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The UMMHC Management System

The UMMHC Management System. Eric W. Dickson, MD President & CEO,UMMHC. The Toyota Way. True North. Best Quality – Low Cost – Shortest Lead Time Best Safety – Highest Morale. Continuous Improvement. Respect for People. PDCA Learning Cycles.

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The UMMHC Management System

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  1. The UMMHC Management System Eric W. Dickson, MD President & CEO,UMMHC

  2. The Toyota Way True North Best Quality – Low Cost – Shortest Lead Time Best Safety – Highest Morale Continuous Improvement Respect for People PDCA Learning Cycles

  3. “It is impossible to improve any process until it is standardized. If the process is shifting from here to there than any improvement will just be one more variation that is occasionally used and mostly ignored. One must standardize the process before improvements can be made.” Masaaki Imai

  4. Early Internal Challenges • Four years of declining operating performance prior to being named CEO • 2/25/13 Dickson’s first day as CEO is spent working in the emergency department seeing patients – To his knowledge he killed no one that day. He has no president of the 700 bed medical center and no president of the 1100 medical physician group • 3/13 Interim medical center president appointed - medical center COO, Associate COO and CQO leave the organization • 4/13 MNA strike authorization vote at medical center passes • 5/13 MNA gives its mandatory 10 day strike notification – Hospital was emptied and replacement nurses brought in at a cost of ~ $10 Million • 7/13 Controller realizes they have been miscalculating the debt service coverage ratio and we are likely to default on our publicly traded bonds in October • 8/13 Moody down grades UMMHC inc to BB “Junk Bond Status” • 9/13 A patient on our psychiatry ward murders another patient on the ward • 10/13 UMMHC finishes the fiscal year with a $55 Million operating loss “its worst year ever” – CFO takes new position • Between 11/13 and 3/14 we laid off 600 people and sold 7 buildings to cut operating costs and avoid defaulting on bonds - morale is at an all time low • 6/14 CIO and CHRO leave the organization (50% of the executives in the organization turned over in the organization in the first 16 months)

  5. UMMHC operating performance 2009-2013 Operating Margin $ (2.7%) -55,100 FY2009 FY2010 FY2011 FY2012 FY2013 4 years of declining operating performance Source Audited Financials

  6. What would you do?

  7. “It is impossible to improve any process until it is standardized. If the process is shifting from here to there than any improvement will just be one more variation that is occasionally used and mostly ignored. One must standardize the process before improvements can be made.” Masaaki Imai Standardization is not the loss of autonomy it is the adoption of excellence.

  8. Define True North For the Organization Customer Satisfaction Employee Satisfaction • 0 Defects • 100% Value Added • 1 x 1 in Sequence • Challenge • Secure • Mental & Physical Safety

  9. Best Place To Give Care – Best Place to Get Care

  10. Unlike our Mission and Vision Statement True North represents a compact between management and the front line staff.  It is a commitment by management that we will work every day to meet the legitimate needs of our people and it is a commitment by our people that they will work everyday to meet the needs of our patients and the organization.  It's a commitment that everyone of us will work everyday to make UMMHC the best place to give care and the best place to get care. 

  11. Best Place To Give Care – Best Place to Get Care Our Patients Inpatient Mortality ED Borders AQC Gate Scores HCAHPS Access Score Our People Caregiver Engagement Our Long-Term Financial Health Days Cash on Hand Operating Margin Our Discoveries Number of Ideas Implemented Clinical Research Funding

  12. UMMHC Framework for Performance Excellence True North Best Place To Give Care – Best Place To Get Care • Measurement System Aligned with True North (True North Metrics) • system Level True North Metrics set yearly (Level 1 VMS) • Each level 2 and level 3 VMS has set of True North Metrics aligned with Level 1 metrics Strategic and Operating Plan Aligned with True North UMMHC/UMMS joint strategic plan updated every 5 years. UMMHC strategic plan updated twice yearly as informed by ~ 25 different strategic planning events held across the organization each year Project Management Strategy is broken down into 10 Mother A3s at system level each assigned to one executive (Level 1 VMS). Each level 2 and level 3 VMS has baby A3s aligned with mother A3s Performance Management Individual Goals Aligned with True North Metrics and Key Behavioral Indicators Engage Everyone Everyday in Improving Our Processes and Executing Our Strategic Plan Unit Based Idea System (level 3 VMS)

  13. System Entity Department

  14. Level 1 – UMMHC (system) Level 2 - Individual Entities and Major Business Units (IT Marketing etc..) Level 3 – Individual patient care areas and business units Aligning the Organization With True North Using 3 Levels of Visual Management

  15. How do you get your board to understand this? True North Best Place To Give Care – Best Place To Get Care • Measurement System Aligned with True North (True North Metrics) • system Level True North Metrics set yearly (Level 1 VMS) • Each level 2 and level 3 VMS has set of True North Metrics aligned with Level 1 metrics Strategic and Operating Plan Aligned with True North UMMHC/UMMS joint strategic plan updated every 5 years. UMMHC strategic plan updated twice yearly as informed by ~ 25 different strategic planning events held across the organization each year Project Management Strategy is broken down into 10 Mother A3s at system level each assigned to one executive (Level 1 VMS). Each level 2 and level 3 VMS has baby A3s aligned with mother A3s Performance Management Individual Goals Aligned with True North Metrics and Key Behavioral Indicators Engage Everyone Everyday in Improving Our Processes and Executing Our Strategic Plan Unit Based Idea System (level 3 VMS)

  16. Helping the board learn to see • Recruit people that get it or are at least open to it • Onboard them to the management system on day one • Visit a high performer • Gemba walks • Develop them the same way you develop your people • Make it visual, make it visual, make it visual

  17. Level 1 Visual Management System

  18. Level 2 VMS (Medical Group)

  19. Level 2 Projects Aligned with Level 1 projects

  20. Medical Center (Level 2) TNM aligned with System (Level 1) TNM.

  21. Level 3 TNM aligned with Level 2 TNM 1. Connect 2. Translate 3. Filter

  22. Level 3 Level 1 System Entity Level 3 Level 1 Department

  23. Unit Based Idea System (Level 3 VMS) Patients People Financial Sustainability Innovation A place on every unit where the team comes together at an idea board, talks about performance (TNM), ideas for improving performance, tracks progress on ideas being implemented (PDSA) and celebrates success.

  24. Inpatient Nursing Units 3 Lakeside Step Down 6 West 4 Admissions Unit 3 East & West 4 East & West 5 East

  25. Maternity team ideaFunded from Innovation fund Maternity team at Memorial requested materials to educate families on safe sleep practices, which is a focus of DPH this year. The team identified a book for families and designed a visual reminder of the safe sleep position. Congratulations to the Maternity team!

  26. Current State Level 3 VMS • Idea systems now exist in 400 business units • Over 35,000 front line staff ideas implemented • All executives now huddle weekly with front line staff in there own areas plus an area not under their control (spread) • Idea of the week published across the system in Everyday Innovators Blog • All new employees receive 4 hours of idea system training • Monthly innovation celebrations across the system • Yearly Champions of Excellence Celebration (~600 people) and $10,000 Innovators of the Year Award given out by BOT • Innovation fund created in FY 2015 Process has been defined and embraced by most including organized labor

  27. Best Place To Give Care – Best Place to Get Care Our Patients Inpatient Mortality ED Borders AQC Gate Scores HCAHPS Access Score Our People Caregiver Engagement Our Long-Term Financial Health Days Cash on Hand Operating Margin Our Discoveries Number of Ideas Implemented Clinical Research Funding

  28. https://www.youtube.com/watch?v=Y_e0R-ExExE&feature=em-upload_ownerhttps://www.youtube.com/watch?v=Y_e0R-ExExE&feature=em-upload_owner Best Place To Give Care – Best Place to Get Care

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