Leading Out of the Mess

 

Roger L. ChaufournierExecutive DirectorCSI Solutions, LLC

September 2009

Michigan Primary Care Association

Fall 2009 Annual Conference

Objectives of the Workshop

1) Understand how to utilize a leadership Framework to drive improvement in the organization

2) Understand best practices of leadership in driving organizational change

Overview Chapel Road Case Study

Framework for Leadership

Leading Transformation

Bringing it All Home: Next Steps

CHAPEL ROAD HEALTH CENTER

Chapel Road Health Center

Single site FQHC located in an urban environment

Leadership turned over List of challenges to overcome

What are your impressions of this organization?

Common Leadership Practices

Reactive vs. Proactive Blame the people Throw people or policies at the problem Gimmicks

Slogans/campaignsNew Policies/Approval Process & SignaturesReorganizationsUse of extrinsic motivation (carrot and stick)

All Leadership Approaches Work! Autocratic-Top Down-Controlling

Hands Off

Team based

But certain leadership principles lead to higher levels of performance ….

“Hardly a competent workman can be found who does not devote a considerable amount of time to studying just how slowly he can work and still convince his employer that he is going at a good pace. Under our system a worker is told just what he is to do and how he is to do it. Any improvement he makes upon the orders given to him is fatal to his success.”

Frederick Taylor

“We trained hard...but it seemed that every time we were beginning to form up into teams we would be reorganized.  I was to learn later in life that we tend to meet any new situation by reorganizing; and what a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency and demoralization.”

Who do you think said this and in what era did they live?

Peter Drucker“Every few hundred years in the history of Western society a transformation takes place. The transformation transcends all aspects of society; the government, the schools, the values, religion, culture, etc. The transformation is not sudden, but takes place over a 50 year or more period. The transformation is so profound that the children born in that era can not comprehend the time in which their parents were born and in which their grandparents lived.”

Transformational Leadership Problem Solving: System Focused not People

Focused Strategic vs. Reactionary Focus on Quality as a Business Strategy Measurement and Feedback as a driver for change Leadership as a system; continuous reflection and

improvement Build organizational capacity for excellence

Small Group Dialogue

What would you do to right the ship? What role should the Chief Medical Officer

Play? If you were the CEO, what would you do? How can the CEO best work with the

Medical Director to develop a game plan?

Baldrige Health Care Criteria for Performance Excellence FrameworkA Systems Perspective

4Information and Analysis

6Process

Management

2StrategicPlanning

5StaffFocus

1Leadership

3Focus on Patients,Other Customers,

and Markets

Organizational Profile:Environment, Relationships and Challenges

Malcolm Baldrige National Quality Award

7Organizational

Results

Peter Drucker’s Effective Executive: Eight Practices

1. They ask “what needs to be done”2. They ask “what is right for the enterprise”

3. They develop action plans4. They take responsibility for decisions5. The take responsibility for communicating

6. The focus on opportunities rather than problems7. They run productive meetings8. They think and say “we” rather than “I”

Give the executive the

knowledge they need

Convert the knowledge into effective action

Ensure that the whole organization feels responsible and

accountable

PULL

PUSH

1. Set Direction: Mission, Vision and Strategy

3. Build Will• Plan for Transformation• Set Aims/Allocate Resources• Measure System Performance• Provide Encouragement• Make Financial Linkages• Learn Subject Matter• Work on the Larger System

5. Execute Change• Use Model for Improvement for Design and Redesign• Use Change Leadership Model• Review and Guide Key Initiatives• Spread Ideas• Communicate results• Sustain improved levels of performance

Make the status quo uncomfortable

Make the future attractive

Leadership for Transformation

2. Establish the Foundation• Reframe Operating Values

• Build Improvement Capability

• Build Relationships

• Develop Future Leaders

• Personal Preparation

• Choose and Align the Senior Team

4. Generate Ideas• Read and Scan Widely, Learn

from other Industries/Disciplines• Benchmark to Find Ideas• Listen to Customers• Invest in Research

&Development• Knowledge management• Understand Organization as a

System

IHI 2003

Leadership

Build will through a clear vision people want to buy into

Communicate Clear system level metrics Clear system priorities Empower staff to move the dots Align organization and remove barriers

Strategic Leadership

Clear vision and mission Constant Fingerprinting of the vision Set a limited number of core strategic

drivers-the vital few System of accountability

Quality Initiatives Must be Broad Enough and Deep Enough to Move the Big

Dot

Organization message: this year, patients will not acquire catheter-related bloodstream infections, surgical site infections, or ventilator-associated pneumonia

Organization message: this year, patients will not acquire catheter-related bloodstream infections, surgical site infections, or ventilator-associated pneumonia

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IOM aim: Care should be safe

IOM aim: Care should be safe

JHHS-level goal: patients will not be infected as a result of being in our hospital

JHHS-level goal: patients will not be infected as a result of being in our hospital

Projects (often cross-departmental): CABG surgical site infection initiative, ICU catheter initiative, laminectomy initiative, etc.

Projects (often cross-departmental): CABG surgical site infection initiative, ICU catheter initiative, laminectomy initiative, etc.

Each absolutely MUST have clear metrics:

you manage what you measure. If you don’t

capture the data, develop a way

JHM Strategic Priority: Clinical excellence

JHM Strategic Priority: Clinical excellence

Source: Richard Davis, Ph.D. Johns Hopkins Medicine

Aligning Workto your Business Imperative

Community Health HealthHealth Center CenterAssessment Strategic Plan QI Plan &

MonitoringSystem

Priorities forParticipation inImprovement Projects andPriorities for Spread

Collaborative TeamEstablished

PlanAct Do Study

Cycles

PlansForSpreadBased on SuccessfulPDSA

Mon

thly

mea

sure

s

ImprovedHealthCenterPerformance• lower cost• > clinical outcome• >patient & staff satisfaction

Update the plan

Information Management and Analysis Set of system level measures for the

organization They focus on “moving the dots” Information is available to front line work

force Data driven decision making

SJHS Performance Metrics Balanced High level Linked to

trended run and control charts

Indicator-specific comparative rates (green circle)

Adds focus to “move to the outside circle”

Some successes22

04/10/23

Dashboards

© 19 99 Arthu r Ande rsen. All rig hts re served .

Informed decisions through the use of appropriate and timely data

KQI_ending-063004.pdf

Source: Richard Davis, Johns Hopkins Business of Medicine Program

Work Process Management

Put people to work on building the better mouse trap

Use change methods to drive improvement

Empower staff with the tools to study and improve work

Drive the improvement efforts

Every Leader Needs a Toolkit of Improvement Methods To Lead ChangeImprovement Methods: PDSA PICOS/Lean Six sigma (DMAIC) AIM Kaizen Reengineering

These tools are specific to the improvement task at hand.

All have similarities in approach: applying the scientific method to improvement: defining, measuring and testing

Value Stream Mapping Phases

Preparation

Current State

Future State

Planning

Agreeing on what process to study, how to map it and who will participate.

Agreeing on a well understood map of the current situation.

Agreeing on a shared vision of a lean future state.

Agreeing on how to implement the future state vision

Adapted from Lean Enterprise Institute

Pre-Registration / RegistrationReimbursement Received

Bills Processing

Chart Coded

Chart Collected

Discharge Order Written

Clinical Documentation Improvement

Patient Care Rendered

Medical Record / Encounter Form Created

The Johns Hopkins HospitalRevenue Recovery Initiative

Revenue Cycle

Denials Management

Late Charge Management

Standards Identified(selected examples....) 98% overall accuracy rate of registration 90% competency rate of registration staff 100% of claims include referral/auth. 95% insurance verification and precert. 90% TOS payments collected/counseled Reduce denial rate Increase patient satisfaction

Standards to guide PICOS groups

PICOS Groups Redesign Registration Processes Key metrics for each group

Vision for new processes

Action items Short Term: implement immediately after workshop Long Term: implement over 12 months while group

continues to meet

Revenue Recovery Revenue Recovery AccomplishmentsAccomplishments

  

Activity Baseline FY00 FY01 FY02 FY03 FY04 FY05 (Q2)

Competency Scores 65% 80% 90% 92% 91.4% 92.5% 93.5% Admin. Denial Rate 1.4% 1.4% 1.4% 1.4% 1.4% 2.0% 1.7%

Clinical Denial Rate 2.3% 1.7% 2.0% 2.0% 1.8% 1.8% 1.8%

TOS Collections $13.8m $17.5 $8.7m* $10.1m $8.6M $9.5M $4.4M Collection Rate 85.6% 87.4% 87.5% 88.1% 88.6% 89.3% 87.9% Days in A/R 118 96 75 61 56.3 50.6 53.7

Late Charges 9% 4% 4% 3% 2.6% 3.1% 2.5%  

 Cumulative Revenue FY00 – FY05 = $98,000,000

Work Force Management

Create an environment that breeds success

Recruit great people Train and empower the work force Recognition as a driver or performance Building “Good to Great” cultures

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What Leads to Intrinsic Motivation? Control over the variables Feedback The ability to make a contribution and

succeed Variation Recognition

Make work like a Nintendo game!

Role of Recognition

The Carrot Principle Gostick and Elton 2007 200,000 employee ten year study Frequent, variable, meaningful praise tied to:

Goal SettingCommunicationTrustAccountability

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Recognition Formula Annual expenditures $1000 per employee or 2%

of payroll Every 7 days thank for free (hand written note,

verbal, email) 4-6 /year above and beyond wards ($100-$2000 $100 annually- 2 times per year event award $200 year Service Awards (90 day;1 yr;3 yr;

5yr;10yr; every five year thereafter

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Empowerment

How do you build an empowered organization? Philosophy Delegated authority Training Monitoring Communication Reinforcement Celebration

BRINGING IT ALL HOMEWhat do I do now?

Bring it All Home-Key Points

Leadership can be viewed as a system A framework can help you improve your

leadership system Each Domain of the Framework has

principles and best practices you can learn to master

You should maintain a continuous learning environment

Action Planning

What three steps can you take upon return? (new concepts you want to explore)

What next step do you need to do to continue your learning journey?

Where to find more information Malcolm Baldrige National Quality Award IHI.org Monograph: The Seven Leadership Leverage

Points Built to Last; Jim Collins and Jerry Porras. First, Break All the Rules: What the World’s Greatest

Mangers Do Differently, Marcus Buckingham and Curt Coffman

The Leadership Challenge, James Kouzes and Barry Posner

The Carrot Principle Gostick and Elton 2007