Using Data to Enhance Operations & Plan. OPEN MINDS 2010 Strategic Planning Institute May 21, 2010

Transcription

1 Metrics-Based Management: Using Data to Enhance Operations & Track the Progress of Your Strategic Plan Joseph Naughton-Travers, Ed.M., Senior Associate, OPEN MINDS OPEN MINDS 2010 Strategic Planning Institute May 21, 2010

2 Outline I. The Four Cornerstones of Metrics-Based Management II. Steps in Designing Management Metrics Report Assessing & Deploying Metrics in Your Current System III. How to Use Management Metrics in Supervision & Program Management IV. Examples of Reporting Used for Metrics Based Management 2

3 I. The Four Cornerstones of Metrics-Based Management 3

4 Today s Reality When used correctly, measurement data can help an executive team better lead its organization and can help direct the organization toward positive change. Most organizations have the data they need to support metrics-based management in their current information systems but they don t know how to organize the information. 4

5 There are four cornerstones of data that management needs in order to drive innovation, enhance care quality, and improve operational performance. 5

6 Four Cornerstones of Metrics-Based Management Routine operational and management reports Key performance indicators Benchmarking and performance targets Management dashboards or alerts 6

7 Routine Operational & Management Reports These ensure that all staff has access to the accurate, up-to-date information that they need to do their jobs on a daily basis. With roughly ninety ypercent of the reporting needs for organizations being planned and predictable, this simply pymeans producing and using meaningful reports from the management information system and making certain that staff know how to use them. 7

8 Key Performance Indicators With basic operational and management reports in place, the next building block for developing a measurement culture is to make certain that the executive team and operational managers know whether or not the organization s strategic and operational objectives are being achieved. An effective key performance measurement system uses financial and non-financial measures and is driven by structured data from the information system, based upon the organization s strategic objectives. 8

9 Benchmarking & Performance Targets The third cornerstone is using benchmarks and performance targets to challenge and drive continuous improvement in service quality and operations. Benchmarking performance metrics allow your organization to compare with other firms in your industry; develop cross-industry comparisons; develop points of reference or standards of practice; make best-in-class determinations; and to develop best practices. 9

10 Management Dashboards or Alerts The last phase in implementing metrics- based management is to make certain that your managers and staff cannot miss key performance information by using some form of a management dashboard. This is the in-your-face dil daily data dt that thtmanagers receive to keep them abreast of key issues and routine operations delivered d via computer screen dashboards, widgets, or Smartphone and alerts. 10

11 Management Dashboards or Alerts Typically, management dashboards or alerts include discrete performance metrics that measure critical operational components of your organization. Examples include: daily census versus budget tfor inpatient, t residential, and day program units billable staff productivity month-to-date to versus budget hospitalizations and critical incidents in the last 24 hours 11

12 II. How to Use Management Metrics in Supervision & Program Management 12

13 Building the Foundation of Measurement: Start your metrics management approach by ensuring that staff have access to data via routine reporting to manage day-to-day operations and supervise staff 13

14 Routine Report Needs Analysis Internal or External Internal reports are reports identified for use by the agency staff to manage operations. External reports are those required periodically by outside parties (such as state agencies). This list was developed d for a large county-based mental health provider organization rolling out new reporting and software across its program lines. 14

15 Routine Report Needs Analysis Pi Priority it Level Additionally, i reports are given a preliminary priority level by the management team. The priority levels are as follows: Priority One An essential report that must be operational on the day the organization begins to use its new software application. Priority Two A non-essential report, but highly desired as soon as possible after the new software implementation. Priority Three A non-essential report, but anticipated as part of a longer term expansion of management reporting and enhanced operations 15

16 Sample Management & Operational Report List Caseload Report This is a consumer caseload listing for individual clinicians. Staff Productivity Report The purpose of this report is to manage the time spend on behalf of consumers (direct and indirect client care) as well as billable hours. Thus, the report should summarize by clinicians the total number of direct, indirect, billable, and non-billable hours for a given time frame as well as the accompanying gross and net revenues for the billable time. Care Access Measures Reports This report would detail the average number of days between various metrics related to the care access process (e.g., number of days between initial call and diagnostic evaluation, etc.) 16

17 Sample Management & Operational Report List (cont.) Waiting List Report This report provides detailed d and summary information for consumers on waitlists for specific programs, services, funding sources, and/or individual clinicians. Closed Case Notification Report This report details the consumers who have not had a service within a specific time frame to aid clinicians in identifying cases that may need to be closed. Care Provider and Program Admissions Report by Client This report is a listing of all internal and external care providers for a consumer as well as what programs into which the consumer is admitted. 17

18 Sample Management & Operational Report List (cont.) External Referral Report This report details and summarizes the referrals received by the organization in a given time period. It should include basic consumer information, referral source, referral reason, and disposition information. Internal Referral Report - This report is like the previous one, except used for referrals from one program to another within the organization. No-Show and Cancellation Report This report details the number of cancellations and no-shows for a given date range of services. 18

19 Sample Management & Operational Report List (cont.) Discharge Report - This report details and summarizes the consumer discharges from the organization in a given time period. It should include basic consumer information, discharge reason, and disposition information. Consumer Demographics Reports This report should be available in detail and summary format to identify consumers with a broad range of specific demographics or combinations thereof (e.g., age group, gender, race, zip code, diagnosis, medication, etc.) Mandated Treatment Monitoring Reports These reports should be available in detail and summary formats to support compliance with various mandated treatment requirements. 19

20 Sample Management & Operational Report List (cont.) Medication Profile & Report - This report details the number and percentage of consumers who are receiving specific medications. Daily Census This report should detail the names and basic information for consumers admitted to a per diem program on a specific date. Tickler Report - This report details all required, but not completed, medical records events and other requirements by consumer and care provider. High Risk / Priority Consumer Report This report should detail and summarize the consumers identified as high-risk and/or priority cases by program and overall. 20

21 Sample Management & Operational Report List (cont.) Crisis Call Tracking - This report details and summarizes the crisis calls received by the organization in a given time period. It should include basic consumer information, referral source, referral reason, and disposition information. Consumer Service History - This report details all of the services rendered to an individual consumer within a specific time period. Substance Use Report - This report details the number and percentage of consumers who are using specific non-prescribed medications or substances. 21

22 Sample Management & Operational Report List (cont.) Credentialing Warning Report - This report warns users of clinician credentialing needs and other required events (such as continuing education requirements, contract renewals, etc.) Aged Trial Balance Report - This report details and summarizes the current accounts receivable, including all billing, payment, contractual expense, and write-off data on an individual claim basis. General Ledger Posting Report - These reports detail the credit/debit entries by G/L account number for posting month end financial data into an accounting software application. 22

23 Sample Management & Operational Report List (cont.) Pre-Billing Edit Report - These reports detail all services entered into the system that encountered a billing edit (e.g., missing diagnosis, missing authorization, etc.), allowing users to correct problems that may prevent payment prior to billing services. Deposit Reconciliation Report - This report details the bank deposits, including payers and check amounts, for a given date range so that users can reconcile deposits entered into the system with bank statements. Collection Follow-Up Report - This report is an expanded Aged Trial Balance report, with the addition of payer contact information and collection/follow-up notes. 23

24 Sample Management & Operational Report List (cont.) Bad ddebt btwrite-off Report - This report details and summarizes the bad debt write-offs to the accounts receivable for a given date range of transactions (billing and service dates), including consumer, payer, amount, and write-off reason. Missing Demographics Report -This report details consumers who are missing required demographic data elements (for billing, state reporting, etc.) Missing Service Authorizations Report -This report details all services entered into the system that t are missing i required service authorizations, including primary clinician, consumer, date of service, and service. 24

25 Sample Management & Operational Report List (cont.) Service Authorization ti Warning Report -This report is designed to be warn clinical staff of service authorizations that are pending expiration or exhaustion, based on the expiration date or the number of authorized services remaining.. Appointment Schedule -This report details the scheduled appointments for service. Outcome Reports -These reports would detail and summarize consumer outcome information for selected metrics (such as level of functioning i measures, hospitalizations, ti days in sobriety, maintained employment, etc.). 25

26 Sample Management & Operational Report List (cont.) Average Length of fstay Report This report should summarize the average length of stay by days or visits by clinical program or overall. Average Number of Services Report - This report should summarize the average number of services per consumer per organizational or clinical program admission. Dismissal Report This report should detail consumers referred to a program but not admitted either due to non-acceptance or non-compliance. Service Plan Variance Reporting This report should detail by consumers all services rendered that were not part of the service plan. 26

27 But Routine Reporting Is Not Enough! Organizations Need Key Operational & Strategic Performance Metrics 27

28 Kick It Up a Notch by Implementing Key Performance Indicators Key performance indicators (KPIs) are financial & nonfinancial measures used by the management team to ensure that the agency is moving forward din achieving i its strategic & organizational objectives. Driven by structured data from the information system, the KPIs represent those data points that measure the health of your organization. 28

29 Steps For Developing KPIs 1. Start with strategy and strategic plan 2. Create performance measures from strategic plan: quantifiable objectives, timelines, assignments, and budgets 3. Design the metrics of success (the KPI ) in terms of those measures 4. Create reporting formats for these metrics 5. On-going monitoring and proactive management based on KPI 29

30 Balanced Scorecard Concept Based on assumption that focusing on financials alone is path to failure Balanced set of KPI reflect four key management perspectives p Financial performance Customer performance Organizational innovation Internal operations (clinical and administrative) 30

31 How the Executive Team Uses KPIs Monitor representative metrics of organization s performance Proactively address problems ( leading indicator concept) Use as guide to selecting issues for further exploration To stretch to better performance! 31

32 Case Study #1 Examples from a large rural behavioral health provider in the southwest United States 32

33 Financial Metrics Revenues by line of business Expenses by line of business Profit/loss by line of business Unit cost by service by site 33

34 Customer Metrics Number of referrals by referral category Discharges by reason category Number of grievances Number of appeals Number of complaints Number of critical incidents Return rate after intake by site 34

35 Internal Operational Metrics Number of new hires Number of terminations Average number of days positions vacant by site by category Percent claims denied Number of crisis responses, after hours Number of crisis responses, daytime Percent of crisis responses resulting in hospitalization 35

36 Internal Operational Metrics No show rate for intake No show rate for MDs Percent of consumers served by out of region contract providers by line of business Percent of staff who met clinical productivity requirements by site Rolling turnover rate (3-month) by site by category Number of new positions Number of vacancies 36

37 Innovation Metrics Number of linkages and new resources in community Number of community ed hours Number of community ed participants Number of PR events Number of staff development hours Number staff development participants Number of positive media mentions 37

38 Case Study #2 $20 million catholic family service agency Chose to measure performance from three perspectives: #1 Management team #2 Board of directors and key funding organization #3 Community report card 38

39 Management Team & Board KPI Two types of metrics: organization-wide indicators and program specific indicators Organization-wide i id indicators Revenues Expenses Net profit (loss) Staff vacancies by department/program Staff hires and terminations 39

40 Management Team & Board KPI Program-specific indicators Number of new cases opened Number Of cases closed Unsuccessful discharges by outcome Client satisfaction indicators 40

41 Building a Community Report Card Strengthening families and our community Number of clients service by program Number/percent of church hclients served by program Number of community trainings and education programs Number of participants i t in community training i and education programs Number/percent of clients receiving service subsidy Number/percent of church clients receiving service subsidy 41

42 Building a Community Report Card (cont.) Achieving results for the community Client satisfaction indicators Successful discharges, by program 42

43 Case Study #3 ABC county department of mental health (A county-based behavioral health authority) 43

44 Case Study #4: Strategic Objectives Strategic Objective #1: Develop and dimplement within ihi the next calendar year, a measurement system that demonstrates that high-quality clinical services for consumers with best value for taxpayers is delivered. Strategic Objective # 2: Develop and implement within the next calendar year a management system that assures consistent high-quality service delivery within budget realities. Strategic Objective # 3: Encourage the state to adopt the behavioral health delivery system model that is best for county residents. Strategic Objective # 4: Add value to the county and the state through development of a prototype for sharing operational expertise with other Area Programs, through increasing collaboration with the state s Health Care System and through exploration of information sharing with the Department of Social Services. 44

45 Financial Measures Current month s revenue, budgeted revenue, and variance by product line Number of consumers served dby product line Lag days by product line Preliminary IBNR (incurred but not received) Average payment and cost per unit of service 45

46 Customer Measures Number of consumer inquiries Number of consumer complaints Number of authorization appeals Number of grievances Appeal overturn rate 46

47 Customer Measures (cont.) Grievance overturn rate Number of network provider inquiries Number of network provider complaints Average number of days to care access by product line 47

48 Innovation Measures Number of community trainings/ workshops/ education services Number of staff training i days 48

49 Internal Operational Measures Internal provider yield Claims processing measures: Beginning claims inventory New claim receipts Claims processed Ending claims inventory Days on hand Data entry procedural accuracy Dollar accuracy 49

50 Strategic Plan Progress Measures Number of overdue tasks 50

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57 Hillside Approach. 2.1 Strategy translated in strategy map 2.2 Strategy described in Balanced Scorecard 2.3 Targets identified for all measures 2.4 Strategic t initiatives iti rationalized 2.5 Executives accountable for initiatives

58 Strategic Intent: The leader in translating research into effective practice solutions. Stakehold er Financial S1. HFA s system of care produces positive outcomes. F1. Diversify revenue streams S2. Local communities experience a sense of ownership of Hillside. F2. Develop a stronger system of care through growth. Customer Operational Excellence C1. EB practices achieve effective outcomes. Innovatio C2. Create customer n solutions. Partnership s C3. Preferred provider of services W3.EB s practices are delivered according to design W7. Service growth includes research grants. W10. We understand Strategic Partners needs. W2. User-friendly systems provide accurate data W1. Efficient standard work processes drive productivity. Internal Work Processes W5. Service models are based on research. W6. We infuse innovation across our value chain. W4. Hillside has research partnerships. W9. Strong parent and youth advocacy W8. Communication exceeds customer expectations. L1. IT systems add value and ease complexity L3. Research infrastructure supports HFA system of care. L4. Hillside is a destination for diverse talent. Learning and Growth L2. Organized system shares knowledge and learning. L5. Behaviors consistent with COI values. HFA BSC FY0809, rev

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60 Deliver Our Mission Excellence & Innovation Strategic Themes Provider, Employer, Charity of Choice Strategy Map Finance Grow Non-operating Revenue Increase Margins & High Margin Business Customer Strong Brand Significant Player in Operating Markets Internal Processes Program Quality Lean Corporate Infrastructure Build A/R Capabilities Know Key Customer Drivers Innovative Service CoreCompeten cy Innovate & Grow Positively Aligned & Accountable Retain, Recruit, Train the Best Staff Access to Strategic Info 60

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62 Benchmarking & Performance Targets: Moving Strategic Performance To The Next Level 62

63 Why Benchmark? To compare with other firms in your industry To develop cross-industry comparisons To develop points of reference or standards of practice To make best-in-class determinations To develop best practices 63

64 Benchmarking Process: A Collaborative Approach Develop group of organizations to initiate benchmarking process Agreement of organizations i about process, goals, measures to benchmark Cll Collect tdt data and analyze Create data collection instrument Reality check and refinement Publish benchmarks 64

65 Benchmarking Another option is to purchase or acquire benchmark data and compare it to your organization s measures 65

66 Pennsylvania Community Providers Association (PCPA) Benchmark Initiative The information gathered is being used in three ways: Provide participating organizations with individualized comparative benchmark data to provide context for their measured outcomes Improve PCPA advocacy by providing information about the relative health and performance of Pennsylvania s behavioral health care providers, particularly as compared to providers across the country Identify best or promising practices through the use of process benchmarking to identify methods used by top performers 66

67 Pennsylvania Community Providers Association (PCPA) Benchmark Initiative (cont.) Eighty PCPA member organizations have been participating in the initiative. The benchmarking system features secure on-line data submission and the ability to generate on-demand, real- time benchmarking reports with the ability to differentiate program sites and provide comparisons with state and national comparison groups. Each organization s information is confidential, and can be used within an organization to generate internal quality improvement data. 67

68 Pennsylvania Community Providers Association (PCPA) Benchmark Initiative (cont.) The benchmarks cover the following clinical, operational, and financial management factors: 10 clinical i l benchmarks and 57 measures, which h include use of restraint procedures, no-show and cancellation rates, and homelessness or incarceration 11 operational benchmarks and 61 measures, which include staff retention and turnover rates, salary and benefit levels, clinical productivity, and access to outpatient 12 financial benchmarks and 25 measures, which include days of cash on hand, net days in accounts receivable, current assets/liabilities ratio, and revenue by payer source 68

69 Management Dashboards: Up-to-the-Minute the Performance Data Your Staff Can t Miss! 69

70 Management Dashboards A dashboard is an information system user interface that (similar to an automobile s dashboard) is designed to be easy to read. They are part of a common suite of business intelligence tools. 70

71 Management Dashboards These are discrete performance metrics that measure critical operational components of your organization. Dil Daily census versus budget bd Productivity or units of service month-to-date versus budget Hospitalizations, critical incidents, etc. in last 24 hours??? 71

72 Management Dashboards Select these must-have data elements and work with your technology team and partners to make them unmissable Computer screen dashboards d or widgets Smartphone and alerts?? 72

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81 III. How to Use Management Metrics in Supervision & Program Management 81

82 How to Use Management Metrics in Supervision & Program Management Manage daily operations and individual staff performance with routine and operational reports Sl Select, report, and manage to performance metrics for clinical programs and staff St Set performance targets t for programs and didiid individual staff tff members. 82

83 How to Use Management Metrics in Supervision & Program Management (cont.) Benchmark program and individual performance with other programs and individuals (internal and external) Use dashboards d as a means to keep your staff s eyes on the performance targets. 83

84 Putting It All Together: Steps for Implementing the Four Cornerstones of Metrics-Based Management 84

85 Steps for Implementing the Four Cornerstones of Metrics-Based Management #1 Routine Management & Operational Reports Analyze business needs and find or develop required reports, focusing on the must-have reports first! Ensure easy access to reports and train staff in their use #2 Key Performance Indicators As part of your next strategic planning or budgeting process, select a balanced scorecard of KPI metrics Implement, train, and modify as needed 85

86 Steps for Implementing the Four Cornerstones of Metrics-Based Management #3 Benchmarking & Performance Targets For select KPIs, select performance targets and benchmark with other organizations if possible. #4 Management Dashboards & Alerts For key staff positions, focus management efforts on performance targets by displaying dashboard data as frequently as possible! 86

87 The Must-Have Management Reports Five Categories of Management Reporting You Can t Live Without! 87

88 The Must-Have Have Management Reports #1 Access To Care Reports # of referrals / % accepted for admission # of admission i denials by reason Waitlist information Time metrics for access to care #2 Revenue / Productivity Reports Census to budget Unit-fee productivity reports 88

89 The Must-Have Management Reports (cont.) #3 Financial Reports Averages days in A/R Collection % Bad debt percentage, dollars, by reason Late charges Income statement, budget to actual 89

90 The Must-Have Management Reports (cont.) #4 Outcome & Satisfaction Reports Outcomes Successful discharges #5 Compliance Reports Records compliance Critical incidents 90

91 Questions & Discussion 91

92 Resources Metrics-Based Management: Using Data Decision Making htm Mental Health System Design to Support Not Impede Consumer Recovery Features Integrated Funding, Consumer-Driven Care, & Performance Metrics Manage Marketing Dollars Using Performance Metrics: Make Estimating Your Marketing ROI Possible by Moving From Context to Metrics Use of Data-Driven Metrics-Based Management Improves CMHC No- Show Rates & Consumer Satisfaction Accuracy 92

93 Upcoming Educational Events OPEN MINDS and NHS Human Services, Inc. Management Excellence Seminar Series: Using Metrics to Manage &Improve Organizational lperformance June 3, 2010, Blue Bell, Pennsylvania OPEN MINDS and NHS Human Services, Inc. Management Excellence Seminar Series: Creating a Roadmap for Success: Strategic Planning and Marketing Planning September 2, 2010, Blue Bell, Pennsylvania The 2010 OPEN MINDS Executive Leadership Institute: Discover the Lessons of Great Leaders in Times of Crisis September 22 24, 2010, Historic Gettysburg Hotel, Gettysburg, Pennsylvania OPEN MINDS and NHS Human Services, Inc. Management Excellence Seminar Series: Models For Responding to Challenging Market Conditions With Mergers, Acquisitions, & Strategic Partnerships October 13, 2010, Blue Bell, Pennsylvania The 2010 Institute for Behavioral Health Informatics: The 6 th Annual Conference on the Future of Technology in Behavioral Health November 10-12, 2010, Baltimore Convention Center, Baltimore, Maryland 93

94 Bringing The Management of Behavioral Health & Social Services Into Focus York Street, Gettysburg PA