Renewing Your Quality Process

Through the Looking Glass: Reviewing, Renewing Your

Organization’s Commitment to Quality

Through the Looking Glass: Reviewing, Renewing Your

Organization’s Commitment to Quality

HCW: 11 ASQ World CongressHCW: 11 ASQ World Congress

Management Consulting in Healthcare & Katherine Reller Consulting

1

Through the Looking Glass: Surviving and Reviving Your Organization’s

Commitment to Quality

Through the Looking Glass: Surviving and Reviving Your Organization’s

Commitment to Quality


2

SESSION OBJECTIVESSESSION OBJECTIVES

• Identify the importance of recognizing ‘cornerstones’ of organizational quality

• Conduct a reflective review of your organization’s quality direction and /or programs

• Identify the importance of recognizing ‘cornerstones’ of organizational quality

• Conduct a reflective review of your organization’s quality direction and /or programs

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SESSION OBJECTIVESSESSION OBJECTIVES

• Identify commonly missed “danger signs” that a focus on quality is lost

• Discover how past lessons can renew hospital wide quality efforts

• Identify commonly missed “danger signs” that a focus on quality is lost

• Discover how past lessons can renew hospital wide quality efforts

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Today’s workToday’s work

• Conduct a reflective assessment of your own organization

• Review the ‘real life’ case study

• Discuss lessons to apply to your own organizations

• Identify real strategies and tools to take home to apply

• Conduct a reflective assessment of your own organization

• Review the ‘real life’ case study

• Discuss lessons to apply to your own organizations

• Identify real strategies and tools to take home to apply

5


Your expectations of the morning?Your expectations of the morning?

What are 1-2 major questions you would like answered, as a part of

today's workshop?

What are 1-2 major questions you would like answered, as a part of

today's workshop?


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Healthcare 25 Years AgoHealthcare 25 Years Ago

Continuous reimbursement

dance

Recruitment issues

High cost

High regulatory&

patient expectations

Transparency & disclosure expectations

High public scrutiny

High Leadership

turnover

7


Healthcare TodayHealthcare Today

Continuous reimbursement

dance

Recruitment issues

High cost

High regulatory&

patient expectations

Transparency & disclosure expectations

High public scrutiny

High Leadership

turnover

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The “Hidden Costs”? The “Hidden Costs”?

• What can be the result, if organizations don’t focus on internal quality?

• What are some signs and symptoms that you may be getting off track?

• What can be the result, if organizations don’t focus on internal quality?

• What are some signs and symptoms that you may be getting off track?

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The “Hidden Costs”? The “Hidden Costs”?

• What are some things that can distract organizations?

• If you are off track how do you recognize it, gather support, and get going in the right direction?

• What are some things that can distract organizations?

• If you are off track how do you recognize it, gather support, and get going in the right direction?

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The Self AssessmentThe Self Assessment

EXERCISE ONE

DO YOU???

EXERCISE ONE

DO YOU???

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The Case StudyThe Case Study

Caring Medical CenterCaring Medical Center

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The Case StudyThe Case Study

• Caring Medical Center (C.M.C.)– 501(c)3, 150 bed hospital– Located in a Midwestern city /population 125,000

(500,000 county) serving 3 counties– Today, part of a four hospital system – 1200 employees– Several major hospital competitors in a 3 county area

• Caring Medical Center (C.M.C.)– 501(c)3, 150 bed hospital– Located in a Midwestern city /population 125,000

(500,000 county) serving 3 counties– Today, part of a four hospital system – 1200 employees– Several major hospital competitors in a 3 county area


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A Bit’o HistoryA Bit’o History

What was happening in healthcare in 1995?

• Approaches to quality?• Approaches to cost• Approaches to staff empowerment?

What was happening in healthcare in 1995?

• Approaches to quality?• Approaches to cost• Approaches to staff empowerment?


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What Happened Next?What Happened Next?

• Front line employees were trained in multiple improvement techniques selected by the training department– Leaders sent to seminars– Team members received in-house training

• Employee led teams select quality projects generated via idea box – teams meeting weekly

• Some projects selected by management • Employees encouraged to solve problems• Many projects with many employees underway

• Front line employees were trained in multiple improvement techniques selected by the training department– Leaders sent to seminars– Team members received in-house training

• Employee led teams select quality projects generated via idea box – teams meeting weekly

• Some projects selected by management • Employees encouraged to solve problems• Many projects with many employees underway


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1 Year Later Quality Improvement “Lite”1 Year Later Quality Improvement “Lite”Less work – Less filling• Fewer employees working on fewer projects • No oversight, each department goes it’s own

way• New silos established (some continue strong)• Fewer improvement ideas generated – no

tracking• Quality newsletter established (plus, slogans,

posters, etc.)

Less work – Less filling• Fewer employees working on fewer projects • No oversight, each department goes it’s own

way• New silos established (some continue strong)• Fewer improvement ideas generated – no

tracking• Quality newsletter established (plus, slogans,

posters, etc.)


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Results – 2 years laterResults – 2 years later

Groups took on a series of small to medium issues• Little evidence of measurable results• Support dried up and projects stopped being

chartered• Sponsors focused on financial issues• Quality newsletter still published

Groups took on a series of small to medium issues• Little evidence of measurable results• Support dried up and projects stopped being

chartered• Sponsors focused on financial issues• Quality newsletter still published


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A New Perspective….A New Perspective….

• A new CEO came in and brought with him a new perspective on organizational systems and customer service

• Many service departments faced cutbacks • Clinical areas were immune to review• A new wave of change was in the air• The season of “reengineering & redesign

began”

• A new CEO came in and brought with him a new perspective on organizational systems and customer service

• Many service departments faced cutbacks • Clinical areas were immune to review• A new wave of change was in the air• The season of “reengineering & redesign

began”


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Re-engineer the System! Re-engineer the System!

The new CEO brought with him consultants to “re-engineer” organizational systems

The new CEO brought with him consultants to “re-engineer” organizational systems


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Two Years Later…..Two Years Later…..

No evidence of re-engineering could be found No evidence of re-engineering could be found

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Attack Customer Service!Attack Customer Service!• A new VP Ops. The introduction of a

packaged program successful at “my previous hospital”

• Everyone trained… and trained• Customers and families were surveyed • Rewards were distributed depending on

manager’s level of buy in

• A new VP Ops. The introduction of a packaged program successful at “my previous hospital”

• Everyone trained… and trained• Customers and families were surveyed • Rewards were distributed depending on

manager’s level of buy in


21

Then what happened?Then what happened?

• Area hospital competition increased and revenue stagnated. Several area hospitals added new clinical service programs

• CMC implemented a hiring freeze, stopped all travel to seminars and meetings and started planning a new medical office building

• Area hospital competition increased and revenue stagnated. Several area hospitals added new clinical service programs

• CMC implemented a hiring freeze, stopped all travel to seminars and meetings and started planning a new medical office building


22

Then ….Then ….

A nearby larger facility brought CMC into their system of 3 hospitals

A nearby larger facility brought CMC into their system of 3 hospitals

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Progress…Progress…

• A new wing was added to the hospital with new OR’s as a major part of the construction project

• CMC builds ambulatory surgical center on the edge of town

• A new wing was added to the hospital with new OR’s as a major part of the construction project

• CMC builds ambulatory surgical center on the edge of town


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Devastating News…Devastating News…• CMC receives its worst JCAHO review ever.

– A very public discussion of the level of hospital quality takes place in the area’s largest newspaper

• A significant group of surgeons leaves CMC to open own ambulatory surgery center

• The board of directors holds a retreat to discuss their role in quality improvement – brings in Don Berwick

• CMC receives its worst JCAHO review ever.– A very public discussion of the level of hospital quality

takes place in the area’s largest newspaper

• A significant group of surgeons leaves CMC to open own ambulatory surgery center

• The board of directors holds a retreat to discuss their role in quality improvement – brings in Don Berwick


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Devastating News…Devastating News…

• NOW, what do you think happens?• NOW, what do you think happens?


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Who’s at Fault?Who’s at Fault?

• The board of directors asks for and receives resignations of:

»CEO»COO»CFO»VP Nursing

• The board of directors asks for and receives resignations of:

»CEO»COO»CFO»VP Nursing


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And then there were none… And then there were none…


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Massive Layoffs in the CommunityMassive Layoffs in the Community

• The area’s largest employer lays off 1,000 people for an unknown period of time

– Service volumes increase for a short period, then decline by 10%

• The area’s largest employer lays off 1,000 people for an unknown period of time

– Service volumes increase for a short period, then decline by 10%


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TransitionTransition

• CMC looking for new leadership

• High unemployment in community

• High public scrutiny from poor JCAHO review

What should CMC do now?

• CMC looking for new leadership

• High unemployment in community

• High public scrutiny from poor JCAHO review

What should CMC do now?

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Lessons LearnedLessons Learned

EXERCISE #2

Where did CMC go wrong?

• What were the danger signals?

EXERCISE #2

Where did CMC go wrong?

• What were the danger signals?


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Current StateCurrent State

EXERCISE #3

• CMC next steps?

EXERCISE #3

• CMC next steps?

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Your OrganizationYour Organization

EXERCISE #4

• Charting your hospital’s condition

EXERCISE #4

• Charting your hospital’s condition

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Through the Looking Glass- Reviewing, Renewing

ASQ World Congress

Through the Looking Glass- Reviewing, Renewing

ASQ World Congress

Kenneth G. Bast

Management Consulting in Healthcare

1505 Rushmore Drive

Burnsville, MN 55306

www.MgtConsultinginHealthcare.com

[email protected]

Cell: (612) 817-3548

Kenneth G. Bast

Management Consulting in Healthcare

1505 Rushmore Drive

Burnsville, MN 55306

www.MgtConsultinginHealthcare.com

[email protected]

Cell: (612) 817-3548

M. Katherine Reller RN MS, CPHQ

Reller Consulting

3936 HWY 52 North Suite 285

Rochester MN 55901

[email protected]

Office: 507-206-3023

Cell: 507-261-4873

M. Katherine Reller RN MS, CPHQ

Reller Consulting

3936 HWY 52 North Suite 285

Rochester MN 55901

[email protected]

Office: 507-206-3023

Cell: 507-261-4873

34Management Consulting in Healthcare & Katherine Reller Consulting

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