“A Quest for Quality….The Business Case”

1. “A Quest for Quality….The Business Case” Chris Boldt, Operations VP Steven Chies, Sr. VP for Operations Benedictine Health System 2011 AHCA/NCAL Quality Symposium February, 2011

2. The Frequent Questions: Why did BHS adopt quality process? How did you achieve six (6) AHCA Gold Quality Awards?

3. Benedictine Health System - Today • BHS owns and/or manages more than 70 LTC facilities on 40 campuses across 7 states • BHS Profile • 4,000 NF Beds • 2,000+ Housing with Services/ Assisted Living Suites • 6,000+ Employees

4. Core Values • Hospitality • Stewardship • Respect • Justice

5. Vision Creating Benedictine Living Communities where health, independence and choice come to life.

6. Creating a Quality Culture • Leadership…commitment, passion from the top • Foundational elements…mission, vision, values • The LTC Quality Story…and baggage! • The long, long run…

7. What do we know as factual? • Perception of quality is poor • Demographics are changing • Dementia diagnosis is increasing • Boomers have different expectations • Governmental commitment is waning • Understanding of need is poor • Current product line is aging • Unexpected events will impact society • All politics and health care is local

8. Quality in Long Term Care • The perception of the American public of the quality of care and quality of life in a “nursing home” is extremely poor. • The vast majority of Americans do not want to go to a “nursing home”. • They believe they are places we go to die and lose our independence and dignity.

9. What is the public perception? • 95 % Question • Do you want to go to a nursing home?

10. Implications of Quality Perception: • Guilt and Fear of individuals and families • Demand for Quality Improvement • Regulatory Reaction – More is Better • Poor regulatory compliance – More Surveyors • Media Coverage of poor compliance • Poor compliance – litigation opportunities

11. Where are they? Greatest Generation (1905-25) 50 Million Silent Generation (1926-45) 35 Million Boomer Generation (1946-1964) 77 Million Xer Generation (1965-1982) 65 Million Millennium Generation (1983-02)80 Million

12. Implication of Demographics: • Fewer people….more competition • Fewer tax payers….more competition • More competition for client • Product line need to meet expectations • Need for process enhancement

13. Implications for Government Payment: Cannot rely on stable source Personal Responsibility will prevail Pay for Performance Expectation of Improved Outcomes

14. Dr. Donald Berwick Challenge Providers to: Reduce Resources by 10% without: Single instance of harm Without rationing care Without excluding services Knowledge of Quality Understands Data Expectation of Performance

15. BHS Leadership Systems • Solid Governance • National leaders in long term care on staff • Systematic meetings to share, learn and plan among all levels of employees • BHS Leadership Institute • Ongoing leadership communication • Compliance and risk programs

16. Benedictine Framework for Performance Excellence Organizational Results 7 Dashboard 2Strategic Planning Strategic Planning and Deployment Model 1 Values-Centered Leadership Hospitality•Stewardship Respect•Justice . 3 Customer and Market Focus Satisfaction Surveys Compliant Management Process 6 Management P-D-C-A Care Processes Support Processes Staff Focus 5 Service Standards Mission and Values Survey 4 Measurement and Analysis Dashboard

17. http://www.quality.nist.gov/HealthCare_Criteria.htm

18. Drivers Systems Results. 7 1 • Results: • Health Care • Patient • Satisfaction • Financial/Market • Staff & Work • System • Organizational • Effectiveness • Governance/Social • Responsibility 5 Leadership People Strategic Planning 2 Operations 6 3 Customer Focus Measurement, Analysis & Knowledge Management 4

19. Operational Improvement • The theory sounds great…but • How does it get to the bed side? • How do you determine improvement? • How do you sustain the improvements?

20. BHS Strategic Planning • Strategic Challenges • Strategic Objectives • Goals • Focus Areas • Care • Service • People • Finance • Growth

21. BHS Alignment Model BHS Vision and Direction BHS Board and SMT Strategic Objective & Corp. Action Plans BHS SMT and Corporate Directors Facility Specific Goals Participating Organizations Facility Action Plans Departments and Teams Employee Goal Employee Focus

22. Execute Align Review Focus BHS Strategy Development and Deployment Model Determine action plans, resources, accountability and Metrics/Action Plan Goals Action Plans Quarterly review of progress and Performance Results Vision, Facility Strategic Objectives and Goals Internal and External Analysis BHS Corporate Strategic Objectives SWOT

23. Strategy Deployment • Adoption of “Focus and Execute” a web-based application • Tracking of progress of Action Plans • Team • Open access • Remote management - Webinar • Continuous review of progress on Action Plans

24. BHS Facility “Focus and Execute” Plan

25. BHS Quality Performance Excellence • The Mission and Core Values are the basis • Led by President/CEO • All 6 SVP are Lead for a Baldrige Category • Quality Director • Supports and coordinates • Provides training

26. BHS Customer Service Standards • Based upon the Core Values of the organization • Behavioral expectations for all staff • Self-evaluation of performance by each employee at annual evaluation • Performance Management System

28. BHS Service Recovery • Service Recovery is bringing a customer back from the brink of defection – and doing so in a timely fashion to the customer’s satisfaction. • The ART of Service Recovery • A = Acknowledge • R= Resolve • T= Trend

30. Customer Satisfaction Surveys • Nursing Facility • Newly Admitted Resident • Resident • Family – MyInnerview • Assisted Living • Tenant - MyInnerview • Family- MyInnerview • Housing • Tenant - MyInnerview

31. BHS Facility Example

32. BHS Dashboard • Internal IT system • Current performance on key strategic measures • Trend performance • Best practice performance identified

34. National AverageBHS System Median  Target Best Practice Quartile Opportunity for Improvement Quartile Good Care – Percent of Pain

35. BHS Operating Cash Flow Margin Median  Target Best Practice Quartile Opportunity for Improvement Quartile Good Finance –Operating Cash Flow Margin

36. Current Structures for Performance Review CEO, Board and SVP Strategy Senior leaders OVP, & CD Results Pillar Metrics & PP OVP & Regional Consultants Pillar Metric, PP & other metrics Administrator, QMC, DON, and other Facility Functioning 30 measures

38. BHS Facility Example

39. Employee Performance Management • Developed by a team of team from corporate office and facilities • Common Job Descriptions across all sites • Behavioral based • Supervisory training • Self evaluation including self-evaluation of performance compared to the Customer Service Standards.

40. BHS Key Systems and Processes Business Systems Resident & Tenants Customer Facing Systems Support Systems

41. Process Improvement – P-D-C-A • PDCA aka • Shewhart Cycle • Deming Cycle 42

42. PDCA Improvement Example

43. “Bottom Line Value:” • Organizational Focus • Clear/Crisp Strategic Direction • Alignment throughout the System • Enhanced Management Processes and Systems… Consistent Performance • Customer Focus…Enhanced Satisfaction • Strong Financial Performance • Committed, Energized Workforce • Measurable Results!

44. Closing Thoughts “The problems that exist in the world today cannot be solved by the level of thinking that created them.” Albert Einstein

45. Contact Information • Chris.boldt@bhshealth.org • Steven.chies@bhshealth.org • 763-689-1162