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Assignment is due tomorrow Sunday 01/17/16 at 6 pm eastern timeAPA formatOption #1: Sustaining Process ImprovementReview the five major requirements of sustaining process improvement achievements listed in the Studer (2014) article. Select the three requirements that you feel are most important within a healthcare setting and summarize them. Address the following questions:Why are these three requirements the most important?What are some examples of how they have been successfully utilized (provide examples from either your own professional experience or from academic articles)?How do these three requirements translate to improvement in service quality and return on investment?Write a 2- to 3-page paper that provides a rationale for your selections. Reference examples from your work experience and include at least two sources beyond the textbook.FEATURE STORY Quint Studer making process
improvement ‘stick’ There are five traits common to healthcare organizations
that develop process improvement initiatives that successfully sustain gains.
AT A GLANCE To sustain gains/rom II proceu improvement initiative, healtheare
organizations should: ) E)tplain to slaH why II proccn improvement initiative
is needed. ) Encourage leader$ within the organi:z:alion to champion the
process improvement, and tie their evaluilltions to its outcomes. > Ensure
thai both leaden and employees have the skills to help sustain the sought-after
proceu improvements. Once again. health systems are investing heavily in
process improvements. The latest push aims to curb costs to help hospitals
survive in a market environment that increasingly demands greater efficiency in
the delivery of care. Market drivers-including cost pressures associated with
payment reform and the information boom-will demand a ~o to 40 percent
improvement in overall efficiency. The multipronged approach required for such
change will include performance improvement, clinical transformation, scale and
integration, and asset rationalization. Such organizational changes will
facilitate the ongoing shift from episodic to value -based care. In a March
2014 report to Congress, the Medicare Payment Advisory Commission identified
three common traits of healthcare organizations with poor financial performance
that were closing or on the brink of closure: ) Low occupancy ) High
readmissions ) Poor patient satisfaction Although this finding underscores the
critical nature of process improvement, it is also clear that we’ve been here
before, and our effons to sustain process improvement gains over the long term
never seem to stick. Why is it that so many process improvement tools- like
reengineering and continuous quality improvement- that have worked so well in
other industries struggle to take hold in health care? Many process improvement
efforts in health care appear to achieve strong initial results. Such
initiatives might stan with a big kickoff by the CEO to stir employee
enthusiasm, but four years later, there tends to be little evidence to show
whether goals were achieved, indicating a loss of momentum. The repeated
failure to sustain process improvements in health care makes it more difficult
to engage leaders, employees. and providers the next time a new initiative is
introduced. They experience change fatigue. This is particularly true of
physicians, who playa critical role in ensuring a health system’s ability to
compete under value-based care. Nonetheless. some organitations are able to
sustain the gains and make process improvement ~stick.~ In our experience.
these organitations share five traits in common. A Connection to the
“Why” Although it seems obvious to tell people why an organization is
changing a process. much more frequently. such conversations tend to focus
only. or predominantly. on what is changing. Unlike workers in industries such
as manufacturing. however. individuals who work in health care are
intrinsically motivated and so are more invested in understanding the
“why” of change. Nurses and physicians. in particular. need to
understand why a new methodology improves clinical outcomes for patients or
ensures a better work environment in which to practice medicine. One of the
ways leaders in healthcare organizations that are able to sustain improvements
address these needs. and communicate mutual expectations more clearly. is by
moving to a more objective performance appraisal system. By more fairly
rewarding high performers who align within organizational priorities. such a
system better enables these organizations to sustain their missions. These
organizations understand the importance of connecting to hearts and minds
before asking for behavioral change . Change is unsettling. It creates pushback
unless there is compelling evidence that the new best practice will advance the
organization’s mission to prOvide high-quality care for patients. even if it
creates extra steps or inconvenience. When organizations can show that a new
process will result in fewer infections or improved outcomes for stroke
patients. providers’ values will compel them to be receptive to the new
process. This dynamic also is true for financial stewardship. By explaining to
employees why dramatic cost reduction is necessary to enable the organization
to remain solvent and sustain its mission to save lives. financial managers can
improve provider and employee engagement. In year one, UConn Health saved
approximately $1 million, which included standardization on hips, knees, and
other high-cost implants through consolidation and price caps without
eliminating choice. At UConn Health. an integrated academic health center with
5.000 employees and 500 unionized physicians in Farmington. Conn .. Anne
Diamond, the CEO of the organiUltion’s flagship hospital. debuted a comparative
effectiveness committee in 2012. The committee’s goal is to empower physicians
to decide the best care for patients. while standardizing equipment and
supplies fo r substantial cost savings. Every surgical specialty is
represented. and all surgeon members receive one vote, as do administration and
nursing. Representatives from procurement and contracting also attend. “If
a surgeon wants an expensive piece of new equipment, the surgeon will present
evidencebased literature on why the item will improve clinical quality and
safety at a committee meeting for focused discussion and a vote by peers on
whether to pilot or adopt it,” Diamond says. MBy allowing physicians to
build consensus on clinical quality and taking the mystery out of what thiugi
cost, outstanding financials have followed.- In year one. UConn Health saved
apprOximately $1 million, which included standardiUltion on hips. knees. and
other high -cost implants through consolidation and price caps without
eliminating choice. In year two, the organization saved $485,000 on implants.
including spinal and mesh implants and prostheses for total hip arthroplasty.
In 2014. the organization is on track to save $900,000 on biologics, spinal
implants, Mma.ortotal joints, custom packs, and its green
initiative to reprocess reusable instruments. MNew surgeons come in with
personal preferences,” Diamond says. “So we set expectations early
about how this peer-review process works. What physicians want are the best
resources to do their jobs well. By hardwiring a process where they are
empowered to make those decisions, the organization also wins.M Process
Improvement as Part 0′ an Organizational Framework When a process improvement
is identified. it cannot be a stand-alone process. Organizations that are able
to sustain performance improvement demonstrate evidence-based leadership that
provides an execution framework for consistently reducing costs. improving clinical
quality, and enhancing the patient experience, much as adherence to evidence
-based medicine delivers better clinical outcomes for patients. Evidence-based
leadershipSM reduces operational variability through three broad. consecutive
steps: > Identifying and cascading organization goals or desired outcomes
> Identifying and hardwiring necessary leadership behaviors > Selecting
necessary processes and technology A 2012 study by lohns Hoplcins found that
patients injured with head trauma on the weekend were 14 percent more likely to
die than those injured on a weekday and found the Mweekend effect” also
applied to heart attack. stroke, and aneurism care (Schneider, E.B .. et al..
“Beating the Weekend Trend: Increased Mortality in Older Adult Traumatic
Brain Injury (TBI) Patients Admitted on Weekends.” Journal ofSurgical
Research, October 2012). Beginning with the desired organizational or
departmental outcomes, assigning objective performance metrics (i.e., goals
that are aligned and cascaded for accountability), and closing skill gaps with
prescriptive training sustains any process improvement. Generally, the
healthcare industry is very capable of identifying processes that need
improving. For instance, it has readily identified the need for new ITto improve
up -front collections. However. the industry frequently fails to realize
promised gains because it doesn’t effectively maximize necessary behaviors for
success. For instance , if hand -washing is identified as a mandatory behavior,
how do organizations ensure all clinical staff consistently wash their hands?
Validation is the key. If organizations don’t validate, they may assume they
have consistent behavior and waste ALIGNMENT THROUGH EVIDENCE·BASED
LEADERSHlpslo4 ……… ,…. It M • , Go.ls .nd Skills Procen .nd Technology
92 JUNE 20M he.lthcarefln.nd.I ……. gement financial resources by investing
in additional processes and technologies. Meanwhile. what is needed is
consistent execution to see results. Compliance conserves resources. Achieving
a “lean” organization is not the job of one individual or department.
Rather. that goal is achieved by creating a culture in which leaders feel safe
to raise questions about areas of opportunity. Although culture and alignment
are foundational to success. many organizations neglect those aspects in favor
of a narrow focus on implementation of lean tools and tactics. MStrong
leadership is critical. but it’s only one piece of great performance for our
patients.” says Scott Buchalter, MD. a pulmonologist and quality education
officer for UAB Medicine, a regional not-for- profit academic medical center
with six hospitals in Birmingham. Ala. Myou may get some wins with low-hanging
fruit for some breakthrough projects, but you’ll never sustain the gains or move
to the next level to achieve continuous incremental improvements over time
without quality improvement knowledge and skills among staff.” UAB
Medicine instituted a quality academy and partnered with the School of Health
Professions at UAB. Now in its second semester, the academy aims to eventually
develop a critical mass of improvement champions by moving physician, nurse,
and administrative leaders with oversight responsibilities through its core
semester-long curriculum on continuous process improvement. Although small
teams initially learn the methods and focus on applying them on breakthrough
projects, the real value occurs post-training. Buchalter says. MThese
individuals are teaching and cascading the quality improvement methods they’ve
learned 10 teams on their units,” Buchalter says, MIt·S really about
spreading expertise widely and deeply for incremental improvement with eventual
100 percent participation and accountability.~ Organizational Objectives Tied
to Leader Performance Evaluations If we identify a process to improve outcomes
but do not hold leaders accountable. we imply that alignment with
organizational objectives is a matter of choice. In organizations that can
sustain success in process improvements. individuals do not receive strong performance
reviews without demonstrating such alignment. Weight a goal at 10 percent of a
performance evaluation, and you create awareness; weight it at 20 percent. and
you create focus. To create urgency, you need to weight it at 30 percent.
Imagine, for example. that a hospital is working with a supplier to identify a
new system for surgical supplies estimated to save $1.4 million over 12 months.
A savings of$83S,ooo is bud – geted conservatively in year one while the
process and new technology are implemented. Using evidence- based leadership as
part of this process would require a first step of aligning the director of
surgery’s performance evaluation with the desired outcome. Because it is an
urgent organizational priority, the goal is weighted at SAMPLE REVENUE CYCLE
MANAGEMENT GOAL: CASH COLLECTIONS GOIII: Meet or exceed YTD cash collections
lit 101 percent of the prior month’s net totlll (less blld
30 percent of the leader’s evaluation.
Performance metrics of 1 to 5 are assigned so that exceeding the savings goal
results in a better evaluation and underperformance results in a poor
evaluation. Leaders with the Skills to Meet Performance Expectations The next-
and most frequently missing- trait required to make process improvement stick
is having leaders who possess all of the skills needed for success. Leaders
need to be able to identify these skills. Perhaps strengthened communication
skills are needed to better cascade information. Perhaps the leader needs to
improve his or her ability to have difficult conversations with individual
reporters who are not meeting expectations. In such an instance. the leader
needs to document clear expectations and low performance as part of an ~up or
out” approach. Foundational leadership skills are required enterprisewide.
These skills frequently include understanding how to manage change, run
effective meetings. manage financial resources. answer tough questions without
creating a blame culture, understand the external environment, think
critically. and select and develop talent. Imagine a leader who scores poorly
on ~comm indication” on an employee attitude survey. How can that leader
engage employees in consistently executing the new process improvement if the
leader is not trained to effectively communicate why. what, and how? In
organizational assessments we conduct with healthcare organizations nationwide.
leaders are asked to predict what results their organizations would see over
the next five years if there were no changes in processes. cost structure.
efficiencies, and patient care volume. Typically. more than 30 percent of
leaders predict their organizations will perform the same or better. There is a
gap in their understanding about the urgency of the need for change due to the
external operating environment. A leader requires skill in explaining the
“why” and “how” of the changing operating environment to
create a burning platform for change. From 2:010 to 2:013. we surveyed 3S,633
leaders (senior leaders, directors. managers, and supervisors) in 700
healthcare organizations in 44 states to identify barriers to process
improvement in an increasingly challenging operating environment. A key finding
was highlighted in answers to the question, -How well does your current leader
training prepare you to lead for success in the organization today?~ Fony-five
percent of respondents rated training effectiveness as fair, poor. orvery poor
on a five -point scale. How can leaders excel in an increasingly challenging
operating envirorunent with inadequate training? When many leaders have strong
leadership skills, the organization builds bench strength for efficiently
managing the change process. integrating it into daily activities, and managing
high-performing individuals across the organizalion to sustain a culture of
high performance. In one innovative arrangement for building lead – ership
skills. five federally qualified health centers (FQHCs) partnered in 2011 to
share training resources to improve operational performance and health
outcomes. The goal was to remain financially viable in the face of changes in
payer mix and rapid growth due to the Affordable Care Act. Leadership training
has included best practices around selecting and deselecting talent- two
organizations replaced half their executive teams as a result. Other best
practices focused on conflict resolution, team building, targeted goal setting.
and tracking through actionable monthly “flash reports” or dashboards
to track trends and ROt Even though four of the FQHCs compete for market share
in Miami, they have a shared commitment to put community health first. When
becoming a medical home was announced as a federal FQHC requirement. the
partnership put together a task force to reduce patient wait times and improve
access. MWe each want patients to be satisfied, employees to be engaged for
lower turnover, and higher clinical quality.” says Annie Neasman,
president and CEO of Miami -based Jessie Trice Community Health. one of the
FHQC Collaborative members. “It’s truly been a win-win for all of
us.” FEATURE STORY Organizations that enjoy success in sustaining process
improvement understand what their employees require to excel in a fast-paced.
changing operating environment. experience and reduces patients’ anxiety by
clarifying for them what to expect with a procedure. By asking C-suite
executives, board members, and hospital auxiliary members to role -play the
patient in practice sessions, the leadership team has signaled the
organization’s commitment to get it right with every patient every time. That
approach also has created buy-in from the board to hold staff accountable
during their hospital visits. Leaders introduced the concept by first
explaining why it was a best practice in delivering quality care. Stephanie
Orr. chief nursing officer. Since the start of the partnership, employee
turnover has decreased and operating margins have improved at each site.
Employees Equipped with Future-Ready Skills validated employee practice
sessions by observOrganizations that enjoy success in sustaining ing staff and
providing feedback to them and process improvement understand what their later
to managers. who used a competency checkemployees require to excel in a
fast-paced. list to rate effectiveness. changing operating environment.
“We need 100 percent of staff to understand and When Community Health
Network (CHN) in demonstrate competency,” Orr says. “By
involvIndianapolis decided to move preauthorizations ing senior leadership and
validating this new to a centralized financial clearance model, it skill, we
communicated this is no ‘flavor of the invested heavily in educational
resources. That month’ initiative.~ effort ensured staff had the unique
clinical and process knowledge needed to make preauthoriza- The Prime
Ingredient: Building a Culture 0′ tion decisions. High Performance ~You can’t
just flip a switch,” says Charlie Meadows. vice president, revenue cycle,
CHN. ~We trained staff around the process, the tech – nology’ and shared the
current process compared to best practices.~ Steele Memorial Medical Center, a critical
access hospital in Salmon, Idaho (one of the most remote hospitals in the lower
48 states), has used continuous leadership and staff training to drive an 8-4
percent operating margin in 2013, which exceeded its goal by 6,4 percent. Such
training also is credited with reducing total ITE turnover by 25.9 percent in
2012 and an additional 10 percent in 2013. This year. staff training has
focused on teaching employees how to increase the quality of patient
interactions to improve patient satisfaction and loyalty. The hospital uses a
standardized introduction that ~manages up” the individual’s training and
Although much has changed in health care, some constants remain. Those who work
in health care have great passion, fortitude. and a willingness to learn. Usually,
these characteristics are paired with a desire to have purpose. worthwhile
work, and the ability to make a difference. Process improvement is lengthy and
requires an organizational culture of alignment, collaboration, and empowerment
through training and development to feed employees’ natural enthusiasm, sustain
gains. and continue reaching higher .•
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