Kaiser Permanente\'s Large Scale Implementation Of Performance Improvement
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Transcript of Kaiser Permanente\'s Large Scale Implementation Of Performance Improvement
Kaiser Permanente’s Large Scale Implementation of Performance Improvement
Lisa Schilling, RN MPH, VP, Healthcare Performance ImprovementWCBF Lean Six Sigma and PI in Healthcare Summit
New Orleans, LAMay 12, 2011
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Top
dow
nR
educ
e va
riatio
n
Learning system
• Economic and social context for change
• Models of workplace learning
• Team performance
• Define organizational needs • Create system view• Plan/ manage improvement
• Align with strategy • ID drivers and portfolios • Build capability to improve
• Engaging the hearts and minds of the front line
• Creating “line of sight” to strategic goals
• Define high performing unit-based teams
Bottom
upLearning and im
provement
High Performing Organizations Build Culture and Capability
Principles What we “do”
© Kaiser Permanente 2010 reproduce by permission only
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Big Aim
Strategy
Dashboard
Targets
Domain 2011 2012 2013
Population Health Self perceived health status data for 15% of members
Self perceived health status data for 20% of members
Self perceived health status data for 25% of members
Population Care Management - Chronic Conditions
HEDIS composite at 90th percentileAll CV, diabetes, and cancer screening
metrics at 90th percentile
Prevention screening 90%Diabetes/CVD metrics 90%
Inpatient HSMR TJC Composite
Reduce HSMR: Below US Medicare average, crude mortality 10% from 2010 baselineTJC Composite at national 90th percentileReadmit rate<15% of all cause readmissions
Reduce HSMR: Below US MedicareTBD - May shift to inpatient outcomesReadmit rate<10% of all cause readmissionsTJC Composite at national 90th percentile
Reduce HSMR: Below US MedicareTJC Composite at national 90th percentile
Safety Never Events 10% less events than 2010 10% less events than 2011 10% less events than 2012
Workplace Safety 10% reduction from 2010 goals Per regional targets Per regional targets
Clincal Risk Management 5% reduction in claims from 2010 0 to 5% reduction in claims from 2011
0 to 5% reduction in claims from 2012
Service Hospital
At national 75th percentile (final quarter)
At national 75th percentile (rolling 12 months)
Above National 75th percentile(Rolling 12 months)
Service Outpatient & Health Plan
75th percentile in local or national in x of 8 regions (pending benchmark
data)
75th percentile in local or national in x of 8 regions (pending benchmark
data)
Above 4 Stars on Medicare Overall Service Measures
Equitable CareReduction of gap in race-based
clinical disparities for the 8 HEDIS signature measures examined
Same as 2011, in addition, assess the applicability and utility of other
socioeconomic factors in the measurement of equity
Same as 2012, in addition, assess the applicability and utility of other
socioeconomic factors in the measurement of equity
Id tif i t ti t d th D th b % D b % 2012
Add goal to maximize the CMS Quality bonus?
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From Strategy to Execution
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5
HOW: Mortality & Inpatient Effectiveness Driver
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Quality Goals Timeline – 2011 – 2013
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Aligning Strategy: Data to Monitor Variation
Range 85% - 95%
Range 94% - 98%
The Joint Commission Index Across Hospitals: Demonstrated Progress in Reducing Variation
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Our system is based on the attributes of high performing organizations
Best qualityBest service
Most affordableBest place to
work
KP needs to build capability in these six areas in order to achieve breakthrough performance
© Kaiser Permanente 2010 reproduce by permission only
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Kaiser Permanente’s Performance Improvement System
AIM: Assist regions and facilities in developing, testing and implementing a
KP-wide performance improvement system that builds the capacity to
execute on high priority initiatives in each KP region by 2010.
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10page 10
Achieve Breakthroughgoals
Manage Local Improvement
Develop Human Resources
Spread and sustainProvide Leadership forLarge system Projects
Provide Day-to-DayLeaders for Micro Systems
Execution in KP’s System
Source: IHI 2008
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Lets look at the far left side: Manage local improvement
Moving from a project by project mentality to looking at system level improvement (end to end process with sequencing)Creating clear lines of accountability and oversightInsure the right portfolio of initiatives to assure ourselves that we are doing enough to move the Big Dot
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Building Improvement Capability
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We can build our capacity to improve by developing our skills
Delivering Improvement Advisor through front line skills development program focused on 4 audiences Using common language for the organization based on MFI, Lean, six sigmaAligning executive through front line capability by matching infrastructure with new skills
Source: API 2006
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Experts Operational
Leaders (Executives)
ChangeAgents
(Middle Managers, Stewards,
project leads)
Everyone
(Staff, Supervisors,
UBT lead triad)
Continuum of PI Knowledge and Skills
Deep Knowledge
Many People Few People
Our approach will be to make sure that each group receives the knowledge and skill sets they need
when they need them and in the
appropriate amounts.
A key operating assumption of
building capacity is that different groups of people will have different levels of
need for PI knowledge and skill.
Content: What Skills Do We Need?
SharedKnowledge
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On-boarding
Dev
elop
and
Test
the
Syst
em
at a
Fac
ility
leve
l
Developing deeper capability to achieve big results over time
Expa
ndIm
prov
emen
t sys
tem
to
all
faci
litie
s
Dee
pen
impr
ovem
ent
know
ledg
e w
ithin
faci
litie
s
September 2008 June 2009 2010 & 2011Waves of Improvement Institute
Learning and sharing systems regionally and program-wide Improvement Institute
Implementation Expansion ContinuousImprovementComplete
We are here
Level of Project
Difficulty
• All Regions• 500 IA’s• 15 internal faculty
Mentors• 3,000+ Operations
Managers• 20,000+ Front line staff• IHI Forum and courses
• 7 regions• 300 Improvement
Advisors • 35 UBTC’s• 1,250 Operations
managers• 8,000 Front line staff• IHI Forum and courses
• 5 regions• 65 Improvement Advisors• 300 operations managers• 3,500 Front line staff• IHI Forum
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KP’s Improvement Model has Four Phases
•Process map•Baseline data•Charter project•Create portfolio•Data collectionplan
•Training•Policy & procedures
•Feedback loops•Error proofing•Control charts•Spread plan
•Standardizeand simplify
•Reduce waste•6S•Reduce defects•Apply evidence-based practices
AssessDevelop/ Identify
Change Test Implement/Control
What are we trying to accomplish?
How will we know that change is an improvement?
What change can we make that will result in improvement?
Source: API© 2006
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Case Study: Improving CHF Readmission Rates
Problem statement: CHF 30 day readmission rates at 16% want to
decrease as much as possible while improving health outcomes
Where would you start?What would you measure?Whom would you involve?
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Where we started
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Where? KP-SCAL w/CMIHow? •Coordinated concurrent medication
reconciliation by Home Health RN, PharmD, and Patient in the patients home.
•Improved identification of Heart Failure patients in the Hospital
•Increased reliability of Home Health visit within 48 hours
•Increased reliability of Out-patient Heart Failure Clinic follow up in one week
•Implemented readmission diagnostic tool to identify system gaps
Results •Reduced 30-day re-hospitalization rate to 9% (and 90 day readmission to 20%).•Improved the reliability of the Transitions Care Program component bundle measures from 61%-95%•$ value estimated at $1,800,000
Goal: Reduce all cause 30-day Heart Failure readmissions from 15.7% to 10% by 4/1/08
Case Study: Readmission Reduction CHF
At South Bay, it takes a village to manage our heart failure patients, with the help of our local, regional and national leadership teams and the strength of our administrative infrastructure, we have been able to make an improvement with 3 key components: real time medication reconciliation at the home health visit, home health visits in a timely manner and the use of the diagnostic readmission tool. Joan Fredella, Pharm. D., Clinical Pharmacist
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How we know we are better: Organizational Capability Tool
0.0
1.0
2.0
3.0
4.0
5.0
Leadership
Learning
Systems & Process
Measurement
Capacity & Sustainment
Culture & Communication
2009Q4 Target
January 2008 December 2009
Regions and Medical Centers are more capable of achieving better performance
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“The future of healthcare is ours to imagine.”
-Institute for Healthcare Improvement
Change your thoughtsand you change your world.
-Peale