TN Quality ForumHolding the gains

Andrew Stephen May, M.D., FAAFPSullivan County Regional Health DepartmentOctober 9, 2012

Mission, Vision, Values

MISSION: To identify and respond to the public health needs and improve the public health status of Sullivan County citizens through education and service with a highly motivated and well trained workforce. (The two key elements are our customers and our employees.)

VISION: To be a national model and leader in providing public health services.

VALUES: Service: Caring and compassion to all our customers Leadership: Through collaboration and innovation

Fiscal Responsibility: Stewards of public money Integrity: Honesty in all we do

Excellence: Pursuing a higher professional standard

CORE COMPETENCIES: Education Prevention Community Need Workforce

The Sullivan Health Way Journey to Excellence

2002: Changes in Senior Leadership (Regional Director and Medical Director)

2002 – 2004: First Strategic Planning Retreat, MVV Creation

2005: Level l – Interest Award

2007: Level 2 – Commitment Award

2008-2010: WORK WORK WORK towards improving!

2011: Level 3 – Achievement Award

2012 : WORK WORK WORK towards improving!

Figure 1.1-1 Key Result Areas

Public Health and Baldrige Integration

GPI’s DPI’s Customer Satisfaction Survey C3 Stakeholder Satisfaction Survey Workforce Engagement

Survey Healthy Rounding

Assessments

Receiving and Assessing Patients Delivery of Clinical Services Billing and Fiscal Management Education of Patient and Community Community Partnering

Key Work Processes Work System Design

Figure 1.1-1 Figure 6.2-1

Continuous Process Improvement

Plan-Do-Check-Act Performance Improvement Teams (PIT’s)

Continuous Process Improvement

Plan-Do-Check-Act Performance Improvement Teams (PIT’s)

Continuous Process Improvement Model

DefinitionHistory7 componentsRelevance to our missionRelevance to organizational viability

Why EPSDT?(Early Periodic Screening, Diagnosis & Treatment)

A better understanding of the Baldrige Criteria helped SCRHD to streamline strategic objectives from 7 pages down to 1. You cannot do it all at once!

Last Updated 23 January 2009

Performance

Graph &

Strategic

Action

Mgt.

Measures forTrend

Target

DataTarget

Text

Objectives

Plan

Steward

SO

0506

07+/-

0809

0607

Reference

KSO

1.) Train staff on Performance

Management System

UShort May

Percent of staff trained

2008

2.) Support at least three (3) SLs to serve

on the TNCPE Board of Examiners Short Mayes

Number of TCNPE examiners

2009

1.) Deploy the use of DPIs and action

plans to all departments U

Short / LongMcElyea

% APs developed per 1/4

% APs implemented per 1/4

2008-2010

2.) Implement communication & feedback

of strategic planning process with

stakeholder groups (Staff, HC, CC, TDH) Short Mayes

% of stakeholder groups

completed per SPP calendar

(Figure 2.1-1)

2009

(c) Increase the utilization

of continuous process

improvement across all

departments.1.) Reenforce process improvement

system and tools with staff through

various workshops

Short/ LongMay

*Percent of staff trained

*Number of PIs utilized by

individuals & teams

2008-2009

Legend: KRA = Key Result Area; Term: short (1 yr) or long (3 yr); SO = strategic objective; Mgt. Steward = Management Steward; Status (U = underway; C = Completed; % = percent complete)

Blue=Missing or Unavailable; Green=On-Target; Yellow=Alert; Red=At risk/adverse; * = YTD

KRA 1: Management Practice

(b) Increase the utilization

of strategic planning and

action plan deployment

across all stakeholder

groups.

KRA

Term

1

(a) Enhance organizational

effectiveness through the

adoption of Performance

Excellence principles.

Sullivan County Regional Health Department Strategic Objectives and Action Plan Deployment Matrix

Mission : To identify and respond to the public health needs and improve public health status of Sullivan County citizens through education and service with a highly motivated and well trained workforce.

Vision: To be a national model and leader in providing public health services.

AP S

tatu

s

Past, Present & Target

Benchmark

Last Updated 23 January 2009

Performance

Graph &

Strategic

Action

Mgt.Measures for

Trend

TargetData Target

Text

Objectives

Plan

Steward

SO05 06 07 +/- 08 09 06 07

Reference

KSO

1.) Create Workforce Development Plan

(Michelle to fill in sub elements)

U Short HughesCompleted plan

2008-2009

2.) Establish employee turnover targets

based on revised assessment of T/O.

HOW ARE WE REDUCING??

PROCESS?

U Long HughesTurnover rate (revised)

18% 23% 21% -15% 11% 10% 18%

2008-2009

3.) Improvement plan formulation based

on key theme findings from Workforce

Engagement Survey.

Short Hughes* Completed (documented)

process

2009

4.) Development and Deployment of

"Healthy Rounding" Process.

Short PEC Steering

Group

Number of Rounds performed

every quarter.

2009

Legend: KRA = Key Result Area; Term: short (1 yr) or long (3 yr); SO = strategic objective; Mgt. Steward = Management Steward; Status (U = underway; C = Completed; % = percent complete)

Blue=Missing or Unavailable; Green=On-Target; Yellow=Alert; Red=At risk/adverse; * = YTD

KRA 2: Human Resource Development

Sullivan County Regional Health Department Strategic Objectives and Action Plan Deployment Matrix

Mission: To identify and respond to the public health needs and improve public health status of Sullivan County citizens through education and service with a highly motivated and well trained workforce.

Vision: To be a national model and leader in providing public health services.

AP

Stat

us

Past, Present & TargetBenchmark

KR

A

Term

2

(a) Create a workforce

development plan with a

special focus on employee

communication, retention,

competencies, and

recognition.

Last Updated 23 January 2009

Performance

Graph &

StrategicAction

Mgt. Measures for TrendTarget Data Target Text

ObjectivesPlan

StewardSO

05 06 07 +/- 08 09 06 07 Reference

KSO1.) Government Revenue

Long Mayes Every three year evaluation of program funding

2012

2.) Private Revenue Short/Long

Mayes EPSD&T #'S, FP #'S, WIC #'S, DENTAL #'S

2009

3.) Expense RevenueShort/Long

Mayes Captial, Daily, & Program Expenses; Rehire/Workforce Replacements

2.) Increase capacity for grant writing across the organization Long Mayes Hire grant writer by 2009 2009

Legend: KRA = Key Result Area; Term: short (1 yr) or long (3 yr); SO = strategic objective; Mgt. Steward = Management Steward; Status (U = underway; C = Completed; % = percent complete)

Blue=Missing or Unavailable; Green=On-Target; Yellow=Alert; Red=At risk/adverse; * = YTDKRA 3: Financial Systems

(a) Maintain financial stability through improved financial reporting, capitol improvement & financial management.

KR

A

Term

3

Sullivan County Regional Health Department Strategic Objectives and Action Plan Deployment Matrix

Mission: To identify and respond to the public health needs and improve public health status of Sullivan County citizens through education and service with a highly motivated and well trained workforce.

Vision: To be a national model and leader in providing public health services.

AP

Stat

us

Past, Present & Target Benchmark

Last Updated 23 January 2009

Performance

Graph &

StrategicAction

Mgt.Measures for Trend

Target Data Target Text

ObjectivesPlan

StewardSO

05 06 07 +/- 08 09 06 07 Reference

KSO

(a) Increase system-wide

reliability, availability and

redundancy

1.) Enhance 5 YR IT Plan (Thomas to

provide sub DRAFT elements)

U Short Shaffer Plan approved by LT

2009

1.) Shared Health & eRXLong May

2008-2009

2.) CareSpark IntegrationLong Shaffer

2008-2010

3.) Exploration of EMRLong Shaffer

2011-2012

(c) Maintain mechanisms

that communicate public

health status and health

information for key

stakeholders

1.) Reevaluate community health status

data and follow through with

dissemination

Long May/McElyea Successful reevaluation and

distribution of HSD (both on-

line & hard)

end 2009

1.) Complete deployment for

organizational learning and share drive

utilization.

U Short/ Long

May 1.) Completion of written

process that describes

organizational knowledge

2009

2.) Modify Sullivan County Regional

Health Department Intranet to promote

effective and efficient access to

organizational information.

Short Shaffer 2.) Completion of Intranet

modifications

2008-2009

3.) Deploy use of crystal reporting for

performance management measures

(DPI's)

Long May/McElyea/

Shaffer

3.) Completion of electronic

performance management

reporting system.

2009

Legend: KRA = Key Result Area; Term: short (1 yr) or long (3 yr); SO = strategic objective; Mgt. Steward = Management Steward; Status (U = underway; C = Completed; % = percent complete)

Blue=Missing or Unavailable; Green=On-Target; Yellow=Alert; Red=At risk/adverse; * = YTD

KRA 4: IT and Data System

(b) Develop and integrate

plans for an electronic

medical record (WHAT TO

CALL THIS: ELECTRONIC

MEDICINE…)

4

(d) Enhance organizational

knowledge system

Sullivan County Regional Health Department Strategic Objectives and Action Plan Deployment Matrix

Mission: To identify and respond to the public health needs and improve public health status of Sullivan County citizens through education and service with a highly motivated and well trained workforce.

Vision: To be a national model and leader in providing public health services.

AP

Stat

us

Past, Present & TargetBenchmark

KR

A

Term

Last Updated 23 January 2009

Performance

Graph &

Strategic

Action

Mgt.Measures for

Trend

TargetData Target

Text

Objectives

Plan

Steward

SO

05 06 07+/-

0809

0607

Reference

KSO

1.) Continue deployment of patient

satisfaction survey and action planning of

survey themes and findings. Short McElyeaCompleted process

--

-

+

2009

2.) Deployment of patient real-time

feedback process

Short McElyeaDeployment and utlization real-

time process

2009

3.) Train staff on best practices for

customer relationship building. Long Honeycutt1.) Percent of staff trained on

best practices, 2.) customer satisfaction rates

2008-2010

Legend: KRA = Key Result Area; Term: short (1 yr) or long (3 yr); SO = strategic objective; Mgt. Steward = Management Steward; Status (U = underway; C = Completed; % = percent complete)

Blue=Missing or Unavailable; Green=On-Target; Yellow=Alert; Red=At risk/adverse; * = YTD

KRA 5: Customer Focus and Satisfaction

(a) Clarify expectations (survey) and improve customer (patient/ stakeholders) satisfaction

to enhance loyalty

KR

A

Term5

Sullivan County Regional Health Department Strategic Objectives and Action Plan Deployment Matrix

Mission: To identify and respond to the public health needs and improve public health status of Sullivan County citizens through education and service with a highly motivated and well trained workforce.

Vision: To be a national model and leader in providing public health services.

AP

Stat

us

Past, Present & TargetBenchmark

Last Updated 23 January 2009

Performance

Graph &

Strategic

Action

Mgt.

Measures forTrend

TargetData Target

Text

Objectives

Plan

Steward

SO

0506

07+/-

0809

0607

Reference

KSO

6

(a) Strengthen Key

Communities

1.) Continue process to ensure that

SCRHD is represented and engaged on

all defined key community outreach

programs via gap analysis for any missed

opportunities or groups

Long MayTBD

2009-2010

Legend: KRA = Key Result Area; Term: short (1 yr) or long (3 yr); SO = strategic objective; Mgt. Steward = Management Steward; Status (U = underway; C = Completed; % = percent complete)

Blue=Missing or Unavailable; Green=On-Target; Yellow=Alert; Red=At risk/adverse; * = YTD

KRA 6: Public Health Capacity

Sullivan County Regional Health Department Strategic Objectives and Action Plan Deployment Matrix

Mission: To identify and respond to the public health needs and improve public health status of Sullivan County citizens through education and service with a highly motivated and well trained workforce.

Vision: To be a national model and leader in providing public health services.

AP

Stat

us

Past, Present & Target

Benchmark

KR

A

Term Last Updated 23 January 2009

Performance Graph &Strategic Action Mgt. Measures for Trend Target Data Target Text

Objectives Plan Steward SO 05 06 07 +/- 08 09 06 07 ReferenceKSO1.) Reevaluation of Community Health Status and Priorities

Short May/McElyea Completed evaluation 2011

2.) develop process for updating statistical graphs and tables

Short McElyea Completed process 2009

1.) Review immunization program processes and implement improvements -- including facilitating improve private sector immunization rates. (DR. MAY TO AP NOTES FROM 1/12 IMMUNIZATION MEETING)

Long Williams/May Immunization rates (for both HD clients and community-wide)

2009

2.) Increase capacity for dental services to uninsured

Short/ Long

Honeycutt dental encounters 957/NA 1043/NA 1200/NA + 1300 1400 1100 2009-2010

3.) Explore feasibility of satellite health department in Bristol, TN.

Long Mayes 2011-2012

Legend: KRA = Key Result Area; Term: short (1 yr) or long (3 yr); SO = strategic objective; Mgt. Steward = Management Steward; Status (U = underway; C = Completed; % = percent complete)Blue=Missing or Unavailable; Green=On-Target; Yellow=Alert; Red=At risk/adverse; * = YTD

KRA 7: Health Status

(a) Continue process for evaluating health status and developing priorities that impact public health

outcomes.

7(b) Enhance services and outputs that impact public health outcomes

Sullivan County Regional Health Department Strategic Objectives and Action Plan Deployment MatrixMission: To identify and respond to the public health needs and improve public health status of Sullivan County citizens through education and service with a highly motivated and well trained workforce.

Vision: To be a national model and leader in providing public health services.

AP

Stat

us Past, Present & Target Benchmark

KR

A

Term

EPSDT Results

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 YTD

Ex-pected Year End

0

200

400

600

800

1000

1200

1400

1600

1800

2000

1056

883

579

690

1222 1264

16751749

1828

846

1692

EPSD&T Count

Sullivan County Washington County (NER) Jackson Madison County

Exa

ms P

erf

orm

ed

How did we do it?

Paper reduction Clinical efficiency flow through Missed opportunity reduction Open Access TENNderCare Outreach Collaboration TennCare Insurance

providers Summer EPSDT Days Telephone update Clinic reorganization

Appointment Show rate (FP)Appointment Show rate (FP)Appointment Show Rates (Family Planning)

66%

84%83%

72%

66%

79%

88%89%

86% 86%87%

81%

68%

82%84%

85% 85%

88%

84%

69%

66%

85% 86% 85% 86% 86% 86%

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

Blountville Kingsport SCRHD Best in State

Open access

EPSD&T Count

16751739

579

883

1056

690

12221264

1828

0

200

400

600

800

1000

1200

1400

1600

1800

2000

2003 2004 2005 2006 2007 2008 2009 2010 2011

Exam

s Per

form

ed

Sullivan County

A team was assembled to improve the EPSD&T process including streamlining of required paperwork.

Hold the gains strategies

Sharing of data with staff Celebrating success Performance Improvement Teams (PITS) Positive health results from patients with

stakeholders Revenue benefits for organization Sharing customer feed back via our C3

process and customer surveys

Challenges

Increased outside physician participation Approaching maximal staffing production Declining numbers of children population Measures update, numbers vs percentage EMR strategies, challenges

Questions

Andrew Stephen May, M.D., FAAFPSullivan County Regional Health Department154 Blountville BypassBlountville, TN 37617423-279-2795asmay@sullivanhealth.org