Based on some discussions at the recent meetings of the CHRISTUS Health Board of Directors, it seems appropriate to articulate the Senior Leadership Team’s approach to optimizing performance. Utilizing our Journey to Excellence, we have attempted to answer the right questions which should result in positive performance trends over time and ultimately facilitate the achievement of excellence – the CHRISTUS Health vision. These eight questions include:
1. Has CHRISTUS Health clearly established what is important?
Journey to Excellence
Sponsoring Congregations’ Goals
2. Has CHRISTUS Health determined expected performance levels for all four Directions to Excellence and other critical success factors?
Answer: Benchmark metrics have been determined and in place since the formation of CHRISTUS. These are reviewed and updated annually.
3. Has CHRISTUS Health developed a balanced measurement system?
Answer: CHRISTUS Health has used a balanced scorecard since its formation, which is also used by all regions and business units.
4. Has the current CHRISTUS Health performance been assessed?
Answer: The performance measurements are reviewed monthly, and improvement plans are continuously refined to attempt to move the scores from good to great. The measurements are shared with all levels of governance.
5. Has the business case for performance improvement been clearly established?
Answer: Our data has been studied for the last eight years, verifying that clinical service and patient satisfaction improvements drive improvements in business literacy (financial operations).
In addition, capital budgets have been driven by the sum of depreciation and operational margins and philanthropic donations.
Capital constraints have been put into place during periods when operating performance is not satisfactory.
6.Are departments/ functional areas aligned with the CHRISTUS system’s organizational performance expectations?
Answer: All regions and business units have goals which support the four Directions to Excellence.
Pay-at-risk is driven by annual metrics from the four Directions to Excellence.
The “success sharing” program for Associates is driven by the clinical and service quality goals.
7. Are priorities for process improvement identified?
Answer: The monthly CAP calls review the action places and progress year-to-date.
Specific focus is given to discussing improvement plans for those areas not attaining or sustaining their goals at the “excellent” level.
8. Are appropriate tools and methods used to bring about successful change and improved performance?
Answer: CHRISTUS Health uses a select number of tools, and uses “crosswalks” to make sure they are integrated sufficiently to accelerate the Journey to Excellence. These tasks primarily include:
•External surveys including Joint Commission, including U.S. and international lab, rehabilitation, community benefit and trauma centers.
•Journey to Excellence in the four Directions and the “must haves” that are known to create success in each.
•Magnet status for nursing
•State quality awards
•Malcolm Baldrige National Quality Award
•Toyota production system/ lean management
I have talked previously about the importance of external surveys, the four directions on the Journey to Excellence, Magnet status for nursing and the state quality awards mentioned above. Hence, you will fine below a brief summary of Six Sigma and lean management tools, which are being utilized in our revenue cycle and supply management programs, and the Malcom Baldrige National Quality Award, which we hope to apply for as a system some time between 2009 and 2011.
About Six Sigma
Origin: Six Sigma was developed by Motorola in the early 1980s as a means to eliminate defects in the manufacturing process and ultimately improve customer satisfaction.
Core Tenet: Six Sigma is a data-driven quality improvement methodology that is designed to eliminate variation from a process. To achieve Six Sigma quality, a process must produce fewer than 3.4 defects per million opportunities.
Key Components: The major components in the Six Sigma improvement framework are: define, measure, analyze, improve and control.
The Process: Six Sigma requires significant leadership commitment because of the executive education mandates and extensive employee training and orientation framework. Organizations must select and train managers as Black Belts – employees with extensive knowledge and training in Six Sigmas who work full-time directing Six Sigma projects. Projects are carried out by Green Belts, employees who manage projects from conception to completion. Yellow Belts are employees who are trained in Six Sigma techniques but have not yet completed a Six Sigma project. Six Sigma projects averaged about five or six months from conception to completion.
Benefits: Six Sigma helps eliminate variation, thereby reducing the likelihood of errors, streamlining processes and ultimately reducing costs.
Challenges: Implementation is resource-intensive, requiring significant financial investment and employee commitment. Availability of personnel and long project cycle times can limit the number of projects that are undertaken at a given time. The investment of training Black Belts, etc., can alienate some employees who don’t feel part of the process.
Best Applications: Six Sigma can be applied to almost all hospital processes, including medical error reductions, business operations, patient case management and patient satisfaction.
For more information, visit www.motorola.com/motorolauniversity.jsp.
About Toyota Production Systems/Lean Management
Origin: The development of the Toyota Production System (TPS) began after World War II as a means to improve quality and streamline processes.
Core Tenet: TPS is a business philosophy that seeks to improve quality and efficiency by identifying and eliminating waste (“muda” in Japanese) from processes. TPS identified seven common types of waste defects, including excess motion, inappropriate processing, overproduction, transporting unnecessary inventory and wait times.
Key Components: The basis of lean management is determining the value of a given process by breaking it down and identifying the value-added steps and the non-value-added steps. By eliminating non-value-added steps, processes become streamlined and more effective. A central element is “stop the Line,” which allows any employee to stop a process when a defect is identified or suspected. By fixing mistakes early in the process, the final product will have zero defects.
The Process: Lean management begins by identifying so-called value streams within an organization. These processes support principle services, such as an emergency room visit or an inpatient stay. Mapping out the process as a whole helps identify where improvements can be made. This is done by bringing together involved individuals for a kaisan, an intensive four- or five-day event that analyzes the process and implements change. Individual roles and responsibilities or expectations are outlined at the end.
Benefits: TPS allows for quick identification and improvements. Successful lean implementation can have a positive impact on throughput, cost, quality and productivity.
Challenges: Implementing lean requires workers to identify waste in the jobs they perform regularly, a task that may draw initial resistance. Leadership commitment is critical to break down traditional silos within the organization because many processes are carried out or affected by multiple departments.
Best Applications: TPS/ lean management can be applied to many types of processes within a hospital, from administrative functions to direct patient care.
Visit www.ihi.org/IHI/Results?Whitepapers?GoingLeaninHealthCare.htm for more information.
About the Malcolm Baldrige National Quality Award
Origin: The Malcolm Baldrige National Quality Award, created in 1987, is handed out by the U.S. National Institute of Standards and Technology. It recognizes organizations for performance excellence in six categories: manufacturing businesses, service businesses, small businesses, educational organizations, health care organizations and nonprofit organizations.
Core Tenant: Baldrige is a results-oriented performance management system with a basis in measurement, analysis and knowledge.
Key Components: The Baldrige health care criteria are a set of 18 performance-oriented requirements that are divided into seven categories: leadership; strategic excellence; focus on patients, other customers and markets; measurement, analysis and knowledge management; workforce management, process management and results.
The Process: Applying for the Baldrige Award is a two-step process. Organizations must first submit an eligibility certification package to the Baldrige National Quality Program, followed by an award application package. The applications are reviewed by the board of examiners and scored on a 1,000-point scale. Each organization receives a feedback report at the end of the review process. The examiners select organizations for site visits based upon their scores. Depending on the quality of the applications and the results of the site visits, a winner may or may not be selected.
Benefits: Extensive leadership requirements help ensure leadership involvement and buy-in. The program can help organizations align resources with performance improvement methodologies, such as Six Sigma.
Challenges: Adopting the Baldrige criteria requires extensive cultural change. The self-examination and continuous monitoring and reporting bring transparency to an organization, which may result in some push-back from staff.
Best Applications: Baldrige is a framework for an organization’s performance management system, overseeing all aspects of organizational performance.
For more information about the Baldrige Award, visit www.quality.nist.gov.
To reach the CHRISTUS Health Journey to Excellence goals and sustain them for each and everyone who enters our doors and turns their lives over to us requires that all 28,000 Associates and 9,000 physicians in the CHRISTUS family declare excellence a necessity and not a luxury. We must live in a CHRISTUS culture that will not let us slow down until we reach excellence in carrying out our sacred work in the CHRISTUS Health ministry.