative Advantage
2.1 Projects with Expense Reduction, 2.1 Projects with Expense Reduction, Efficiency, and Revenue GrowthEfficiency, and Revenue Growth
The cumulative number of active projects that should yield The cumulative number of active projects that should yield significant expense reduction, efficiency, or revenue growth significant expense reduction, efficiency, or revenue growth benefits.benefits.
Project Requests Year end 2009
Expense Reduction 100
Efficiency 235
Revenue Growth 69
3.4 Support for Mayo Transformation 3.4 Support for Mayo Transformation InitiativesInitiatives
On target to meet plan Moderate risk of not meeting plan
$4,000,000$4,000,000
TBDTBD
$5,385,000 $5,385,000
TBDTBD
TBDTBD
$12,200,000$12,200,000
$9,100,000$9,100,000
$1,400,000$1,400,000
$4,996,000$4,996,000
TBDTBD
$4,160,000$4,160,000
NANA
$5,000,000$5,000,000
$5,000,000$5,000,000
YESYES
YESYES
YESYES
YESYES
YESYES
YESYES
YESYES
YESYES
YESYES
YESYES
YESYES
YESYES
YESYES
YESYES
1. Hospital Census Management1. Hospital Census Management
2. Manage Patient Mix/Access2. Manage Patient Mix/Access
3. New Models for Internal Consults3. New Models for Internal Consults
4. Surgical Redesign & Coding Improvement4. Surgical Redesign & Coding Improvement
5. Critical Care Delivery System of the Future5. Critical Care Delivery System of the Future
6. Manage to Reimbursement6. Manage to Reimbursement
7. Staff to Workload for Outpatient Practice7. Staff to Workload for Outpatient Practice
8. Transcription Services Redesign8. Transcription Services Redesign
9. Center for Innovation (CFI)9. Center for Innovation (CFI)
10. Employee and Community Health IMP 10. Employee and Community Health IMP ProjectsProjects
11. International Destination Medical Center11. International Destination Medical Center
12. Lab PACE12. Lab PACE
13. Blood Management13. Blood Management
14. MS14. MS--DRG/DocumentationDRG/Documentation
Potential Potential ImpactImpact
S&P S&P SupportSupport
StatusStatusProjectProject
3.5 – S&P Quantitative Metrics3.5 3.5 –– S&P Quantitative MetricsS&P Quantitative Metrics
*External Consultant Hourly Charge, $200-$500/hr(References on external consultant hourly charges)
S&P Estimated Hourly Consulting Expense* $80-$90(Includes salary and benefits for all analysts, S&P leadership, and support staff and appropriate overhead expenses)
% S&P Consultant Time Dedicated to Projects 90%
Examples of Additional S&P Projects with Quantitative Impact
Examples of Projects with Quantitative Examples of Projects with Quantitative ImpactImpact
Overall 2 FTE reduction/day, $24,000 Overall 2 FTE reduction/day, $24,000 (cost savings for printing)(cost savings for printing)
EMR Auto Dismiss of Clinical EpisodesEMR Auto Dismiss of Clinical Episodes
Optimize patient itinerary length Optimize patient itinerary length --overall reduction of 1,200 hours/monthoverall reduction of 1,200 hours/month
Neurology Appointment DurationNeurology Appointment Duration
*$79,800,000 *$79,800,000 (potential cost avoidance)(potential cost avoidance)Barcode Medication ChartingBarcode Medication Charting
$680,000 $680,000 (cost savings)(cost savings)Cardiac Cath Lab Consolidation ProjectCardiac Cath Lab Consolidation Project
$600,000 $600,000 (cost savings)(cost savings)Transportation Expense ManagementTransportation Expense Management
$500,000 $500,000 (revenue enhancement)(revenue enhancement)Gonda 3 Process Improvement projectGonda 3 Process Improvement project
$500,000 $500,000 (cost savings)(cost savings)PPI enabled through Patient PortalPPI enabled through Patient Portal
$180, 000 $180, 000 -- $200,000 $200,000 (cost savings)(cost savings)Waste Expense ReductionWaste Expense Reduction
Significant revenue loss avoidanceSignificant revenue loss avoidanceMayo Rochester & MHS ICDMayo Rochester & MHS ICD--9 to ICD9 to ICD--1010
Improved on time arrivals from 66% to Improved on time arrivals from 66% to 96%96%
Surgical AM AdmissionsSurgical AM Admissions
50% reduction in cycle time50% reduction in cycle timeACTION: Cancer Center Clinical Trials ACTION: Cancer Center Clinical Trials IntegrationIntegration
Quantitative Annual Impact Quantitative Annual Impact Project DescriptionProject Description
*One study found that each preventable Adverse Drug Event that took place in a hospital added about $8,750 (in 2006 dollars) to the cost of the hospital stay.” (IOM – Preventing Medication Errors; July 2006)
3.6 3.6 –– S&P Qualitative S&P Qualitative AdvantageAdvantage
•• ““End to EndEnd to End”” Consulting Consulting –– Providing Services from project initiation Providing Services from project initiation through final execution/implementationthrough final execution/implementation
•• Knowledge Retention Knowledge Retention –– Knowledge from completed projects is retained Knowledge from completed projects is retained at Mayo and subsequently leveragedat Mayo and subsequently leveraged
•• Improved Consulting Cycle TimesImproved Consulting Cycle Times –– Internal consulting staff are Internal consulting staff are positioned to expedite turnaround on project deliverablespositioned to expedite turnaround on project deliverables
•• Relationship Credibility Relationship Credibility –– LongLong--term relationships lead to improved client term relationships lead to improved client understanding, buy in and commitment understanding, buy in and commitment
•• Objective/integrative institutional perspective Objective/integrative institutional perspective –– Strategic, operational Strategic, operational and healthcare business experience allows staff to provide broadand healthcare business experience allows staff to provide broadinstitutional perspectivesinstitutional perspectives
•• Commitment to the Mayo Vision Commitment to the Mayo Vision –– An internal consulting group An internal consulting group understands the value and is committed to the institutional Missunderstands the value and is committed to the institutional Mission and ion and Vision Vision
•• Networking with External Expertise Networking with External Expertise –– An institutional resource with the An institutional resource with the knowledge and expertise to effectively benchmark with external knowledge and expertise to effectively benchmark with external organizations.organizations.
4.2 Education and Professional 4.2 Education and Professional Development Development
ActivityActivity Year end 2009Year end 2009% of % of core trainingcore training modules completed by staffmodules completed by staff 54%54%
% of % of advanced trainingadvanced training modules completed by staffmodules completed by staff available 2010available 2010
# of S&P staff who attended conferences # of S&P staff who attended conferences 1717
# of abstracts/presentations/poster presentations # of abstracts/presentations/poster presentations 2727
# of manuscripts submitted/articles published# of manuscripts submitted/articles published 77
# of adjunct faculty at external academic institutions# of adjunct faculty at external academic institutions 33
# of staff who have Mayo Quality Fellow certification# of staff who have Mayo Quality Fellow certification 99
S&P sponsored the Mayo Clinic Conference on Systems Engineering S&P sponsored the Mayo Clinic Conference on Systems Engineering and and Operations Research in HealthcareOperations Research in Healthcare
Questions?Questions?