“Finding Nemo”: Helping a Hospital
Establish Alignment
Eric Hung Le, Ph.D., MBA
Master Black Belt
Grace L. Duffy
Management and Performance Systems
Agenda
• The Healthcare Challenge
• The Outcomes
• The Journey
• Lessons Learned
Avg. Life Expectancy vs. Per Capita Spending (*)
(*) UC Atlas of Global Inequality, 2010
A story about a little fish
who believes he can make
a difference!
Metrics 2009 2010 % Improved
Gallup Survey –
Engagement Score
40th percentile 89th percentile 122%
Staff w/ Perfect
Attendance
13 31 138%
Staff Sick Calls 95 45 52%
Employee Giving
Campaign Participation
40% 89%
122%
Outcomes – The People
Engaged people drive …
Metrics 2009 2010 % Improved
Heart Failure Discharge
Compliance
58.8% 90.3% 54%
Anticoagulation Service –
Monitoring & Intervention
643 3746 482%
Pharmacists monitoring /
intervening on med. orders
received
6767 7872 16%
Unit-Based Pharmacist Model
(#interventions)
None
1,029/mo
1,848/mo
80%
Technician placed in the ED to
perform Med. Reconciliation
None 5,000 med.
Reconciliations
performed
Brand new
service
Outcomes – The Service
… excellent Service, which drives …
Metrics 2009 2010 % Improved
Physician Satisfaction 95.6 percentile 97.8 percentile 1%
Outcomes – Other Business Metrics
Metrics Budgeted 2010 Actual 2010 Variance
Pharmaceutical
Expenditures
$11.8 M $9.1 M $2.7 m
(23%)
Productivity 100% 122% 22%
… great business results!
Our Journey …
The Environment – The Pharmacy Department
• Provides pharmacy services to a 300-bed hospital
• No. of staff
– 1 director
– 2 managers
– 4 clinical pharmacists
– 25 pharmacists
– 25 technicians
• Education levels range from a HS degree to Doctorate
• 3 million doses dispensed a year
• Annual budget - $12 million per year
• 7x24 operation
Nursing
Physicians
Patients
Enabling Processes • Facilities / Equipment Management • Human Resources Management • Financial Management • Information Management
Strategic Planning
Pharmacy Education
Medication Management
Core Business Processes
Quality Control
Other OUs
VCU & Other
Schools
Dispense
Medications
Consults
Develop
Guidelines &
Protocols
Core Services Business Processes Partnership Customers
TJC /Rx Board ASHP Competitions Talent Pool Technology Government
Process Evaluation
External Forces
What Does The Pharmacy Do?
Organization Problems
• Lack of vision & direction
• Leadership being reactive
• Rapid expansion
• Rapid pace of changes
• Too many initiatives
• Work silos
• Information overload
• Poor performers
• Poor coordination of ops
• Staff conflicts
• Misplaced priorities
• “WIIFM” syndrome
• Lack of staff engagement
• “Clock-in Clock-out” mentality
• Process disconnects
Organization Problems (cont.)
Process Improvement at the Hospital
• Six Sigma deployment a few years earlier (2006)
– One Black Belt
– A handful of Green and Yellow Belts
– A few process improvements were initiated with good
results, but the culture has not changed
• Realization:
– Can’t sustain the gain, can’t make that big delta –
how do we “move the mass”?
– LSS concepts and tools are still not second nature –
how do we create a culture shift?
– Is there a more effective way to “connect” with
people at the core?
Employee commitment translates directly to
customer loyalty and profitability
10% Increase
Employee Commitment
7% Increase
Customer Loyalty
5% Increase
Profitability Drives Drives
The
Employee’s
Work
Experience
Employee
Commitment
Customer
Interaction
Areas
Corporate
Image
Customer
Loyalty
Customer
Interaction
Areas
Corporate
Image
Customer
Loyalty
Revenue,
Profits
and
Shareholder
Value
Drives Drives
(*)
How do we maintain a balance between gaining short-term
benefit and building long-term organization alignment?
The Right People Are Your Assets
(*) Manufacture Industry Benchmark Study, Deloitte 2000
Position Power vs. Organizational Influence
N=5 (C-suite)
Administrators
N= 30
Directors
N=1500
Employees
Most Corporate Training & Development Programs are
focused at the management and leadership levels
Can We “Move the Mass”?
Program Design Objectives
• Create the foundation to enable a cultural change – Front-
line staff alignment and teamwork
• Establish building blocks using the 3 R’s (Relate, Repeat,
and Reframe) framework
• Focus on incremental progress – avoid information
overload!
• Institute a mechanism to reinforce concepts learned
• “Unbundle” core Lean Six Sigma concepts and relate
them to what people see and do everyday!
Unless you change what you do,
you are staying where you are!
Achieving
Operational
Excellence
Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Dec.
Eff
icie
ncy &
Eff
ecti
ve
ness
“Sharpen The Saw” Series –
Align
“First Who, Then What”
Self-Assess
“ Put First Thing First”
“Start with the End in Mind”
Understand Data
Link Actions to Outcomes
Think Lean
Make processes work better
Understand Variations
Sustain
Holistic Approach to Work
(*)
(*) “The Seven Habits of Effective People”, by Steven Covey.
Coaching & Mentoring
Engaging Staff
• Co-create the vision
– Where are we going?
– What’s the impact?
– Share and learn
• Engage team members in meaningful and
noteworthy moments they’ve had
• Encourage shared responsibilities
• Nudge the team to move forward and make
progress
It takes lots of patience and practice!
Sustaining the Energy: What Makes it Stick?
• The value of being aligned and working as a team for front-line staff
• Very strong leadership who is committed to service excellence – Engage the staff
– Reinforce concepts learned and put into practice
• Concepts taught each month are reinforced and build on the previous month – Mandatory participation
– Same coach (1 voice)
– Consistent messages delivered each month
– Habit-changing
– “You’re never a prophet in your own land”
• Build on the 3 R’s (Relate, Repeat, Reframe)
With alignment, you can get to
your destination more
easily & quickly!
“Talent wins games,
but teamwork +
intelligence wins
championships”
Michael Jordan
Building a Championship Team
“The answer to the decade-long conundrum may
have little to do with investing in high-tech
equipment and evidence-based protocols.
Instead, improving patient outcomes may require
first investing in and focusing on the culture of the
organization itself.”
The Annals of Internal Medicine, March 2011
23
Building a Performance Culture
Q &A