Hazelden Betty Ford Foundation’s Journey:

Using Systematic Problem Solving (SPS)

to Build a Culture of Continuous

Improvement

PEN Conference

November 10, 2014

Speakers

Corporate Director of Quality &

Process Improvement @ HBFF

Responsible for executing an

organization-wide Lean initiative at

HBFF– A3 management

– Lean 101 certifications

– Economic impact >$700K YTD

Was Lean Deployment Manager at

HealthEast until 2014– Strategy Deployment

– Daily Management system

– Kaizen Workshops

– A3 Workshops

BS Industrial Engineering and MHA

Corin Hammitt

President and CEO of Rendement

Group

An expert and innovative leader in

Customer Experience and Process

Improvement as well as business

process transformation/re-design

Has lead Finance and Lean Six Sigma

organizations within world class

companies including Dun &

Bradstreet, Hertz, GE and most

recently Select Comfort

Six Sigma Master Black Belt

BS Business Administration and

Economics

Edwin Boon

About Hazelden Betty Ford Foundation (HBFF)

Private, not-for-profit Addiction

Treatment Provider– 16 sites across the country

– Residential and outpatient

treatment for youth, adults, and

families

– Hazelden founded in 1949

– Merged with Betty Ford Center in

2014

HBFF also includes:– Publishing

– Accredited Graduate School of

Addiction Studies

– Butler Center for Research

Mission, Vision, Triple Aim

Mission

We are a force of healing and hope for individuals,

families and communities affected by addiction to alcohol

and other drugs.

Vision

Together, we will overcome addiction.

Triple Aim: better care for individuals, improved health for

the population we serve and lower cost of care per

patient.

Where our journey began

Re-birth of Quality & PI

Need to demonstrate value (and quickly!)

Very little Lean knowledge within workforce

“Ready, Fire, Aim” is status quo

Quality & Process Improvement at HBFF

Solving Strategic Issues with Meaningful Impact™

“Systematic Problem Solving, SPS, Metric of Urgency and Meaningful Impact have pending trademarks of the Rendement Group LLC and Edwin Boon.”

Creating Organizational Focus

Projects Strategic

Issue

Many

Low

Impact

Projects Strategic

Issue

Vital

Few

Meaningful

Impact™

Accepted Practice Desired State

SPS provides focus in problem solving to improve

Strategic Issues and deliver Meaningful Impact™

Organizations Must Align Strategic Learning with Operational Learning Using Metrics

Vital few Insignificant many

Project/initiative Impact

Customer Satisfaction

Competitive Advantage

Profit Margin

Strategic Issue

Metrics

SPS produces a compelling business case for change by integrating strategic issues, the right metrics, and the vital few projects

Creating Organizational Knowledge

Using the 4-step SPS process

11/9/2015 © Copyright Rendement Group, LLC 2015 - Confidential and Proprietary 10

Business Case“Problem Statement”Strategic Issue

Lagging Indicators

Financial

Key Leading Process Indicator

Metric of Urgency™

Develop

DriversDecide

Projects/Initiatives

Deliver =

Define

Competitive

Customer

Vital Few Projects/Initiatives x Improvement Tool Box

STR

ATE

GY

OP

ERA

TIO

NS

Vital Few Other

Vital Few Other

FastTrack to Meaningful Impact™

Meaningful Impact™

Creating Strategic Focus

Assessment

Financial data analysis to discover top areas of financial

opportunity– Build relationship with Finance early

Voice of Business meetings with CEO, all VPs and key stakeholders

Operations data analysis to identify patient retention across levels

of care and performance data (lead time, cycle time)

Process observation and process map analysis

Assessment of patient and employee satisfaction data

Socialized conclusions of above with CEO and CFO

Integrating strategic challenges, the right metrics, and the vital few priorities to drive change

Rigorous analysis of financial and operational process data

Creating a Problem Statement for Each Issue

Customer: patient satisfaction in outpatient sites was less than

organizational goal of 90th Percentile

Financial: Direct margin is eroding in residential facilities

Quality: Patient retention across levels of care and beyond 90

days duration is less than target

Developing and Searching for the right Metrics

Leading

Indicators

Lagging

Indicators

Patient

Experience

Financial

Quality

• % patients participating in

group tour

• % patients scheduled to admit

same day

• Patient satisfaction percentile

rank as measured by Press

Ganey

• Cost Growth versus Revenue

Growth

• Direct Margin contribution by

department

• Length of stay

• Counselor time spent

documenting

• % patients retained in the

HBFF system from residential

to outpatient

Selecting the Vital Few Organizational Drivers

Priority Projects

Customer: Patient Satisfaction in St. Paul– Largest outpatient site

– Largest opportunity to impact patient satisfaction

Financial: Medical Services in Center City Residential– Largest cost driver

– Timeliness of patient experience

Quality: Outpatient program redesign– Increase length of engagement

– Single counselor model to build therapeutic alliance

– Increased counselor productivity and efficiency gains

35%

10% 9% 7% 7% 7%5% 5% 5%

2% 3%1% 1% 2% 2%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Percent of Time Spent on Provider Duties

Percent of Total

Prioritizing the Vital Few Projects

Strategic Challenge: Financial;

Medical Services History & Physical productivity

• Largest portion of

provider time spent

• Timeliness of H&P

Creating Alignment

All 3 improvement initiatives are directly aligned with the

strategic plan

Delivering Results that Matter

Deployment

• Improvement approach

• Resource planning

• Patient Value Team:• Ownership and Accountability

• Balanced score cards & Dashboards

• Review Cadence

• Project Execution Structure– A3 coaching

– Kaizen workshops

– Project leaders and sponsors learning their roles

– Engaging frontline staff

• Appropriate Goal Setting

• Organization-wide education and Lean 101

certifications

Project features on intranet

A3 project reviews at Senior Leader level– Awareness

– Accountability

– Sustainability

– Opportunities to cross-pollinate

Strategic Transformation Teams

Economic Impact Report to Executive Team

Q&PI Project scorecard to Executive Team

Deploying at all levels

Communication

Achieving Desired Outcomes

Customer: Patient Satisfaction in St. Paul– Increased PG Top Box Score by 10 percentage points

Financial: Medical Services: History & Physical

productivity– Increased % of H&Ps complete within 72 hours of admission by 38

percentage points

Quality: Outpatient program redesign– Doubled % of patients engaged for longer than 6 weeks

Results

Experiencing Organizational Learning

The importance of socializing

Having the right team members on projects

Weekly meetings to review project progress, metrics,

and to drive accountability

Role of sponsors needs to be more clear

Role of coaches must be clear to all

Maintain ownership with project teams

Lessons Learned

Cultural Changes Underway

Standardized economic impact report with blessing by

CFO. A strong partnership with finance is paramount.

VOB interviews helped build understanding of Q&PI/

Lean

Education workshops for all staff are a huge success-

strong desire for development opportunities

“Learn by doing” with A3 workshops spreads the

thinking, but keeps the Q&PI team’s capacity available

for strategic projects

Wins

SPS Delivers 7 Integrated Outcomes

THE VITAL FEW

PRIORITIES

METRIC OF URGENCY™

BUSINESS CASE

PROBLEM STATEMENT

STRATEGIC FOCUS

MEANINGFUL IMPACT™

CONTINUOUS LEARNING

Learning to use the Model

SPS drives culture of systematic continuous improvement

SPS quickly maps the linkage between strategic challenges and the vital projects so the organization only works on projects that matter

11/9/2015 © Copyright Rendement Group, LLC 2015 - Confidential and Proprietary 26

Lagging Indicators

Key Leading Process Indicator

Metric of Urgency™: Cost Growth > Revenue Growth

Develop

LocationDecide

Department

Deliver =

Define

Medical Services x Lean

STR

ATE

GY

OP

ERA

TIO

NS

Residential MN Other

Treatment Other

Direct Margin Example

Meaningful Impact™

PI to Improve Margins by $2MDeclining Margins in 2013Top Tier Operating Performance

of 15% EBIDA by 2016

Board of Directors: Gap to Sustained 15% Operating Margin

Competitive: Gap to Industry Peers

Financial: 2013 EBIDA @12% and declining

Searching for the Metric of Urgency™

Learning what drives Patient Experience at St Paul Outpatient facility

DISCOVERYMETRIC OF URGENCY™

MEANINGFUL IMPACT™

• % patients participating in

group tour

• scheduled to admit same day

Need to explore other

levers to further improve

patient satisfaction

SPS Delivers Meaningful Impact™

SPS delivers change that is “felt” by key stakeholders:

customers, management and employees

Improvement Business Case

Meaningful Impact

Incremental

0 – 30%

Breakthrough

50 – 90%

Stretch

30 – 50%

Project Leaders, Team Members &

Improvement Specialists

Process Owners& Improvement

Leaders

Senior Leaders

Top-down SPS:Solve new strategic

issue

Bottom-up SPS:Evaluate current projects

against strategic issue

When?• Continuous and/or

periodic (deadline triggered)

When?• Annual review• Any new initiatives

Why?• Align new improvement

initiatives with strategy• Prioritize new projects• Develop the right

performance metrics

Why?• Prove the value of existing

improvements initiatives/projects• Prioritize existing projects• Train, motivate & drive culture

change from the bottom

Who?• Senior Leaders• Process Owners• Improvement Leaders

Who?• Improvement Leaders• Project Leaders & Team Members• Improvements Specialists

SPS is Flexible making Deployment Easy

HBFF’s Journey with SPS™