Renee Tew, Director of Quality, Maury Regional Medical Center

Maury Regional Medical Center
Managing Change through
Pursuit of Performance
Excellence
Renee Tew, Director of Quality Improvement
[email protected]
Who We Are….
Maury Regional Medical Center
• 275 bed comprehensive facility in
Columbia Tennessee
–
–
–
–
Interventional and surgical heart program
Neonatal intensive Care
Comprehensive Cancer Services
Neurosurgery
• Serving 250,000 people in 8 counties
• Over 200 physicians
Maury Regional Medical Center
• Flagship for a group of facilities
–
–
–
–
Marshall Medical Center, Lewisburg, TN
Wayne Medical Center, Waynesboro, TN
Lewis Health Center, Hohenwald, TN
Spring Hill Health Center, Spring Hill, TN
Maury Regional Medical Center
Service Area
Culture
Culture of performance excellence
with pursuit of quality in each area
to provide our patients with the
quality care they deserve
World-Class Care
Every Patient. Every Day
Mission
To serve our region
with clinical excellence
and compassionate
care.
Vision
Maury Regional Medical Center strives
to deliver, for every patient every day, an
individualized, innovative health care
service by combining value and worldclass clinical outcomes within a
personalized, caring environment, and by
improving the health of the community
through partnerships and integrated
networks.
Values
P - Patient Focused…Provide care with love and compassion.
R - Respect…………..Treat everyone as they wish to be treated.
I
- Integrity…………Do the right thing for the right reason.
D - Dedication………Be Committed to achieving excellence.
E - Enthusiastic………Be positive and friendly.
World-Class Care
Every Patient. Every Day.
Keys To Success
Quality – Achieve best practices clinical outcomes.
Service – Achieve excellence in patient satisfaction.
People – Attract, develop and retain a highly qualified
healthcare team.
Financial – Produce the financial resources to achieve the
mission and vision.
Growth – Increase market share by providing excellent care.
Community Health – Improve the health & wellness of the
population in our service area.
Why the Baldrige framework?
Focus on All Aspects Critical to an
Organization’s Success
A Systems Perspective
Baldrige Performance Excellence Framework
1
Leadership
2
Strategic
Planning
5
Workforce
Focus
3
Customer
Focus
6
Operations
Focus
7
Results
4
Measurement, Analysis, and Knowledge Management
2
Strategic
Planning
LEADERSHIP TRIAD
1
Leadership
Leadership Focus on Strategy and on
Patients and Stakeholders
3
Customer
Focus
5
Workforce
Focus
RESULTS TRIAD
Organization’s workforce and key
operational processes accomplish the
work of the organization that yields
overall performance results.
All sections point to results
7
Results
6
Operations
Focus
LEADERSHIP
From
Parent-Child
To Shared Governance
STRATEGIC PLANNING
From Book on Shelf
I. ORGANIZATIONAL
REVIEW Dec. - Feb.
V. STRATEGY
ACHIEVEMENT
Sept. – Nov.
•Evaluate Scorecards &
KPIs
•Develop Action Plans
•Revise Plan
•Celebrate Successes
•Review/Revise Mission,
Vision, Values, Core
Competencies , & Keys to
Success
•Review Previous Year’s
Performance
•Conduct SWOT Analysis
•Conduct Environmental
Scan: Market Preference,
Market Share, Regulatory,
& Competitor Information
III. STRATEGY DEPLOYMENT
Jul. – Aug.
•Identify Benchmarks
•Create Scorecard Metrics
•Communicate &
Disseminate
Plan to Stakeholders
•Create Departmental &
Individual Goals
II. STRATEGY
DEVELOPMENT Mar. – Jun.
•Develop Priorities
•Establish Long Term
& Short Term Goals
•Create Key Performance
Indicators (KPIs)
•Develop Timeline
•Allocate Resources
•Establish Budgets
•Assign Plan Owners
CUSTOMER FOCUS
From: “We know
what the patient
wants/needs”
Listening and Learning
Patient satisfaction survey
Nurse Manager rounds
Physician Liaison office visits
Patient complaint management process
Community event/program evaluations
Community health fairs
Community organization involvement
Peer review committee for physician complaints
Market Perception Study
“We Are Maury”
Previous Patients on CPC & WC Advisory
Committee
Care Rounding
Planetree Focus Groups
Social media: Web site for
complaints/compliments; Facebook page
Frequency
Stage of
Relationship
W
D
D
Former
Current
Future
D
Former/ Current
R
Future/ Former
R
Future/ Former
D
Future/ Former
Q
Former/ Current
B
M
Future
All
M,Q
Former
D,W
A
Current
Former
D
All
W-weekly, D-daily, R-randomly, B-biannually,
Q-quarterly, M-monthly, A-annually, S-semiannually
KNOWLEDGE MANAGEMENT: From Information Silos
and Confusion
Figure 4.1-1
Physician Systems
Physician Orders
Physician Documentation
EMR Remote Access
Diagnostics Remote
Access
Decision Support
Anthem
Premier
Action O/I
Clinical Systems
Nursing
Lab
Imaging
Pharmacy
Oncology
ED
Maury Regional
Information Systems
Scheduling
Admissions
Orders & Results
Electronic Medical Record
Health Information Exchange
Financial Systems
Billing
Receivables
Payables
Materials
General Ledger
Budgeting
Employee Access
Intranet
Email
We Are Maury
Patient Access
Internet Website
WWW.MauryRegional.Com
WORKFORCE
FOCUS
From Not Asking…
“our employees are
happy and productive”
Or are they?
Performance Improvement
Methodology
Move from Traditional PDCA
to use of LEAN
• Identify and eliminate waste
• See with “new eyes”
• Change where the work happens
• Involve people that do the work
• Leadership rounds
• Visual Management
Focus Of Lean: Elimination of Waste
Making the Right Work Easy to Do
•
•
•
•
•
•
•
•
Defects
Over-Production
Waiting
Not clear (Confusion)
Transporting
Inventory
Motion
Excess Processing
The 8 Types of
Waste
30
All 4 Rules are Pre-specified with Built-in Tests
Rules-in-Use
• Rule 1: Activities
(standard work)
–
–
–
–
–
Content
Sequence
Timing
Location
Outcome
• Rule 2: Connections
– Direct
– Yes/No (unambiguous)
– Paced
Adapted
• Rule 3: Pathways
– Simple
– No forks or looping
• Rule 4: Improvement
– Closest to the Problem
– Using the Scientific
Method (experiment)
– By Those Doing the
Work
– Supported by a Coach
from “Decoding the DNA of the Toyota Production System” Bowen/Spear, HBR 1999
31
Why is this easy to learn and easy to apply?
• Simple, agile concepts
– Waste must be reduced / eliminated
– All regular work must move closer to IDEAL
– Apply the 4 Rules-In-Use to move in the direction
we want to go!
• Simple, flexible tools
– Observation
– Value Stream Mapping
– A3 Problem Solving
32
Observation:
•
•
•
•
•
•
•
•
Is one person at a time
Is a structured process
Uses a framework
Is documenting the work exactly as it is being performed
Is What “is” vs what “should be”
Helps quantify waste in the way work is done
Creates a continuous improvement culture
Can reveal reality from the patient’s perspective and “voice of
the customer”
• Exposes variation in how tasks are completed or lack of
processes
• Exposes broken communication
• Exposes poor equipment/supply availability and long travel
distances
33
Process Map
Traditional Process Map: Viewed
from how we do our work
Value Stream Map
Value Stream Map: Viewed from
what the customer sees
Different from a conventional flow chart because it
indicates when nothing is happening
The A3 Problem Solving Process
• Views situation with a microscope
• Tool for “drilling” down into ‘variation’ in
the problem
• Documentation of problem solving
activity
• Tells the story visually
36
ISSUE
TARGET CONDITION
TITLE
TO
BY
DATE
BACKGROUND/MEASUREMENT
CURRENT CONDITION
COUNTERMEASURES
IMPLEMENTATION PLAN
what
who
when
outcome
PROBLEM ANALYSIS
COST
COST BENEFIT/WASTE RECOGNITION
TEST
FOLLOW
UP
37
©2010 Healthcare Performanc
Results – Average % Improvement
from 2007 through 2013
• Quality – 80% improvement
• Service – 15% improvement
• People – 90% improvement
• Financial – 57% improvement
• Growth – improved market share and
increased OP volumes
Baldrige Performance
Excellence Program
“Continuous effort – not strength
or intelligence - is the key to
unlocking our potential”.
- Sir Winston Churchill
QUESTIONS