Leadership Workshop - Leading Out of the Mess

Leading Out of the Mess Michigan Primary Care Association Fall 2009 Annual Conference Roger L. Chaufournier Executive Director CSI Solutions, LLC September 2009

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/campaigns
New Policies/Approval Process & Signatures
Reorganizations
Use 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 Framework A Systems Perspective 4 Information and Analysis 6 Process Management 2 Strategic Planning 5 Staff Focus 1 Leadership 3 Focus on Patients, Other Customers, and Markets Organizational Profile: Environment, Relationships and Challenges Malcolm Baldrige National Quality Award 7 Organizational Results

Peter Drucker’s Effective Executive: Eight Practices
They ask “what needs to be done”
They ask “what is right for the enterprise”
They develop action plans
They take responsibility for decisions
The take responsibility for communicating
The focus on opportunities rather than problems
They run productive meetings
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
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 2. Establish the Foundation
Reframe Operating Values
Build Improvement Capability
Build Relationships
Develop Future Leaders
Personal Preparation
Choose and Align the Senior Team

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
IOM aim : Care should be safe 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. 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 Source: Richard Davis, Ph.D. Johns Hopkins Medicine

Aligning Work to your Business Imperative Community Health Health Health Center Center Assessment Strategic Plan QI Plan & Monitoring System Priorities for Participation in Improvement Projects and Priorities for Spread Collaborative Team Established Plan Act Do Study Cycles Plans For Spread Based on Successful PDSA Monthly measures
Improved
Health
Center
Performance
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 successes

09/30/09 Dashboards Informed decisions through the use of appropriate and timely data 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 Change
Improvement 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

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 Accomplishments 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

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 Setting
Communication
Trust
Accountability

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

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

BRINGING IT ALL HOME
What 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

Leadership Workshop - Leading Out of the Mess

by MPCA on Sep 30, 2009

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