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.

1 comment:

Michael Considine said...

Dr. Royer,

I saw your talk at the HFMA conference this week. It was one of the most inspiring moments of my adult professional life. It is refreshing to know that there are healthcare executives out there who still put the patient first and put wellness above profit. I will definitely be reading your blog now to stay up to date on your insights.

Thank you so much for that talk!

Best Regards,
Mike Considine