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  • In a nutshell, this presentation should tell the story of how “it” used to be, why “it” had to change and how we changed “it” at SFMC with brief examples of results and lessons learned. The “it” we are talking about is Performance Improvement in Patient Care Outcomes. In the past, MDs kind of did their own thing, based on their culture of independence and learning from expert physicians. Traditionally, hospitals provide performance data from quality management department – but rarely pushed for practice changes and MDs changed practice as their experience & knowledge sources provided evidence for change. There has been a critical shift in the Healthcare environment due to public awareness of quality and safety issues and regulatory and payor response. Due to this critical shift, the old order of PI has had to change. Hospitals are challenged to improve performance and to engage and enable Physicians to change theirs.
  • Who we are and why we were looking for change...
  • How it used to be... The traditional physician culture creates roadblocks to collaboration and rapid improvement...
  • In addition, the healthcare culture is steeped in the old way of doing business – Just a few years ago, benchmarking to mediocrity was the norm. Like most HC systems of the old order, we had a very solid set of beliefs that were barriers to true performance improvement.
  • The IOM report “To Err is Human” was the stimulus for a critical shift. The old order of hospital and MD “quality management” was put on trial and judged guilty of being ineffective! What to do now...
  • Initial skepticism was fueled somewhat by our learning from manufacturing. However, the bigger skepticism came from our own history with performance improvement.... Flavor of the Month... Bottom up rather than top down... No commitment from the top...
  • Initial pressure came from CAT contract and invitation to learn 6 Sigma Management System to create significant change in outcomes by improving processes.
  • We adopted 6 Sigma as a framework for Transformation change. It would not be a program or a department – no flavor of the month.. Deployment was about developing new competencies in problem solving and about aligning improvement efforts with strategy. Not additional work, but the WAY we would do our work.
  • Transforming how people think about and do their work
  • Scientific Approach Data required Rigorous application of methodology Sophisticated knowledge and use of data Successful projects – results sustained over time Listen and respond to concerns
  • (LORI)
  • (LORI)
  • (LORI)
  • Choose a physician champion who has early adopter characteristics Respected as a Physician Good at communicating Willing to standup when needed (has courage) Good social skills and relationships Primary care background a bonus Be sure you have a physician champion who can Make the case for the change Show potential gaps in performance Constantly communicated your message in multiple ways to multiple groups Recognize that when you talk with one physician you have talked to one physician You need to pay him for his time You need to keep him informed You have to have clear alignment and support ( no waffling when a heavy producer starts to squawk)
  • QQ is committed to working jointly with clinicians, employers, payers and patients to effect lasting positive changes in healthcare. Not really here to talk about QQ initiative as much as the EBS project….
  • Local – every facility and every md is important to this community and can make a difference Respect – We all have different vantages points that will add value, their involvement is essential to success Process - 6 sigma mantra… it’s not people it’s process Environment --Md’s often trapped in the system Opportunity - input Talents – “the product I produce is not as good as I would like it to be, but I am good” Expertise – leverage and articulate what is good about them SBAR – clear direction and an end point.
  • Transcript

    • 1.
      • Achieving Physician Buy-in for
      • Performance Improvement:
      • Leveraging 6 Sigma Management System
      • at
      • OSF Saint Francis Medical Center
      • Tim C. Miller, M.D.
      • Vice President, CMO & Director of Academic Affairs
      • &
      • Tom Thomas
      • 6 Sigma Black Belt
      • WCBF’s 7 th Annual Lean, Six Sigma and Process Improvement in Healthcare Summit
    • 2.
      • Achieving Physicians Buy-in for Performance Improvement
      • OBJECTIVES
      • Traditional PI and the Physician Culture
      • New Order of PI for Physicians
      • Credibly Engaging Physicians & Residents
      • Experiences, Results, & Lessons Learned
    • 3. 1877 2007
      • 570 Beds
      • 27,000 Discharges
      • 520 Attending Staff
      • 944 Total Credentialed Providers
      • Academic Medical Center
      OSF Saint Francis Medical Center Peoria, Illinois
    • 4. Traditional Performance Improvement and The Physician Culture
    • 5. Traditional Physician Culture
      • Traditional Physician Training:
      • Is Independent, Autonomous, Scientific
      • Is Focused on the Individual Versus System Thinking
      • Maximizes Individual Competence Rather than Team-based Learning
      • Is Concerned with Individual Patient Safety and Outcomes
    • 6. Traditional Healthcare Performance Improvement
      • Attempts to benchmark facilities with similar service lines...
      • Our hospital is different.
      • Impossible to achieve exceptionally high levels of quality ... Patients are non-compliant, co-morbidities…
      • My patients are different.
      • Poor data, validity suspect...
      • We can’t trust the data.
      • Complexity of human diseases compared to assembly-line “widgets”…
      • We will never be able to attain 6-Sigma levels.
      • Driven by bottom line or external market conditions...
      • It’s all about the money.
    • 7. Creating a New Order of Performance Improvement with Physicians
    • 8.
      • Since the first IOM Report, there has been a public outcry for immediate and comprehensive improvement in healthcare quality and safety.
      • CMS, Joint Commission, and other regulatory agencies and payers have responded by raising the performance bar to new levels with significant consequences for performance failure.
      • These conditions are challenging the old order of relationships.
      Burning Platform Critical Shift in Healthcare
    • 9. Learning from Manufacturing
    • 10. ADMISSIONS - 34,160 Total (Payor Source) Thousands ~ FY 2006 10.65 6.546 4.392 3.86 2.854 2.34 2.128 1.39
    • 11. Improvement Methodologies Methodology Wars IHI Collaboratives 6 Sigma Lean & Kaizan TQM/CQI EBM Nursing Research KEEP IT SIMPLE!
    • 12. 6 Sigma The Unifying Framework for Improvement Adequate Human Resources Living Our Values Every Day OSF Mission Improve Capacity Improved Patient Safety Improved Service Improved Cost and Reimbursement Community Safety Quality Service Value 6 Sigma
    • 13.
      • The organizational commitment and involvement that engages and further develops its people - starts with CEO
      • Improving performance by improving key processes
      • Focusing highly skilled, highly trained people on your highest priorities
      Attributes of The 6 Sigma Culture
    • 14.
      • Data-driven, fact-based decision making
      • Rigorous alignment of actions with strategy
      • Aligned with evidence based practice
      • Measuring clinical outcomes and continuous performance reporting
      Attributes of The 6 Sigma Culture
    • 15. Build and Maintain Credibility
    • 16. Operations First Demonstrate use of 6 Sigma to address MD complaints with operations! Target key operations processes that frustrate physicians to demonstrate the improvement power of 6 Sigma Y = f (x)
    • 17. Strategy: Best Quality September 5, 2007; Page D1
    • 18. Strategy: Growth
      • CT Scanner utilization
        • CFH 35% increase in from 52% to 70%
        • Main Campus 26% increase
      • General Radiology Throughput
        • 37% improvement cycle time IP arrive to complete
      • OP Radiology
        • 50% reduction in delays and cancellations
      • Interventional Radiology (IR) Patient Throughput
        • 3.7 additional CT cases per day
        • 6.3 additional IR cases per week
        • Decreased direct cost of procedure 26.2% and 25.7% respectively
    • 19. Strategy: Growth
      • Operating Room Utilization
        • 24% improvement of SFMC OR from 63% to 78%
        • 71% improvement CFH Ambulatory OR from 35% to 60%
      • Capacity Project Portfolio
        • 44% improvement in Patient diversions from 102 to 57
        • IT Enabled Bed Management Process Improvement
        • Admission Process Improvement
        • Capacity Management Process
    • 20.
      • Where Are MD Concerns About Quality?
      • Create Solid Wins Early
      • Don’t Make Lack Of Baseline Data A Deal Breaker
      Listen, Leverage, & Engage MD Champions
    • 21. 6 Sigma Relationship to EBM 6 Sigma doesn’t create clinical evidence – it helps us use it consistently 6 Sigma Targets Reducing Variation And Elimination Of Errors to Reliably Deliver Quality Care In A Safe Environment Y = f (x)
    • 22. SFMC Project Examples
    • 23. Reducing Ventilator Acquired Pneumonia
    • 24. Strategy: Best Quality 4Q07 Based on 2 Months Reported REDUCING BSI
    • 25. Clinical Projects & Outcomes Reducing Blood Stream Infections Kickoff RN Bundle Red Rule
    • 26. 6-Sigma Physician Involvement
    • 27. 6-Sigma Projects Portfolio ~ February 2007
    • 28. 6 Sigma Projects Completed ~ February 2007 4 48 30 29 12
    • 29. 6-Sigma Active Projects ~ September 2007 2 19 11 17 6
    • 30. 6-Sigma Academic Integration Resident Involvement
    • 31. 6-Sigma OTHER GME ALIGNMENT
      • Member of “Sentinel Event” Teams
      • Member of “Near Miss” Teams
      • Coordinate New Projects with Clinical/Academic Strategies
      • TAL (Teaching, Administration and Leadership) video
    • 32. Engaging Physicians I heard that you are a certified 6 Sigma Black Belt Zombie. Is that true? He didn’t seem dangerous, Dr. Smith. I’m an assertive and innovative professional, experienced in lean, six sigma and process improvement in healthcare. I just sat through a 3-hour project review meeting.
    • 33.
      • Project Example: Quality Quest and Evidence-Based Standards
      • Quality Quest is a strategic partnership between OSF HealthCare System and Caterpillar Inc .
      • Goal: Improving the quality and efficiency of healthcare delivery and improve health in the tri-state area.
    • 34.
      • To establish the consistent application of evidence-based care standards for Central Illinois tri-county area health providers.
      Project Goal :
      • Identify, evaluate, and recommend evidence-based guidelines/protocol sets
      • Recommend endorsement and adoption process to gain acceptance and use
      • Identify implementation and maintenance support requirements
      • Identify operational processes and relationships
      Deliverables:
    • 35.
      • 17 community physicians representing all 4 major hospitals at all levels and types of service
      • 2 executive level nurses
      • 1 change agent expert
      • 1 6 Sigma Black Belt
      Who did we bring to the table?
    • 36.
      • Healthcare is local
      • Respect
      • Process & Environment
      • Opportunity to be a part of the change
      • Talents & Expertise
      • SBAR
      How did we get them there? “ W e are going to ask you to do some tough things …”
    • 37. Articulate the Burning Platform What will make you uncomfortable enough that you will want to be a part of the change? In the future, everybody will have 15 minutes of quality health care. State Ranking on Quality Dimension
    • 38.
      • Constantly articulate the vision
      • Establish aggressive agendas & timelines
      • Extensive sub-team work
      • Scientific approach
      • Take-aways (WIFM)
      How did we keep them there?
    • 39.
      • Clear goals
      • Exposed and validated concerns
      • Leveraged a physician champion
      • Detailed project plan with all meetings scheduled before kick-off
      • Specific tasks linked to specialty
      • Change management principles
      • Communication
      What we did right…
    • 40. What did we do wrong?
      • Team too large to function as a group
      • Avoid tedious tasks (i.e. creating surveys)
      • Benefit of meeting 1-on-1 with team members
      • Timelines (i.e. Resident Hand Off Project)
    • 41.
      • 4 Major hospitals
      • represented by 17 physicians
      • and 2 of the communities largest payers
      • CAME TO AN AGREEMENT
      • on 1 set of Evidence Based Standards guidelines
      • for the Tri-County area
      • IN JUST 90 DAYS
      Project Outcome…
    • 42. Involving Physicians “Rules of the Road”
      • Establish and Maintain Credibility
        • Aggressive Agenda
        • No Agenda, No Meeting
        • Send Materials for Pre-meeting Prep
        • Provide Key Articles from Scientific Journals
        • Provide Bibliography or References for Further Reading
      • Respect MD Time and Be Flexible with Participation Methods
    • 43. Engaging Physicians
      • “ If physicians participate on teams, communicate their needs and help design improvement strategies, it is more likely that their concepts will become an integral part of the improvement plans.
      • Physicians should not act as innocent bystanders in process improvement but must actively participate and support teams in performing the hard work that goes along with it .”
      • ~ Lee Adler, D.O. (iSixSigma Magazine)
    • 44. “ Why don’t clinicians engage with quality improvement?” Editorial: J. Health Serv Res Policy Vol 3 July 2007
      • Limited understanding of QI methods
      • Suspicious of differing definitions of clinical quality
      • Belief that high quality care is already present – especially locally
      • Waste of scarce personnel and resources
    • 45.  
    • 46. Finally ...
      • 6 Sigma Works
      • Operations Must Go First
      • Data Credibility is Essential
      • We Must Include the MDs
        • - Find and Develop MD Champions
        • - Meet Them Where They Are
      • Communicate & Celebrate Success!