results at a system level- leadership leverage points and the … · 2019-01-29 · change leaders...
TRANSCRIPT
Results at a System Level- Leadership Leverage Points and
the Execution Framework
Anna Roth, RN, MS, MPHChief Executive Officer ,
Contra Costa Regional Medical CenterFellow, Institute for Healthcare Improvement
Agenda
• What we know about how great organizations leading a large portfolio of changes successfully
• Overview of leadership leverage points• An example of using framework• Learning from your experiences and questions
Objectives• Understand how to use a framework to move
beyond project-based improvements to whole system transformation
• Understand how to drive change at all levels of your system
• Explore similarities and difference of improvement at different scales
Consider this…• Most organizations can get one or more project done but,
• It is unlikely that the list of projects will align with the strategy to yield results, and
• Even if they are lined up with the strategy, the changes in the projects need to become coordinated and sustained processes that work together…
How to get there?
Seven Leadership Leverage Points
Reinertsen JL, Bisognano M, Pugh MD. Seven Leadership Leverage Points for Organizational-Level
Improvement in Health Care (Second Edition). Cambridge, Massachusetts: Institute for Healthcare Improvement; 2008. (Available on www.ihi.org)
Three: Channel Leadership Attentionto System-Level Improvement: PersonalLeadership, Leadership Systems, andTransparency
Seven Leverage Points
• Learning about what it takes to execute change on a large scale:• Focus on one or two major aims• Rigorous steering of the execution plan using good data from the field• Resourcing strategic improvements with capable improvers andchange leaders as their primary job responsibility
• Emphasis on the critical role of the board in quality• Learning about the power of stories and data at the board level
• Confirmation and examples of the power of leadership attentionto improvement aims• A major new emphasis on the power of transparency to driveimprovement and change
• Original leverage point focused on establishing the mosteffective senior leadership team• Revised leverage point focuses exclusively on the transformational role of patients and families on leadership and improvement teams
• Learning about the potentially powerful role CFOs can play inimprovement once they see “reduce waste in core processes” as the primary driver of cost reductions, rather than the traditionalapproach of “reduce inputs to (defective) core processes”
• Developed an entirely new framework for engaging physicians in a shared quality agenda, with extensive examples
• Continued reinforcement of the critical need to build capableimprovers at every level as an important underpinning for theother six leverage points
One: Establish and Oversee SpecificSystem-Level Aims at the HighestGovernance Level
Two: Develop an Executable Strategy toAchieve the System-Level Aims andOversee Their Execution at the HighestGovernance Level
Four: Put Patients and Families on theImprovement Team
Five: Make the Chief Financial Officera Quality Champion
Six: Engage Physicians
Seven: Build Improvement Capability
Actions/Execution
Focus on Execution
Execution Step-by-Step
1. Setting Priorities and Breakthrough Performance Goals
2. Developing a Portfolio of Projects to Support the Goals
3. Deploying Resources to the Projects That Are Appropriate for the Aim
4. Establishing an Oversight and Learning System to Increase the Chance of Producing the Desired Change
Nolan TW. Execution of Strategic Improvement Initiatives to Produce System-Level Results. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2007.
Execution for System Level Performance
Manage Local Improvement
Achieve Breakthrough
Goals
Develop Human Resources
Provide Leaders forLarge System Projects
Provide Day-to-Day Leaders for Micro Systems
Spread and Sustain
Example
• 1 million• $780 million• 700 sq miles
• 12,000 • 46,000• 460,000
Our System• Primary Care• Family Practice Residency• Integrated Public Health System• Population/Regional Focus• Focus on Vulnerable Populations
Common things uncommonly well….
Where were we?• VAP• Total Joints• Infection Control• Flow• Code Blues• Medication Safety• PACS• EMR• and on, and on….
Leading change
Finding the levers
1. Aim for excellence
Board to bed
2. Action/ Execute
Transforming Care at the Bedside (TCAB)
Behavioral Health
Clinical Informatics
Emergency Services
Central Line Infection Team
Multidisciplinary Rounds
Rapid Response TeamOffice Practice Team
Perinatal Impact Team
Total Joint Team
VAP Prevention Team
Perioperative Care
Medication Reconciliation Team
Focus on system level performance
Manage Local Improvement
Achieve Breakthrough
Goals
Develop Human Resources
Provide Leaders forLarge System Projects
Provide Day-to-Day Leaders for Micro Systems
Spread and Sustain
3. Monitor and surveillance
Lead by standing still/ oversight
Care that is;
safe, effective, patient-
centered, timely, efficient and equitable
Staff satisfaction
Involve Patients in all improvement teams
Involve ethics in all improvement and operations
Culture of continuous quality improvement
Build Innovation engine
Mortality-RRT, Sepsis Medication safety Falls Pressure Ulcers Re-admissions– Transitions Harm/Adverse events Infection-SSI,UTI,VAP,MRSA
Ownership of agreed upon set of outcomes Review of outcomes at each meeting Quality and safety comprises 25% of agenda Involve patients in safety Visible on all senior leader agenda Culture of Safety/Fair and Just
Shared meaningful vision from Board to the patient
Expert at communication and marketing methods coaching
Program design and structure
Infrastructure supports improvement measurement
Clear, shared measurement set
Inventory national programs and measurements
Recovery plans for unmet outcomes
Strengthen IT infrastructure
Secondary Drivers Primary Drivers
OPERATIONS/
QUALITY DRIVERS
Leadership and Culture
Deliver the Program
Measurement
Communication
Capacity and Infrastructure
1.
2.
3.
4.
Improvement Plan 1
What are we trying toaccomplish?
How will we know that achange is an improvement?
What change can we make thatwill result in improvement?
Model for Improvement
PlanAct
DoStudy
Improvement Plan 2
What are we trying toaccomplish?
How will we know that achange is an improvement?
What change can we make thatwill result in improvement?
Model for Improvement
PlanAct
DoStudy
Improvement Plan 3
What are we trying toaccomplish?
How will we know that achange is an improvement?
What change can we make thatwill result in improvement?
Model for Improvement
PlanAct
DoStudy
Improvement Plan 4
What are we trying toaccomplish?
How will we know that achange is an improvement?
What change can we make thatwill result in improvement?
Model for Improvement
PlanAct
DoStudy
System Measures
TOTAL SALES
190
210
230
J M M J S N J M M J S N J M M J S N
MIL
LIO
NS
1993 1994 1995
TOTAL INJURIES
05
1015
J M M J S N J M M J S N J M M J S NIN
JUR
IES
/MO
1993 1994 1995
ABSENTEEISM OF 160 EMPLOYEES
0
5
10
15
J M M J S N J M M J S N J M M J S N
PE
RC
EN
T A
BS
199519941993
CYCLE TIME
5152535
J M M J S N J M M J S N J M M J S N
CY
CL
E T
IME
IN
D
199519941993
After ChangeBefore Change
UNIT COSTS
7580859095
J M M J S N J M M J S N J M M J S N
CE
NT
S/P
OU
1993 1994 1995
Overall SystemCharter
1.
2.
3.
4.
1.
2.
3.
4.
Improvement Plan 1
What are we trying toaccomplish?
How will we know that achange is an improvement?
What change can we make thatwill result in improvement?
Model for Improvement
PlanAct
DoStudy
Improvement Plan 1Improvement Plan 1
What are we trying toaccomplish?
How will we know that achange is an improvement?
What change can we make thatwill result in improvement?
Model for Improvement
PlanAct
DoStudy
Improvement Plan 2
What are we trying toaccomplish?
How will we know that achange is an improvement?
What change can we make thatwill result in improvement?
Model for Improvement
PlanAct
DoStudy
Improvement Plan 2Improvement Plan 2
What are we trying toaccomplish?
How will we know that achange is an improvement?
What change can we make thatwill result in improvement?
Model for Improvement
PlanAct
DoStudy
Improvement Plan 3
What are we trying toaccomplish?
How will we know that achange is an improvement?
What change can we make thatwill result in improvement?
Model for Improvement
PlanAct
DoStudy
Improvement Plan 3Improvement Plan 3
What are we trying toaccomplish?
How will we know that achange is an improvement?
What change can we make thatwill result in improvement?
Model for Improvement
PlanAct
DoStudy
Improvement Plan 4
What are we trying toaccomplish?
How will we know that achange is an improvement?
What change can we make thatwill result in improvement?
Model for Improvement
PlanAct
DoStudy
Improvement Plan 4Improvement Plan 4
What are we trying toaccomplish?
How will we know that achange is an improvement?
What change can we make thatwill result in improvement?
Model for Improvement
PlanAct
DoStudy
System Measures
TOTAL SALES
190
210
230
J M M J S N J M M J S N J M M J S N
MIL
LIO
NS
1993 1994 1995
TOTAL INJURIES
05
1015
J M M J S N J M M J S N J M M J S NIN
JUR
IES
/MO
1993 1994 1995
ABSENTEEISM OF 160 EMPLOYEES
0
5
10
15
J M M J S N J M M J S N J M M J S N
PE
RC
EN
T A
BS
199519941993
CYCLE TIME
5152535
J M M J S N J M M J S N J M M J S N
CY
CL
E T
IME
IN
D
199519941993
After ChangeBefore Change
UNIT COSTS
7580859095
J M M J S N J M M J S N J M M J S N
CE
NT
S/P
OU
1993 1994 1995
System Measures
TOTAL SALES
190
210
230
J M M J S N J M M J S N J M M J S N
MIL
LIO
NS
1993 1994 1995
TOTAL INJURIES
05
1015
J M M J S N J M M J S N J M M J S NIN
JUR
IES
/MO
1993 1994 1995
ABSENTEEISM OF 160 EMPLOYEES
0
5
10
15
J M M J S N J M M J S N J M M J S N
PE
RC
EN
T A
BS
199519941993
CYCLE TIME
5152535
J M M J S N J M M J S N J M M J S N
CY
CL
E T
IME
IN
D
199519941993
After ChangeBefore Change
UNIT COSTS
7580859095
J M M J S N J M M J S N J M M J S N
CE
NT
S/P
OU
1993 1994 1995
Overall SystemCharter
4. Patients and Families
Change agents
“A vision of hope”
Healthcare Partnership
5. Engage Finance
Quality matters
Quality is Value
• The connection between quality improvement and business performance is still weakly made in most health care organizations, but that is changing.
• Current fiscal reality requires innovation driven redesign.
• CFOs and Operational leaders are finding significant opportunities to improve patient care margins by reducing and eliminating error and clinical waste.
Does Improving Safety Save Money?
103 ICUs Working on Central Line Infections: • 82% Reduction in Mean Infection Rate• 1,578 Lives Saved (Deaths Avoided)• 81,020 Hospital Days Saved• Over $165,000,000 in Costs Averted
New Models For Operation/Quality/Value
Inputs to Core Processes
•Supplies•Staff•Equipment•….
Core Processes
•Evaluating•Diagnosing•Treating•Communicating•….
Outputs
•Quality Results•Safety Results•Costs•…
Where Other Industries’ go to
Reduce Costs
Where Health Care goes to Reduce
Costs
6. Engage physicians
Engage everyone
How to
Use data
Use story
Use science
7. Build improvement capacity
Build from the inside
• Improvement Academy• Change Agent Fellowship• Innovation Council• Model it- quality is personal• Communicate
• Change Theory • Discipline
34
What are your results
Prophylactic Antibiotics One Hour Prior to Incision
Hours of Behavioral Restraint Use
Inpatient Psychiatry: Discharge Care Planning
VAP per 1000 Ventilator Days
11.610.8
1.5 1.3
3.1
0
2
4
6
8
10
12
14
2003 2004 2005 2006 2007
Ventilator Days were 777 in 2006 and 645 in 2007
VAP per 1000 Ventilator Days
VAP per 1000 Ventilator Days
CCRMC 30 Day Readmission Rates
Heart Failure Discharge Instructions Given
Heart Failure Discharge Instructions Given
Percent of Patients Who Received All Heart Failure Interventions at CCRMC
Percent of Patients Who Received All Heart Failure Interventions at CCRMC
All-or-Nothing Measurement
Challenge
Summary• The Leadership Leverage points is built on experience in health care and
other industries.
• It may not be the shortest path, but it has proven helpful to bring strategic and sustainable performance improvements.
To Do:• If you do nothing else, review your portfolio of projects and decide if they
are strategic and lined up to reach the big goals for your organization. It can be the beginning of one of the most important conversations.
• It’s your system, your transformation
Thank you
Anna Roth, CEOContra Costa Regional Medical Center
Clinica Family Health Services
5/27/10Carolyn Shepherd, MD
The Journey to the PCMH
Who/where do we serveIn the beginning…
•1988
•One location
•Seven staff members
•3,000 patients a year
•Migrant farm workers
Clinica Patient Population 2010
170,000 visits
Physical Health
Behavioral Health
Dental
Homeless
38,000 active patients
50% uninsured
40% Medicaid
5% CHP+
56% < Poverty
98% <200% of Poverty
Clinica Family Health Services
68 Physical Health Provider
13 Behavioral Health Providers
4 Dental Providers
Clinics in the Homeless Shelter and Safehouse
2 Full Pharmacies, School of Pharmacy
Total Staff of 300
Admit to 3 community hospitals
Community based EMR 2005
Leadership from the TopEngaged CEO
Collaborative management style
Serious conversation around tough issues
Clear organizational goals
Improvement focused in Key Success Areas
Executive team responsible for outcomes that move the Key Success Areas forward
MISSION: To be the medical and dental care provider of choice for low income and other underserved people in south Boulder, Broomfield and west Adams counties. Care shall be culturally appropriate and prevention focused.
VISION: Our vision for the future is that every low income and other underserved person in south Boulder, Broomfield and west Adams counties will have access to high quality, preventative medical and dental care which is integrated with behavioral health care.
VALUES: * Service to Others * Creativity * Diversity * Excellent Teamwork * Do the Right Thing * Make Clinica a Great Place to Work *
Key Success Factor: Financial Stability Goal: To be a financially stable organization, obtaining and maintaining funds from diverse sources and supporting quality health care services to the underserved.
Objective: Improve collection rate by 6.5% through improved screening and billing.
Key Success Factor: Access Goal: To continually strive to increase patient visit capacity to meet the primary health care needs of all underserved people in south Boulder, Broomfield and west Adams Counties.
Objectives: Add Two Dentists and a Hygienist with support staff at Pecos. Add fully staffed night hours at Thornton, Lafayette and People's and add a pod at Thornton. Add enough behavioral health professionals to have 1 per pod at Adams County sites.
Patient Access Goal: 17.75 visits per day Patient Care Outcome Goals: 70% of Pregnant women quit s moking 90% of 2 year olds are fu lly immunized 90% with asthma use inhaled steroids 75% on antidepressants get 2 week follow-up 80% with diabetes have HbA1c measured in last year 75% of patients see their PCP
Key Success Factor: Our People Goal: To have a stable and diverse staff who function as a high performing team and view Clinica as a great place to work.
Objectives: Create a leadership development program for Clinica staff. Reduce the voluntary turnover rate. Improve systems for orienting new staff to Clin ica's systems and culture. Promote cooperation and teamwork through communicat ion, recognition and appreciation
Key Success Factor: Facilities Goal: To have high quality, attractive facilities that provide an efficient and safe environment for meeting the health care needs of all underserved people in south Boulder, Broomfield and west Adams counties.
Objectives: Replace the People 's Clinic facility. Expand Thornton site to add a pod & GV space Replace phone systems at Lafayette and People's. Pecos Dental Clinic. Assure IT system stability and stay current with technology. Develop a facilit ies maintenance program and "green" facilit ies as remodels are undertaken.
Key Success Factor: Community Partnerships Goal: To work collaboratively with other providers of services to our patients to assure that resources are maximized and that services are integrated seamlessly.
Objectives: Work with Boulder Community Hospital and its admitting obstetricians to support the delivery of Clinica 's maternity patients in Boulder. Work with Dental Aid to integrate physician and oral health. Work with the Boulder County to assure that the Boulder County Human Services Master plan objectives for access to health care are achieved. Work with Community Mental Health Centers in Boulder, Broomfield and Adams Counties to integrate physical and behavioral health services. Explore the potential for training family physicians at Clinica with the St. Anthony North Hospital Family Practice Residency Program. Work with providers of services to homeless people in Boulder County to assure access to primary health care services. Explore the potential for a nursing education collaboration with Regis University.
Key Success Factor: Outcomes Goal: To provide excellent acute and preventive medical, dental and health education services that measurably improve the health status of Clin ica patients.
Objectives: Enhance use of EHR / EDR as quality improvement tool. Reduce outcome variat ion between clinics. Improve full use of team talents and focus clinicians on clinician work.
Key Success Factor: Customer Service Goal: To be the provider of choice for underserved people because we offer world class customer service, which delights our patients.
Objectives: Improve working conditions and reduce turnover in call center. Improve call center service grade on patient satisfaction survey.
STRATEGIC PLAN 2009-2011
Organizational Structure
High functioning work teams
Executive–VPs of HR, Finance, Clinical, IT, Dental
Site leadership-Clinic Director, Clinic Medical Director
Pod leadership-clinical microsystem unit
Stephen R. Covey The 7 Habits of Highly Effective People
Key leadership responsibilityBuild a mindful system to better care for patients
E.H. Wagner, B. Austin, and M. Von Korff, “Improving Outcomes in Chronic Illness,”
Using the Chronic Care Model Focus on the BIG SIX
Continuity
Access to care
Team based care model
Co-location, line of sight, patient centered process
Alternative visit types
Continuity and access groups, telephonic care, email
Optimizing information systems
Igniting patient activation
Crisis Management
Use the strategic plan
Growth (access) is an effective strategy
Closed the Huron Clinic1995
No closing 2006 state, and hospital
No closing 2009 with state budget cuts
PCMH
Submitted 5/17/2010
Able to submit evidence in all 9 standards
No additional process redesign needed
6
Pts24
Standard 4: Patient Self-Management Support A. Assesses language preference and other
communication barriersB. Actively supports patient self-management**
20
Pts3
4
35
5
Standard 3: Care ManagementA. Adopts and implements evidence-based guidelines
for three conditions **B. Generates reminders about preventive services for
clinicians C. Uses non-physician staff to manage patient care D. Conducts care management, including care plans,
assessing progress, addressing barriers E. Coordinates care//follow-up for patients who receive
care in inpatient and outpatient facilities
21
Pts
2
33
64
3
Standard 2: Patient Tracking and Registry Functions A. Uses data system for basic patient information (mostly
non-clinical data) B. Has clinical data system with clinical data in searchable
data fields C. Uses the clinical data system D. Uses paper or electronic-based charting tools to
organize clinical information**E. Uses data to identify important diagnoses and
conditions in practice**F. Generates lists of patients and reminds patients and
clinicians of services needed (population management)
9
Pts
45
Standard 1: Access and CommunicationA. Has written standards for patient access and patient
communication**B. Uses data to show it meets its standards for patient
access and communication**
4
Pts121
Standard 9: Advanced Electronic Communications A. Availability of Interactive Website B. Electronic Patient Identification C. Electronic Care Management Support
15
Pts
3
33
3
21
Standard 8: Performance Reporting and Improvement A. Measures clinical and/or service performance by
physician or across the practice** B. Survey of patients’ care experience C. Reports performance across the practice or by
physician **D. Sets goals and takes action to improve performance E. Produces reports using standardized measures F. Transmits reports with standardized measures
electronically to external entities
4
PT4
Standard 7: Referral Tracking A. Tracks referrals using paper-based or electronic
system**
13
Pts7
6
Standard 6: Test Tracking A. Tracks tests and identifies abnormal results
systematically** B. Uses electronic systems to order and retrieve tests
and flag duplicate tests
8
Pts332
Standard 5: Electronic Prescribing A. Uses electronic system to write prescriptions B. Has electronic prescription writer with safety checksC. Has electronic prescription writer with cost checks
**Must Pass Elements
Clinica Lessons Learned
Leadership is key
Put the patients first
Start small but start!
Use the QI tools that work
Chronic care model,
The IHI Model for improvement
Sequential learning with PDSAs
FMEA
Make improvement and safety a system characteristic
Free up leaders to innovate and “spin the fly wheel faster”
Measure data over time
You don’t need a double blind RCT to get better
Challenges
Health care reform and the possibility of significant growth
Address the issue of the digital divide
Stephen WeegHealth West
Southeast Idaho
Health West: Background
Founded in 1976, migrant and community health center
Clinics in 6 communities in southeast Idaho centered in Pocatello; 90 miles between clinics
8,000 patients; 29,000 visits per year; of which 50% are uninsured
Over 60% of patients in American Falls and Aberdeen Clinics are Hispanic
Pocatello, American Falls, and Aberdeen Clinics are formally engaged in the SNMHI
Triathlon: Year One
Buy into the vision
Expand to all clinics
Training: managers and staff and Board
Huddles and team care
Adopt the language/meeting agenda
Data, data, data
Triathlon: Year One
E-prescribing
Electronic Medical Record implementation
System focus on use of EMR to enhance care coordination
Begin to adapt policies and procedures
Integrate with other program requirements and/or initiatives
Implementation is hard work!
The vision must be compelling!
Engaged Leadership
Energize the vision
Stamina and stubborn persistence
Encouragement
Create the environment for success
Allocate resources: time, staff, finances
Engaged Leadership
Walk the walk
Leadership comes from all levels; everyone in
Energy continues from synergy
Power comes from focus
Support the value of data
Present trumps Promise
Tyranny of Now
Structure of a sick care system
Immediate patient needs
Demands of dollars
Staff transitions
Non-aligned academic training
Tyranny of Now
Workload demands
Multiple priorities
Oh, no…
another survey
Organizational culture
Life is messy!
A Better Place for Patients and Staff
Moving Forward
Continue the training
Keep the energy alive
Real change is at the clinic/patient level
Capitalize on the EMR
Consistently work the gas pedal, there are plenty of brakes!
Contact Information
Stephen WeegExecutive Director
Health WestPocatello, Idaho
Engaged LeadershipEngaged Leadership
CoCo--Habitating at the Habitating at the Squirrel Hill Health CenterSquirrel Hill Health Center
Andrea Fox, MD Medical Director
The Squirrel Hill Health Center The Squirrel Hill Health Center (SHHC)(SHHC)
New paperNew paper--start FQHC opened in June start FQHC opened in June 20062006
Application through the Jewish Healthcare Application through the Jewish Healthcare FoundationFoundation
Focus on older adults, religious and ethnic Focus on older adults, religious and ethnic minoritiesminorities
Built on tenets of Perfecting Patient CareBuilt on tenets of Perfecting Patient Care
FoundationFoundation
Electronic Health RecordElectronic Health Record
Culturally and linguistically diverse staff and Culturally and linguistically diverse staff and patientspatients
One site located on campus of senior housing One site located on campus of senior housing continuum sitecontinuum site
Integrated MH services, care managementIntegrated MH services, care management
Billable staff 1 internist/geriatrician, 1/2 FM, 1 Billable staff 1 internist/geriatrician, 1/2 FM, 1 FNP/ office managerFNP/ office manager
Accessible site, large exam rooms, language Accessible site, large exam rooms, language line, newline, new
ChallengesChallenges
Building patient baseBuilding patient base
Managing diverse staffManaging diverse staff
Lack of access to specialty and hospital Lack of access to specialty and hospital servicesservices
Difficult to reach target populationDifficult to reach target population
Pittsburgh does not easily embrace the Pittsburgh does not easily embrace the ““newnew””
LeadershipLeadership
Executive DirectorExecutive Director
CFOCFO
Medical DirectorMedical Director
Office managerOffice manager
After 4 yearsAfter 4 years
Almost 5000 patients servedAlmost 5000 patients served
39 different languages39 different languages
2 full time MD2 full time MD’’s, 1/2 time, NPs, 1/2 time, NP
Psychiatrist, Ob/Gyn, ophthalmologyPsychiatrist, Ob/Gyn, ophthalmology
ARRA money for mobile unit, dental clinicARRA money for mobile unit, dental clinic
Teaching site for PittTeaching site for Pitt
Merged leadershipMerged leadership
Medical director as neckMedical director as neck
Tight quarters, CEO, CFO, MDTight quarters, CEO, CFO, MD’’ss
Patient storiesPatient stories
News of the staffNews of the staff
Problem solvingProblem solving
Fundraising based on patient storiesFundraising based on patient stories
Specific ProjectsSpecific Projects
Culture statementCulture statement
Vaccination effortsVaccination efforts
ProductivityProductivity
WomenWomen’’s Health Servicess Health Services
Culture StatementCulture Statement
Challenges of diversity of staff: language, Challenges of diversity of staff: language, culture, statusculture, status
Refocus on missionRefocus on mission
Intolerance of intoleranceIntolerance of intolerance
Reorganization of staffReorganization of staff
Culture of Squirrel Hill Health Center: The Mission of the Squirrel Hill Health Center is to provide high quality, comprehensive primary and preventive health care to everyone in our community with a special concern for patients’ religious beliefs, race, national origin, language, age, gender, and disability, and without regard for their insurance status or ability to pay. No matter what position we fill, we all serve this mission; We are here to provide high quality, compassionate health care for our patients, no matter what
their backgrounds; We will treat our patients with respect and dignity; We understand that we are creating a “health home” for our patients, where they feel welcome
and cared for. Our patients come to us for healing. We know that feeling sick may not always bring out the best in people, but we will respond with kindness and care. Daily interactions will be undertaken with an attitude of compassion and good will. We will talk about our patients only if there is a clinical need to do so, and then only in a setting and manner which preserves their privacy;
We are creating an excellent work place for ourselves. We will treat each other with the same respect and dignity we afford our patients;
We will support and encourage each other, assuming that each of our coworkers is also trying to do a good job. We will all work together to establish an atmosphere that promotes learning and the sharing of ideas;
We will talk to each other, with civility, rather than about each other; we will listen to one another with care. If there is an issue we are unable to resolve with a co-worker, we will go to our direct supervisor for help;
We are as varied as our patients. In our private lives we have different beliefs, values, lifestyles, and cultural backgrounds. In the workplace we will all embrace this culture, including respect, listening, caring, and learning;
SHHC exists because we have always had a positive, optimistic attitude. Together, as members of the SHHC community, we can overcome obstacles and create both a health home, where our patients receive excellent, compassionate care, and a workplace in which each of us is supported in working to our greatest potential.
Vaccination FocusVaccination Focus
Low vaccine rates for UDS, 20% first year Low vaccine rates for UDS, 20% first year (2 of 10)(2 of 10)
Few children, didnFew children, didn’’t want to turn awayt want to turn away
Many orthodox, resistant to vaccinationMany orthodox, resistant to vaccination
Daytime outreach to schools by MDsDaytime outreach to schools by MDs
Night time outreach to principals, rabbis, Night time outreach to principals, rabbis, community MDscommunity MDs
Improved to Improved to 67%,67%, but many on but many on schedules, immigrantsschedules, immigrants
Ob/Gyn ServicesOb/Gyn Services
Based on patient storiesBased on patient stories
Egyptian MD, 2 previous CEgyptian MD, 2 previous C--sectionssections
Activated leadershipActivated leadership
OnOn--site servicessite services
Growth in overall patients, women, men, Growth in overall patients, women, men, babiesbabies
ProductivityProductivity
FreeFree--flowing onflowing on--going conversationgoing conversation
What is our product?What is our product?
Bodies through the doorBodies through the door
Bodies seen by MDBodies seen by MD
Technology appliedTechnology applied
Accessible appointmentsAccessible appointments
High quality care, patient satisfactionHigh quality care, patient satisfaction
HealthHealth
Challenges AheadChallenges Ahead
Growth, moveGrowth, move
Continued reorganizationContinued reorganization
Medical home applicationMedical home application
UDSUDS
Continuous change, sustainabilityContinuous change, sustainability
What to do about ToyotaWhat to do about Toyota