600 East Superior Street, Suite 404 I Duluth, MN I Ph or I

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1 600 East Superior Street, Suite 404 I Duluth, MN I Ph or I A Blueprint for Critical Access Hospital (CAH) Performance Excellence and Value (Part 2) Region 5 Trustee Meeting April 26, 2014 Geoff Kaufmann CEO North Central Blood Services American Red cross Board Member NRHRC Blueprint Sources Remaining Relevant: Rural Hospitals Challenge, Louisiana Hospital Association, 2012 Rural Policy Research Institute (RUPRI), U of Iowa Rural Hospital Performance Improvement Project (RHPI) Federal Office of Rural Health Policy (ORHP) National Rural Health Association (NRHA) 2011 CAH Quality Leadership Summit 2012 CAH Financial Leadership Summit 2013 CAH Performance Excellence Summit 2013 Top 100 CAHs, ivantage Health, 2013 Survey 1

2 It s Complicated! Even small health care institutions are complex, barely manageable places. Large health care organizations may be the most complex organizations in human history. - Peter Drucker Current Health Care Business Model Based on volume, the more you do, the more money you make 2

3 It s Changing! The Triple Aim Better health Better care Lower cost Future Health Care Business Model Based on Patient Value Quality + Service Patient Cost Value = = Patient Value 3

4 CAHs Cross the Shaky Bridge Source: Continued relevance for rural hospitals in a transformed system will require a multifaceted systems-based approach: Leadership Vision and strategy Partnerships and community focus Translating data into strategic information Change ready, adaptable workforce Efficient and effective operations and processes All leading to excellent performance, and success in a value-based system 4

5 Baldrige Performance Excellence Framework A systems based management tool to align focus on quality and performance A blueprint for rural hospitals Baldrige Performance Excellence Framework Developed in 1987 in response to a crisis in US competitiveness $24.6 billion savings on $120 million cost Health care added as new criteria in 2002 Hospitals using Baldrige seven times more likely to be in Reuters Top 100 5

6 Objectives of Using Baldrige Identifies strengths and improvement opportunities Facilitates improvement, alignment and integration Assists in delivery of value to stakeholders Facilitates organizational and personal learning Monitors strategic progress over time Source: Performance Excellence Network, Baldrige Award Winners Henry Ford Health System (2011) North Mississippi Health Services (2012) Schneck Medical Center (2011) Alaska Native Tribal Health Consortium (2012) Source: Performance Excellence Network, 6

7 A Framework for Excellence Drivers Strategic Planning Leadership Customer Focus Core Work Workforce Focus Operations Management Results Results Measurement, Analysis, and Knowledge Management Source: Performance Excellence Network, CAH Survey Methodology Purpose: To identify the level of importance and the level of ease with implementing Critical Success Factors within the Baldrige Criteria ed the Top 20 CAHs each in finance, quality, and patient satisfaction (60 total) 7

8 Total Average Weighted Scores of Critical Success Factors Average Weighted Score Level of Importance Level of Ease 1 0 Leadership Customers & Workforce Community Baldrige Criteria Outcomes Digging Deeper On June 5 and 6, 2013, the National Rural Health Resource Center brought a small group of CAH leaders and experts together to gather knowledge and best practices, and to recommend a CAH Performance Excellence Blueprint. 8

9 Top 20 CAH Critical Success Factors Leadership 1. Educates and engages the hospital board 2. Aligns hospital leaders, managers and staff around value-based strategies 3. Locks in physicians and other primary care providers 9

10 Leadership Leadership is critical to helping organizations understand the WHY of needed change. Strategic Planning 4. Does meaningful strategic planning at least annually and monitors progress 5. Uses a systems framework for planning to ensure a holistic approach 6. Communicates the plan organization-wide in easy to understand language 10

11 Strategic Planning Strategy Map 11

12 Patients, Partners & Communities 7. Excels at customer services and publicly reports patient satisfaction 8. Partners with larger systems or other rural network hospitals 9. Partners with other providers in the service area 10. Engages and educates the community to encourage use of local health services Patients, Partners & Communities It is easy to get feedback from our patients, we need input from our community. Start small focus on employee health improvement, or one primary issue in your community. 12

13 Measurement, Feedback, & Knowledge Management 11. Uses a strategic framework to manage information and knowledge 12. Evaluates strategic progress regularly and shares information organization-wide 13. Gathers and uses data to improve health and safety of patients in the service area Measurement, Feedback, & Knowledge Management If you don t have data, mythology wins. 13

14 Balanced Score Card Workforce & Culture 14. Develops a workforce that is change ready and customer / patient focused 15. Has an intense focus on staff development and retention 14

15 Workforce & Culture Operations & Processes 16. Develops efficient business processes and maximizes revenue cycle management 17. Continually improves quality and safety processes 18. Uses information technology to improve both efficiency and quality 15

16 Operations & Processes Impact & Outcomes 19. Publically reports and communicates outcomes internally and externally 20. Documents value in terms of cost, efficiency, quality, satisfaction, and population health 16

17 Impact & Outcomes The only way to remain relevant is to define excellence and achieve it. What Can Rural Hospitals Do Now? (at Low Cost) Educate board, leadership, providers and staff about the value-based health system Partner with physicians and other providers Apply for value-based demos and grants Begin population health management with hospital employees 17

18 What Can Rural Hospitals Do Now? (at Low Cost) Reach out to local public health, long term care, and mental health providers Improve the efficiency of financial, clinical and operational processes Begin an ongoing dialog with community leaders and local employers Maximize the value of electronic health records and health information exchange Summary The health care market is undergoing transformational change. Leadership awareness and support will be critical in helping rural hospitals stay relevant during the market transformation. The Performance Excellence Blueprint is a tool to help CAH leaders manage system wide improvement and navigate change. 18

19 Slide 36 k1 May want this as a separate slide if going to list some of the potential tools for development? kweng, 6/17/2013

20 Summary The framework is flexible and can be used in multiple ways a starting point is just reviewing the key success factors and taking a critical look at your organization. Tools to support use of the framework broadly, and individual focus areas are being developed and will be available at Rural Health System Analysis & Technical Assistance Rural Assistance Center (RAC) Institute for Healthcare Improvement (IHI) Flex Monitoring Team Resources 19

21 Slide 37 k2 May want this as a separate slide if going to list some of the potential tools for development? kweng, 6/17/2013 Slide 38 k3 May want this as a separate slide if going to list some of the potential tools for development? kweng, 6/17/2013

22 A Collaborative Effort We are in this Together 20