ZSFG Strategic Direction: 2018-2019 X-Matrix - sfdph.org 27/04 A3... · 19/20 1 1 1 Star Rating 1...

ZSFG Strategic Direction:

2018-2019 X-MatrixJoint Conference Committee

March 27, 2018

Susan P. Ehrlich, MD, MPP

TRUE NORTH

3/21/2018Zuckerberg San Francisco General

Hospital and Trauma Center2

X-MATRIX



3 2 2 2 1 1 3 1 2 2 1 2 1 2 2 2 1 2

2 1 1 3 2 1 2 1 1 2 2 1 2 2 2 2 2 2 2 2 2 1 1

1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 2 1 1 2 2 1 1 2 1 2 2 2 2 2 1

By

6/3

0/1

9, I

ncr

ease

% o

f u

niq

ue

pat

ien

ts s

een

at

ZSFG

wit

h R

EAL

(40

%)

and

SO

GI (

10

%)

dat

a

com

ple

tio

n

By

6/3

0/1

9, I

ncr

ease

Dep

artm

enta

l PIP

S re

po

rtin

g

wit

h a

t le

ast

on

e m

etri

c st

rati

fied

by

REA

L to

35

%

By

6/3

0/2

01

9, A

chie

ve %

of

EHR

imp

lem

enta

tio

n

def

ined

by

ph

ase

- G

rou

nd

wo

rk, D

irec

tio

n,

Ad

op

tio

n, T

esti

ng,

Tra

inin

g, G

o-L

ive

By

6/3

0/2

01

9, R

edu

ce t

ota

l nu

mb

er o

f p

atie

nt

har

m

even

ts t

o le

ss t

han

10

/mo

nth

.

By

6/3

0/2

01

9, R

edu

ce h

osp

ital

rea

dm

issi

on

fro

m

14

.46

% t

o 1

4.3

2%

By

6/3

0/2

01

9, R

edu

ce a

mb

ula

nce

div

ersi

on

fro

m

52

.8%

to

40

%

By

6/3

0/2

01

9, I

ncr

ease

% IC

AR

E ad

op

tio

n a

nd

adh

eren

ce t

hro

ugh

dai

ly s

tatu

s sh

eets

, sta

ff

cele

bra

tio

ns

and

dri

ver

or

wat

ch m

etri

c to

16

dep

artm

ents

By

6/3

0/2

01

9, I

ncr

ease

th

e n

um

ber

of

ZSFG

dep

artm

ents

th

at h

ave

imp

lem

ente

d D

MS

to 1

4

By

6/3

0/2

01

9, I

ncr

ease

% o

f ZS

FG e

xpan

ded

exec

uti

ve le

ader

s w

ith

on

e id

enti

fied

PD

P A

3

targ

et t

o 8

5%

By

6/3

0/2

01

9, A

chie

ve %

sta

ff s

atis

fact

ion

an

d

read

ines

s fo

r EH

R b

y p

has

e -

Gro

un

dw

ork

,

Dir

ecti

on

, Ad

op

tio

n, T

esti

ng,

Tra

inin

g, G

o-L

ive

By

6/3

0/2

01

9, R

edu

ce #

of

day

s sl

ipp

age

for

com

ple

tio

n o

f ca

pit

al p

roje

cts

to 0

/mo

nth

By

6/3

0/2

01

9, D

ecre

ase

sala

ry v

aria

nce

Aiy

ana

Joh

nso

n

Bre

nt

An

dre

w

Dav

e W

oo

ds

Raj

iv P

ram

anik

Jen

nif

er B

off

i

Jim

Mar

ks

Kar

en H

ill

Kim

Ngu

yen

Mar

gare

t D

amia

no

Sue

Car

lisle

Susa

n E

hrl

ich

Terr

y D

ento

ni

Tod

d M

ayTo

san

Bo

yo

Tro

y W

illia

ms

Baseline

(FY16/17)

FY

17/18

Target

FY

18/19

FY

19/20

1 1 1 Star Rating 1 Star 2 Star 2 Star 3 Star 1 1 1 1

1"Would Recommend

Hospital" (HCAHPS)78.3% 80.0% 82.0% 84.0% 1 1 1

1

"Would Recommend

Provider's Office" (CG-

CAHPS)

65.4% 67% 69.0% 71% 1

1

Limit Percent Spend of

General Fund to Total

Budget

17% 17% 17% 17% 1 1

1

"Likelihood to

Recommend ZSFG to

Friends and Family as a

Place to Work"

33.8%

(CY 15)40% 45% 50% 1 1 1

1 1 1 1

Reduce BAA heart failure

readmissions (vs

hospitalizations)

31.7% 1 1 1 1

1 =

2 =

3 =

4.4%

FY 18/19FY 17/18 FY 19/20

Safety Care Experience

"Likelihood to

Recommend

Provider's Office to

Friends and Family"

(Specialty Clinics)

Implementing Enterprise-wide Electronic Health Record

The ZSFG Way

Building Our Future:

Optimizing Clinical and Academic Space at ZSFGEq

uit

y

Safe

ty

Qu

alit

y

Car

e Ex

per

ien

ce

Dev

elo

pin

g O

ur

Peo

ple

71.5% 75% 77%

Reduce Harm Events EMP: 433

ZSFGComp:

112

"Likelihood to

Recommend

Hospital to Friends

and Family"

78.3%

Likelihood to

Recommend

Working Here

BAA Cardiovascular -

All Hospitalizations

important

correlation or

core team

38% 45% 60%

Legend

weak

correlation or

rotating team

strong

correlation or

team leader

Reduce Reliance on

General Fund

(Growth)

Fin

anci

al S

tew

ard

ship

Financial StewardshipEquity Developing Our PeopleQuality

Strategies / A3

True North Outcomes

Tru

eN

ort

h G

oal

s

Per

form

ance

SFHN True North Outcomes



ACHIEVING OUR OUTCOMES

Outcomes measured over 5 years

Perf

orm

an

ce m

easu

red

th

rou

gh

ou

t 2

01

8 t

o d

rive

o

utc

om

es

3 2 2 2 1 1 3 1 2 2 1 2 1 2 2 2 1 2

2 1 1 3 2 1 2 1 1 2 2 1 2 2 2 2 2 2 2 2 2 1 1

1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 2 1 1 2 2 1 1 2 1 2 2 2 2 2 1

By

6/3

0/1

9, I

ncr

ease

% o

f u

niq

ue

pat

ien

ts s

een

at

ZSFG

wit

h R

EAL

(40

%)

and

SO

GI (

10

%)

dat

a

com

ple

tio

n

By

6/3

0/1

9, I

ncr

ease

Dep

artm

enta

l PIP

S re

po

rtin

g

wit

h a

t le

ast

on

e m

etri

c st

rati

fied

by

REA

L to

35

%

By

6/3

0/2

01

9, A

chie

ve %

of

EHR

imp

lem

enta

tio

n

def

ined

by

ph

ase

- G

rou

nd

wo

rk, D

irec

tio

n,

Ad

op

tio

n, T

esti

ng,

Tra

inin

g, G

o-L

ive

By

6/3

0/2

01

9, R

edu

ce t

ota

l nu

mb

er o

f p

atie

nt

har

m

even

ts t

o le

ss t

han

10

/mo

nth

.

By

6/3

0/2

01

9, R

edu

ce h

osp

ital

rea

dm

issi

on

fro

m

14

.46

% t

o 1

4.3

2%

By

6/3

0/2

01

9, R

edu

ce a

mb

ula

nce

div

ersi

on

fro

m

52

.8%

to

40

%

By

6/3

0/2

01

9, I

ncr

ease

% IC

AR

E ad

op

tio

n a

nd

adh

eren

ce t

hro

ugh

dai

ly s

tatu

s sh

eets

, sta

ff

cele

bra

tio

ns

and

dri

ver

or

wat

ch m

etri

c to

16

dep

artm

ents

By

6/3

0/2

01

9, I

ncr

ease

th

e n

um

ber

of

ZSFG

dep

artm

ents

th

at h

ave

imp

lem

ente

d D

MS

to 1

4

By

6/3

0/2

01

9, I

ncr

ease

% o

f ZS

FG e

xpan

ded

exec

uti

ve le

ader

s w

ith

on

e id

enti

fied

PD

P A

3

targ

et t

o 8

5%

By

6/3

0/2

01

9, A

chie

ve %

sta

ff s

atis

fact

ion

an

d

read

ines

s fo

r EH

R b

y p

has

e -

Gro

un

dw

ork

,

Dir

ecti

on

, Ad

op

tio

n, T

esti

ng,

Tra

inin

g, G

o-L

ive

By

6/3

0/2

01

9, R

edu

ce #

of

day

s sl

ipp

age

for

com

ple

tio

n o

f ca

pit

al p

roje

cts

to 0

/mo

nth

By

6/3

0/2

01

9, D

ecre

ase

sala

ry v

aria

nce

Aiy

ana

Joh

nso

n

Bre

nt

An

dre

w

Dav

e W

oo

ds

Raj

iv P

ram

anik

Jen

nif

er B

off

i

Jim

Mar

ks

Kar

en H

ill

Kim

Ngu

yen

Mar

gare

t D

amia

no

Sue

Car

lisle

Susa

n E

hrl

ich

Terr

y D

ento

ni

Tod

d M

ay

Tosa

n B

oyo

Tro

y W

illia

ms

Baseline

(FY16/17)

FY

17/18

Target

FY

18/19

FY

19/20

1 1 1 Star Rating 1 Star 2 Star 2 Star 3 Star 1 1 1 1

1"Would Recommend

Hospital" (HCAHPS)78.3% 80.0% 82.0% 84.0% 1 1 1

1

"Would Recommend


CAHPS)

65.4% 67% 69.0% 71% 1

1

Limit Percent Spend of

General Fund to Total

Budget

17% 17% 17% 17% 1 1

1

"Likelihood to

Recommend ZSFG to

Friends and Family as a

Place to Work"

33.8%

(CY 15)40% 45% 50% 1 1 1

1 1 1 1

Reduce BAA heart failure

readmissions (vs

hospitalizations)

31.7% 1 1 1 1

1 =

2 =

3 =

4.4%

FY 18/19FY 17/18 FY 19/20

Safety Care Experience

"Likelihood to

Recommend

Provider's Office to

Friends and Family"

(Specialty Clinics)

Implementing Enterprise-wide Electronic Health Record

The ZSFG Way

Building Our Future:

Optimizing Clinical and Academic Space at ZSFGEq

uit

y

Safe

ty

Qu

alit

y

Car

e Ex

per

ien

ce

Dev

elo

pin

g O

ur

Peo

ple

71.5% 75% 77%

Reduce Harm Events EMP: 433

ZSFGComp:

112

"Likelihood to

Recommend

Hospital to Friends

and Family"

78.3%

Likelihood to

Recommend

Working Here

BAA Cardiovascular -

All Hospitalizations

important

correlation or

core team

38% 45% 60%

Legend

weak

correlation or

rotating team

strong

correlation or

team leader

Reduce Reliance on

General Fund

(Growth)

Fin

anci

al S

tew

ard

ship

Financial StewardshipEquity Developing Our PeopleQuality

Strategies / A3

True North Outcomes

Tru

eN

ort

h G

oal

s

Per

form

ance

SFHN True North Outcomes

2017 TRUE NORTH STRATEGIESTRUE NORTH GOALS

Equi ty

Safety

Qual i ty

Care Experience

Developing our People

Financial Stewardship

STRATEGIES

Advanc ing Equ i t y

Improv i ng Va lue and Pa t i en t Ou t comes

Ensur i ng F l ow and Access

Op t im i z i ng Care Exper i ence

Opt im i z i ng Work fo rce Care & Deve lopmen t

The ZSFG Way

Bu i l d i ng f o r t he Fu tu re

Imp lemen t ing an en te rp r i se -w ide E lec t ron i c Hea l t h Reco rd



6 8

2017 SUCCESSES



QUALITYEMERGENCY DEPARTMENT FAST TRACK (FT)

170 169 165 158 157 152

125

145

165

185

Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17

Emergency Department Fast Track (mean minutes)

ESI 4/5

53%64%

89%

53%

89% 91%

44%

0%

50%

100%

Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17

Comprehensive Joint Replacement Program (Percent)

FY1617 Baseline…

COMPREHENSIVE JOINT REPLACEMENT (CJR) PROGRAM

SAFETY

ACHIEVING TARGETS IN QUALITY AND SAFETY

2017 LESSONS LEARNED



• 67% of the True North metrics were off target

• Realign and refocus True North goals and metrics

• Move the focus to operational level

2018 TRUE NORTH OVERVIEW



TRUE NORTH GOALS

Goals are defined by our mission, vision, values, tactics, and metrics that represent the direction we are heading in.

6STRATEGIES

Each True North Goal has 1-2 improvement strategies to guide the work.

3PERFORMANCE METRICS

Performance measured throughout 2017 to drive outcomes

12OUTCOMES METRICS

Outcomes measured over 5 years.

6

Hoshin Nov 2017 created focus

8 16 8

The ZSFG WayAdvancing Equi ty

Improving Value and Pat ient Outcomes

Ensur ing F low and Access

Opt imiz ing Care Exper ience

Financia l Stewardship

Building for the Future

Implementing an enterprise-wide Electronic Health Record



Advanc ing Equ i t y

Improv i ng Va lue and Pa t i en t Ou t comes

Ensur i ng F l ow and Access

Op t im i z i ng Care Exper i ence

Opt im i z i ng Work fo rce Care & Deve lopmen t

The ZSFG Way

Bu i l d i ng f o r t he Fu tu re

Imp lemen t ing an en te rp r i se -w ide E lec t ron i c Hea l t h Reco rd

8

TRUE NORTH GOALS

6STRATEGIES


12OUTCOMES METRICS

6

3



TRUE NORTH GOALS

6STRATEGIES


12OUTCOMES METRICS

6

Equity Safety Care Experience Financial

Stewardship

Boyo Dentoni & Williams Johnson Boffi

The ZSFG Way

Mar

ks &

Ngu

yen

By 6/30/19,

Increase

Departmental PIPS

reporting with at

least one metric

stratified by REAL to

35%

By 6/30/2019, Reduce

total number of patient

harm events to less than

10/month.

By 6/30/2019,

Reduce hospital

readmission from

14.46% to

14.32% (Prime)

By 6/30/2019,

Reduce

ambulance

diversion from

52.8% to 40%

By 6/30/2019, Increase

% ICARE adoption and

adherence through

daily status sheets, staff

celebrations and driver

or watch metric to 16

department

By 6/30/2019,

Increase the number

of ZSFG departments

that have

implemented DMS to

14

By 6/30/2019,

Increase % of ZSFG

expanded executive

leaders with one

identified PDP A3

target to 85%

By 6/30/2019,

Decrease salary

variance to 0

Building Our

Future

Bo

yo &

Dam

ian

o

By 6/30/2019,

Reduce # of days

slippage for

completion of

capital projects to

60/month

Implementing

an Electronic

Health Record

Den

ton

i & M

ay

By 6/30/19,

Increase % of

unique patients

seen at ZSFG with

REAL (40%) and

SOGI (10%) data

completion

By 6/30/2019, Achieve

% of EHR

implementation defined

by phase - Groundwork,

Direction, Adoption,

Testing, Training, Go-

Live


% staff satisfaction

and readiness for EHR

by phase -

Groundwork,



Live

Executive Key Performance Indicators

Stra

teg

ic A

3s

Quality Developing our People

Marks & May Marks & Nguyen



HOW WILL WE CREATE FOCUS?Equity Safety Care Experience Financial

Stewardship


The ZSFG Way

Mar

ks &

Ngu

yen

By 6/30/19,

Increase

Departmental PIPS

reporting with at

least one metric


35%




10/month.

By 6/30/2019,

Reduce hospital

readmission from

14.46% to

14.32% (Prime)

By 6/30/2019,

Reduce

ambulance

diversion from

52.8% to 40%



adherence through




department

By 6/30/2019,

Increase the number

of ZSFG departments

that have

implemented DMS to

14

By 6/30/2019,

Increase % of ZSFG

expanded executive

leaders with one

identified PDP A3

target to 85%

By 6/30/2019,

Decrease salary

variance to 0

Building Our

Future

Bo

yo &

Dam

ian

o

By 6/30/2019,

Reduce # of days

slippage for

completion of

capital projects to

60/month

Implementing

an Electronic

Health Record

Den

ton

i & M

ay

By 6/30/19,

Increase % of

unique patients

seen at ZSFG with

REAL (40%) and

SOGI (10%) data

completion


% of EHR





Live




by phase -

Groundwork,



Live


Stewardship

Advancing EquityImproving Value and

Patient Outcomes

Optimizing a Care

Experience Model

Daily Management

System

Financial

Stewardship


Ensuring Flow and Access

Developing our PeopleQuality

Operational A3s


Stra

teg

ic A

3s




TRUE NORTH GOALS

6STRATEGIES


12OUTCOMES METRICS

6


Stewardship


Reduce BAA heart

failure readmissions

"Would Recommend

Hospital" (HCAHPS)

Limit Percent Spend

of General Fund to

Total Budget

"Would Recommend


CAHPS)

"Likelihood to

Recommend ZSFG to

Friends and Family as

a Place to Work"


Star Rating

Ou

tco

me

Met

rics


HOW DO WE ALIGN WITH THE ORGANIZATION?



Ca

sca

din

g in

form

ati

on

Periop Equity Safety Care Experience Financial

Stewardship

The ZSFG Way 1 Metric Stratified SSI (e.g skin cleansing) Add-On Wait Times ICARE Key Behavior 1 Department Dept. Salary Variance

Building Our

Future

100%/phase

Implementing an

Electronic Health

Record

100%


ALIGNMENT

Unit-Level Key Performance Indicators: Drive (D) or Watch (W)


Stewardship


The ZSFG Way

Mar

ks &

Ngu

yen

By 6/30/19,

Increase

Departmental PIPS

reporting with at

least one metric


35%




10/month.

By 6/30/2019,

Reduce hospital

readmission from

14.46% to

14.32% (Prime)

By 6/30/2019,

Reduce

ambulance

diversion from

52.8% to 40%



adherence through




department

By 6/30/2019,

Increase the number

of ZSFG departments

that have

implemented DMS to

14

By 6/30/2019,

Increase % of ZSFG

expanded executive

leaders with one

identified PDP A3

target to 85%

By 6/30/2019,

Decrease salary

variance to 0

Building Our

Future

Bo

yo &

Dam

ian

o

By 6/30/2019,

Reduce # of days

slippage for

completion of

capital projects to

60/month

Implementing

an Electronic

Health Record

Den

ton

i & M

ay

By 6/30/19,

Increase % of

unique patients

seen at ZSFG with

REAL (40%) and

SOGI (10%) data

completion


% of EHR





Live




by phase -

Groundwork,



Live


Stra

teg

ic A

3s



DAILY MANAGEMENT SYSTEM

DEPARTMENTS

• 4A Skilled Nursing Facility

• Care Coordination

• Critical Care and

Respiratory

• Emergency

• Finance (Health Information

System)

• Imaging

• Inpatient (Med/Surg

Nursing)

• Inpatient and Outpatient

Pharmacy

• Peri-Operative

• Perinatal ( incl OBGYN/

Nursery/ NICU) Psychiatry

• Rehabilitation Services

• Specialty Care

• Urgent Care Center



HOW DO WE PREPARE OUR LEADERS?

TOOLS

• Daily Status Sheets

• Huddles

• Plan-Do-Study-Act

• Leadership team



Emergency Department

Heal th In format ion Serv ices

NEXT STEPS



•A3 Team Meetings

•Teams to develop strategy to achieve metrics and performance outcomes

Strategic A3 Development

•Align with Strategic A3

Operational A3 Development •Strategic and operational

A3s presented at JCC over the year

•True North Scorecard presented at JCC quarterly

JCC Updates

Date post:	30-Nov-2018
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