What High Performers do Differently - Using Data to

Drive Change

Terry Grundy MBA Managing Director

Press Ganey Associates (Australia and New Zealand)

Traditional Approaches to Quality Improvement

TQM, CQI

Lean Thinking

Productive Ward

Process

Re-Design

Re-Engineering

High Performers Know It’s About Managing Behaviour

Process Improvement then Accelerates

The Most Significant Difference in Driving Change Through Data

High Performers Invest in their Leadership and Hold Leaders Accountable as Leaders

NOT as Clinicians

Press Ganey is the world’s largest provider of healthcare experience/satisfaction measurement services (now over 10,500 clients across 18 countries) with over 880 employees.

July 2012 Milestone: 310,000 surveys distributed every 24 hours, (65 million in 2012) – (185 million in 2013)

11 of the 15 Malcolm Baldrige Quality Award Winners: are PG Clients

14 of the 17 Honour Roll Hospitals: are PG Clients

240 of the 395 Magnet organisations: are PG Clients

Sample Australian Clients

OUTCOME FOCUSED DEFINITION

You can ask the cleaner what the hospital’s goals are, and whether they have been achieved? They will be able to tell you ………

“Vision without execution is h a l l u c i n a t i o n .” Thomas Edison

Employee Engagement

Patient Satisfaction

Doctor Engagement

Growth

&

Capacity Management

Funding Our Future

Health Outcomes

Advocate Good Samaritan Hospital – 2010 Baldridge Winner

High Performers = Balanced Scorecard Strategic Planning and Accountability

Service Quality People Finance Growth Community

Reduced claims

Reduced legal expenses

Reduced malpractice expense

Doctor Satisfaction

Patient Satisfaction

Improved clinical outcomes – decreased nosocomial infections

Reduced medically unnecessary days and delays

Reduced re-admits

Reduced medication errors

Reduced turnover

Reduced vacancies

Reduced agency costs

Reduced overtime

Reduced cost to orientate

Employee Satisfaction & Engagement

Improved operating income

Decreased cost per adjusted discharge

Improved debtors

Reduced accounts receivable days

Reduced advertising costs

Higher volume

Increased revenue

Decreased left without treatment in the ED

Reduced outpatient no-shows

Increased doctor activity

Increased Philanthropy

Provision of services to meet mission

Improved relationships & involvement with local communities

High Performers = Constantly Collect Data to Populate Metrics

Service

Patient Satisfaction

Goal: min xx% Percentile improvement needed xx%

Target: xx% recommend overall

Baseline: xx.x mean AMGA: Goal: x% improvement over baseline

Target: xx% percentile -main Campus Target: xx% percentile - RMP

People

Employee Satisfaction

xx% Improvement over 2 years

Reduce RN Turnover

Goal: xx% Reduction

Target: xx.x%

Current: xx.xx%

Quality Reduction of Patient Falls

Goal: xx% Reduction

Target: .xx/100 Pt. Days

Current: .xx/100 Pt. Days

ACE Inhibitor

Goal: x% Increase

Target: xx%

Current: xx%

Growth

New Patient Volume Growth

x%

Surgical Growth

Outpatient: x% Inpatient: x%

Financial

Operating Margin

Goal: x%

Reduction in Adjusted Cost/Day

TBD

On Time O.R. Starts

Target: xx% Current: xx%

The Cleveland Clinic: Top 4 Hospitals in the US since 1995

• 1,300 beds • 54,000 admissions • 3.7 million outpatient visits • 2,000 Doctors on staff

St Vincent’s Private Hospital Sydney

Balance Score Card

Alignment of Data to Individual Leaders

NOT JUST SPECIALTIES

Calvary Canberra Scoreboard

Showcase Outcomes to All

High Performers Showcase Their Outcomes For ALL

High Performers Provide the Evidence For Change

Savings of $1,230,000 in past 18months

85.1 84.5

83.6

82.0

86.6 87.7

85.2 84.7 83.7

82.1

92.9

88.7 88.6

83.0

81.4 80.9 81.0

83.9

86.4

83.5 83.6

81.2

79.2

91.8

84.7

88.1

77.0

79.0

81.0

83.0

85.0

87.0

89.0

91.0

93.0

95.0

YES

NO

Impact of Discharge Calls on Patient Perception 1 July 2010 – 30 June 2011 (16,000 inpatients)

Impact of Connecting With Discharge Phone Calls

Readmission Reduction

Source: South Carolina Academic Medical Center

Patients that received a post visit call

3 days after discharge had a lower

re-admission rate

High Performers Pursue Loyalty – Not Satisfaction

Zone of Affection

1 2 3 4 5 Very Very Poor Poor Fair Good Good

Zone of Indifference

Adapted from: Jones, T. and Sasser, E. Why Satisfied Customers Defect.

Harvard Business Review. November-December 1995. pp.88-99.

Zone of Defection

0.3% 0.7% 3.8% 27.2% 68.6% Top 5%

0.9% 1.4% 7.9% 39.4% 50.4% IP Benchmark

VALIDATE

High Performers

Trust Their Staff – But Check !!!!

Sometimes Usually Always

“But we're already doing it!"

Why Validation is the Key to Effective Practice Change

Checking execution is: not “sometimes” not “usually” but “always”.

“But we're already doing it!" Why Validation is the Key to Effective Patient-Centred Care

1. Validation through data and documentary evidence. Example: ongoing patient, doctor and employee surveying

2. Validation by the unit leaders (check with patients).

3. Validation by regularly assessing and discussing the outcomes on the unit.

4. Validation by external leaders (DON, quality manager or equivalent - check with patients).

5. Validation with the patient after discharge (through a discharge phone call).

6. Validate by turning the required behaviour into an annual competency, like other skill areas.

7. Follow-through – when behaviour does not meet the requirements, take action.

Leader Rounding on Patients Overall Patient Satisfaction

0

10

20

30

40

50

60

70

80

90

100

July

-04

Sep

t-04

Nov

-04

Jan-

05

Mar

ch-0

5

May

-05

July

-05

Sep

t-05

Nov

-05

Jan-

06

Mar

ch-0

6

May

-06

July

-06

Sep

t-06

Nov

-06

Jan-

07

Mar

ch-0

7

May

-07

July

-07

Sep

t-07

Service Training Began

Source: Advocate Good Samaritan Hospital, Downers Grove, IL, Beds = 303, Admissions = 17,486, measured by Press Ganey Associates, Inc.

Resistence to Process Change

Accountability Applied to Behaviour

Resistence to Accountability

Leaders Supporting High Performers

Acting on Low Performers

When Leadership Improves So Does Clinical Outcome

Thank You Terry Grundy MBA Managing Director Press Ganey Associates (Australia and New Zealand) terry.grundy@pressganey.com.au