You must be the change you wish to see. Mahatma Gandhi

Transcription

1 Maulik Joshi, Dr.P.H. President and CEO Phone: Hig in the he s W tc orld Clinical Variatio n Healthcare Today os ts r pe Ex im ts en 15% 3% of $ on fraud Slow adoption nt ica nif s Sig ritie pa dis Low usage Uninsured Le ad er an d C ship ult ur e About Us National, not-for-profit organization Mission: Improve Health 30+ year history, 250 employees (associates), $30 Million Revenue Associates: Physicians, Nurses, Scientists, Analysts, Reviewers, Improvers Quality Improvement Organization (QIO) for Maryland and DC Customers: Centers for Medicare & Medicaid Services (CMS), State Medicaid Departments, Agency for Healthcare Research and Quality (AHRQ), Private Foundations, Private Firms We Provide: Resources Education Training Data Analysis Clinical Review Best Practice Sharing Collaborative Improvement Leadership 1

2 s Quality Journey What We Are About Performance Annual Curriculum for Coach Training Variable Compensation (Dashboard) DLQI Coaches Playbook Leadership Improvement Results Quarterly All Associate Calls Monthly All Associates Calls Lunch with Maulik/Dateline Delmarva/5 Notes from the President Quarterly Operations Committee Meeting Delmarva Works All Coaches Invited Integrated Strategic Planning with Milestones Dashboard Leadership Scholarships Values and QI Annual Peer Review Semiannual Peer Review Goals Included 360 Degree Feedback Delmarva Doers ISO 9001 Certification ISO Certification Continued for WIC Baldrige Self Assessment 6 State Examiners Submitted State Targeted Improvement Application Six Sigma Green Belt Certification Below Customer Expectation Reporting Process PDSA Improvement through DLQI Projects Best Place Workgroup Performance Passports Measuring Our Mission Annual Associate Satisfaction Survey Semiannual Associate Satisfaction Survey Internal Customer Satisfaction Survey External Customer Satisfaction Survey Subcontractors Included Dashboards You must be the change you wish to see. Mahatma Gandhi Practice what we preach in terms of transparency, measurement, learning culture and transformation 2

3 What We Do DC and MD Quality Improvement Organization (QIO) AHRQ-Knowledge Transfer Maryland Patient Safety Center Public Reporting EQRO External Quality Review Organization UR-Utilization Review Long Term Care Eligibility Florida DD WIC Western Integrity Center Medi-Medi (Medicare/ Medicaid Data Analysis) MER (Medicaid Error Rate) Health Integrity, LLC (MEDIC) Administration Business Development Communications Finance Human Resources Information Technology Baldrige as the Operating Framework Seven Categories 1. Leadership 2. Strategic Planning 3. Customer and Market Focus 4. Measurement, Analysis and Knowledge Management 5. Human Resource Focus 6. Process Management 7. Business Results 1. Leadership What We Are About Delmarva Leadership and Quality Institute Coaches Training Talent Management Communications Values in Action Six Sigma, PDSA, ISO Below Customer Expectation Reporting Process Baldrige Journey Dashboards Measuring our Mission Satisfaction Surveys 3

4 2. Strategic Planning E Scan Environmental Scanning Process Sources Competitor Analysis Potential Competitor Competitive Threat (May bid against us or may become a significant competitor) Significant Competitive Threat (Expect them to bid against us) Key Trends Issue Statement; Source; Experts Quarterly Updates Environmental Scan to Strategic Plan Process 4

5 Where We Are Going - Strategic Directions Transformation Healthcare is far from being 100% Safe, Timely, Effective, Efficient, Equitable and Patient-Centered (STEEEP) Many errors, many system failures, low satisfaction from everyone We need to improve healthcare and patient safety (I-TEAM) We will be the best at: TRANSFORMATION Of Systems Of Healthcare Organizations Of Leaders Of Communities Medicare Payment Error Rate Annually = $20 billion Fraud accounts for more than 3% of U.S. Spending (National Health Care Antifraud Association); Healthcare costs are high and rising We need to be more efficient in how we spend our healthcare dollars (DIG/Health Integrity) We will be the best at: ANALYSIS Analysis Of Claims Of Medical Records Of Data Of Information 5

6 Influence Over $500 billion spent on Medicaid annually and is 20% of a state s budget States are struggling with what and how to spend money to get the most for their recipients We need to influence key stakeholders on the agenda for quality (PAV) We will be the best at: INFLUENCE Of Organizations Of Consumers Of Providers Of Policy The environment in which we work impacts our work Teams produce better products and services We need be the best at working with each other and being accountable in leading our mission (S 2 ) We will achieve: EXCELLENCE Excellence In Human Resources In Information Technology In Strategy In Operations All models are wrong, some are useful. George Box Continuously acknowledge that one size does not fit all, but all quality improvement contributes to the good 6

7 Delmarva Foundation s Journey to Quality Strategic Planning Milestones Dashboard 3. Customer and Market Focus Agency for Healthcare Research and Quality Health Services Cost Review Commission Maryland Health Care Commission The Lewin Group Computer Sciences Corporation CareFirst BlueCross BlueShield Centers for Medicare & Medicaid Services Maryland Board of Physicians The District of Columbia Department of Health Medical Assistance Administration American Healthways Florida Agency for Healthcare Administration American College of Cardiology Foundation Virginia Department of Medical Assistance National Rehabilitation Hospital California Department of Health Services Medi-Cal Managed Care Division West Virginia Department of Health and Human Resource Maryland Department of Health and Mental Hygiene Robert Wood Johnson Foundation 7

8 Customer Satisfaction Survey Results 72% 95% 64% 89% 9,10 8,9,10 Value Of Delmarva's Work Likelihood To Recommend 2003 (n=9) / 2004 (n=20) / 2005 (n=39) Overall Service Timeliness Technical Quality Value Of Delmarva's Work Likelihood To Recommend Monitoring and Managing Customer Relationships Process initiated in 2005 Information collected and shared with operations Under Development: Databases tracking customers, partners and suppliers 4. Measurement, Analysis and Knowledge Management Measuring Our Mission Dashboards Improving Health Organizational Health Financial Health 8

9 Drill Down Dashboards Drill Down Dashboards Drill Down Dashboards Next Level Dashboard Analysis and Response 9

10 Dashboard Update Process Data updates made by 15 th of each month in working files Working files reviewed between 15 th and 20 th of each month Corporate Performance Factor and Strategic Planning updated Current files archived on network Working files moved to current Dashboard Review and Distribution Process Monthly Printed copies distributed to CEO, then Management Corporate Performance Factor shown at All Associates Call Quarterly Operations Committee reviews all Strategic Plan shown at All Associates Call Ongoing Contract level reviewed at team meetings For All to Use 10

11 5. Human Resource Focus Leadership and Quality Development Model "Never doubt that a small group of thoughtful, committed people can change the world. Indeed, it is the only thing that ever has. - Margaret Mead Leverage the early adopters and champions 11

12 TOPICS Healthcare Leadership Strategic Planning Patient Safety Workforce Management Quality Improvement Tools Organizational Culture Behavior Change Accreditation Spreading Improvement Best Practices Graduates 12

13 Culture eats strategy for lunch everyday. Andy Grove The bigger aim is purposefully creating your desired culture 6. Process Management Value Creation Processes Internal Customer Satisfaction Results 13

14 7. Business Results DF s Revenue Growth and Net Margin DF s Fund Balance Net Margin per FTE DF s Revenue by Strategy Don t let perfection be the enemy of very good. Encourage innovation through goodness Measuring our Mission Fiscal year 2004: We directly impacted over 350,000 individuals through our work FY04: Approximately $90 a person Fiscal year 2005: We directly impacted over 500,000 individuals through our work FY05: Approximately $70 a person 14

15 DF s Best Place to Work Associate Satisfaction Survey Results I would rather work here than any other place I know. (Percent strongly agree and agree) Annual Quality Report FY 2005 FY

16 Because of Baldrige... Developed a Business Continuity and Disaster Recovery Plan Made the strategic plan and process more transparent and involved more of the associates in the process Developed E-Scanning process and Competitor Analysis Created a Performance Passport for each associate and individual goals are aligned with organizational goals Creation of DF Four Corners as overall model Communication of DF Four Corners (strategic plan, measures) to all associates and to all customers Because of Baldrige... Improved communication and expanded communication to all associates e.g., 5 Notes from the President , monthly lunches Training curriculum expanded and strategically targeted to identified needs Evaluation of training effectiveness with Kirkpatrick method Developing robust Customer database Developing Benchmarking database Developing Supplier database Peer review process expanded to twice a year Because of Baldrige... Used external associate customer satisfaction survey to validate survey method Used external research firm to perform customer satisfaction survey which yielded significantly higher response rates Implemented Internal Customer satisfaction survey Implemented Below Customer Expectation reporting process Improved Ethics manual Developing Coaches Playbook (Manual for Coaches) Succession planning system implemented for all key positions 16

17 Because of Baldrige... Developing Mentoring program Delmarva Doers implemented Actively benchmarking for best practices and data (e.g., site visits and creating benchmark database) Developed corporate quality improvement projects, championed by senior management and based on strategic priorities Baldrige Timeline Prioritize, Make Improvements Baldrige Introduction Initial Self- Assessment Examine, Prioritize, Make Improvements Second Self- Assessment Maryland Application Maryland Site Visit December 2003 March 2004 Jan-Mar 2005 Aug 2005 Nov 2005 Education, Communication, Continuous Self-Evaluation Baldrige Timeline U.S. Senate National Productivity Non-Profit Award Pilot Application Received Due Feedback Report Site visit? National Feedback Report Non-Profit Application Due Site visit? March 2006 May 2006 Nov 2006 May 2007 Nov 2007 Prioritize, Make Improvements 17

18 Baldrige Assessment Scores Initial Assessment Second Assessment Maryland Score Corporate Quality Goals Identify Opportunities Information from: Baldrige Assessments Associate Feedback Below Customer Expectation Reports Environmental Scans Review & Prioritize Use Baldrige Framework as roadmap Operations Review Team Driven Track and Improve Action Plan Monitoring Progress is transparent Implement Action Plans developed and implemented Measures, milestones and goals tracked Challenges Ahead Baseball is 90 percent mental. The other half is physical. Yogi Berra Must focus on execution, not just the ideas Getting buy-in never ends Trying to bake it in Not viewed as more work or in addition to what I do everyday Better defining and using key measures and goals Continuing to build improvement capability It is all about culture 18

19 Vision 's vision is to be a nationally recognized leader in quality improvement through leadership, services, and resources for improving health. The U.S. Senate Productivity Award, Maryland s most prestigious award for organizational performance excellence, is given to organizations that are deemed worthy of emulation throughout the state of Maryland. 19