Value Based Purchasing Changing the Culture of Accountability at an Academic Medical Center Christopher E. Rees, MHSA, MBA, 6σ Master Black Belt Director of System Quality and Accountability Medical University of South Carolina
MUSC Medical Center • Traditional full service AMC • Including a Children’s Hospital, Level 1 Trauma, Transplant, and Psychiatric Hospital • 55% - local 45% - non-local • Annual Admissions: 35,000 • Ambulatory visits: 800,000 • Beds: 709 licensed • Medical Staff: 700
Objectives Objective 1 • To describe the approach of an academic medical center to drive performance on value based purchasing measures through collaboration and coordination of service lines, medical staff and other strategic partners. Objective 2 • To demonstrate the effectiveness of using a standard methodology in tracking and documenting progress with performance improvement initiatives to drive accountability with results.
Future of Healthcare • Healthcare Reform Establishes Three Primary Missions': • Better health care • Better health • Lower costs through improvement
How did we respond in the past? • Top Down • Senior leaders identify opportunities • Dictate solutions • All management decisions / not true process improvement • Did not effectively engage frontline staff • No plan to sustain any gains
What didn’t work? • Did not have a solid structure to keep improvement in control. • Only a few people at the top felt accountable. • All opportunities and solutions came from the top. • Physicians were not formally involved.
So what do we do to change? • In FY 2010 we changed our quality structure in response to a less than stellar Joint Commission visit. • The foundations of our new structure was: • De-centralize – Quality is not owned by one department. • Enhance data reporting – Timely and Accurate. • Hold the right people accountable at all levels of the organization. • Standardize how we problem solved using proven methodologies.
Step 1 - De-Centralize • Established expectations that: • All Service Lines and Strategic Partners must create individualized improvement plans. • The ideas for improvement should come from frontline staff, faculty, and through review of current data.
Step 2 – Data, Data, Data! • Re-Designed Data Analytics. • Centralized function into one department. • Invested heavily in hiring the right types of people. • Created scorecards and analytical tools for service lines that were updated monthly. • Made it easier to request support.
Step 3 - Accountability • Developed a committee lead by the CEO and CMO that oversaw all of the activities. • Each Service Line and Strategic Partner reports monthly on their progress. • Their entire leadership team is expected to be there, including physicians. • All staff have specific goals on their evaluation.
Step 4 – Standardize Approach • Each uses the same format to report status and project progress. • All projects must follow the Hospital’s PI methodology – IMPROVE. • All improvement activities or managed by teams, not individuals. • Projects that stall are assigned a facilitator.
Data, Data, Data • Needed to be transparent with the data • Created Multiple Scorecards and posted them on the web. • Let people know where they needed to work • Sent letters to Attending when there was a failure with one of their patients
Total Results • Increased 31 Points in Process of Care • Dropped 2 Points in Experience but still exceed the threshold in all domains.
Next Steps: • Let’s face it were still not where we want to be! So we have a lot of work to do: • Ensure the faculty are all on board and working with the service lines / strategic partners. • Still have some service lines not making progress towards the goal. More focused support.
Conclusions / Take Away • This can be done, but it is a team effort. • Ensure everyone has access to accurate data in a timely fashion. • Standardize the expectations on reporting and documenting progress. • Use a standard approach to problem solving. • Make everyone accountable to improve!