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Key Changes through our Baldrige Journey

April 9, 2013

Susan S. HawkinsSenior Vice President, Performance Excellence

Henry Ford Health System

Henry Ford Health System (HFHS)

Core Services: Four acute med/surg and two

behavioral health hospitals Henry Ford Medical Group

– 32 Medical Centers– 1200 physicians & scientists

2200 private physicians 1500 MD & DO physician

trainees Health Alliance Plan

Post-acute services: 2 Skilled nursing facilities Home Health Care Outpatient Dialysis Home Products Retail Pharmacies Vision Centers

Other Statistics (annual): Over 23,000 employees Over 200 care delivery sites 102,000 admissions, 2200 beds 418,000 ED visits 3.2 million office visits 88,000 surgeries

8+ Years of Focused Learning

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Sample Results

HFHS Employee EngagementPeople

Good

Service

Good

Press-Ganey: Likelihood to Recommend Top Box

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Quality & Safety

Best Overall Quality (Wayne County)

John M. Eisenberg Patient Safety & Quality Award (April 2012)

Growth

Education and Research

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CommunityEconomic Driver $5.82 billion in direct/indirect economic benefits

Live Midtown Project

Neighborhood development

Community Leader Serve in leadership roles in key organizations, such as

Detroit Chamber of Commerce, Detroit Convention & Visitors Bureau

Leadership volunteer hours exceed 12,000 annually

Community benefit has increased 78% to > $400M/yr

Finance

$(40,000)

$(20,000)

$‐

$20,000 

$40,000 

$60,000 

$80,000 

$100,000 

$120,000 

$140,000 

2004 2005 2006 2007 2008 2009 2010 2011*

Ope

rating

 Income

Fiscal Year(*DMC not included due to acquisition by Vanguard)

System Operating Income(Dollars in Thousands)

HFHS Competitors' Average

Cash Liquidity

Key Changes Leveraging Baldrige

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“The Henry Ford Experience” 7 Pillars of Performance

Mission, Vision, and Values

MissionTo improve people’s lives through excellence in

the science and art of health care and healing

ValuesEach Patient First Respect for People

High Performance A Social Conscience

Learning and Continuous Improvement

Former Vision Statement

To put patients first by providing each patient the quality of care and comfort we want for our families and ourselves.

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HFHS Core Competencies

Innovation – Discovering and applying new knowledge in techniques, technology, processes, services, and structures

– Clinical Research & Technology

– Facilities

– Services and Access Points

– Processes

Care Coordination – Proficiency in coordinating care across the continuum, teams

Partnering/Collaborating – Relationship- building with stakeholders, community, interdisciplinary

HFHS Leadership System

Created Performance Council and New Leadership Processes

Feedback showed opportunities to create more systematic leadership processes to drive strategic planning, deployment, and alignment

Many performance targets – and results – remained the “responsibility” of a few vs. everyone

Evaluated all current leadership teams: membership, roles and responsibilities, meeting frequency, and perceived effectiveness

Launched the HFHS Performance Council– Leaders of every Business Unit, pillar team,

and Corporate area

– Charged with overseeing the Strategic Planning Process and Organizational Performance Review

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Structure: CEO led; all PR staff integrated Linked to pillars

Process: Consistent, repetitive messaging Multimedia, multi-tactic Employee champions: service, safety, equity

Engage Face-to-Face: Town Halls, Leadership Rounds, Huddles, multiple recognitions

Multiple Communications at Every Level

Huddles

Improved Strategic Planning and Implementation

Multiple refinements to the Strategic Planning Process– New processes focused on the criteria

– New common vocabulary:• Strategic Objectives

• Strategic Initiatives

• Action Plans

• Performance Targets

– Aligned the strategic planning and budgeting processes

– Clear expectations for aligned action planning

Cascading Strategic Initiatives Pillar/SO

Key Organizational Performance Measures*

2012 – 2014 System Strategic Initiatives [Owner]

Cascade to BUs

All Pillars Improvement in Key Performance Measures

Baldrige Journey (learning, sharing, & improvement, both internally and externally) [BLT]

YES

Turnover; employee wellness (HRA lifestyle)

Develop a competent, agile workforce positioned to transition as patient and business unit needs fluctuate

YES

Engagement survey mean Develop a high-performance, highly-engaged workforce YES

People: National Leader in healthcare employee’s engagement and wellness

Leadership positions filled inside; diversity of candidate pools

Continue succession planning for key leadership positions YES

Transform the satisfaction and engagement of our customers through a consistent service-centric culture

YES Service: Best-in-class service among U.S. healthcare organizations

Top Box Likelihood to Recommend; HCAHPS Scores Redesign, elevate, and humanize the customer experience. YES Readmission % Reduce readmissions at all facilities

YES

Overall harm No Harm Campaign (2011-2013 )

YES

Quality & Safety: National leader in delivering safe, reliable, high quality, & highly coordinated care Project Helios milestones Clinical Transformation leveraging Epic System YES

Continue IT system enhancements at HAP and in provider system As applic.Continue physician alignment strategies, including HFMG recruitment and HFPN membership expansion.

As applic.

Develop HFHS Business Model (optimal geographic presence, clinical program mix, and business mix)

As applic.

Growth: Dominant health system in MI

Net Revenue – steady state and new strategic growth; Inpatient Admissions and market Share; HAP Members

Continue service line development in chosen areas As applic.

Research: Nationally preferred clinical research partner

External research funding from all sources

Strengthen research & education affiliation with WSU Medical school; including joint research building.

As applic.

Education: Leading independent academic medical center

Trainee readiness to practice without supervision

Strengthen affiliation with WSU and MSU Medical schools to retain MI trained physicians; Continue to Integrate Medical Education System-wide.

As applic.

Improve access to care/services for the under/uninsured As applic. Improve healthcare equity and reduce disparities As applic.

Community: National leader in community health advocacy and involvement

Community Benefit $ Establish Wellness Center of Excellence, community health needs

assessment and outreach As applic.

Finance: Financial strength to fund strategic plan

Net Operating Income; Cost per Unit (case mix index-adjusted admission)

Drive down System cost per unit through local and System tactics, sharing, and spread through expense and utilization management.

YES

Strategic Plan identifies:

Alignment between Strategic Objectives, Key Performance Measures (and targets), and Strategic Initiatives

Clear identification of owners

Clear accountability for strategy cascade starts at PC

All business units must create and share an action plan that shows alignment to System initiatives as well as “local” strategic initiatives, all organized by the 7 pillars

Pillar teams or other System teams also create and share action plans

Targets for next three years for each System performance measure (reported throughout year on System Dashboard)

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Improved Measurement andAnalysis Capabilities

Metrics Committee – operational, financial, and pillar leaders who provide oversight

and expertise to pillar teams and the Performance Council on the best way to define, display (dashboards), compare, and analyze transparent organizational performance

Performance Analytics and Improvement – Measurement and Comparator Selection

– Enterprise Data Warehouse

– Dashboards / Organizational Performance Review

– Knowledge Management

– Performance Improvement / Process Engineering / Project Management

Systematic Organizational Performance Review

System-level dashboard and monthly review of measures at Performance Council (PC)

Continuous search for best measures and comparators / databases

Semi-annual review of all pillars and business unit

System Dashboard – Top Page

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Drill-down Capability

Available to all Employees

Transparency and Accountabilityat each Business Unit - Sample

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Transparency and Accountabilityat each Business Unit (cont.)

Leadership Competencies & Standards: Aligned to Baldrige

40% of Leader and Staff evaluations tied to leader/team standards

Incentives aligned with organizational goals

Patient/Customer Focus

Strategic       Planning

Accountability   for Results/Execution

Staff Focus

Process Management/ Focus on Safety

Performance Analysis & Knowledge Management

Leadership

Patient/Customer Focus

Strategic       Planning

Accountability   for Results/Execution

Staff Focus

Process Management/ Focus on Safety

Performance Analysis & Knowledge Management

Leadership

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How Do We Design and Improve?HFHS Model for Improvement (MFI)

Work Systems & Key Processes

Customer Requirements

Safe

Timely

Efficient

Effective

Patient-Centered

Equitable

Work Systems

Inpatient

Outpatient

Emergency Dept

Community Care Services (pre- and post-acute)

Community Health Partners (health fairs, faith-based communities, etc.)

Key Work Processes

Access to Services

Assessment, Planning, and Care Delivery

Patient Education, Transition, and Care Coordination

Model for ImprovementUsed broadly in our leadership system . . . .

From designing new worksystems HF West Bloomfield Hospital Patient-Centered Medical Home

To kaizen events . . . To front-line daily improvement

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Infrastructure to Share Learnings and Deploy Improvement

System Quality Forum

Care InnovationTeam

Other QualityInitiatives

No Harm Steering

Committee

Medication(Pharmacy Council)

Falls & Pressure Ulcers(CNO Council)

Culture Change(Quality Forum)

OB Harm (OB Collaborative)

Procedural Harm (NSQIP SystemCollaborative)

Glucose(CMO Council)

BSI, VAP, SSI,C-Diff, UTI

(Infection ControlCouncil)

SharePoint Site

Sharing metrics;Building accountability

Design, Manage,Improve

Lessons Learned Essential for senior leaders to drive, support and actively

participate in Baldrige improvements– CEO commitment and involvement

– Leaders as Champions, Category Co-leads

The Baldrige Framework has to be integrated into everyday business – not a separate project – to build sustainable improvements

The writing (and associated self-evaluation) generates as much learning as the feedback reports

Spread the knowledge – build examiner competency across the organization (we started at the State level)

It’s OK to use the “B” word – builds common understanding

Winning does not mean perfection

Clarify and communicate: award or strategy?

…and the Journey Continues 2012/2013 System strategic priorities for continuous

improvement (based on examiner feedback and pre-/post-visit self-assessments):– Refine our approaches for identifying and spreading

improvements, innovations, and best practices; learn from others at Quest

– Continue to communicate and connect System goals and current performance, opportunities, and responsibilities to individuals and front line teams

– Refine strategic planning process steps to hard-wire “tight-loose-tight” – organizational performance reviews, performance dashboards, etc.

– Re-evaluate and re-align key processes, owners, and measures at all business units and work systems

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Questions?