Is there a Roadmap for Transformation? Continuous Improvement in Healthcare: A Roadmap for Transformation Cleveland Clinic November 12, 2012 Alice Lee Vice President, Business Transformation Beth Israel Deaconess Medical Center
Beth Israel Deaconess Medical Center Boston, MA 116 Years in Business 649 Licensed Beds Teaching & Research Affiliate of Harvard Medical School Inpatient, Outpatient, Emergency Services 10,000+ Employees & Physicians Yearly Gross Revenue of Over $1.6 Billion Network of Affiliates and Partnerships
BIDMC Market Position National data from Leapfrog shows that among US and MA hospitals, BIDMC ranks tops for high quality and lower cost This is an extremely strong competitive advantage 2011: We are here Can we stay here?
In the beginning Where am I? Where am I going? Why am I on this journey?
Results Focused Blunt force improvement form of stability To RIE or not RIE Lean as a religion? Traditional
# of Staff Trained Were we successful? We were making measurable improvements & senior management was satisfied: Event Based model Lean Participation at BIDMC Lean Program Financial Improvement Millions Target FY05 FY06 FY07 FY08 * BIDMC's Fiscal Year begins October 1st Basic 1 RIE >1 RIE Cumulative $0 FY06 FY07 FY08 * BIDMC's Fiscal Year begins October 1st Why make a change? Do I only do improvement work if it is scheduled? How do these wins connect to the goals? We helped 4 managers with gemba consultations, how can we help 450?
Where do we go from here? Multiple Paths Hire point Consultants Where do I go now? Traditional Do Nothing Focus on Tools (Rote learning vs thinking)
Where do we go from here? Norm says go to Japan
How did my thinking evolve? We needed: to set a direction & focus to be disciplined & avoid distractions total participation to strive towards: o Easier o Better o Faster o Cheaper = True North
Where do we go from here? Transitional If we know where we are and where we are headed What is the gap? What are the barriers? Traditional
Game Changer Participation! Engage leaders to own the lean journey Transitional Traditional But how?
Vertical Leadership Participation Common Understanding Know why & what s my role Common language of improvement Principles AND thinking Horizontal Teach & Coach others See problems Solve problems
Lean Leadership Development Learn to See True North Difference between Being there vs. Getting there Alignment Idea Systems Favorable Environment Practice Hierarchy of Improvement See Waste Develop more Problem Solvers Problem Solving Foundations Know Why Management Leaders Role Countermeasures Know How
Build Relationships Physician & administrative leaders learn together Leaders go to where the work is done to understand current conditions
Operations Cs VPs Directors Managers Staff + Physicians Chairs Chiefs Directors Attendings Trainees Learn to lead differently together
Operations Cs VPs Directors Managers Staff + Develop all Senior Leaders & Directors Physicians Chairs Chiefs Directors Attendings Trainees Tension = Deep Learning
Operations Cs VPs Directors Managers Staff + Develop all Senior Leaders & Directors Physicians Chairs Chiefs Directors Attendings Trainees Leaders develop their spheres of influence (10,000 people) Ownership = Diffusion
Early Transformation Transformational Transitional Traditional Start to run the business differently
How are we running the business differently? Embedding CI capabilities within key depts CEO COO CFO Medical Education Planning Process Vice Presidents Physician Chiefs Develop formal partnerships with vendors Space Design Supports need to publish Administrative & Clinical Directors Managers & Supervisors Hiring Process Capital Decisions
Aligned Planning Process FY10 Annual Operating Plan 4 pages Compilation of vice presidents goals
Aligned Planning Process FY11 Annual Operating Plan Plan on a page Parallel process creating the goals of our 3 missions Migration from individuals drafting topical goals to broader, shared goals
Aligned Planning Process FY12 Annual Operating Plan Migration back to more specific goals Introduction of a horizontal goal Introduction of multiyear goals
Aligned Planning Process FY13 Operating Plan Clinical Care Education Research True North Quality Ensure reliability Improve the Health & Well-Being Of Patients, Families, Employees & Physicians Through Innovative Clinical Care, Education, & Research Value = Implement processes that measurably decrease harm/defects Improve reliability through standardization Measurably improve patient & family experience Grow and enhance a market-leading system of care that delivers the highest value by creating and sustaining a culture of continuous improvement through engagement, development, and support of our employees, physicians, patients & families & Cost Continuously improve our ability to adapt to changes in the healthcare environment Maximize efficient utilization of resources: Staff Equipment & supplies Space Diagnostic tests & treatment System Advance as a system of care Develop, standardize, improve transitions among sites of care Respond effectively to the needs of our network and affiliates Achieve optimal alignment between physicians & hospitals Fiscal Year 2013 Operating Plan People Engage and develop our people every day Enhance wellness and safety Promote & support a culture of service excellence and continuous improvement Optimize & support learning & development Fewer goals Relevant goals to every employee & physician Reflection guided True North revision Inclusive process for leaders of the 3 missions resulting in an integrated set of goals FY13 Annual Operating Plan Owner/ Date 9/7/12 DRAFT 9/10/12 DRAFT (People Team) 9/11/12 DRAFT (Quality Team) 9/12/12 DRAFT (Ext Aff Team) 9/13/12 DRAFT (Fin Perf Team) 9/19/12 DRAFT (MEC) 9/24/12 FINAL Ops Council Alignment to our strategic plan
Do we select, develop & retain the right talent to lead & thrive in our environment?
Talent Selection 90,000 Applications Annually Competency Assessment 2,200 Hired Annually
Competency Progression Map Core Values Work Style Interpersonal Style Thinking Style Leadership Style
Findings/Results Standardization Quality Satisfaction Productivity Suggested interview questions provide fuller picture Minimize legal risk in hiring process standardized approach vs. subjective Improve the predictive nature of the selection process Managers meet better fit candidates Reduce 90 day & 6 month turnover = 0% Applicant Feedback Easy and reflects positively on BIDMC; Allows you to see me as a person, not just a piece of paper Applicant quote 235 hired using assessments with 83% either Good or Very Good Fits 20,000 assessments taken w/ 84% pass rate; 16% fail rate eliminates 10 weeks of resume review time of poor fit candidates annually Decrease time to fill
Is there a roadmap for Transformation? Transformational Compliance & regulatory Leadership changes Transitional Presidential Election Traditional Conflicting missions Healthcare reform
How do you handle those things that could impact the survival of your journey? Build flexibility & agility Processes operations, support, organizational learning Workforce current & incoming Leadership transform the business Partners universities, vendors, suppliers Structures physical, management structure, organizational plan
Business Transformation at BIDMC Purpose: Promote skills to survive & thrive in an unknown future and to proactively manage change and align our systems & structure to support our direction & goals Innovation Diffusion Think differently to solve longstanding problems See beyond the problem edges Adaptive vs. adoptive thinking Learn together with deep understanding of each others perspective & our systems Shift mindset by practicing new ways of thinking Mobilization of resources (ownership: we see, we feel, we change) Systems Holistic thinking vs. just the end goal Create management systems that can adjust to unpredictable, dynamic conditions Create closed loop systems
Thank you! Are we there yet?