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IHI National Forum “Defining Moments”

M23: Baldrige Performance Excellence Program

Excellence is Every, Every, Every

December 2012

Orlando, FL

Experience Objectives

• Assess, compare, and contrast your

organization’s performance against that of

Baldrige role models and the Criteria for

Performance Excellence.

• Describe how the Baldrige Framework can be

used to create inspired cultures and

immediately improve performance

• Act on the Baldrige excellence roadmap.

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Presenters• Joel Ettinger, President and CEO, Category One Inc. and

Alumni Member of the Board of Examiners, Malcolm Baldrige National Quality Award

• Susan Hawkins, SVP, Performance Excellence, Henry Ford Health System

• Craig Deao, Research and Development Leader, StuderGroup

• Gary Yates, MD, SVP and CMO, Sentara HealthcareDr. Yates is the President of Healthcare Performance

Improvement, LLC a consulting company focused on improving healthcare reliability

What Will NOT Happen

• You will not understand all of it—it’s too

big

• We will not address all elements of the

Framework equally—it’s too big

• Know everything you need to do when

return to your worksite and colleagues—

it’s too big

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Criteria for Performance Excellence

Business Health Care Education

A disciplined approach to addressing key

patient/customer, stakeholder, and operational

requirements integrating cycles of refinement

and innovation

How Do You/We Know That…

• Effective leadership system is in place that assures sustainability, excellence, agility, relentless patient focus – even in economically difficult times

• Pervasive innovation is a key differentiator

• Strategic planning process produces appropriate stretch targets fully deployed

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How Do You/We Know That…

• Market data are valid/segmented to design/deliver products/services that people want/need

• The people we serve can easily access services

• Accurate satisfaction, loyalty, referral, & engagement determination systems exist

• Information systems are based on user needs and produce “actionable” information

How Do You/We Know That…

• Everyone has the knowledge they need to have to “ make” healthcare great

• Culture is optimal, work systems carefully designed, necessary skills secured, all workforce is proud, recognized, loyal, engaged

• New services are designed systematically with patient/customer, evidence-based input

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How Do You/We Know That…

• We provide, always, the finest error free medicine humanly possible

• We out-compete the competition in all important ways – care experience and research funding

• Our clinicians are magnificent members of the an amazing workforce that makes the health care

• All major processes are continually improved, waste eliminated everywhere

How Do You/We Know That…

• All key results based on Critical Success

Factors are measured, trended, compared to

competition and best-in-industry

• The approaches to work and improvement,

and innovation are systematic, deployed and

aligned on an enterprise-wide basis

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These Things Happen,

No Longer

The Baldrige Performance

Excellence Program

What are the Criteria?

“The leading edge of

validated management

practice”

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What are the Criteria?

• Expectations or requirements

• Structured approach to improvement

• Framework for a systems view of performance

management

• Based upon a set of core values

• A common language

Criteria Purposes

• Alignment of key components

• Go beyond conformance-to-standard to a

focus on excellence

• Facilitate communication and sharing among

all types of organizations

• Working tool for understanding and managing

performance improvement

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Criteria Key Characteristics

• Focus on results

• Are non-prescriptive and adaptable

• Support a systems perspective

• Support goal-based diagnosis

THE FRAMEWORK

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Four Harmonized Components

Simplified

• Organizational Profile– Who are we? What is important to us?

• Core Values– What do we believe in?

• Criteria– How do we do it

• Performance Differentiators– How well are we doing it? (results)

BALDRIGE: The Pursuit of Excellence

FEELING, THINKING, BEING, THEN DOING

Visionary Leadership

Patient-focused Excellence

Organizational and Personal

Learning

Valuing Workforce Members

and Partners

Agility

Focus on the Future

Managing for Innovation

Management by Fact

Social Responsibility and

Community Health

Focus on Results and Creating

Value

Systems Perspective

ORG PROFILE & 7 CATEGORIES OF CRITERIACORE VALUES/CONCEPTS

PERFORMANCE DIFFERENTIATORS (ADLI)

How are our APPROACHES SYSTEMATIC?

How are our approaches fully DEPLOYED?

How does LEARNING and IMPROVEMENT

happen?

How is our work ALIGNED and INTEGRATED?

HOW DO YOU KNOW EMPOWERMENT

SO WHATWHAT ARE YOU THINKING

EVERY, EVERY, EVERY

HOW DOES INNOVATION

DISTINGUISH US

CORE COMPETENCIES

SEGMENTATION ENGAGEMENT

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The Comprehensive Excellence

Continuum

Right to

OperateOrg

Excellence

MI

TQM

TPS & Six

Sigma

JCAHO

ISO9000HFAP

CMS/State

Surveys

Other

Govt.

Surveys

Leadership/Customer

Driven

Compliance/QA/QC

Driven

Magnet

Maintain Innovation

DNV

Improvement

Accelerators

Pillar Framework

6-month EBL assessments

LEM

Stoplight Report

Support Service Survey

PCM

SG Portal

RED Strategy Planning Process

Virtual Tokens of Recognition

Service Guarantee

Leader Evaluation Process

Goal Cascade

Monthly Meeting Model

90-day Plans

Linkage grids

LDI

CDI

Peer Interviewing

30/90 day meetings

AIDET

Managing Up

highmiddlelow Performer

Conversations

Rounding on Employees

Leader Rounding for Outcomes

Hourly Rounding

Pre- and Post-Visit Calls

SG’’’’s Best Practices

Standardization AcceleratorsMust

Haves®

Performance

Gap

Objective

Evaluation

System

Leader

Development

Aligned Goals Aligned Behavior Aligned Process

Specific and interdependent practices that have

value to all businesses to create better places to

work & higher quality services for customers.

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World Class Quality

“ The most comprehensive list of actions to

achieve world-class quality is contained in the

Malcolm Baldrige Criteria. ”

Joseph Juran

Quality Progress

August, 1994

Respondents Who Used the CriteriaQuality Progress

Percent Answering

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The Framework Effectively Enables

• Sustainability

• Innovation

• An engaged workforce

• Significantly greater integrated physician

relationship

• Proactively address the more knowledgeable

customer

The Baldrige Effect

• Reduce cost, waste, errors – Less work, Better Work, More Accomplished

• Silos replaced by system integration and collaboration

• To better manage the future – health care reform, ACOs, declining reimbursement

• Improved performance in all key results

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The Baldrige Effect

• It creates the culture and context to EXECUTE

and FULLY DEPLOY Best Practices…

and, preferably…

• Better Than Best Practices—Intelligent Risk

and Innovation

2012 Award Recipients

• Lockheed Martin Missiles and Fire Control,

Grand Prairie TX

• Mesa Products, Tulsa OK

• North Mississippi Health Services

• City of Irving

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Manufacturing Award Recipients

• 3M Dental Division (1997)

• Armstrong Building Products Operations (1995)

• Boeing Airlift & Tanker Programs (1998)

• Cargill Corn Mill (2008)

• Clarke American Checks, Inc. (2001)

• Corning Telecommunications Products Division (1995)

• Eastman Chemical (1993)

• Honeywell Federal Manufacturing Technologies (2008)

• IBM Rochester (1990)

• Lockheed Martin Missiles and Fire Control (2012)

• Medrad (2003, 2010)

Manufacturing Award Recipients

• Milliken & Company (1989)

• Motorola CGISS (2002)

• Motorola, Inc. (1988)

• Nestle Purina Petcare (2010)

• Solar Turbines Inc. (1998)

• Solectron Corporation (1991

and 1997)

• Sunny Fresh Foods (1999, 2005)

• STMicroelectronics --

Region Americas (1999)

• Texas Instruments Defense

Systems & Electronics

(1992)

• Westinghouse Commercial

Nuclear Fuel Division (1988)

• Xerox Business Products &

Systems (1989)

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Service Award Recipients

• BI (1999)

• Boeing Aerospace Support (2003)

• Caterpillar Financial Services U.S. (2003)

• DynMcDermott Petroleum Operations (2005)

• Federal Express Corporation (1990)

• GTE Directories Corporation (1994)

• Merrill Lynch Credit Corporation (1997)

• Operations Management International, Inc. (2000)

• Premier, Inc. (2006)

• The Ritz-Carlton Hotel Company, L.L.C. (1992 and 1999)

• Xerox Business Services (1997)

Small Business Award Recipients

• Branch-Smith Printing Division (2002)

• Freese and Nichols (2010)

• Granite Rock Company (1992)

• Los Alamos National Bank (2000)

• Mesa Products, Inc. (2006, 2012)

• Midway USA (2009)

• Pal’s Sudden Service (2001)

• K&N Management (2010)

• Park Place Lexus (2005)

• PRO-TEC Coating (2007)

• Stoner, Inc. (2003)

• The Studer Group (2010)

• Texas Nameplate (1998, 2004)

• Trident Precision Manufacturing, Inc. (1996)

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Education Award Recipients

• Chugach School District (2001)

• Community Consolidated School District 15 (2003)

• Iredell-Statesville Schools (2008)

• Jenks Public Schools (2005)

• Monfort College of Business (2004)

• Montgomery City Schools (2010)

• Pearl River School District (2001)

• Richland College (2005)

• University of Wisconsin-Stout (2001)

Non-Profit Award Recipients

• City of Coral Gables (2007)

• City of Irving (2012)

• Concordia Publishing House (2011)

• US Army Armament Research, Development and Engineering Center (2007)

• VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (2009)

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Health Care Award Recipients

• Advocate Good Samaritan

Hospital (2010)

• AtlantiCare (2008)

• Baptist Hospital, Inc. (2003)

• Bronson Methodist Hospital

(2005)

• Heartland Health (2008)

• Henry Ford Health System

(2011)

• Mercy Health System (2007)

• Poudre Valley Health

System (2008)

• North Mississippi Medical

Center (2006)

• North Mississippi Health

Services (2012)

• Robert Wood Johnson (2004)

• St Luke’s Hospital (2003)

• Sharp HealthCare (2007)

• SSM Health Care (2002)

Schneck Medical Center (2011)

• Southcentral

Foundation(2011)

When are you too

busy to pursue

excellence?

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BALDRIGE: The Pursuit of Excellence

FEELING, THINKING, BEING, THEN DOING

Visionary Leadership

Patient-focused Excellence

Organizational and Personal

Learning

Valuing Workforce Members

and Partners

Agility

Focus on the Future

Managing for Innovation

Management by Fact

Social Responsibility and

Community Health

Focus on Results and Creating

Value

Systems Perspective

ORG PROFILE & 7 CATEGORIES OF CRITERIACORE VALUES/CONCEPTS

PERFORMANCE DIFFERENTIATORS (ADLI)

How are our APPROACHES SYSTEMATIC?

How are our approaches fully DEPLOYED?

How does LEARNING and IMPROVEMENT

happen?

How is our work ALIGNED and INTEGRATED?

HOW DO YOU KNOW EMPOWERMENT

SO WHATWHAT ARE YOU THINKING

EVERY, EVERY, EVERY

HOW DOES INNOVATION

DISTINGUISH US

CORE COMPETENCIES

SEGMENTATION ENGAGEMENT

ORGANIZATIONAL PROFILE

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Organizational Profile

• Who are we?

• What’s important to us?

• What do our customers want? What does our workforce need?

• What are we really good at?

• What are our challenges and advantages?

SEVEN CATEGORIES OF CRITERIA

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• Values and expectations

• Ethical leadership

• Ensure sustainability

• Engage, empower, communicate

• Performance reviews, set direction

• Findings and improvement

• Effective Governance

• Improve leadership system

• Regulatory, legal, and ethical responsibilities

• Support of key communities

• Build community health

Category 1: Leadership

1.1

Senior

Leadership

1.2Governance

AndSocial Responsibilities

• Sustainability/blind spots

• Health care markets

• SWOT

• Technology and innovation

• Ability to execute plan

• Action plans and measures

• Financial resouces

• Agility

• Staff plans

• Performance projections

• Alignments of goals and actions

2.1

Strategy Development2.2

Strategy Implementation

Category 2: Strategic Planning

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Category 3: Customers Focus

• Identify and innovate services to meet/exceed expectations/attract new customers

• Deploy support services to entire workforce

• Build and manage culture/ relationships to increase customer engagement

• Listen and learn--actionable

• Manage complaints to increase engagement

• Determine satisfaction and engagement

• Use information to antcipaatefuture markets

3.1

Voice of the Customer

3.2

Customer Engagement

Category 4: Measurement, Analysis and Knowledge Management

• Performance Measurement

• Use of comparative data

• Analysis and communication of performance

• Translating reviews into improvement

• Making information available

• Managing organizational knowledge

• Data/information integrity and security

4.1

Measurement, Analysis and Improvement of

Organizational Performance

4.2

Management of Information, Knowledge, Information

Technology

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• Culture enrichment to secure high performance

• Workforce evaluation and recognition

• Empowerment, innovation, ideas

• Workforce and leadership learning and development

• Learning system

• Capability and capacity

• Recruit and retain

• Safe work environment

• Satisfaction determination and improvement

• Relationship to organizational performance results

5.1

Workforce Environment5.2

Workforce Engagement

Category 5: Workforce Focus

Category 6: Process Management

• Core Competencies

• Process requirements

• Work system and process design

• Delivering value

• Suppliers, partners, collaborators

• Emergency readiness

• Meeting requirements continuously

• In-process process measures--productivity, costs, cycle time and supplier performance

• Reducing inspections, rework

• Improving processes, reducing variation

6.1

Work Systems

6.2

Work Process

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PERFORMANCE DIFFERENTIATORS

Characteristics of Great Companies

• Know the right things to do

• Do the right things

• Do the right things well

• Do the right things well…ALL THE TIME.

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Performance Differentiators

Approach/Deployment

1. Approach--Systematic

• Approaches are repeatable

• Use data/information to enable evaluation, learning and improvement

2. Deployment--Full

• Extent to which systematic approaches are used by all appropriate work units

3. Learning/Improvement—Ongoing Cycles

• Evidence of fact-based systematic evaluation and improvement

• Organizational learning important to the achievement of critical success factors

4. Integration and Alignment

• Integration of plans, processes, information, resources, actions, results, analysis and learning throughout the organization

Approach and Deployment

• Approach

– A method or process

– Steps

– Ownership

– Repeatability

(systematic)

• Deployment

– The approach is

disseminated to all

places and people

– The approach includes

and/or considers all

segments

– What is your systematic

approach to

deployment?

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Learning, Alignment, and Integration

• Learning / Refinement

– Is the process effective?

– How do you know?

– What measures do you review?

– When are they reviewed?

– What is your systematic approach to learning, improvement, and innovation for this process?

• Alignment / Integration

– Do our systems and processes support and/or reinforce what matters?

– Do our systems and processes appropriately and effectively work together

Performance Differentiators

• Results:

– Current good or excellent results

– Results trended > three years show improving trends

– Trended results compared to industry performance

are at least good

– Trended results are best-in-industry, world-class

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CORE VALUES

Health Care Core Values

• Visionary leadership

• Patient-focused excellence

• Organizational and personal learning

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Health Care Core Values

• Valuing workforce members and partners

• Agility

• Focus on the future

• Managing for innovation

Health Care Core Values

• Management by fact

• Public responsibility and community health

• Focus on results and creating value

• Systems perspective

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Scoring Band Information

BandBand

NumberDescriptors

0-250 1

Early stages of developing and implementing approaches to Category

requirements. Important gaps exist in most categories.

251-350 2

Beginning of a systematic approach to the primary purposes of the Items,

but major gaps exist in approach and deployment in some Categories.

Early stages of obtaining results stemming from approaches.

351-450 3

A systematic approach to the primary purposes of most Items, but

deployment in some key Areas to Address is still too early to demonstrate

results. Early improvement trends in some areas of importance to key

requirements.

451-550 4

Effective approaches to many Areas to Address, but deployment in some

Areas is still at early stages. Further deployment, measures and results

are needed to demonstrate integration, continuity and maturity.

Scoring Band Information

BandBand

NumberDescriptors

551-650 5

A sound, systematic approach responsive to many of the Areas to Address with

a fact-based improvement process in place in key areas. No major gaps in

deployment, and a commitment to organizational analysis and learning.

Improvement trends and/or good performance reported for most areas of

importance.

651-750 6

Refined approaches, including key measures, good deployment and good results

in most Areas. Some outstanding activities and results clearly demonstrated.

Good evidence of continuity and maturity in many Areas. Basis for further

deployment and integration is in place, with a focus on industry analysis,

learning and sharing of best practices. May be “industry” leaders or

benchmark leaders in some Areas

751-875 7

Refined approaches, excellent deployment, and good to excellent

improvement and levels demonstrated in most Areas. Good to excellent

integration, with analysis. Learning, and sharing of best practices as key

management strategies. “Industry” leadership and some benchmark leadership

876-1000 8

Outstanding approaches, full deployment, excellent and sustained results.

Excellent integration and maturity, with analysis, learning and sharing of best

practices pervasive. National and world leadership.

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ResultsCategory One, Inc.

1.0 Leadership

1.1 Leadership System 70%

1.2 Company Responsibility & Citizenship 60%

2.0 Strategic Planning

2.1 Strategy Development Process 70%

2.2 Company Strategy 60%

3.0 Customer & Market Focus

3.1 Customer & Market Knowledge 65%

3.2 Customer Satisfaction & Relationship

Enhancement 70%

4.0 Information and Analysis

4.1 Selection & use of Information & Data 70%

4.2 Selection & Use of Comparative

Information & Data 55%

4.3 Analysis & Review of Company

Performance 50%

5.0 Human Resource Focus

5.1 Work Systems 70%

5.2 Employee Education, Training &

Development 60%

5.3 Employee Well-Being & Satisfaction 65%

6.0 Process Management

6.1 Management of Product & Service

Processes 65%

6.2 Management of Support Processes 55%

6.3 Management of Supplier &

Partnering Processes 70%

7.0 Business Results

7.1 Customer Satisfaction Results 58%

7.2 Financial & Market Results 60%

7.3 Human Resource Results 55%

7.4 Supplier & Partner Results 65%

7.5 Company-Specific Results 52%

Total Points: 612

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1.0 Leadership

1.1 Leadership System 48%

1.2 Company Responsibility & Citizenship 45%

2.0 Strategic Planning

2.1 Strategy Development Process 50%

2.2 Company Strategy 38%

3.0 Customer & Market Focus

3.1 Customer & Market Knowledge 40%

3.2 Customer Satisfaction & Relationship

Enhancement 37%

4.0 Information & Analysis

4.1 Selection & use of Information & Data 44%

4.2 Selection & Use of Comparative

Information & Data 35%

4.3 Analysis & Review of Company

Performance 45%

5.0 Human Resource Focus

5.1 Work Systems 50%

5.2 Employee Education, Training &

Development 50%

5.3 Employee Well-Being & Satisfaction 55%

6.0 Process Management

6.1 Management of Product & Service

Processes 49%

6.2 Management of Support Processes 50%

6.3 Management of Supplier &

Partnering Processes 40%

7.0 Business Results

7.1 Customer Satisfaction Results 44%

7.2 Financial & Market Results 46%

7.3 Human Resource Results 45%

7.4 Supplier & Partner Results 40%

7.5 Company-Specific Results 45%

Total Points: 448

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Year 4 to Year 5 Progress

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When it comes to Culture and Excellence

“Do or do not.

There is no try.”Yoda

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Percent of Patients Diagnosed

with Ischemic Stroke Receiving tPA

Saint Luke’s Hospital

BETTER

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•

• •

•53

•2 0 0 3 2 0 0 4 2 0 0 5 2 0 0 6 2 0 0 7 2 0 0 8 2 0 0 9 1Q 2011

•Transforming the Patient Experience: 2003 - 2011

•Patient Satisfaction Results - Percentile (Press Ganey)

•93 •91 •91

•88

•18

•29

•35

•77

•61 •63

•78

•54

•72

•77

•83 •80

•38

•18 •16

•100 •98 99 97

•80

•60

•40

•20

•0

•92

•89 •88

•82

•96 94

•95

•79

•60

•76

•83

•62

•38

•Outpatient Inpatient Emergency Amb Surg Conv Care

•52

•Results of Stakeholder Loyalty

•KAPE 110211

•Source: CompData

•Per

cen

t

•25%

•20%

•15%

•10%

•5%

•0%

• 20.5% 20.0%

•G S A M H o s p A H o s p B H o s p C H o s p D

•21.4%

•23.1% 23.4%

•GSAM Market Share For Overlapping Markets •(Overall IP)

•17.0% Increase

•25.6% Decrease

•7.4% Decrease

•2006 2007 2008 2009 Q3 2010

•6.9%

Decrease

•8.4%

Decrease

•57

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Inpatient Satisfaction

Outpatient Satisfaction

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Ambulatory Satisfaction

Emergency Department Satisfaction

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Home Health Satisfaction

Patient Satisfaction Starts

With Employee Satisfaction

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Customer-Focused Outcomes - HCAHPS

Customer-Focused Outcomes

Top Box Scores for Patient Satisfaction

8 years of consistent improvement

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Rate of Change:

SG Partners Improve Where Others

Decline

Source for National Benchmark: NACHR - JWT

Source for Best Practice: ANCC

Good

5.4%

12.9%

14.6%

Bronson Memorial Hospital: RN

Turnover

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Workforce-Focused Outcomes

Staff Voluntary Turnover

Workforce-Focused Outcomes

Physician Engagement Scorecard

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•

•55

•Physician Engagement and Relationship •Physician Engagement Survey Results

•Go

od

•Perc

entile

•Source: HealthStream •Top Decile

•56

NMMC Results

Measure Percentile

Employees 93rd

Physicians 99th

Patients 90th

Key Process Measures – Customer Satisfaction

Press Ganey 501+ beds

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BETTER

*SLH data represents best 5% of comparative group

*

Saint Luke’s Hospital

Net Days in Accounts Receivable

NMMC Results

Cumulative financial gains from

outcomes management of focused

DRG losers

Care-Based Cost Management:

Making the Business Case for Quality

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BETTER

Saint Luke’s Hospital

Admitting Wait Time

NMMC Results

Key Process Measures – Clinical Outcomes

Solucient 501+ bed, Case Mix Adjusted

Measure Below Expected

Mortality 22 %

Charges 37 %

Length of stay 13 %

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50% increase in PVHS discharges from 2000 to 2008

18% increase in Competitor discharges from 2000 to 2008

39% population growth in Competitor’s home county from 2000 to 2008

11% population growth in Larimer County from 2000 to 2008

Financial & Market Outcomes

Patient Discharges: 50% increase since 1st Baldrige

application

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Remaining Competitive

Hospital Charges

NMMC Results

Measure Percentile

FTE’s 14th

Total Labor Expense 9th

Charges per Discharge 8th

Operating Margin 90th

Total Margin 95th

Key Process Measures – Efficiency/Finance

Solucient 501+ bed, Case Mix Adjusted

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2005 Medicare per Capita Spending by Hospital Referral Region

Dartmouth Atlas data

When are you too

busy to pursue

excellence?

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Category One Inc.Redefining Excellence

Joel H. Ettinger

Josh H. Ettinger412-968-1015

joel.ettinger@category-1.com