Sharp HealthCare’s Baldrige Journey Keeping the Drive Alive

1. Sharp HealthCare’s Baldrige Journey Keeping the Drive Alive February 2011

2. Reflection The one thing all famous authors, world class athletes, business tycoons, singers, actors, and celebrated achievers in any field have in common is that they all began their journeys when they were none of these things. Yet still, they began their journeys. Mike Dooley

3. Performance MeasurementLinkage and Alignment Strategic Planning & Deployment Enterprise Work Systems Process Management Seven Step Process Performance Improvement Processes Performance Measurement Data Analysis, Prioritization Dashboards, Report Cards Comparative Data Selection Annual Targets and Goals

4. Output, Input and In-Process Metrics

5. Sharp’s Project Prioritization

6. Management of Information Resources • Common Enterprise IS / Single Sign-on • Standardized IT Products • Intranet

7. S I P O C SuppliersPatientsEmployeesSuppliersOthers CustomersPatientsEmployeesSuppliersOthers ▪ Clinical Information Systems ▪ Sharp University ▪ Communication Plan ▪ Workforce & Leadership Development ▪ Organizational Learning Tools ▪ Succession Planning and Exit Interviews ▪ P&Ps, Protocols, Standard Orders ▪ Best Practice Sharing Process Outputs Inputs Requirements and Feedback Requirements and Feedback Technology Sharp’s Communication Plan Culture of Inquiry, Innovation, and Sharing – Driven by Senior Leaders Data, Information andKnowledge Management

8. Data, Information andKnowledge Management • The communication plan represents an interwoven network of sharing intra-entity forums • Three types of cross-system forums • Centrally structured • Entity-based structure with system collaboration • Hybrid of central and entity-based structure

9. Core Competency Strategically important capabilities that provide an advantage in your marketplace … they frequently are challenging for competitors to imitate and they provide a sustainable advantage.

11. Work Systems – Key Work Processes Enterprise Work Systems Enterprise Work Systems Key Health Care Work Processes Key Health Care Work Processes Emergency Care Emergency Care Home Care Home Care Screening Screening Hospice Care Hospice Care Inpatient Care Inpatient Care Admission Registration Admission Registration Long Long - - term Care term Care Assessment/Diagnosis Assessment/Diagnosis Mental Health Care Mental Health Care Treatment Treatment Outpatient Care Outpatient Care Primary/Specialty Primary/Specialty Discharge/Education Discharge/Education Rehabilitation Rehabilitation Urgent Care Urgent Care Each work system is comprised of each key work process.

12. Key Health Care Processes

13. Key Business & Support Processes

14. SIPOC (forward) andCOPIS (backward)

15. Performance Improvement Processes Team Resource Management Team Improvement Individual Improvement Change Management Knowledge Management Workforce and Leadership Development Process Improvement Process Design and Improvement • Scorecard • Dashboard • Strategic Plan Process Management Strategic Planning & Deployment Process

16. DMAIC 12-Step Processto Discover the Best Solution

17. Change Acceleration Process (CAP)to Process People Through Change Leading Change Creating A Shared Need Shaping A Vision Mobilizing Commitment Current State Transition State Improved State Making Change Last Monitoring Progress Changing Systems & Structures

18. Critical Success FactorsDeployment of Performance Improvement Processes • Executive commitment, clear strategy • Initial priority: Financial ROI • Expert training & mentoring • Cross functional team of Black Belts • Rigorous structure • Accountability for results • Communication plan • Alignment with rewards

19. ED Length of stay FY 2011

20. ED LOS Time Intervals

21. PFS Call Center Six Sigma Rapid Action Project Customer Service Department Average Speed of Answer (Minutes) 21 14 7 0 26sec. Abandonment Rate (%) 40 30 20 10 0 1.4% %

22. System Quality Goal

23. Adding Baldrige Criteria to the Journey • Criteria consistent with vision • External independent review and feedback • Expect focused progress on The Sharp Experience • Unanimous support of senior leaders • Not another project/change/cultural transformation – A tool set to guide/accelerate progress • Mark the milestones of progress along The Sharp Experience

24. Baldrige Criteria and DisciplineDeployed Via Quarterly Leadership Development • Leadership • Strategic Planning • Focus on Patients, Customers, Markets • Measurement, Analysis, Knowledge Management • Workforce Focus • Process Management • Results

25. Early Baldrige Activity 2003 • Assessor training - State • 30 leaders across system • Assessed current state • One day training on writing the application • Established a project leader • Identified Category Leads • Set a schedule for draft to state program

26. Early Baldrige Activity 2004 • First application submitted to state • Had Baldrige Examiner read it just before submitting • Had limited understanding of nuances of application writing • Sent two leaders to State examiner training • Site Visit Prep- meeting in a bag • Earned State site visit

27. The Journey: 2004 CAPE Strengths • Sharp Experience – Culture of Empowerment • Pillars of Excellence • Strategic Planning Process • Atmosphere of Open Communication Opportunities for Improvement (OFI’s) • Early stages of Process Management (we didn’t know process) • Sharp Health Plan not included as part of the system • Organizational Learning lacks a Systematic Approach • Some stakeholders – not integrated • No Succession Planning Process • Lack of Segmented data -target markets • Complaint Management • Little to no benchmarking, Missing results In general, some good things going on but not really process focused. Steep learning curve on “how” versus “what”.

28. Baldrige Activity 2005 • Changed project leadership • Shifted some Category Leads • Had benefit of two examiners • Developed synopsis of 2004 feedback report • Leaders set priorities for areas to focus • Resubmitted to state program

29. The Journey: 2005 CAPE Strengths • Strategic Planning Process • The Sharp Experience – empowerment • Rapid Change Methods • A Collaborative Culture – leaders • Innovation • Measurement – collect and analyze information OFI’s • Knowledge Management, Succession Planning – need a process • Lack Measurable processes for some high-level functions – ethics • Lack Cycles of Improvement to Strategic Planning Process • Complaint Management • Missing some key results and competitor comparisons • Segmentation Missing In general, getting to some processes but weak in cycles of improvement and results

30. Baldrige Activity 2006 • Senior leaders prioritized areas of focus from executive brief of feedback • Decided to apply to NMBQA and state program (!) • Shifted some category leads • Engaged a consultant to review Category 7 (weakest scoring area) • Focused on revisions in Category 7 • Earned a national site visit!

31. The Journey: 2006 CAPE and Baldrige Strengths • Visionary leadership • Comprehensive Strategic Planning Process • Patient-focused excellence as part of The Sharp Experience • Systematic approach to performance measurement and improvement • Systematic approach to personal and organizational learning • Culture of empowerment aligned with mission, vision and values. • Focus on Patient Safety Lots of processes in place and well deployed, great culture of empowerment but delivering average results.

32. The Journey: 2006 CAPE and Baldrige OFI’s • Systematic process for Best Practice Sharing – system wide • Systematic process for Knowledge Management, Complaint Management • Suppliers/Partners – systematic approach • Results Marginally Better than Average • Retention Plans not developed/deployed • Different Performance Levels Across Sharp’s Entities • Declining Patient Satisfaction Results

33. Baldrige Activity 2007 • Senior leaders prioritized areas of focus from executive brief of feedback • Applied to MBNQA • Shifted some category leads • Consultant reviewed process flows, application and did mock site visit • Organizational stressors: Magnet visit, CPOE go-live, building projects

34. The Journey: 2007 Baldrige Strengths • Visionary Leadership • Strategic Planning Process • Patient Focused Excellence • Actualizing vision of Best Place to Work, Best Place to Receive Care • Senior leader communication • Alignment with Pillars • System-wide review of performance metrics • Availability of data and information • Workforce engagement and enrichment • Core Competency – The Sharp Experience • Performance tools • Excellent results for inpatient care Much work yet to be done, the journey will never end.

35. The Journey: 2007 Baldrige OFIs • Systematic improvement of systems • A systematic process for innovation • Improve governance process • Succession planning systematic • Link key process and customer requirements to day to day metrics • Organize Work Systems around Sharp Experience • Align and integrate Human Resource plans to the strategic objectives • Some results not sustained i.e. patient satisfaction • Engage/enrichment process for physicians • Unfavorable trends at certain hospitals

36. Site Visit Preparation • Communication across system • Meeting in a Bag, same message as The Sharp Experience • Website: slides, documents, updates, schedule • Point person at each site to coordinate rooms/personnel • Document preparation • Everything mentioned in application • Segmentation • Schedule for site visit • Command Center • Interviews – who should participate? • Lessons learned

37. I AM Sharp HealthCare