The Power Of ‘AND’

The power of ‘AND’’Laura Kinney, VP Lean/Operational ExcellenceSignature HealthcareBrockton, MA

Understand the basicsof Baldrige and Lean (highlevel summaries). Understand how the Baldrige framework and LeanTransformation can be leveraged to work togetherfrom strategy alignment to problem solving. How to use both approaches to invest in people atall levels.

Director, Business Process Design - Community Health Plan ofWashingtonOrganizational Excellence Consultant, Practice LeaderEnvironmental Sustainability, Baldrige SME - MultiCare HealthSystemVice President, Strategy and Excellence – Yakima Valley MemorialHospital, now VMMemorialDirector, Lean Transformation – Geisinger Health, Danville, PAVice President, Lean and Operational Excellence – SignatureHealthcare, Brockton, MAProfessional Affiliations – ASQ (American Society for Quality), National Baldrige Program –Performance Excellence, PiPex – New England Program for Baldrige, ACHE – AmericanCollege of Healthcare Executives

Baldrige has a simple purpose. The purpose of the Baldrige framework is simply to helporganizations—no matter the size or the types of health care servicesit offers—answer three questions: Is your organization doing as wellas it could? How do you know? What and how should yourorganization improve or change? The questions (divided into six interrelated process categories and aresults category) represent seven critical aspects of managing andperforming as an organization:1. Leadership2. Strategy3. Customers4. Measurement, analysis, and knowledge management5. Workforce6. Operations7. ResultsFrom 2017-2018 Baldrige Criteria for Performance Excellence - Healthcare

Nota list of standards No shalls, musts, or required language Doesn’t tell you what to do Itmerely asks ’How do you .’ Simple, right?From 2017-2018 Baldrige Criteria for Performance Excellence - Healthcare

Processes are the methods your organization uses to accomplish its work.The Baldrige framework helps you assess and improve your processesalong four dimensions:1. Approach: How do you accomplish your organization’s work? Howeffective are your key approaches?2. Deployment:How consistently are your key approaches used in relevantparts of your organization?3. Learning: How well have you evaluated and improved your keyapproaches? How well have improvements been shared within yourorganization? Has new knowledge led to innovation?4. Integration: How well do your approaches align with your current andfuture organizational needs? How well do your measures, information,and improvement systems complement each other across processes andwork units? How well are processes and operations harmonized acrossyour organization to achieve key organization-wide goals?From 2017-2018 Baldrige Criteria for Performance Excellence - Healthcare

The Baldrige framework leads you to examine your results from three viewpoints: the externalview (How do your patients, other customers, and other stakeholders view you?), theinternal view (How efficient and effective are your operations?), and the future view (Is yourorganization learning and growing?).In Baldrige, results include all areas of importance to your organization. This composite ofmeasures ensures that your strategies are balanced—that they do not inappropriately tradeoff among important stakeholders, objectives, or short-and longer-term goals. The Baldrigeframework helps you evaluate your results along four dimensions: Levels: What is your current performance on a meaningful measurement scale? Trends: Are the results improving, staying the same, or getting worse? Comparisons: How does your performance compare with that of other organizations andcompetitors, or with benchmarks or industry leaders? Integration: Are you tracking results that are important to your organization and thatconsider the expectations and needs of your key stakeholders? Are you using the results indecision making?From 2017-2018 Baldrige Criteria for Performance Excellence - Healthcare

The linkages among the Health Care Criteria categories are anessential element of the systems perspective provided bythe Baldrige framework. Some examples of these linkagesare: the connections between your processes and the resultsyou achieve; the need for data in the strategic planning process and forimproving operations; the connection between workforce planning and strategicplanning; the need for patient, other customer, and marketknowledge in establishing your strategy and action plans; and the connection between your action plans and anychanges needed in your work systems.From 2017-2018 Baldrige Criteria for Performance Excellence - Healthcare

From 2017-2018 Baldrige Criteria for Performance Excellence - Healthcare

(1) HealthCare Service Offerings What are your main health care service offerings? What is therelative importance of each to your success? What mechanisms do you use to deliver yourhealth care services?(2) What are your mission, vision and values? What are your organization’s core competenciesand what is their relationship to the mission?(3) Workforce Profile What is your workforce profile? What recent changes have you experiencedin workforce composition or in your needs with regard to your workforce? what are your workforce or employee groups and segments, the educational requirements for different employee groups and segments, and the key drivers that engage them in achieving your mission and vision? what are your organized bargaining units (union representation)? What are yourorganization’s special health and safety requirements?

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Examiners will readyour applicationresponses then review the as well as the “key factors”Criteria requirements for your organization thatthey have identified from theOrganizational Profile then, considering theevaluation factors they will develop Strength andOFI feedback comments like theones on the following slides.A-D-L-I for ProcessesLe-T-C-I for Results

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ExamplePoudre Valley Health System 2008 Baldrige Recipient

ExampleHeartland Health 2009 Baldrige Recipient

ExampleHeartland Health 2009 Baldrige Recipient

ExampleWhoWhatHow do you Know?Charleston Area Medical Center, 2016 Baldrige Recipient

ExampleCharleston Area Medical Center, 2016 Baldrige Recipient

ExampleCharleston Area Medical Center, 2016 Baldrige Recipient

ExampleCharleston Area Medical Center, 2016 Baldrige Recipient

ExampleThe ResultsCharleston Area Medical Center, 2016Baldrige Recipient

“I see the Baldrigeprocess as a powerfulset of mechanisms fordisciplined peopleengaged in disciplinedthought and takingdisciplined action tocreate greatorganizations thatproduce exceptionalresults.”—Jim Collins, author ofGood to Great: Why SomeCompanies Make the Leap. . . and Others Don’t

Lean is all about looking at things from the customer’s (orpatient’s) perspective to deliver the highest value. It focuses on improving culture and processes so that we candeliver the best experience possible to patients. Front-line employees are developed and empowered throughproblem-solving and coaching. Leadership is also developed alongside of an effective dailymanagement system.28

1.Improvement System Structure a consistenttransformation journeyacross platforms andservice linesEliminate waste andvariability in keyprocessesUse analytics and afact-base to prioritizeopportunitiesBuild problem-solvingcapacity in pcapabilitiesMindsets &CapabilitiesSOURCE: McKinsey Operations Practice29

2.Performance Management Align on keyperformance metrics totrack Build a dailymanagement system tomonitor progress Institute regular,cascading huddles at alllevels of the organization pabilitiesMindsets &CapabilitiesStructure foraccountability; strategyalignmentSOURCE: McKinsey Operations Practice30

3.Mindsets & Capabilities Create cross-functionalteams to drive change Train staff on “hard”and “soft” skills Empower front-linestaff to drive thetransformation effort Engage physiciansextensively Be a catalyst forcultural emLeadershipcapabilitiesMindsets &CapabilitiesSOURCE: McKinsey Operations Practice31

4.Leadership Establish LeanLeadership to buildleadership capabilities toImprovementcoach through andSystemsupport & sustain changeRemove challenges esMindsets &CapabilitiesSOURCE: McKinsey Operations Practice32

5.The Patient Experience Lean management isbuilt upon listening tothe voice of thepatient/member andunderstanding LeadershipcapabilitiesMindsets &CapabilitiesSOURCE: McKinsey Operations Practice33

1.2.Improvement System Structure a consistent transformation journey acrossplatforms and service lines Eliminate waste and variability in key processes Use analytics and a fact-base to prioritizeopportunitiesPerformance Management Align on key performance metricsto track Build a daily management systemto monitor progress Institute regular, cascadinghuddles at all levels of theorganizationBuild problem solving capacity in all Performance Structure for accountability;Management strategy 3.Leadership Establish Lean Leadershipto build leadershipcapabilities to coachthrough and support &sustain changeMindsets &CapabilitiesRemove challenges &barriersMindsets &Capabilities Create cross-functionalteams to drive change Train staff on “hard” and“soft” skills Empower front-line staffto drive thetransformation effort Engage physiciansextensively Be a catalyst for culturaltransformationGo to the Gemba!!5.The Patient ExperienceLean management is built upon listening to the voice of the patient/member and understanding their journeySOURCE: McKinsey Operations Practice

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Alignment – consistency among plans, processes,information, resource decisions, workforce capabilityand capacity, actions, results, and analyses that supportkey organization-wide goals.Effective alignment requires: a common understanding of purposes and goals the use of complementary measures and information forplanning, tracking, analysis and improvement at threelevels:1.2.3.organizational levelkey process leveldepartmental or work unit level36

Source: 2017–2018 Baldrige Excellence Framework (Health Care)37

One Geisinger Overall Priorities& LT StrategiesPlatforms/Institutes Operational Plans &Dashboards; LeanImplementation Goals inPMSDept AE Boards & PMSGoals for LeanIndividual PMS Goals forLean & DailyHuddle Boards38

AEBoards are a simple way to keep track of the mostimportant key performance indicators (KPIs) for adepartment/unit. The visualrepresentation should draw in staff andleaders alike by showing the most important work ofa department. Someof the measures may align with strategicobjectives of the organization, but not necessarily all.39

Thereare 3 main components: Objective – what are you trying to improve? Performance measure or Key Performance Indicator(KPI)- how are you measuring improvement on theobjective? Action Plan – what is your department doing to improveperformance (www)?40

ExampleStrategic Priorities41

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Example1.Cost shifting impacting affordability for manyAmericans and employers2.Shift from volume to value—linking quality/serviceand alternative payment models3.Physician/health care provider shortages4.Pressure to reduce health care cost5.Disruptive innovationchallenging traditional models

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ExamplePerformance Tracking

ExampleAccountability and CorrectiveAction

ExampleOur Vision & MissionOur 6 Yr. Strategic DirectionOur Strategic ImperativesOur PillarsOur Foundation

Example VisualManagement of our Lean Management Systemis evident throughout the entire SHC organization Each department has the following VisualManagement tools in place Problem Solving BoardBalanced ScorecardMulti-Purpose Board

Example Each department meets daily to– Discuss new Points of Recognition (opportunities forimprovement)– Review the progress of Problem Solving– Monitor organization performance against annual goals andidentify gaps in performance– Monitor day-to-day operationalmetrics and information andidentify opportunities forimprovement