A distinguished panel of healthcare executives recently shared their thoughts on the importance of leaders taking an active and visible role in their organization’s quality initiatives. They also agreed on the need for organizations to develop the right management systems and structures to adequately support their quality efforts, measure outcomes and encourage accountability.
Speaking on the campus of Harvard University in Cambridge, Massachusetts, USA, at the 2006 Quality Colloquium, the four executives were:
Since beginning a major improvement initiative in 2003, New York Presbyterian Hospital has achieved significant results in terms of quality, satisfaction and financial outcomes – with an additional $68 million to the bottom line. It moved from No. 11 to No. 6 on the U.S. News & World Report list of top hospitals in the country, received two awards at the 2006 Global Six Sigma Summit, and was a finalist in the American Hospital Association-McKesson Quest for Quality Prize. Dr. Mary Cooper noted, however, that it is not about the awards, but about focusing on continuous improvement and doing the right thing for the patient.
“Early on, we understood that if you had good quality, you could achieve all your other objectives – financial stability, patient satisfaction and so on,” said Dr. Cooper. “We used the Six Sigma toolkit as a paradigm change in our organization. The concept of measurement is critical – and more importantly the notion that people can come up with new ideas and new ways to solve problems.”
Starting in 2000, New Jersey’s Virtua Health took a series of steps designed to support its Star initiative and move the organization from “average” to “excellent.” Its progress and results have been so amazing that it has become a model for other organizations, and Virtua also has been recognized through numerous awards. Virtua has seen both higher quality and a healthier operating margin. As CEO, Rich Miller has been a champion for change in the organization.
“Whether it’s Six Sigma, Lean or something else, it’s important that the CEO is very active in the initiative,” said Miller. “I attend every Six Sigma report-out on a monthly basis and I’m involved in our best-people review. We also brought in a new learning and leadership approach and this has fundamentally changed our organization. It has really put accountability in the system and that was key.”
Based in Harlingen, Texas, Valley Baptist Health System also has seen tremendous results through the deployment of Six Sigma four years ago, and more recently through the adoption of new management and leadership systems that help to align all of the system’s strategic initiatives.
“I had worked in other settings before coming to Valley Baptist,” said Jim Springfield, “and I’d observed basically the same set of problems – they’re everywhere in healthcare. So we adopted some of the change management and Six Sigma tools. It’s about starting with the customer, to really understand and meet their needs. And it’s about continually raising the bar in terms of performance.”
Springfield noted that not only has he attended every single R4 report-out in the last four years, but he also asks pertinent questions and demonstrates his sincere interest in what the various project teams are doing.
“In many organizations, quality is relegated to a quality director to get things done,” he said. “And that’s important, but it’s not connected to the management structure. At Valley Baptist, we made a commitment to make our management process and Six Sigma one and the same. People need to know their senior leaders are interested and supportive. This is a central point in a successful quality initiative.”
As CEO at Nebraska Medical Center, Glenn Fosdick has always placed a strong emphasis on sustainable quality. The center’s Six Sigma program began in 2002 with specific goals to help the organization: 1) achieve measurable, sustained results that significantly improve key processes, and 2) advance focus and commitment to continuous quality improvement. They were recently recognized for service excellence under the J.D. Power and Associates Distinguished Hospital Program, acknowledging a strong commitment to provide an outstanding patient experience.
“We have had quality initiatives for a long time in our organization,” Fosdick said. “Bringing the Six Sigma tools in allowed us to have a common approach to issues and has given us great strategic advantages. In addition to better quality results, the structure we’ve put in place is working well for us financially. We haven’t laid anyone off in four years.”
“I didn’t make this negotiable,” Springfield said of the initiative. “I said we’re going to do this – it’s a journey, and it will be our operating system. If you can commit to it, great. If you can’t, we’ll serve as a reference for you. We used to have quality councils without leadership representation, but we’re using a year-round management structure now, with one common approach. Many of our board members have actually consulted our Six Sigma teams for issues they deal with.”
“When we began our initiative, it was about partnering with physicians and nurses at the bedside,” said Dr. Cooper. “We went out to enlist their participation and to make sure they understood what we were doing and how it would benefit patient care. Management staff are now our strongest supporters because we were successful in getting the clinicians on board first.”
“Without that senior leadership support, you face an incredibly tough challenge,” said Fosdick. “And it can’t just be the CEO – you also have to involve the board. It has to be a fundamental principle of the organization. We work closely with the board, and we have even involved the board in a project around our medical credentialing process.”
Successful initiatives can have a motivational impact on the workforce. New York Presbyterian Hospital recently received 103 applications for 10 open Black Belt positions – a testament to the fact that more people both inside and outside the organization have seen the program’s success and want to be involved. Virtua Health also reports that many top performers are waiting in line and recognize the value of participation in terms of career development. “The Black Belt role is now growing to become a senior role in the organization,” said Miller.
In some cases, healthcare organizations have been hesitant to embrace methods like Six Sigma and Lean because they worried about the investment of money, time and resources that might be involved. Springfield’s response to this is unequivocal:
Here are examples of core operating room performance indicators provided by the Healthcare Financial Management Association:
“Healthcare is generally ineffective and we focus on the wrong things,” he said. “So we asked how can we afford not to invest in this? We initially spent a lot of money – but we got a huge return, qualitatively and quantitatively. I would counsel other organizations not to take a shallow view. If they don’t want to make the investment, they may be saying they don’t believe they can get these results. You’re investing in better quality and the capability of your people.”
Miller concurred with the value of such an investment. “There used to be a mindset in healthcare that raising quality meant raising the costs. But we’ve learned that, in many cases, higher quality also means lower costs.”
“We’ve always included finance as part of our projects to measure results,” said Fosdick. “But when you go to a department and you’re only talking about money, you won’t get the buy-in. For a successful project, you need to improve outcomes, increase efficiency or make somebody’s job easier. If all you’ve done is make someone’s job easier, it’s well worth the effort.”
Dr. Cooper noted that return on investment from projects also is monitored at New York Presbyterian Hospital, but not always in financial terms. “Sometimes it has to do with patient safety or service excellence,” she said. “We’ve had numerous CMS and JCAHO visits and we were able to show what we’ve done to improve.”
Tools such as Six Sigma can be applied to solve a variety of issues. “But first and foremost,” said Miller, “you have to develop a culture in your organization to become more accountable. We do this through a rigorous operating system that gives us greater predictability in managing our organization. The important thing is to measure everything you do, and hold people accountable for results.”
While there are many examples of success in the industry, not every hospital or health system may be immediately ready to take on a full-scale improvement initiative. Successful leaders might advise their reticent peers to at least consider projects that could produce pockets of change in order to demonstrate a new approach and build momentum. Given the challenges facing healthcare today, wherever the starting point may be, complacency does not seem to be an option.