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Mad docs virginia mason case study v 02132020
- 2. A Marketing Case Study Similar Situation, Different Results andCENTRAL LUZON DOCTORS’HOSPITAL VIRGINIA MASON MEDICAL CENTER Celeste Mae T. Belmonte, MD Godofredo V. Dungca, III, MD Ma. Theresa T. Enrile, MD Richard B. Pascual, MD
- 4. SITUATION ANALYSIS • CLDH was profitable but very low NPAT • Increasing competitors & competition
- 6. SITUATION ANALYSIS • VMMC was losing money for the past two years • Healthcare landscape was changing
- 7. SITUATION ANALYSIS • Sense that quality of care was below par • Healthcare was provider-centric
- 8. SITUATION ANALYSIS Institute of Medicine (US) Committee on Quality of Health Care in America; Kohn LT, Corrigan JM, Donaldson MS, editors. Source Washington (DC): National Academies Press (US); 2000. • 44,000 to 98,000 people die /yr because of preventable MEDICAL ERRORS • Cost of errors is $17 to 29 billion/yr • Errors cause by faulty systems, processes and conditions.
- 9. SITUATION ANALYSIS • Poor condition of FACILITIES • Lack of more sophisticated medical equipment • No STANDARD processes that led to preventable MEDICAL ERRORS
- 10. SITUATION ANALYSIS Results. The overall prevalence of medication errors is 97.8%. The most common type of errors identified were prescribing, followed by compliance, then administration errors
- 11. SITUATION ANALYSIS CLDH DATA 30% 28% 39% 3% 145 REPORTED MEDICATION ERRORS FROM 2015 TO 2017 Transcription error Administration error Documentation error
- 12. OBJECTIVE “Before we even think of advertising and promoting our hospital, let us FIX our PRODUCT first and make sure that it meets the expectations of our clients” Ferdinad Francis DL Cid, MD CLDH President and CEO
- 13. STRATEGIES • REFURBISH the physical plant and UPGRADE our service capabilites • EDUCATE our staff on QUALITY and quality improvement processes • Establish SYSTEMS and STANDARDS on our processes
- 14. Tactics, Action, Controls Refurbished Private Room Extracorporeal Shockwave Lithotripsy • REFURBISH and UPGRADE using MPIC investment for CAPEX
- 15. Tactics, Action, Controls • Go for ISO:9001 certification • ISO certification achieved and maintained • Deviations remained due to lack of proper monitoring and documentation
- 16. Tactics, Action, Controls • ENROLL our staff with the Institute for Healthcare Improvement • Less than HALF certified • NO follow-up and clear direction regarding quality assurance
- 18. STRATEGIES
- 19. TACTICS We attract and develop the best team. • Make the implicit, EXPLICIT
- 20. TACTICS We relentlessly pursue the highest quality outcomes of care. • Focus on PATIENT SAFETY Mistake Proofing
- 21. TACTICS We create an extraordinary patient experience. • VALUE Stream Mapping
- 22. TACTICS We foster a culture of learning and innovation. • SHARE learnings
- 23. ACTION • Engage doctors in drafting the compact • Adopt /adapt TOYOTA production system for VMMC Services • Set clear direction for VMMC with approval and support from the board.
- 24. CONTROLS • Establish clear KPI’s and Targets • Continuous and rigorous monitoring and of documentation KPI’s • Adoption of Plan, Do, Study and Act (PDSA) cycle for improvement of processes
- 26. Community Checkup report: www.WACommunityCheckup.org More about the Alliance: www.WAHealthAlliance.org
- 27. • Preferred hospital of businesses
- 29. Situation Defective Product Defective Product Objective Improve to become Preferred Brand Improve to become Preferred Brand Strategy Refurbish & Modernize, Standardize, Educate People, Quality, Service, Innovation Tactics Refurbish, ISO 9001 IHI Education Compact, Safety, Value Stream, Education Action Invest, Iso Certification, IHI Enrollment Set and Support Direction, Engage, Adapt/Adopt TPS Control Revenue as KPI , No monitoring and documentation Clear KPI’s , Continuous Review, Rigorous Documentation
- 30. LEARNINGS • SET Direction & ENGAGE your Board & Physicians • Set and ALIGN KPI’s with strategies and tactics • Document and Monitor
Editor's Notes
- In the ever changing landscape of healthcare, hobbled with the twin challenges of having a defective product and a provider centered system, how will a hospital respond in the face of increasing competition in order to maintain viability and profitability?
- Goodday to everyone. In behalf of the Mad Docs , Lee Belmonte, Terit Enrile, Chuck Pascual and Myself, I present to you a marketing Case study on Central Luzon Doctors’Hospital and Virginia Mason Medical Center, two hospitals with similar situations but achieving different results.
- Central Luzon Doctors’Hospital is a 175 bed tertiary training hospital located in Tarlac City. Established in 1962 by a group made up mostly of physicians, CLDH became the largest privately owned and operated hospital in the province. In the last quarter of 2013, Metro pacific Investment Corporation acquired majority ownership of CLDH, making it the 9th hospital in its hospital holdings portfolio.
- At the time of the MPIC takeover, CLDH was a profitable enterprise albeit with very low net profit. It also faced an increasing number of Competitors as well as more robust competition.
- Virginia Mason Medical Center was established 1920 by a group of six doctor from Mayo Clinic and the University of Virginia. They believed in TEAM medicine and modelled their group practice after the Mayo Clinic. Over the course of eight the decades grew the hospital into a 336-bed world class acute care hospital with 445 doctors.
- However an the cusp of the new Millenium, Virginia Mason lost money for two consecutive years. They were just a medium Sized hospital competing with two much larger institutions. On top of that, the healthcare landscape was changing because of what many described as ill conceived changes to managed care that left many hospitals in the United States struggling to make a profit.
- For both CLDH and Virginia Mason, the heathcare delivery system at that time was provider centric. The physicians mostly dictated the way care was delivered. Waiting times for clinic visits and procedures were notoriously long. There was no such thing as patient centerd care. More importantly, there was a sense by both institutions that the product they were selling was defective : The quality of care rendered was not safe and was below reasonable expectations.
- For Virginia Mason, the sense that the product was defective was brought about by the report Published by the institute of Medicine entitled To Err is Human –Building a Safer Health Care System. Published in 2000, the report showed that anywhere from 44 to 98 thousand patients die Annualy in the United states because of PREVENTABLE medical error. These errors, whether fatal or not, costs from 17 to 29 billion dollars a year. The report concluded that these preventable medical errors were caused by FAULTY systems, processes and conditions.
- For CLDH, it was easy to see that we had a faulty product. At the time of the MPIC takeover, most of our equipment were outdated And our physical facility run down. Our most sophisticated medical equipment was a diagnostic ultrasound machine. This lack of More sophisticated medical equipment severely hampered our service capabilities. On top of all of these, there were no existing SYSTEM nor STANDARD that led to preventable medical errors.
- A report from the Philippine General Hospital in the year 2000 showed an overall prevalence of medication errors of 97.8% Among admitted patients.
- CLDH data from 2015 to 2017 showed total of ____ reported medication errors. 39 % were errors of Documentation, 30% were transcription errors while 28% were administration errors. This data only focused On the obvious and reported errors. Thus the actual number of medication errors is actually bigger.
- From the outset, recognizing that the product is “defective, CLDH president and CEO Dr. Ferdinand Francis Cid set as the Overarching quality objective of Fixing the Product to meet the expectations of the clients.
- To achieve this singular objective, three strategic thrusts were established, namely: 1. to refurbish the hospital physical plant and to upgrade and modernize its service capabilities through the acquisition of modern medical equipment 2. To establish systems and set standards for our processes 3. to educate our personnel on quality and quality improvement processes.
- Refurbishing the hospital rooms and the physical plant and the acquisition of new and modern medical equipment was pretty straight forward. The initial investment made by MPIC was channelled to doing just that. The impact of the changes were immediate and visible. New medical Equipment purchased were evaluated based on their ability to generate income and meet their expected return on investment (ROI) time table.
- In order to establish systems and set standards for our hospital processes, CLDH went for ISO certification . The goal was to put into writing our policies, guidelines, procedures work instructions. With these written standards , deviations could easily be spotted and corrected. A consulting firm was engaged and managers required to write their respective department manuals. After almost a year of preparation, CLDH achieved and was able to maintain its iso 9001 certification. However deviations from Standards remained as no proper monitoring and documentation was implemented.
- CLDH enrolled its medical and nursing personnel with the Institute for Healthcare Improvement so they can learn quality improvement Processes. IHI certification became a part of the performance evaluation of our medical and nursing personnel. Unfortunately, less than half of those enrolled achieved certification. The lack of follow-up and clear direction prevented those who achieved certification from meaningfully contributing to quality improvement at CLDH.
- For the Virginia Mason Medical Center, the singular objective was very clear – to deliver patient-centered service . In the Virginia Mason strategic hierarchy , the patient is at the very top, even above its vision and mission. This was deliberate so as to remind everyone of the institution’s patient –centric orientation.
- The pursuit of its mission and vision was anchored on four strategies: Attracting the best people to form the BEST team. Relentlessly pursuing the highest quality outcomes of care Creating extraordinary patient experience Fostering a culture of learning and innovation
- In order to attract and retain the best physicians, Virginia Mason engaged its key medical staff in drafting a Physician compact. This document clearly states what the physician can expect from Virginia Mason and what The hospital expects from them. By making the implicit explicit, there is clear accountability from each side making it easy for the institution to engage the best physicians. This type of compact was eventually adopted for The Virginia Mason leadership and its other healthcare professionals.
- Virginia Masons Pursuit of quality outcomes focused on PATIENT SAFETY. Acknowledging the prevalence of preventable medical errors, VMMC went about reviewing and mistake proofing their processes. This is exemplified by this anesthesia table which was organized in a way that ensured that the injectable medications were not interchanged and that the correct equipment were easily accessible. Continuous monitoring, documentation and review was part and parcel of this quality assurance initiative.
- In order to create an extraordinary patient experience, VMMC adopted the value stream mapping procedure as exemplified by this back pain value stream map. By eliminating the steps in the consultation process that are of questionable value and benefit, and adopting evidence based medicine, the time it takes for the patient to effective intervention is drastically shortened. This also eliminated significant waste of diagnostic and therapeutic resources.
- Whatever learnings are realized by VMMC, these were properly documented and disseminated amongst its personnel. They institutionalized these learnings through the establishment of the Virginia mason Institute who in turn shared these with other partner institutions like the National Health Service.
- To implement its strategies and tactics, VMMC at the outset set a clear objective and direction of its action. More Importantly it had full and unconditional support of its governing board. It also proactively engaged its physician’s in drafting a meaningful compact. It innovatively adopted and adapted the Toyota Production System to come up with is own Virginia Mason Production System thus significantly improving its product.
- Following its actions, VMMC also set clear KPI’s and targets for each of its improvement initiatives with rigorous monitoring and documentation. This allowed its staff to follow the Plan Do Study and Act or PDSA cycle of improvement advocated by the Institute for Healthcare improvement.
- In 2018, according to the community checkup report, a non-profit organization that ranked and evaluated healthcare In the state of Washinton
- VMMC was rankeds as the top healthcare provider among commercial medicial group based on at least 15 measures. This is a validation of the thrust of VMMC putting the patient at the top iof its strategic pyramid.
- VMMC also became the preferred hospital of several big business in the Seattle area.
- What can CLDH from Virginia Mason Medical Center ? There are three key points that CLDH can learn from Virginia mason when it comes to improving its services and patient experience.
- We have two istitutions with acknowledged defective product wanting to improve these so they become the preferred brands. They have set out their strategies and tactics accordingly with significant differences in their chosen actions and controls. Virginia Mason has set clear directions and of the full support of the governing board. Knowing that they have to change from being provider centric to patient centric, they engaged their physicians in coming up with a compact that explicitly states what the physicians and the hospital can expect from each other setting clear areas of accountability. As far as control is concerned, CLDH was clearly deficient in setting, monitoring and documenting KPI’s that were aligned with its strategies and tactics.
- Knowing now their differences CLDH can now Having compared their SOSTAC’s , we now say that Engaging and gaining the support of the governing board is crucial in any improvement initiative especially if the process is lengthy and may not initially translate to increased revenues. In a physician centered healthcare system, getting them on board is crucial in ensuring success of the hospital’s initiatives. We must also set clear KPI’s that are aligned with your strategies and tactics. Setting only revenue targets as KPI’s may not always reflect the intended results of any change initiative. Once the KPI’s are set and properly aligned with tactics and actions , meticulously document and monitor these set measurement parameters. The lack of proper documentation and monitoring has greatly hampered the improvement initiatives of CLDH. Without documented evidence of KPI’s CLDH had no way of meaningfully assess its chosen actions.
- Having a clear objective or in mind and knowing why, it will now be easier to work on the how to achieve this end. Remember the ZYX of beginning with the END in mind.
- In the end, these learnings will help CLDH improve and come up with best-selling products and services. After all, it’s all about CREATING, COMMUNICATING and delivering a VERY GOOD PRODUCT that satisfies the needs, wants and demands of the customer, better than the competition.