IHI Triple Aim

Key Thoughts:

IHI (Institute of Health Improvement) is an educational institution that promotes improvement in the delivery of healthcare. They became famous after their successful Save 100,000 Lives campaign, and just recently finished their Save 5 Million Lives campaign. Today, I just came across their many other new initiatives. It's call Triple Aim. Each of this initiatives has something that our hospital can benefit even if we do not participate in the campaign officially.

The Triple Aim are-

• health of the defined population
• Enhance the patient care experience (including quality, access
and reliability)
• Reduce, or at least control, the per capita cost of care

You will notice straight away that this is a much broader initiative involving other stakeholders in the healthcare delivery continuum. In 2007, IHI translated the Triple Aim into specific action plans-

1. A focus on individuals and families
2. Redesign of primary care services and structures
3. Population health management
4. A cost-control platform
5. System integration and execution

Summary:

Obviously, there's so much to explain on this noble but massive change management campaign. I am going to deviate from the usual by not summarizing a topic, but to point you towards the Triple Aim main page to read for yourself.

There are several links which provided much in-depth details. There's a case study CareOregon, concept design paper, and an overview of the model.

My Comments:

As I mentioned earlier, each initiative from IHI provides us with something worth implementing. To fully live the mission of serving the community, we must stay on this journey, there are challenges no doubt, there's also vast opportunities to do something of significant for the community. What if we can significantly improve the healthcare delivery for our community without increasing the cost of providing it? That's worth fighting for, isn't it?

Do spend time today to understand what this is all about.

Reference: The Triple Aim, Institute of Healthcare Improvement, http://www.ihi.org/IHI/Programs/StrategicInitiatives/TripleAim.htm, accessed: 18 Jan 2009.

The Breakthrough Company

Key Thoughts:

I'm reading another strategy book, this was a gift by our Financial Management vendor during our signing ceremony. Strategy is a complex subject, having read at least a dozen books on strategy, I think I had only one tenth of it down.

I will list down some of the most profound questions raised in this book. An incredibly fitting book for our organization as it's a research based on small companies who had made the breakthrough to greatness. Here's the incredible numbers, 7,000 companies over 5 years, spoke to over 1,500 key executives, and reviewed & cataloged more than 5,600 articles, annual reports and studies. And from the list, they conducted 90 day in-depth studies with 52 firms. The author goal "was to conduct the most exhaustive research ever undertaken on the subject." As empirical as it gets.

Questions:

Keith started with 3 questions that started him on his journey (page 3).

1. Why do most companies start small and stay that way?

2. What is special about the handful of companies that successfully "break through" the entrepreneurial stage of development?

3. What can a leader do to ensure that his company maximizes its chances for breakthrough?

A Few Squirts from the Grapefruit:

Surprises uncovered from their research (p18-22).

1. The most interesting companies may not operate in the markets that Wall Street and the business press consider interesting or "cool".

There's 3 types of breakthrough companies, 1) in hot markets dominate those hot markets 2) in dud markets igniting their sector 3) in stalled/dead markets that figure out a way to transition into more attractive markets.

2. Sticking to the knitting won't always get you there. They ignore the experts and re-define their business.

3. Don't look for extraordinary people; build a place where ordinary people can do extraordinary things. While hiring talent is a must, they also 'creating systems that helped their people grow along with the business.'

4. It's not about where (or whether) you went to school. The leaders in the breakthrough companies ranges from PhDs to high school graduates. It has less to do with qualifications than to do with 'how they see the world, and what they do with those insights.'

5. You don't always need other people's money.

6. How employees feel about working in a place is a significant driver of success. Many of the 9 featured companies won awards for best workplace.

The rest of the book is illustration of what the above means and MORE!

My Comments:

There are many common sense insights in the book, each of them is worth a 'deep think' on. Chapter 10 sums up what to do after all the 'thinking'! A leader 'can influence a business via 1) crafting and adapting strategy, 2) getting the most out of people, and 3) driving execution. (p202)

Another 'take-away' for me was to ask these questions during our strategy review every quarter (p210):-

1. What have been our most important strategic accomplishments during the past ninety days?

2. What are the most important ways we fell short of our strategic potential during the past ninety days?

3. What are the most important things we have learned about our strategy during the past ninety days?

For PAH, strategic review always look forward, there's very little looking back and LEARN. The strategy learning cycle (p209) should be adopted.

Despite stating that this is not intended to be a recipe book, chapter 10 was like a prescription to me, we suckers certainly love that, and I certainly didn't mind having it. Seriously though, strategy making is as elusive and uncertain as ever, however, we can take heart from the book that if we learn from the best, there's a greater than even chance that we can breakthrough. As the subtitle of the book says, "how everyday companies become extraordinary performers", do we want to join the rank? Dare we dream?

For all the details in between the introduction and the conclusion, read the book! It's in the Finance Library.

Reference: The Breakthrough Company: How everyday companies become extraordinary performers, Keith R. McFarland, Crown Press: 2008.

Risk Management Workshop on Key Risk Indicators (KRIs) and Risk Framework

Key Thoughts:

The implementation of risk management strategies is more pertinent today than ever before. The speaker, Marc Ronez is well-experienced in this field. His insight and knowledge helps provide the foundation to build a sound risk management framework for the organization.

Summary (sound bites):

- risk assessment is very much sentiment dependant, eg. subprime - 12 months ago, CEO: why aren't we doing more?, now, CEO: why are we in it? - same data, different conclusion

- Risk management sophistication doesn't guarantee safety - eg. Societe General

- tendency to jump to conclusion. CEO: Don't bring me problem, bring me solution. When majority of the report focus on justifying, then it's not risk analysis, it's rationalization

- vast majority of corporate failures is in strategies and implementation, not financial risk

- Business Continuity Planning is part of Enterprise Risk Management, not the other way round

- The most important risk mitigation for charitable organization is REPUTATION!

My Comments:

- PAH does a reasonable done with clinical risk management, but Enterprise Risk management is much broader -- Change the Emphasis.

TO DO LIST

- map risk and choose techniques to mitigate risk

- build Key Risk Indicators into Riskman and SAS FM

- Calculate cashflow to finance potential losses, especially several exposures at once

- setup Risk Register

- build Riskman for decision making

- link Risk Management to incentives payment

- use Event Tree to identify consequences

- derive KRIs and KCIs from KPIs/CSF/KFRIs

- explore further education from Asian Risk Management Institute

Conclusion: a most valuable session to understand the latest thought leadership in Enterprise Risk Management.

Reference: Risk Management Workshop by CCH, 15 December 2008. March Ronez, Asian Risk Management Institute, www.amiri.org.

A Complaint Is A Gift

Key Thoughts:

2009 is the year we get serious about actively managing our customer experience. This updated book by Janelle Barlow and Claus Moller was a very exciting read.

The book detailed tonnes of knowledge of why customer feel/react the way they do, each point backed by scientific research. In addition, great stories of service recovery helps emphasize the points and helps reinforce it (besides being a good read! As the authors alluded, complaints are far more entertaining to hear/read than good service).

The most stand out thing I learned from the book is 'Complaining customers are often the loyal customers, disloyal customers are more likely to not say anything and into the arms of your competitors'. I have used this phrase to good effect the last two weeks.

The gist of the book as described in the Foreword by Tony Hsieh of Zappos.com is our loyalty to a company is influenced by how someone at that company respond or didn't respond to our complaints or service issues.

Short Summary:

The book is organized into 3 sections (taken from Introduction).

1. Complaints: Lifeline to the Customer - outlines strategy that will help maintain a positive mind-set toward complaining customers. It emphasis the value of listening to customers, using the opportunistic encounter to cultivating more business, talks about why most dissatisfied customers rarely complain. Finally, it talks about what's on the mind of the customer when he/she complains.

2. Putting the Complaint Is a Gift Strategy into Practice - focuses on how to handle the complaints you do receive. There's an Eight-Step Formula (outlined below). How to deal with the Internet phenomenon in terms of customers airing their dissatisfaction directly to the world and use the Web to our own advantage.

Eight-Step Gift Formula

1. Say, "Thank you."

2. Explain why you appreciate the feedback.

3. Apologize for the mistake.

4. Promise to do something about the problem immediately. Take responsibility.

5. Ask for necessary information.

6. Correct the mistake - promptly.

7. Check customer satisfaction.

8. Prevent future mistakes.

3. Dishing It Out and Taking It In: The Personal Side of Complaints - apparently applying to your personal life can save marriages! Common strategies includes listening to their complaints, learn to notice when 'someone is upset and to respond in a way to leads to resolving the conflict'.

'You can't take your girlfriend for granted, and you can't take your customer for granted. Every time, it always works out the same way. Somebody else gets them' Gordon Bethune, former CEO of Continental Airlines.

As mentioned earlier, many good examples were presented. 'Ideas that are almost sure to work are the best practices of other companies in your industry. But the breakthrough ideas often come from outside, from an industry that routinely solves a problem that's new to you.' Wally Bock

My Comments:

An excellent resource from TMI as usual. As in keeping with anything worth it's place in the marketplace, plenty of additional materials are available on the website. www.tmius.com

I am re-reading the book the second time starting this week, so more detail summary may be posted in a later post. In the meantime, the book is in the Finance Library. I'm also going to propose a daily briefing sheet for each Pillar for Daily Stand Up Meeting (as mentioned last week in our monthly meeting), expect to see materials presented in this book to be on the briefing sheet.

Reference: A Complaint Is A Gift: Recovering Customer Loyalty When Things Go Wrong, Janelle Barlow & Claus Moller, Berrett-Koehler Publishers.

Creating The Ultimate Healing Environment

Key Thought:

Building a hospital based on Evidenced-Based Design, integrated IT solutions and Patient Safety. How to do it?

Summary:

Case of OhioHealth building Dublin (Ohio) Methodist.

OhioHealth believed that a guiding principle in the construction effort was basing building design on the best available research to positively impact balanced scorecard measures of quality and safety; patient, family and staff satisfaction; operational efficiency; and financial performance.

Another guiding principle was an investment in cutting-edge IT that assist in improving patient safety, at the same time allowing the hospital to be digital, wireless and paperless to the maximum extent possible.

Dublin (Ohio) Methodist was build by paying attention to stress-reducing design and creating a patient/family-centered environment that improves safety while respecting privacy and dignity.

Evidence-based design features:-

- Rooms are acuity adaptable, allowing patients to remain in the same room regardless of level of illness eliminating intra-hospital transfer

- rooms are like-handed (what is on the left in one room is on the left in the next room); diminish the need for care providers to search for what they need for patient care

- rooms has access to natural light to reach nearly 90 percent of all occupied spaces

- windows in patient rooms partially open to let in fresh air

- a waterfall and trees in the lobby help to reduce stress among patients, families and hospital staff

- decentralized work station bring caregivers closer to their patients

- sound-absorbing ceiling tiles and a noiseless paging system create a quieter environment

Weaving IT into evidence-based design:

- patient's medical information is accessible via networked PC, wireless tablet PCs, and handheld devices

- no admitting department but has a group of people who perform the admitting function in the patient's room upon arrival

- single sign-on with biometrics reader

- integration of patient call lights, cardiac monitor alarms and bed exit alarms with wireless communication badge and earpiece worn by each caregiver

- use of computerized physician order entry (CPOE)

- digital ED and surgery management systems

- bed management system allows proper placement of patients quickly and sends messages to environmental services when beds need to be cleaned

- only hire employees who were willing to use IT

- physicians applying for privileges at Dublin Methodist agreed to be trained in and use the available technology

- employees are required to attend 8 weeks of training before hospital opened

Evidence-based design was led by The Center for Health Design, a leading research and advocacy organization. Before design and construction started, a design company Big Red Rooster completed a cultural report by conducting research about patients and staff perceptions of hospitals and the environment. The research was centered around traditional hospital cultures to help identify areas for improvement such as healthcare quality, patient satisfaction, staff retention, operational efficiency and productivity, and attracting more patients.

My Comments:

Many of these principles can and should be incorporated into our new hospital tower.

Reference: Creating the Ultimate Healing Environment: integrating Evidence-Based Design, IT and Patient Safety by Cheryl L. Herbert RN and Lamont M. Yoder RN FACHE, Healthcare Executive, SEPT/OCT 2008, p17-23.

Technology in Healthcare

Key Thoughts:

Each budget cycle, we struggle to produce a reasonable budget by maintaining or reducing total FTEs, reigning in other expenses, (optimistically) projecting market share growth, approving a handful of new business initiatives and, not infrequently, negotiating the negotiating the margin target downward.

Each year it gets more challenging to find new, material expense reduction or revenue generation opportunities.Short of dramatically altering service to the community and, thus, your organization's commitment to the community, what else is available to address the complex business challenges we continually face?

The current revenue and expense environment makes every miss tougher to accommodate, making the organization's ability to fulfill its challenges more difficult.

EMR - if we ask why invest in EMR, you will get a reflexive response citing the imperative to improve safety, enhance quality and lower costs. If we ask what was the decision making process used to allocate significant capital toward an EMR, or ask about its return on investment or specific improvements in patient safety and quality metrics the EMR has produced a couple of years down the road, or what organizational performance dashboard has changed and by how much due to their EMR implementation, the frequent response is an awkward silence - a scary reaction about an investment hat costs tens of millions of dollars and untold millions in consulting expenses and staff time to implement and support.

Traditionally, organizations has sorted technology needs based on cost and perceived priority. They also continued to invest in new technologies without a more comprehensive understanding of their hard and soft yields and their relative ability to accomplish the organization's goals - a key miss when the available resource pool with which to invest in any technology is increasingly challenging to fund.

What we need is an awareness of how to leverage technology to solve our more vexing business problems, a systematic thinking about how a given technology can be creatively and strategically harnessed as a tool to support a process and facilitate fundamental operational or organizational improvement. Which purchase, for example, will help improve market share and by how much? And, why is it superior to the other capital budget requests vying for funding?

Summary - a organized, thoughtful approach in harnessing technology for healthcare delivery:

1. A strategic focus for technology review

What is it that you want technology to accomplish our mission and strategic plan?

2. A framework for assessing a technology's value to the organization

An organized method to evaluate any given technology's potential to solve business issues that extend beyond readily available information about what the technology promises to do.

3. Knowledge of technology trends

4. Tools for finding and staging high-value technologies

Summary - emerging technologies that solves operation problems

Ergonomics - patient mobility devices such as lean-stand assisted lifts, sit-stand wheelchairs, lateral transfer devices, gait belts and repositioning devices, holds great potential to decrease workplace-related injury and disability, reduce costs and help ensure a healthier work force that can remain working

Wireless communication - consolidation of multiple platforms - electronic whiteboards allowing real-time tracking of patients, lab and ancillary results, room status, equipment status and triage state, RFID which tracks and records patient, equipment and staff movement throughout the facility

RTLS (real-time location system) - reduces hunting time for supplies, staff and patients

Point-of-care testing - moves testing to bedside, offering faster test results with fewer transportation-related errors. The ability to obtain quicker test results can increase efficiency and lead to shorter hospital stays and reduced complications

Modeling and simulation - used for training and credentialing, and facilities design

Remote patient management - increase the coverage of scarce specialists clinicians eg telemetry ICU. increasing life expectancy and the rise in chronic disease are driving development of new technologies such as sensors for independent living; remote disease monitoring of asthma, diabetes and congestive heart failure; remote device monitoring for cardiac implants and artificial joints; video-based care for stroke, psychiatric and dermatology patients, cell phone platforms for management, monitoring and testing; and TV, PC and robotic platforms for communication, education and information.

My Comments:

Technology plays a key role in improving healthcare delivery across the board. 'Innovation and care system transformation through technology are inevitable...Making this transition will require a willing ness to replace the standard practice of viewing technology as a capital budgeting decision with a a systematic, comprehensive approach for evaluating technology and its potential to address vexing business challenges and be innovatively leveraged in the service of mission and margin.

Reference: Technology in healthcare: leveraging new innovations by Marc G. Larsen FACHE, Healthcare Executive SEPT/OCT 2008, pg 9-14.

Strategy Execution & Leadership in Today's Uncertain Times

Key Thought:

A very popular topic at the moment in light of the financial crisis around the world today. Presented by Professor Paul Tiffany of University of California - Berkeley.

Summary:

- rationality is a western biased concept, there's a lot more at play particularly in Asian economies than hard, cold rational decision making - eg. fengshui, lucky numbers

- Risk management has always talked about pricing the risk, however, at some point, we moved to uncertainty, and that cannot be measured/mitigated using traditional understanding of risk or rational thinking

- things happen for a reason, people (customers) do not choose randomly, they choose for a reason, find out what is the reasons

- China will not be a dominant economy in the 21st century. Reason: innovation belongs to the second and third child, not the first. With China's one child policy, it will not work

- Interesting tidbit: UCB Nobel prize winners gets free parking. Greater incentive than money or position

- Paul Tiffany & associates will never recommend hiring first child as HR Director!

- On corporate structure, we optimize for effectiveness and efficiency, not suitable when we need to be flexible and responding to marketing changing condition

- Marxism concept: Marx was a change agent. Things happen oftentimes because of the environment condition, eg. Khmer Rouge. Kill everyone with glasses, start from a clean slate, too hard to change people

- Many CEO are Marxist and don't know it. Wholesale changes alienate the very people they are dependant on to make changes to turnaround company

- Hawthorne Studies - besides employees being more productive when being watched, recognition also improves productivity

- GURU - Geee...You are You, and being asked to pay for it.

- Values in a company is What You Are Willing to Reward

My Comments:

This presentation was part of HASS - KMDC Executive Series Co-Presentation. It was a useful synopsis of Strategic Planning and Execution. Good for those who are new to this area, unfortunately I am already familiar with most of it. Key thoughts I learned in these two days was Risk and Uncertainty. The networking was also fantastic.

Reference: Strategy Execution & Leadership in Today's Uncertain Times by Professor Paul Tiffany, Haas-KMDC Executive Series Co-Presentation, Dec 1-2, 2008.