Katherine Gottlieb, MBA, DPS (h.c.), President/CEO
Steve Tierney, MD, Medical Director – Quality
Improvement
Michelle Tier...
Objectives
 Describe the customer-owned and
relationship based Southcentral Foundation
Nuka System of Care
 Understand a...
SCF Board of Directors

Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Indian Self-Determination and
Education Assistance Act 1975
Government recognized that:
If the people receiving the health...
The Drive to Change
 Unfriendly and rude staff
 Guinea pig for new doctors
 Customers waited for everything
• Long wait...
Everyone Was Frustrated …
 Customers frustrated – waiting, impersonal,
paternalistic, crowded, unfriendly
 Clinical staf...
Our Choice
 Alaska Native people were given this choice and we
chose to assume the responsibility for our own
health care...
Customer-owner
 Southcentral Foundation uses the term customerowner instead of:
• Patient
• Client
• Customer

Copyright ...
Customer Focus
Key Improvements
 Governing board
 Advisory committees
 Elders Council
 Focus Groups
 Annual Gathering...
Vision

A Native Community
that enjoys physical,
mental, emotional
and spiritual wellness

Mission

Working together with
...
Key Points
Shared Responsibility
Commitment to Quality
Family Wellness

Copyright © 2011 Southcentral Foundation. All Righ...
Operational Principles
Relationships between customer-owner, family and provider must be fostered and supported
Emphasis o...
At 591,000 square miles, Alaska is as wide as
the lower 48 states and larger than Texas,
California and Montana combined.
...
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
From 1982 to 2013…
Operating Budget
$227m

• 64,000 Customer-owners
• 54,000 Anchorage and Valley
• 10,000 55 villages

• ...
Why Listen to Our Story

Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Measures of Success
• Utilization
– 75% decrease in hospital admissions since 1999
– 71% decrease in hospital days per 100...
Measures of Success
 Customer-owner satisfaction
• Overall 93%

 Employee satisfaction
• Overall 94%
• Response rate 95%...
Whole system
transformation
SCF Programs and Services
 Behavioral Health
• Fireweed
• PCC








BURT
Denaa Yeets’
TRAILS and FASD
The Pathway...
SCF Programs and Services









Compliance
Data Services
Organizational Development
Development Center
Human Re...
SCF Programs and Services












Dental (ANMC and Fireweed)
Facilities
General Counsel
Information Technol...
Organizational Structures
 Office of the President
• Divisional structure

 Executive and Tribal Services, Medical Servi...
Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Then and Now …

Copyright © 2011 Southcentral Foundation. All Rights Reserved.
Then and Now …

Copyright © 2011 Southcentral Foundation. All Rights Reserved.
"The Nuka system of care: Lessons for healthcare redesign in Wales"
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"The Nuka system of care: Lessons for healthcare redesign in Wales"

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1000 Lives Improvement hosted Katherine Gottlieb, CEO of Southcentral Foundation, to discuss how they transformed a system of care in Anchorage, Alaska, and how their lessons could help in transforming healthcare in NHS Wales.

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    SCF has grown dramatically in the past 27 years – the workforce has grown…
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    Why listen to us, well of course, we are a Baldrige recipient, but here are some of our results
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  • "The Nuka system of care: Lessons for healthcare redesign in Wales"

    1. 1. Katherine Gottlieb, MBA, DPS (h.c.), President/CEO Steve Tierney, MD, Medical Director – Quality Improvement Michelle Tierney, MPA, MA, Vice President Organizational Development and Innovation Kevin Gottlieb, DDS, Vice President Resource and Development and Chief of Staff Copyright © 2011 Southcentral Foundation. All Rights Reserved. NOTICE: Unless otherwise indicated, this work represents copyrighted material protected by United States and international law. This work may not be used, reproduced, downloaded, disseminated, published, transferred or transmitted, in whole or in part, in any form or by any means, electronic or mechanical, including photocopying, recording or information storage and retrieval, except with the express written permission of the publisher. This work may not be edited, altered, or otherwise modified, in whole or in part, except with the express written permission of the publisher.
    2. 2. Objectives  Describe the customer-owned and relationship based Southcentral Foundation Nuka System of Care  Understand a different way of thinking about healthcare  Answer questions Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    3. 3. SCF Board of Directors Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    4. 4. Indian Self-Determination and Education Assistance Act 1975 Government recognized that: If the people receiving the health service are involved in the decision making processes, better yet, if they own their own health care – programs and services have a potential for enhancement and the people and their health statistics will improve. Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    5. 5. The Drive to Change  Unfriendly and rude staff  Guinea pig for new doctors  Customers waited for everything • Long waits for scheduled appointments • Four- to six-hour waits common Long waits on phone, pharmacy, everywhere  Inconsistent treatment  Risky place to go Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    6. 6. Everyone Was Frustrated …  Customers frustrated – waiting, impersonal, paternalistic, crowded, unfriendly  Clinical staff frustrated – too many people, not enough time, no personal relationships, too many demands  Management frustrated – lots of unhappy people, hard to motivate staff, poor financial performance, challenging facilities Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    7. 7. Our Choice  Alaska Native people were given this choice and we chose to assume the responsibility for our own health care • Change everything • Total redesign • With our choices and values Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    8. 8. Customer-owner  Southcentral Foundation uses the term customerowner instead of: • Patient • Client • Customer Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    9. 9. Customer Focus Key Improvements  Governing board  Advisory committees  Elders Council  Focus Groups  Annual Gathering  24- hour hotline  Community gatherings  Personal interaction with employees  Satisfaction surveys  Comment cards Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    10. 10. Vision A Native Community that enjoys physical, mental, emotional and spiritual wellness Mission Working together with the Native Community to achieve wellness through health and related services Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    11. 11. Key Points Shared Responsibility Commitment to Quality Family Wellness Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    12. 12. Operational Principles Relationships between customer-owner, family and provider must be fostered and supported Emphasis on wellness of the whole person, family and community (physical, mental, emotional and spiritual wellness) Locations convenient for customer-owners with minimal stops to get all their needs addressed Access optimized and waiting times limited Together with the customer-owner as an active partner I ntentional whole-system design to maximize coordination and minimize duplication Outcome and process measures continuously evaluated and improved Not complicated but simple and easy to use Services financially sustainable and viable Hub of the system is the family I nterests of customer-owners drive the system to determine what we do and how we do it Population-based systems and services Services and systems build on the strengths of Alaska Native cultures Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    13. 13. At 591,000 square miles, Alaska is as wide as the lower 48 states and larger than Texas, California and Montana combined. Alaska San Francisco Charleston Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    14. 14. Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    15. 15. From 1982 to 2013… Operating Budget $227m • 64,000 Customer-owners • 54,000 Anchorage and Valley • 10,000 55 villages • Employees • 1982: Fewer than 100 • 2013: About 1,600 • Operating Budget • 1982: $3 million • FY 2013: $227 million $3m 1982 FY 2013 Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    16. 16. Why Listen to Our Story Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    17. 17. Measures of Success • Utilization – 75% decrease in hospital admissions since 1999 – 71% decrease in hospital days per 1000 since 1999 – 36% decrease in outpatient visits per 1000 customer-owners • Clinical quality – Level 3 NCQA Patient Centered Medical Home – 75 or 90 percentile for HEDIS outcome measures o Diabetes o Cancer o Cardiovascular disease Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    18. 18. Measures of Success  Customer-owner satisfaction • Overall 93%  Employee satisfaction • Overall 94% • Response rate 95%  Employee Turnover • 10.8%  Baldrige National Quality Award - 2011 Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    19. 19. Whole system transformation
    20. 20. SCF Programs and Services  Behavioral Health • Fireweed • PCC       BURT Denaa Yeets’ TRAILS and FASD The Pathway Home Quyana Clubhouse Dena A Coy • Residential • Outpatient • Willa’s Way  Behavioral Health Service McGrath Behavioral Health Clinics  Therapeutic Family Group Homes • Cottonwood • Rendezvous • Cleveland  Alaska Womens Recovery Project (AWRP)  Access To Recovery (ATR) Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    21. 21. SCF Programs and Services         Compliance Data Services Organizational Development Development Center Human Resources Quality Assurance Research Nuka Institute  Tribal Relations and Village Initiatives  Traditional Healing Clinic  Planning Grants  Communications & Public Relations  RAISE Programs  Elder Program  Seattle Office  Board Support  Corporate Office Support Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    22. 22. SCF Programs and Services            Dental (ANMC and Fireweed) Facilities General Counsel Information Technology Special Assistant Program Budget Planning and Management Contracts Financial Operations Patient Accounts Payroll Reimbursement Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    23. 23. Organizational Structures  Office of the President • Divisional structure  Executive and Tribal Services, Medical Services, Behavioral Health, Resource and Development and Organizational Development and Innovation • Line Authority  Functional committee structure • 4 areas of focus to get to high performance     Operations– effective day to day operations Quality Assurance– compliance with standards etc. Process Improvement– improving systems and structures Quality Improvement– improving clinical and educational services Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    24. 24. Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    25. 25. Then and Now … Copyright © 2011 Southcentral Foundation. All Rights Reserved.
    26. 26. Then and Now … Copyright © 2011 Southcentral Foundation. All Rights Reserved.

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