Results at a System Level- Leadership Leverage Points and the … · 2019-01-29 · change leaders...

Results at a System Level- Leadership Leverage Points and

the Execution Framework

Anna Roth, RN, MS, MPHChief Executive Officer ,

Contra Costa Regional Medical CenterFellow, Institute for Healthcare Improvement

Agenda

• What we know about how great organizations leading a large portfolio of changes successfully

• Overview of leadership leverage points• An example of using framework• Learning from your experiences and questions

Objectives• Understand how to use a framework to move

beyond project-based improvements to whole system transformation

• Understand how to drive change at all levels of your system

• Explore similarities and difference of improvement at different scales

Consider this…• Most organizations can get one or more project done but,

• It is unlikely that the list of projects will align with the strategy to yield results, and

• Even if they are lined up with the strategy, the changes in the projects need to become coordinated and sustained processes that work together…

How to get there?

Seven Leadership Leverage Points

Reinertsen JL, Bisognano M, Pugh MD. Seven Leadership Leverage Points for Organizational-Level

Improvement in Health Care (Second Edition). Cambridge, Massachusetts: Institute for Healthcare Improvement; 2008. (Available on www.ihi.org)

Three: Channel Leadership Attentionto System-Level Improvement: PersonalLeadership, Leadership Systems, andTransparency

Seven Leverage Points

• Learning about what it takes to execute change on a large scale:• Focus on one or two major aims• Rigorous steering of the execution plan using good data from the field• Resourcing strategic improvements with capable improvers andchange leaders as their primary job responsibility

• Emphasis on the critical role of the board in quality• Learning about the power of stories and data at the board level

• Confirmation and examples of the power of leadership attentionto improvement aims• A major new emphasis on the power of transparency to driveimprovement and change

• Original leverage point focused on establishing the mosteffective senior leadership team• Revised leverage point focuses exclusively on the transformational role of patients and families on leadership and improvement teams

• Learning about the potentially powerful role CFOs can play inimprovement once they see “reduce waste in core processes” as the primary driver of cost reductions, rather than the traditionalapproach of “reduce inputs to (defective) core processes”

• Developed an entirely new framework for engaging physicians in a shared quality agenda, with extensive examples

• Continued reinforcement of the critical need to build capableimprovers at every level as an important underpinning for theother six leverage points

One: Establish and Oversee SpecificSystem-Level Aims at the HighestGovernance Level

Two: Develop an Executable Strategy toAchieve the System-Level Aims andOversee Their Execution at the HighestGovernance Level

Four: Put Patients and Families on theImprovement Team

Five: Make the Chief Financial Officera Quality Champion

Six: Engage Physicians

Seven: Build Improvement Capability

Actions/Execution

Focus on Execution

Execution Step-by-Step

1. Setting Priorities and Breakthrough Performance Goals

2. Developing a Portfolio of Projects to Support the Goals

3. Deploying Resources to the Projects That Are Appropriate for the Aim

4. Establishing an Oversight and Learning System to Increase the Chance of Producing the Desired Change

Nolan TW. Execution of Strategic Improvement Initiatives to Produce System-Level Results. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2007.

Execution for System Level Performance

Manage Local Improvement

Achieve Breakthrough

Goals

Develop Human Resources

Provide Leaders forLarge System Projects

Provide Day-to-Day Leaders for Micro Systems

Spread and Sustain

Example

• 1 million• $780 million• 700 sq miles

• 12,000 • 46,000• 460,000

Our System• Primary Care• Family Practice Residency• Integrated Public Health System• Population/Regional Focus• Focus on Vulnerable Populations

Common things uncommonly well….

Where were we?• VAP• Total Joints• Infection Control• Flow• Code Blues• Medication Safety• PACS• EMR• and on, and on….

Leading change

Finding the levers

1. Aim for excellence

Board to bed

2. Action/ Execute

Transforming Care at the Bedside (TCAB)

Behavioral Health

Clinical Informatics

Emergency Services

Central Line Infection Team

Multidisciplinary Rounds

Rapid Response TeamOffice Practice Team

Perinatal Impact Team

Total Joint Team

VAP Prevention Team

Perioperative Care

Medication Reconciliation Team

Focus on system level performance

Manage Local Improvement

Achieve Breakthrough

Goals

Develop Human Resources

Provide Leaders forLarge System Projects

Provide Day-to-Day Leaders for Micro Systems

Spread and Sustain

3. Monitor and surveillance

Lead by standing still/ oversight

Care that is;

safe, effective, patient-

centered, timely, efficient and equitable

Staff satisfaction

Involve Patients in all improvement teams

Involve ethics in all improvement and operations

Culture of continuous quality improvement

Build Innovation engine

Mortality-RRT, Sepsis Medication safety Falls Pressure Ulcers Re-admissions– Transitions Harm/Adverse events Infection-SSI,UTI,VAP,MRSA

Ownership of agreed upon set of outcomes Review of outcomes at each meeting Quality and safety comprises 25% of agenda Involve patients in safety Visible on all senior leader agenda Culture of Safety/Fair and Just

Shared meaningful vision from Board to the patient

Expert at communication and marketing methods coaching

Program design and structure

Infrastructure supports improvement measurement

Clear, shared measurement set

Inventory national programs and measurements

Recovery plans for unmet outcomes

Strengthen IT infrastructure

Secondary Drivers Primary Drivers

OPERATIONS/

QUALITY DRIVERS

Leadership and Culture

Deliver the Program

Measurement

Communication

Capacity and Infrastructure

1.

2.

3.

4.

Improvement Plan 1

What are we trying toaccomplish?

How will we know that achange is an improvement?

What change can we make thatwill result in improvement?

Model for Improvement

PlanAct

DoStudy

Improvement Plan 2





PlanAct

DoStudy

Improvement Plan 3





PlanAct

DoStudy

Improvement Plan 4





PlanAct

DoStudy

System Measures

TOTAL SALES

190

210

230

J M M J S N J M M J S N J M M J S N

MIL

LIO

NS

1993 1994 1995

TOTAL INJURIES

05

1015

J M M J S N J M M J S N J M M J S NIN

JUR

IES

/MO

1993 1994 1995

ABSENTEEISM OF 160 EMPLOYEES

0

5

10

15


PE

RC

EN

T A

BS

199519941993

CYCLE TIME

5152535


CY

CL

E T

IME

IN

D

199519941993

After ChangeBefore Change

UNIT COSTS

7580859095


CE

NT

S/P

OU

1993 1994 1995

Overall SystemCharter

1.

2.

3.

4.

1.

2.

3.

4.

Improvement Plan 1





PlanAct

DoStudy

Improvement Plan 1Improvement Plan 1





PlanAct

DoStudy

Improvement Plan 2





PlanAct

DoStudy






PlanAct

DoStudy

Improvement Plan 3





PlanAct

DoStudy






PlanAct

DoStudy

Improvement Plan 4





PlanAct

DoStudy






PlanAct

DoStudy

System Measures

TOTAL SALES

190

210

230


MIL

LIO

NS

1993 1994 1995

TOTAL INJURIES

05

1015


JUR

IES

/MO

1993 1994 1995


0

5

10

15


PE

RC

EN

T A

BS

199519941993

CYCLE TIME

5152535


CY

CL

E T

IME

IN

D

199519941993


UNIT COSTS

7580859095


CE

NT

S/P

OU

1993 1994 1995

System Measures

TOTAL SALES

190

210

230


MIL

LIO

NS

1993 1994 1995

TOTAL INJURIES

05

1015


JUR

IES

/MO

1993 1994 1995


0

5

10

15


PE

RC

EN

T A

BS

199519941993

CYCLE TIME

5152535


CY

CL

E T

IME

IN

D

199519941993


UNIT COSTS

7580859095


CE

NT

S/P

OU

1993 1994 1995

Overall SystemCharter

4. Patients and Families

Change agents

“A vision of hope”

Healthcare Partnership

5. Engage Finance

Quality matters

Quality is Value

• The connection between quality improvement and business performance is still weakly made in most health care organizations, but that is changing.

• Current fiscal reality requires innovation driven redesign.

• CFOs and Operational leaders are finding significant opportunities to improve patient care margins by reducing and eliminating error and clinical waste.

Does Improving Safety Save Money?

103 ICUs Working on Central Line Infections: • 82% Reduction in Mean Infection Rate• 1,578 Lives Saved (Deaths Avoided)• 81,020 Hospital Days Saved• Over $165,000,000 in Costs Averted

New Models For Operation/Quality/Value

Inputs to Core Processes

•Supplies•Staff•Equipment•….

Core Processes

•Evaluating•Diagnosing•Treating•Communicating•….

Outputs

•Quality Results•Safety Results•Costs•…

Where Other Industries’ go to

Reduce Costs

Where Health Care goes to Reduce

Costs

6. Engage physicians

Engage everyone

How to

Use data

Use story

Use science

7. Build improvement capacity

Build from the inside

• Improvement Academy• Change Agent Fellowship• Innovation Council• Model it- quality is personal• Communicate

• Change Theory • Discipline

What are your results

Prophylactic Antibiotics One Hour Prior to Incision

Hours of Behavioral Restraint Use

Inpatient Psychiatry: Discharge Care Planning

VAP per 1000 Ventilator Days

11.610.8

1.5 1.3

3.1

0

2

4

6

8

10

12

14

2003 2004 2005 2006 2007

Ventilator Days were 777 in 2006 and 645 in 2007

VAP per 1000 Ventilator Days

CCRMC 30 Day Readmission Rates

Heart Failure Discharge Instructions Given

Percent of Patients Who Received All Heart Failure Interventions at CCRMC

Percent of Patients Who Received All Heart Failure Interventions at CCRMC

All-or-Nothing Measurement

Challenge

Summary• The Leadership Leverage points is built on experience in health care and

other industries.

• It may not be the shortest path, but it has proven helpful to bring strategic and sustainable performance improvements.

To Do:• If you do nothing else, review your portfolio of projects and decide if they

are strategic and lined up to reach the big goals for your organization. It can be the beginning of one of the most important conversations.

• It’s your system, your transformation

Thank you

Anna Roth, CEOContra Costa Regional Medical Center

[email protected]

mailto:[email protected]

Clinica Family Health Services

5/27/10Carolyn Shepherd, MD

The Journey to the PCMH

Who/where do we serveIn the beginning…

•1988

•One location

•Seven staff members

•3,000 patients a year

•Migrant farm workers

Clinica Patient Population 2010

170,000 visits

Physical Health

Behavioral Health

Dental

Homeless

38,000 active patients

50% uninsured

40% Medicaid

5% CHP+

56% < Poverty

98% <200% of Poverty

Clinica Family Health Services

68 Physical Health Provider

13 Behavioral Health Providers

4 Dental Providers

Clinics in the Homeless Shelter and Safehouse

2 Full Pharmacies, School of Pharmacy

Total Staff of 300

Admit to 3 community hospitals

Community based EMR 2005

Leadership from the TopEngaged CEO

Collaborative management style

Serious conversation around tough issues

Clear organizational goals

Improvement focused in Key Success Areas

Executive team responsible for outcomes that move the Key Success Areas forward

MISSION: To be the medical and dental care provider of choice for low income and other underserved people in south Boulder, Broomfield and west Adams counties. Care shall be culturally appropriate and prevention focused.

VISION: Our vision for the future is that every low income and other underserved person in south Boulder, Broomfield and west Adams counties will have access to high quality, preventative medical and dental care which is integrated with behavioral health care.

VALUES: * Service to Others * Creativity * Diversity * Excellent Teamwork * Do the Right Thing * Make Clinica a Great Place to Work *

Key Success Factor: Financial Stability Goal: To be a financially stable organization, obtaining and maintaining funds from diverse sources and supporting quality health care services to the underserved.

Objective: Improve collection rate by 6.5% through improved screening and billing.

Key Success Factor: Access Goal: To continually strive to increase patient visit capacity to meet the primary health care needs of all underserved people in south Boulder, Broomfield and west Adams Counties.

Objectives: Add Two Dentists and a Hygienist with support staff at Pecos. Add fully staffed night hours at Thornton, Lafayette and People's and add a pod at Thornton. Add enough behavioral health professionals to have 1 per pod at Adams County sites.

Patient Access Goal: 17.75 visits per day Patient Care Outcome Goals: 70% of Pregnant women quit s moking 90% of 2 year olds are fu lly immunized 90% with asthma use inhaled steroids 75% on antidepressants get 2 week follow-up 80% with diabetes have HbA1c measured in last year 75% of patients see their PCP

Key Success Factor: Our People Goal: To have a stable and diverse staff who function as a high performing team and view Clinica as a great place to work.

Objectives: Create a leadership development program for Clinica staff. Reduce the voluntary turnover rate. Improve systems for orienting new staff to Clin ica's systems and culture. Promote cooperation and teamwork through communicat ion, recognition and appreciation

Key Success Factor: Facilities Goal: To have high quality, attractive facilities that provide an efficient and safe environment for meeting the health care needs of all underserved people in south Boulder, Broomfield and west Adams counties.

Objectives: Replace the People 's Clinic facility. Expand Thornton site to add a pod & GV space Replace phone systems at Lafayette and People's. Pecos Dental Clinic. Assure IT system stability and stay current with technology. Develop a facilit ies maintenance program and "green" facilit ies as remodels are undertaken.

Key Success Factor: Community Partnerships Goal: To work collaboratively with other providers of services to our patients to assure that resources are maximized and that services are integrated seamlessly.

Objectives: Work with Boulder Community Hospital and its admitting obstetricians to support the delivery of Clinica 's maternity patients in Boulder. Work with Dental Aid to integrate physician and oral health. Work with the Boulder County to assure that the Boulder County Human Services Master plan objectives for access to health care are achieved. Work with Community Mental Health Centers in Boulder, Broomfield and Adams Counties to integrate physical and behavioral health services. Explore the potential for training family physicians at Clinica with the St. Anthony North Hospital Family Practice Residency Program. Work with providers of services to homeless people in Boulder County to assure access to primary health care services. Explore the potential for a nursing education collaboration with Regis University.

Key Success Factor: Outcomes Goal: To provide excellent acute and preventive medical, dental and health education services that measurably improve the health status of Clin ica patients.

Objectives: Enhance use of EHR / EDR as quality improvement tool. Reduce outcome variat ion between clinics. Improve full use of team talents and focus clinicians on clinician work.

Key Success Factor: Customer Service Goal: To be the provider of choice for underserved people because we offer world class customer service, which delights our patients.

Objectives: Improve working conditions and reduce turnover in call center. Improve call center service grade on patient satisfaction survey.

STRATEGIC PLAN 2009-2011

Organizational Structure

High functioning work teams

Executive–VPs of HR, Finance, Clinical, IT, Dental

Site leadership-Clinic Director, Clinic Medical Director

Pod leadership-clinical microsystem unit

Stephen R. Covey The 7 Habits of Highly Effective People

Key leadership responsibilityBuild a mindful system to better care for patients

E.H. Wagner, B. Austin, and M. Von Korff, “Improving Outcomes in Chronic Illness,”

Using the Chronic Care Model Focus on the BIG SIX

Continuity

Access to care

Team based care model

Co-location, line of sight, patient centered process

Alternative visit types

Continuity and access groups, telephonic care, email

Optimizing information systems

Igniting patient activation

Crisis Management

Use the strategic plan

Growth (access) is an effective strategy

Closed the Huron Clinic1995

No closing 2006 state, and hospital

No closing 2009 with state budget cuts

PCMH

Submitted 5/17/2010

Able to submit evidence in all 9 standards

No additional process redesign needed

6

Pts24

Standard 4: Patient Self-Management Support A. Assesses language preference and other

communication barriersB. Actively supports patient self-management**

20

Pts3

4

35

5

Standard 3: Care ManagementA. Adopts and implements evidence-based guidelines

for three conditions **B. Generates reminders about preventive services for

clinicians C. Uses non-physician staff to manage patient care D. Conducts care management, including care plans,

assessing progress, addressing barriers E. Coordinates care//follow-up for patients who receive

care in inpatient and outpatient facilities

21

Pts

2

33

64

3

Standard 2: Patient Tracking and Registry Functions A. Uses data system for basic patient information (mostly

non-clinical data) B. Has clinical data system with clinical data in searchable

data fields C. Uses the clinical data system D. Uses paper or electronic-based charting tools to

organize clinical information**E. Uses data to identify important diagnoses and

conditions in practice**F. Generates lists of patients and reminds patients and

clinicians of services needed (population management)

9

Pts

45

Standard 1: Access and CommunicationA. Has written standards for patient access and patient

communication**B. Uses data to show it meets its standards for patient

access and communication**

4

Pts121

Standard 9: Advanced Electronic Communications A. Availability of Interactive Website B. Electronic Patient Identification C. Electronic Care Management Support

15

Pts

3

33

3

21

Standard 8: Performance Reporting and Improvement A. Measures clinical and/or service performance by

physician or across the practice** B. Survey of patients’ care experience C. Reports performance across the practice or by

physician **D. Sets goals and takes action to improve performance E. Produces reports using standardized measures F. Transmits reports with standardized measures

electronically to external entities

4

PT4

Standard 7: Referral Tracking A. Tracks referrals using paper-based or electronic

system**

13

Pts7

6

Standard 6: Test Tracking A. Tracks tests and identifies abnormal results

systematically** B. Uses electronic systems to order and retrieve tests

and flag duplicate tests

8

Pts332

Standard 5: Electronic Prescribing A. Uses electronic system to write prescriptions B. Has electronic prescription writer with safety checksC. Has electronic prescription writer with cost checks

**Must Pass Elements

Clinica Lessons Learned

Leadership is key

Put the patients first

Start small but start!

Use the QI tools that work

Chronic care model,

The IHI Model for improvement

Sequential learning with PDSAs

FMEA

Make improvement and safety a system characteristic

Free up leaders to innovate and “spin the fly wheel faster”

Measure data over time

You don’t need a double blind RCT to get better

Challenges

Health care reform and the possibility of significant growth

Address the issue of the digital divide

Stephen WeegHealth West

Southeast Idaho

Health West: Background

Founded in 1976, migrant and community health center

Clinics in 6 communities in southeast Idaho centered in Pocatello; 90 miles between clinics

8,000 patients; 29,000 visits per year; of which 50% are uninsured

Over 60% of patients in American Falls and Aberdeen Clinics are Hispanic

Pocatello, American Falls, and Aberdeen Clinics are formally engaged in the SNMHI

Triathlon: Year One

Buy into the vision

Expand to all clinics

Training: managers and staff and Board

Huddles and team care

Adopt the language/meeting agenda

Data, data, data

Triathlon: Year One

E-prescribing

Electronic Medical Record implementation

System focus on use of EMR to enhance care coordination

Begin to adapt policies and procedures

Integrate with other program requirements and/or initiatives

Implementation is hard work!

The vision must be compelling!

Engaged Leadership

Energize the vision

Stamina and stubborn persistence

Encouragement

Create the environment for success

Allocate resources: time, staff, finances

Engaged Leadership

Walk the walk

Leadership comes from all levels; everyone in

Energy continues from synergy

Power comes from focus

Support the value of data

Present trumps Promise

Tyranny of Now

Structure of a sick care system

Immediate patient needs

Demands of dollars

Staff transitions

Non-aligned academic training

Tyranny of Now

Workload demands

Multiple priorities

Oh, no…

another survey

Organizational culture

Life is messy!

A Better Place for Patients and Staff

Moving Forward

Continue the training

Keep the energy alive

Real change is at the clinic/patient level

Capitalize on the EMR

Consistently work the gas pedal, there are plenty of brakes!

Contact Information

Stephen WeegExecutive Director

Health WestPocatello, Idaho

208 [email protected]

mailto:[email protected]

Engaged LeadershipEngaged Leadership

CoCo--Habitating at the Habitating at the Squirrel Hill Health CenterSquirrel Hill Health Center

Andrea Fox, MD Medical Director

[email protected]

The Squirrel Hill Health Center The Squirrel Hill Health Center (SHHC)(SHHC)

New paperNew paper--start FQHC opened in June start FQHC opened in June 20062006

Application through the Jewish Healthcare Application through the Jewish Healthcare FoundationFoundation

Focus on older adults, religious and ethnic Focus on older adults, religious and ethnic minoritiesminorities

Built on tenets of Perfecting Patient CareBuilt on tenets of Perfecting Patient Care

FoundationFoundation

Electronic Health RecordElectronic Health Record

Culturally and linguistically diverse staff and Culturally and linguistically diverse staff and patientspatients

One site located on campus of senior housing One site located on campus of senior housing continuum sitecontinuum site

Integrated MH services, care managementIntegrated MH services, care management

Billable staff 1 internist/geriatrician, 1/2 FM, 1 Billable staff 1 internist/geriatrician, 1/2 FM, 1 FNP/ office managerFNP/ office manager

Accessible site, large exam rooms, language Accessible site, large exam rooms, language line, newline, new

ChallengesChallenges

Building patient baseBuilding patient base

Managing diverse staffManaging diverse staff

Lack of access to specialty and hospital Lack of access to specialty and hospital servicesservices

Difficult to reach target populationDifficult to reach target population

Pittsburgh does not easily embrace the Pittsburgh does not easily embrace the ““newnew””

LeadershipLeadership

Executive DirectorExecutive Director

CFOCFO

Medical DirectorMedical Director

Office managerOffice manager

After 4 yearsAfter 4 years

Almost 5000 patients servedAlmost 5000 patients served

39 different languages39 different languages

2 full time MD2 full time MD’’s, 1/2 time, NPs, 1/2 time, NP

Psychiatrist, Ob/Gyn, ophthalmologyPsychiatrist, Ob/Gyn, ophthalmology

ARRA money for mobile unit, dental clinicARRA money for mobile unit, dental clinic

Teaching site for PittTeaching site for Pitt

Merged leadershipMerged leadership

Medical director as neckMedical director as neck

Tight quarters, CEO, CFO, MDTight quarters, CEO, CFO, MD’’ss

Patient storiesPatient stories

News of the staffNews of the staff

Problem solvingProblem solving

Fundraising based on patient storiesFundraising based on patient stories

Specific ProjectsSpecific Projects

Culture statementCulture statement

Vaccination effortsVaccination efforts

ProductivityProductivity

WomenWomen’’s Health Servicess Health Services

Culture StatementCulture Statement

Challenges of diversity of staff: language, Challenges of diversity of staff: language, culture, statusculture, status

Refocus on missionRefocus on mission

Intolerance of intoleranceIntolerance of intolerance

Reorganization of staffReorganization of staff

Culture of Squirrel Hill Health Center: The Mission of the Squirrel Hill Health Center is to provide high quality, comprehensive primary and preventive health care to everyone in our community with a special concern for patients’ religious beliefs, race, national origin, language, age, gender, and disability, and without regard for their insurance status or ability to pay. No matter what position we fill, we all serve this mission; We are here to provide high quality, compassionate health care for our patients, no matter what

their backgrounds; We will treat our patients with respect and dignity; We understand that we are creating a “health home” for our patients, where they feel welcome

and cared for. Our patients come to us for healing. We know that feeling sick may not always bring out the best in people, but we will respond with kindness and care. Daily interactions will be undertaken with an attitude of compassion and good will. We will talk about our patients only if there is a clinical need to do so, and then only in a setting and manner which preserves their privacy;

We are creating an excellent work place for ourselves. We will treat each other with the same respect and dignity we afford our patients;

We will support and encourage each other, assuming that each of our coworkers is also trying to do a good job. We will all work together to establish an atmosphere that promotes learning and the sharing of ideas;

We will talk to each other, with civility, rather than about each other; we will listen to one another with care. If there is an issue we are unable to resolve with a co-worker, we will go to our direct supervisor for help;

We are as varied as our patients. In our private lives we have different beliefs, values, lifestyles, and cultural backgrounds. In the workplace we will all embrace this culture, including respect, listening, caring, and learning;

SHHC exists because we have always had a positive, optimistic attitude. Together, as members of the SHHC community, we can overcome obstacles and create both a health home, where our patients receive excellent, compassionate care, and a workplace in which each of us is supported in working to our greatest potential.

Vaccination FocusVaccination Focus

Low vaccine rates for UDS, 20% first year Low vaccine rates for UDS, 20% first year (2 of 10)(2 of 10)

Few children, didnFew children, didn’’t want to turn awayt want to turn away

Many orthodox, resistant to vaccinationMany orthodox, resistant to vaccination

Daytime outreach to schools by MDsDaytime outreach to schools by MDs

Night time outreach to principals, rabbis, Night time outreach to principals, rabbis, community MDscommunity MDs

Improved to Improved to 67%,67%, but many on but many on schedules, immigrantsschedules, immigrants

Ob/Gyn ServicesOb/Gyn Services

Based on patient storiesBased on patient stories

Egyptian MD, 2 previous CEgyptian MD, 2 previous C--sectionssections

Activated leadershipActivated leadership

OnOn--site servicessite services

Growth in overall patients, women, men, Growth in overall patients, women, men, babiesbabies

ProductivityProductivity

FreeFree--flowing onflowing on--going conversationgoing conversation

What is our product?What is our product?

Bodies through the doorBodies through the door

Bodies seen by MDBodies seen by MD

Technology appliedTechnology applied

Accessible appointmentsAccessible appointments

High quality care, patient satisfactionHigh quality care, patient satisfaction

HealthHealth

Challenges AheadChallenges Ahead

Growth, moveGrowth, move

Continued reorganizationContinued reorganization

Medical home applicationMedical home application

UDSUDS

Continuous change, sustainabilityContinuous change, sustainability

What to do about ToyotaWhat to do about Toyota

Results at a System Level- Leadership Leverage Points and the … · 2019-01-29 · change leaders...

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