The Key is Knowledge for a Process Improvement Culture

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Centura HealthCentura Health

The Key is Knowledge for aThe Key is Knowledge for aProcess Improvement CultureProcess Improvement Culture

by Deborah Smith, Ph.D., MBB, MCF

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Objectives

Who is Centura Health? Process Improvement in a Large System Linking Opportunities for Cultural Transformation Generations Working side by side Selecting the Right Person Plan to go forward

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We extend the healing ministry of Christ by caring for those

who are ill and by nurturing the health of the people of our

communities

BEHAVIOR IS A FUNCTION OF VALUES

B=F(V)

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WHO WE ARE?

12 Hospitals

3 Clinics

3 Urgent Care Clinics

367 Skilled nursing beds

116 Alzheimer’s beds

1,051 Residential units

Statewide services include:

Home care

Hospice

HME (home infusion, oxygen, medical equipment

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2005 Centura Health Statistics• Welcomed 12,510 newborns into the world• Calmly and effectively helped in 339,367 emergencies• Provided 87,676 compassionate hospital stays• Provided $333 million in uncompensated healthcare services to our communities• Underwrote $172 million in government care for the elderly and poor• Cared for 19,601 hospice and home care patients• Daily offered loving care to nearly 1,300 elderly residents in our senior care facilities• Contributed $14.7 million to more than 300 community programs• Provided more than 11,000 jobs• Returned more than $489 million in payroll to Colorado’s economy• Committed to nearly $1 billion in healthcare construction projects that support

Colorado’s economy• Fielded more than 82,000 calls from people seeking free health information including

RN health assessment/health education, community programs, facility and physician referrals through our ASK-A-NURSE program

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Our Heritage

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Patient Care Excellence

Focus: Evidence-Based Techniques•Pain Management•Responsiveness•SHARE

Measurements:•Percent 5 Patient Satisfaction

Operational Excellence

Focus: Industry Benchmarking•Labor Productivity•Expense Management

Measurements:•FTE/AOB•OEAA

Clinical Excellence

Focus: Evidence-Based Techniques•Rapid Response Teams•Medication Reconciliation

Focus: Industry Benchmarking•CMS Indicators

Measurements:•CMS Indicators

Associate Excellence

Focus: Evidence-Based Techniques•Rounding for Outcomes•30/90 Day Interviews•Thank You Notes

Focus: Mastery Development

Measurements:•Associate Satisfaction Survey•Voluntary Turnover

MISSIONWe extend the healing ministry of Christ by caring for those who are ill and by nurturing the health of the people in our communities. 

VISIONCentura Health will fulfill a covenant of caring for our communities with excellence and integrity to become their partner for life.

VALUESCompassionRespectIntegritySpiritualityStewardship

ImaginationExcellence

LEADERSHIP COMPETENCIESBusiness AcumenMission and MinistryProcess ImprovementProblem Solving & Decision MakingCommunicationBuilding RelationshipsSelf-ManagementDeveloping OthersChange Management

MASTERDEVELOPMENTIntegrity TrainingSafety TrainingTB TestUnit CompetencyJob DescriptionMasteryLearningChemistryEmpathyDeliveryListeningLiving-Possibility

Line of Sight

Excellence in extending the healing ministry of Christ

SUPERIOR PATIENT EXPERIENCE

QUA

LITY

SERV

ICE

COST

PEO

PLE

GRO

WTH

COM

MUN

ITY

MISSION & COMMITMENT

VISION AND VALUESCONTINUOUS IMPROVEMENT

Excellence in extending the healing ministry of Christ

SUPERIOR PATIENT EXPERIENCE

QUA

LITY

SERV

ICE

COST

PEO

PLE

GRO

WTH

COM

MUN

ITY

MISSION & COMMITMENT

VISION AND VALUESCONTINUOUS IMPROVEMENT

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Why take this Journey toProcess Improvement?

The only way for an Organization to reach its full potential is through people. That can only happen if

the organization is able to recruit and retain a talented and inspired workforce. This begins with a committed leadership team. That is what Process Improvement competency is all about: developing

leaders to take Centura to the top.

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Individual Team Centura

Leadership changes begin, first, with the individual leader. Leadership behaviors impact the team, which drive the

organizational performance

LEADERSHIP

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Defining Success

• Standardization across the system

• Common language and approaches

• Measurable and consistent processes

• A feeling of never being satisfied with good ... … A passion for continuous improvement

• Leadership-driven process

Better for hospitals, better for physicians and staff …Most importantly … better for patients and families

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Centura’s Journey to Process Improvement

Retreat for Executive Leadership.

Retreat for Senior Leadership.

Champions, Projects & Future Leaders identified. Training,

Coaching,

Leading &

Results

Implementation

In progress

Process Improvement cuts across all key initiatives in an Organization.It unifies the initiatives and provides a common language

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• Associate engagement is declining• We haven’t been able to move the patient

satisfaction needle• Layoffs or program eliminations• Physician loyalty in jeopardy• Turnover of key leaders• Quality Scores flat

The Burning Platform for Centura

Are we stuck!

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Quality Initiatives

Malcolm Malcolm Baldrige AwardBaldrige Award

ISO 9000ISO 9000Lean Lean

ManufacturingManufacturing

Total Quality Total Quality ManagementManagement

KaizenKaizenSix SigmaSix Sigma

We have tried them all!!!

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Forming the Strategic Partnership

Laying Foundation: 1st year• Establish operating structure for system• Standardization• Projects alignment with Pillars of Success• Begin Knowledge Practice Transfer for Process

Improvement• ROI based on opportunities, Leadership Guidance and

Data

Knowledge is Key to Perform and Transform• Superior Patient Experience• Preferred Place to Work • Autonomy at Local Level • System transformation• Designing departments/facilities of the future

Clinical & Operational Excellence

Sustainable Results

CulturalTransformation

Str

ate

gic

Tra

ns

form

ati

on

Standardization, Discipline, and Culture Change

Expanding Impact: 2nd year• Structured Deployment of Process Improvement• Leadership Competencies• Associate Competencies• Imbedding practices through support systems

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Culture Transformation Architecture

`

`

I. Secure top-level commitment.

II. Gain critical mass.

III. Transfer competence to internal process improvement leaders.

IV. Roll out to entire organization.

Leaders:Personal leadership commitmentsFacilitated staff meetingsExecutive coachingFollow-up

Skills/Competency:Customized feedback processes Leadership for Results skills workshopsTraining Performance appraisal/compensationPromotions/succession planningPerformance Improvement initiatives

Process:Customer serviceKey company events/ceremoniesRecruitment/hiring/orientationLabor/management relationsAssociate/Patient/Physician Satisfaction

Voice:Advertising/brandingInternal communication Formal communication processes

Effectiveness: Strategic/business planning

Business goals and objectives

Phases Learning Practice Transfer

The retreat is the key catalyst to reach people, create insight, and unfreeze “old story” leadership behavior.

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Generations at Work:• America’s workforce is unique and singular• Mix of race, gender, ethnicity and generations is

stunning• Generational differences cause tension, challenge,

opportunity and promise• Most companies don’t deal with generational

differences at all, much less positively• Increased diversity including more females with

Hispanics being the fastest-growing segment• Managers ill-equipped to manage the new workforce• Less Baby Boomers (workaholics) and more

Generation Xers (life/work balance)

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For the first time, four generations are working side by side.

Veterans: 1925 – 1946

Boomers: 1947 – 1964

Gen X: 1965 – 1977

Gen Y: 1978 – 2000

Understand and speak the languages of the Generations:

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Messages that motivate—Veterans:

• “Your experience is respected here.”• “It’s valuable to the rest of us to hear

what has—and has not—worked in the past.”

• “Your perseverance is valued and will be rewarded.”

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Messages that motivate—Boomers:

• “You’re important to our success.”• “You’re valued here.”• “Your contribution is unique and

important.”• “We need you.”• “I approve of you.”• “You’re worthy.”

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Messages that motivate—Gen X:

• “Do it your way.”

• “You have the newest and best hardware and software.”

• “There aren’t a lot of rules here.”

• “We’re not very corporate.”

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Messages that motivate—Gen Y:

• “You’ll be working with other bright and creative people.”

• “Your boss is in her/his 60s.”• “You and your co-workers can turn this unit

around.”• “You can be a hero here.”

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What qualities do we want in the Process Improvement Team?

CAN DOTechnical Skills

WILL DOPassion & Motivation

FITWork Style

Think of Your Top Talent

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Character

Leading OrganizationalChange

InterpersonalSkills

Personal Capability

Focus on Results

The Process Improvement Team?

The Extraordinary Leader –TurningGood Managers into Great LeadersJohn Zenger & Joseph Folkman

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• Listen, listen, listen• Leaders need to be consistent• Communication is key• Know what is important individually (VOC)• Core Value: EXCELLENCE

In all we do, we will: Put forth our personal and professional best, providing the highest quality of care of which we are capable; Commit ourselves to continuous improvement, seeking to set the recognized performance standards within our industry; Deliver a superior experience for all of our customers, sensing their needs and exceeding their expectations.

Teach how to build a Process Improvement Team:

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Skill Sets to Develop

People

Skill Setsto

ImprovePerformance

Skill Sets to

Lead People

•Career Development•Communications•Developing and Maintaining Relationships•Effective Presentations•Influence, Persuasion and Collaboration•Innovation & Creativity•Judgement & Decision-Making•Learning & Applying Knowledge•Managing Change•Meeting & Exceeding Customer Expectations•Organization & Time Management•Planning & Acting Strategically•Problem Analysis

•Organization’s Mission/Vision/Values•Business Planning and Development•Operational Performance Analysis•Financial and Business Analysis•Information Management•Six Sigma Tools•Performance Measurement System•Performance Improvement Techniques/Processes•Healthcare as a Process•Variation/Measurement•Clinical Quality/Patient Safety Improvement Processes

•Managing Performance•Coaching and Developing People•Building and Leading Teams•Motivating Others•Strategic Leadership•Visionary Leadership

Process Improvement FocusPEOPLE

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To Make this Work

• Need full-time Centura – MBB & BB allocated– MCF allocated

• Centura MBBs to teach Six Sigma and coach Black Belts & Green Belts while doing Projects

• Centura MCFs to teach RDMP and coach Change Facilitators while doing RDMPs

Typical model for 12,000 employees:

12 MBB (1 per 1000 employees) 60 BB (5 per 1 MBB) 1200 GB (20 per BB) 24 MCF (2 per 1000 employees) 240 ( 10 per MCF)

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Tool Knowledge

Recruit the Best

BusinessKnowledge

Min

dse

t

Road Map

Co

re S

kills

ConductTraining & Mentorship

Lead System Initiatives

Strategic Development

•Ready To Go Timeline •Logistics Ready?•Assigned Mentor

•Project management•Help Centura Imagine the possibilities•Heath care knowledge•Operational Skills

Leadership- People Skills•Project Deployment/Execution•Resource Management

•Solve Business Problem Big Y•Operational Skills•Understand Processes•Expertise Building

•Build & Launch •Value Driven

0-6 Months

12-18 Months

Hire

Leaders are Born with Potential and Empowered with Knowledge Leaders are Born with Potential and Empowered with Knowledge

Special ProjectsWork on Big Y

Develop New Skills6-12 Months

18-24+ Months

Skills AcquiredS

tro

ng

Fo

un

dat

ion

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The Challenge•People (GB,BB,MBB,CF,MCF)

• Underutilized Talents• Continuous development structure is not existent• Limited advancement horizontally or vertically

•Business Needs• Not moving fast enough to bring change • Need best talents to develop Process Improvement Team • Need talents to improve internal Satisfaction• Need top talents to lead Centura Process Improvement Team• Need corporate talent pool to meet training commitment for

system

Focus on Continuous Improvement Everyday

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What has been done to date?• Currently in year 2 • Process Improvement experience hired MBB, BB,

MCF• Three waves of Green Belts trained (32) • Three working on Black Belt (3) to help coordinate

and lead waves of training and mentoring • First wave of Change Facilitators (32) trained in

Rapid Decision Making• First wave of Project Managers (75) trained in PM

and Clarity

Pipeline for Process Improvement Talent

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Summary of Project DeliverablesProjects Count Percent Done 43 66.15 Hold 9 13.85 Process 13 20.00 N= 65

• Improved Cycle Times, Productivity, Efficiency in: •Radiology, Emergency, Laboratory, Materiel Management, Chaplain, Nursing Units

• Reduction of Documentation and Standardized for Independent Living• CMS indicators all trending up: CHF, AMI, Pneumonia• Potential 75 lives saved with RRT, Increased Codes in ICUs vs. Nursing Units• Improved time for Food to Residents at Nursing Home• Collaboration with external supply distributor• Financial: Discharged not final Billed improved cash flow:

• Baseline: $7.3M opportunity with $1.4M defects. • Improve: $7.5M opportunity with $526K defects

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Lessons Learnedσ Provide a Vision

“The Soul does not think without a picture.”

σ Communicate Effectively, Openly and Often “There are not facts, only interpretations.”

σ Encourage Problem-Solving & Risk Taking- “ A problem is a chance for you to do your best.”

σ Run Interference and Remove Barriers “ The more I help others to succeed, the more I succeed.”

σ Provide Feedback “Feedback is the breakfast of Champions.”

σ Decisive and Courageous “Only those who risk going too far can possibly find out far to go.”

σ Use Humor “ A cheerful heart is good medicine.”

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Summary

Help Leaders define the culture necessary to Build a Process Improvement Environment

Enhance and implement Line of Sight Connectivity: Mission,Vision, Values, Goals

Take the time to invest in the Right People for theProcess Improvement Team

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We are on our way!! Stay tuned……

Thank YouDeborah Smith303 804 8111

[email protected]