Thursday, June 26, 2008

CHRISTUS Academy Class of 2008 – Projects 3 and 4

Last week we reviewed two of the four projects researched and presented by the latest CHRISTUS Academy graduating class, and I’d like to review the other half of those projects in my post today.

Project 3: Growing Outpatient Services

This CHRISTUS Academy team was asked to identify best practices and business models that will support the development of outpatient services in CHRISTUS Health markets, especially as we have made the commitment to transition our portfolio to one-third acute care, one-third non-acute care (including outpatient services) and one-third international operations.

The team researched numerous hospitals, health systems, imaging centers, ambulatory surgery centers and even car dealerships, an auto parts store and a ski resort. The team also conducted literature searches and customer surveys to gain a perspective on what these best practices do to be financially successful and service-oriented. Key findings that drove the team’s recommendations are as follows:
• CHRISTUS Health’s regions define outpatient services differently
• The current system for analyzing service lines is inconsistent region-to-region
• Each region measures outpatient metrics independently, causing difficulty for comparison to other regions or nationally
• Opportunities are present to grow specific service lines
• Some CHRISTUS regions need to employ or enhance leadership development programs that support outpatient leaders operationally and strategically
• Noticed a of lack of accountability when a new service is introduced into a region that shows little to no success
• Some CHRISTUS regions are behind the curve when introducing customer-focused, volume-driven practices.

As a result, the team concluded that some CHRISTUS regions are employing successful strategies for outpatient growth, but these strategies are not hardwired (practiced at least 90 percent of the time) throughout the system. The team believed that many of their recommendations will not only affect outpatient growth, but also increase patient/physician/Associate satisfaction as well as patient/physician loyalty and reduce turnover. The team’s recommendations are divided into four different categories, which are as follows:

Operational recommendations
• Define outpatient services consistently using ICD-9 and/or DRGs
• Adoption of service lines and service line leaders
• Use of single database and method to gather financial data
• Measure outpatient-specific metrics (management and strategic metrics)
• Use of physician liaisons
• Use of the Management Directive that guides the “new business development process” with more accountability
• Use of “growth teams”

Strategic recommendations
• Joint ventures
• Invest in cardiovascular based on market
• Invest in ortho/neuro based on market
• Invest in imaging based on market
• Invest in oncology based on market
• Employ Planetree practices (a new model for “healthcare/healing/wellness excellence” identified in Putting Patients First by Susan Frampton, Laura Gilpin, Patrick Charmel)

Technology recommendations
• Patient ID cards
• Fingerprint scans/back-of-hand (thermal imaging) scans
• Online registration
• Admitting kisosks
• Electronic email notification of appointments/reminders
• Website posting of service line wait times
• 1-800 numbers with service line information/wait times
• Text messaging for appointment reminders

Educational recommendations
• All regions need to assess Service Line Leaders’ (SLLs) competencies in utilizing standard Meditech reports
• Mandating participation in these programs as part of the development of SLLs
• Improve competency of Microsoft products via Healthstream or the classroom
• Hardwire the “must haves” across the CHRISTUS system
• Training for SLLs on creation and implementation of SMART growth goals
• CHRISTUS Health should create an education plan to enhance project management skills of SLLs
• Assess the SLLs’ financial management skills
• Leadership development, level 1: Human Resource practices, SMART growth goals, “must haves,” programs and systems training
• Leadership development, level 2: Project management, quality improvement, financial management

The team recognized that some CHRISTUS regions have these recommendations in place, but only when all regions are practicing and have them hardwired will CHRISTUS see consistent outpatient growth.

Project 4: Supporting the Umbrella Strategy, Infrastructure Assessment

This CHRISTUS Academy team was asked to examine CHRISTUS’ infrastructure and to answer the question, “Is the current CHRISTUS Health infrastructure ready and able to support the Umbrella Strategy?”

The Umbrella Strategy was developed by CHRISTUS’ leaders in response to industry dynamics (increasing costs, declining reimbursement, governmental mandates, rapidly changing technologies, etc.) and patient needs. The strategy divides the CHRISTUS service portfolio into three equal parts (acute, non-acute and international, as mentioned above). The goal of the strategy is three-fold: 1) to strengthen the organization’s position across the full continuum of services; 2) to develop customer-centric, innovative and integrated approaches to care deliver and 3) to grow and develop CHRISTUS’ international ministry.

The team assessed five major components of the CHRISTUS infrastructure in the course of their research: Human Resources (HR), Information Technology, Financial systems and organizational structure. Research methodology primarily included interviews and surveys of leaders from within and outside of CHRISTUS. Strengths and weaknesses in each area of the infrastructure were identified, as were opportunities and threats. After taking into consideration current initiatives, the team performed a gap analysis and developed recommendations to improve operations and to support the Umbrella Strategy. To this end, they arrived at the following conclusions:

Since there are inconsistencies in the cultural educational opportunities between the acute, non-acute and international ministries, the team recommends centralizing CHRISTUS’ education and development programs. This will support standardized policies, education contact hours, media and materials for branding the CHRISTUS culture through the orientation and continuing development of Associates.

Human Resources
Recruitment and retention continue to be major challenges for many organizations. Therefore, the team recommends the development of innovative recruiting strategies to transform eligible former Associates back into the workforce. When recruiting current and younger generations, consider offering more scheduling flexibility for greater work/life balance.

Information Technology
The team focused on three areas of Information Technology, including the Enterprise Master Patient Index (EMPI), clinical information systems and information systems technical infrastructure. Survey results indicated that a high level of integration in all three areas is important to CHRISTUS leaders. Therefore, the team recommended the active pursuit of an EMPI system. The team also noted the need for systems to connect patient clinical information between acute, non-acute, international and physician information systems.

The team assessed four major components of CHRISTUS’ financial infrastructure, including financial accounting systems, decision support tools, revenue cycle and supply chain. The need for expanded standardization and centralization of processes was noted in each of these areas. CHRISTUS should re-evaluate implementation of an Enterprise Resource Planning solution to provide the needed flexibility, reporting and budgeting systems. All entities (acute, non-acute and international)l, should be considered in the scope of the implementation evaluation.

Organizational Structure
A common theme identified among leaders was the need for centralized leadership for non-acute services. The need for increased centralization, standardization and collaboration was also identified in all areas of the CHRISTUS infrastructure. As such, the team proposed a leadership position be added to manage this three-pronged approach to enable the achievement of goals of the Umbrella Strategy of achieving equal distribution between the acute, non-acute and international sectors of the health system.

Overall, CHRISTUS should focus on implementing system-wide standards and actively pursue implementation of best practices. This will require a cultural shift, especially from the traditional regional perspective and a willingness to release control of some historical responsibilities while still maintaining an oversight role.

Wednesday, June 18, 2008

CHRISTUS Academy Class of 2008 – Projects 1 and 2

As I promised in my last blog post, we will begin a review of the findings and research done by all four CHRISTUS Academy teams that graduated recently. Today, let’s review two of those projects.

Project 1: Weaving Research into the CHRISTUS Tapestry

The CHRISTUS Academy Research team was tasked to determine the extent to which a fully-developed research environment would assist CHRSITUS Health to achieve an environment of excellence and best practice with cutting-edge patient care and patient satisfaction, physician satisfaction, financial health and Associate growth and development, all of which are central to our Journey to Excellence.

Research being conducted in health care systems today consists of far more than the traditional pre-clinical (bench) research and clinical trials for pharmaceuticals and devices. CHRISTUS Health actively engages in Nursing, Community Health, Human Resources, Marketing and Retail research. Life-saving cancer drugs developed by The CHRISTUS Stehlin Foundation for Cancer Research and the titanium rib developed at CHRISTUS Santa Rosa are just two examples of the types of research conducted within the CHRISTUS system.

Today, embracing innovative research is essential for any health care organization to survive, as informed consumers demand a higher quality of care. The CHRISTUS Research Academy team was charged to evaluate CHRISTUS Health’s current state and determine the steps required to create a fully-developed research environment that would assist CHRISTUS Health in achieving excellence and best practices with cutting-edge patient care.

The team contacted numerous facilities involved in research and conducted literature reviews in order to learn what is required to develop a vibrant research environment. Their key findings are as follows:
• A research infrastructure must be in place.
• Culture trumps strategy.
• You must have “the right people on the bus.”
• Partnering with credible organizations and individuals is beneficial.

In order to create a robust research environment, CHRISTUS Health must commit to the following:
• Expand the current research infrastructure to include a system research department.
• Instigate a change in CHRISTUS culture through communications and a recognition program.
• Engage and develop Associates to be innovators with education, mentorship and rewards.
• Identify and support research partnerships.
• Develop the expertise required to locate and secure funding for research.

The CHRISTUS Innovations Institute offers a connection for research to become an integral part of our CHRISTUS mission and to enhance our CHRISTUS brand as a center of innovative excellence.

Project 2: Organizational Excellence: The Baldrige Model

As I have said before, we have done a comparison of our Journey to Excellence goals, the Joint Commission goals, Magnet status and the Malcom Baldrige National Quality Award (MBNQA), and found their goals and requirements to be almost identical. In addition, we are hoping to apply for the Baldrige award for our entire system on or shortly after we reach the June 2009 summit.

This CHRISTUS team was asked to gain an understanding of the measurement, analysis and knowledge management requirements of the MBNQA and evaluate the opportunities for improvement for CHRISTUS Health’s current processes as related to the Baldrige criteria.

According to recent studies, the MBNQA is an excellent indicator of high organizational performance.Health care organizations applying for the award must show a focused and systematic approach to performance management in the following areas:
• Leadership
• Strategic planning
• Customer and market focus
• Measurement, analysis and knowledge management
• Human Resource focus
• Process management
• Business/organizational performance results

Through analysis of winning MBNQA award applications, participation in best practice forums, a site visit to an MBNQA winner, personal interviews and detailed research, a baseline assessment of CHRISTUS’ current processes as related to the MBNQA was achieved.

After an MBNQA award application is reviewed, Baldrige examiners score the application based on the criteria in eight scoring ranges or “bands.” Recent winners have scored in the upper portion of band five. After analysis of the draft MBNQA application for CHRISTUS Health prepared by the team in conjunction with a former Baldrige examiner, they determined that CHRISTUS’ current score is in the range of band two.

According to the band descriptors, CHRISTUS falls into the Early Systemic Approach category, as defined by the Baldrige foundation. This means that CHRISTUS is at the beginning stages of conducting operations by processes with repeatability, evaluation and improvement, and some early coordination among organizational units. Strategy and quantitative goals are being defined.

The team found that CHRISTUS needs to deploy a more robust management of processes throughout the system. To achieve excellence, CHRISTUS must strengthen accountability, deployment of processes and process efficiency in key areas. Our submission of an actual MBNQA application in 2009 will result in valuable feedback from the team of Baldrige Examiners.

CHRISTUS is in the early stages of the Baldrige journey. A careful study of CHRISTUS Health’s draft application and the resulting implementation of the team’s recommendations will align current processes with strategic and operational goals. As a result, CHRISTUS Health will reach organizational maturity and achieve world-class excellence.

For more information on the Baldrige award, see one of my previous posts on optimizing CHRISTUS’ performance.

Wednesday, June 11, 2008

Introduction to the CHRISTUS Academy

Although the availability of the latest technologies and efficient and effective designs of both inpatient and outpatient facilities are significant factors for health care success today, the most critical factor continues to be the quality of leadership. Recognizing this as a critical success factor, when CHRISTUS was formed in 1999, the Senior Leadership Team worked with our Organizational Development department (a division of our Human Resources function) to put together programs which would identify and develop future leaders for CHRISTUS Health that were comprised of ethnic, gender and age diversity. A key program as a result of this effort was the introduction of the CHRISTUS Leadership Academy in the U.S. in 2001 and the introduction of the same activity in Mexico in 2005.

Although during the first year of this program the Academy candidates could be self-nominated, they now need to be nominated by the Senior Team of the region or business unit in which they work or by the leader of the global corporate services division where they are employed. Over 50 potential candidates are identified each year, and 30 are chosen to participate by a selection committee which includes representatives from a cross-section of CHRISTUS leadership.

The successful candidates must have a bachelor’s degree or sufficient experience in health care to serve as a proxy for the college experience. Candidates are also encouraged to be pursuing post-graduate degrees at the time of their selection and are usually at the director level when they enter the class. Once selected, the class begins a 12-month journey which consists of five two-day sessions in various locations throughout the CHRISTUS global system, with one shared session always held in Mexico. In addition, since the Mexico class was formed, two bilingual Mexican Associates are accepted into the U.S. program and two bilingual American Associates participate in the CHRISTUS Muguerza Academy.

This process has added a multicultural dimension to our leadership training and provides an opportunity for the significantly younger population of leaders in CHRISTUS Muguerza to not only be exposed to the U.S. CHRISTUS programs, but also open the doors for the possibility of bilingual leaders working in countries that differ from their birthplace.

During these five sessions, the leaders are addressed by predominately internal faculty, covering all areas of leadership including strategy, business development, finance, advocacy and philanthropy. In addition, the leadership competencies identified by the CHRISTUS Health leadership team (which hopefully will guarantee successful leaders into the future) are all explored and taught through various learning sessions including workshops and panel discussions.

Two significant learning journeys, however, in this year’s program include a significant exposure to the governance process in addition to team participation in one of four projects selected by system and regional leadership, which always takes place before the start of each class. The projects center around current challenges within CHRISTUS with the expectation that the teams from the classes working on each project will come forth in May with significant recommendations to address these challenges with solutions that can be implemented throughout the CHRISTUS system.

Three such projects that have been utilized fully from past classes include
1. How to develop programs and seek that support Magnet status for nurses. This has been fully implemented and has been successful in one of our regions and is now being explored in multiple regions throughout CHRISTUS.
2. The Center for Management Excellence. This project was based on the fact that often the weakest link in leadership is at the management level, and this project team designed a four-day course which is now given to every manager during the quarter that they enter their management role within CHRISTUS.
3. Associate innovative ideas for improvement. This project set forth a process for Associates to submit to their regional leadership or business unit leadership ideas to improve efficiency and effectiveness of the workplace. (If an Associate’s idea is selected and implemented, the Associate will then reap a percentage of the cost savings.) This program has been implemented in several regions and also is being explored throughout the CHRISTUS system for possible future implementation.

The class is divided each year into four teams, each assigned a critical topic similar to those outlined above. They are provided an opportunity to do research, both within and outside CHRISTUS to learn as much as possible about the issue and are expected to prepare a professional paper which is publishable not only this research, but more importantly, their recommendations for solutions to the problem or challenge which was assigned to them. With a graduation of the sixth class in May of this year, 24 projects have been completed, all of which have contributed partially or totally to improvement initiatives within our health system. In addition, the students have learned how to work in teams and to utilize both virtual and real learning tools to advance their knowledge. And finally, they have developed analytical skills which have given them the ability to take the data from their learning and derive recommendations that can be implemented system-wide. Each year, the presentations of their projects are heard by the Senior Leadership Team and regional leaders, who give real-time feedback as to both the benefits of their recommendations as well as constructive input as to how their projects could even be further strengthened.

The learning opportunities from these processes are immeasurable and have increased in value each and every year. The governance exposure the experience affords participants is critical, because the one weakness that many candidates who present themselves for leadership positions within CHRISTUS have is a lack of knowledge about what is involved or the importance of the governance process at both the local and system level. Therefore, incorporated into this Academy experience is a requirement that each of the students participate in a board meeting in the region or business unit in which they work. Their participation is preceeded by a three-hour didactic session on governance presented by the Senior Vice President for Legal Services and the CEO of CHRISTUS Health. In addition, those students who are from corporate global services areas attend a system board meeting in January prior to their graduation. It is interesting to note that the graduates often indicate that this governance exposure is a highlight of their learning journeys.

In closing, I believe we would all agree that developing leaders with the competencies required to transform the present into the future must be a key area of focus for all present leaders in health care and therefore must be a high priority for CHRISTUS Health leadership. The Academy process supplemented by system-wide coaching and mentoring as well as the CHRISTUS Center for Management Excellence and now the Center for Nursing Management Excellence provides a unique opportunity for the up-and-coming leaders in CHRISTUS Health to perhaps even provide better leadership in the future than those of us are providing today who learned much of our leadership skills by on-the-job work experience dotted with many failures as well as successes.

In several future blog posts we will review specifically the four projects completed by the CHRISTUS Academy in the U.S. from this most recent class and we will specifically discuss how these support the strategies for CHRISTUS Health which we have in place for the next several years.

Wednesday, June 4, 2008

New Work Habits for a Radically Changing World

As CHRISTUS Health moves toward our 10th anniversary on Feb. 1, 2009 and anticipates the recommendations emulating from the Futures Task Force II learning journeys, it is most appropriate to pause and reflect on how our health system might need to change from a governance and operational perspective to be successful as our future unfolds.

In a recent leadership booklet published by Price Prichett, which I shared with the Senior Leadership Team, we are reminded that CHRISTUS Health’s work, like that of many organizations, is going global. As the world flattens, jobs are going virtual.

The author states that: “Business is being conducted in ways that were simply impossible a few short years ago. The economy is shifting more and more towards services and towards knowledge work. Before long, top management absolutely won’t be able to run things the old way, even if it desperately wants to.”

In addition, the author reminds us it does no good whatsoever to complain about how new technologies are changing the health care industry. “The world will reward only those of us who will catch on to what’s happening. We must invest our energy in finding and seizing the opportunities brought about by change.”

“And change always comes bearing gifts. Considering the scope and speed of change these days, there will be precious gifts – many priceless opportunities – for those of us who can play by the new rules, positioning ourselves right and take personal responsibility for our future.”

Based on these introductory remarks, the author then articulates 13 guidelines for managing our performance during these times of radical change. These include:
1. Become a quick change artist. Change can be painful. But being a quick change artist can build our reputation, while resisting change can ruin it.
2. Commit fully to your work. We must fully commit to our Journey to Excellence, bringing forth our very best potential.
3. Speed up. We must continue create efficiencies in our processes, enhancing our reputation as an organization that pushes change processes along.
4. Accept ambiguity and uncertainty.
5. Behave like you’re in business for yourself.
6. Commit to life-long learning. We must continue to identify and share best practices. Our ability to debrief on each of our successes and failures and capture lessons learned will continue to be a vital success factor.
7. Increase accountability for outcomes.
8. Evaluate and quantify the added value of all we do.
9. Continue to see ourselves as a service center.
10. Make our own morale and optimism, while being realistic about the “moment in which we are living.”
11. Accept continuous improvement as a critical success factor
12. Be a fixer, not a finger painter.
13. Continuously raise your expectations. We must continuously review our metrics on our Journey to Excellence.

Yes, the future we have envisioned and continue to study will bring forth new challenges while also promising us new possibilities. In our first nine years, CHRISTUS Health has had astounding opportunities. By listening to the learnings from our Futures Task Force II, incorporating them into our future strategies and embracing new work habits we can continue our journey to be one of the best health care and wellness care delivery systems in this radically changing world.