Results

Organizational Change & Improvement

The Client: A 900-bed trauma hospital with teaching and research responsibilities and 7,000 employees

The Situation: After 35 years of stability the hospital replaced a number of key leaders (CEO, COO, CFO, VP Nursing, etc.) over a short period of time. At the time, the hospital was involved in a very public and negative examination of its quality by the state Health Department. The new COO realized that he had to improve quality and customer service, increase two-way communications with employees and begin to eliminate organizational silos in order to jump-start an effective outcomes improvement plan, and begin to correct the public and state perception of poor quality.

The Results: Guided by Focus 5, hospital executive leadership, along with other formal and informal leaders, designed an approach to reach and involve every employee every month in generating improvement ideas, carrying out appropriate interventions and measuring success. 100+ departmentally based teams were established. These teams are led by trained managers and guided by full-time, management level Process Facilitators. Hospital Focus 5 developed the training for both the “change agent” managers and the Process Facilitators, utilizing just-in-time techniques and incorporating Lean and Six Sigma methods.

Organizational Change and Survival

The Client: A 150-bed community hospital.

The Situation: Facing a rapidly declining financial situation a hospital made up of two newly merged community hospitals found itself struggling with single digit patient satisfaction ratings and a lack of community support for its plan to build a new replacement facility in addition to its failing finances.

The Results: We targeted the impending financial failure as the key priority, but realized that a “slash and burn” approach would not resolve the issues surrounding satisfaction levels or support. Consequently, we developed an organization-wide effort involving all employees and physicians focused along two directions: patient care and satisfaction and cost reduction opportunities. In the first six months following development of a concrete plan, several thousand ideas were generated, prioritized and then developed for implementation by front-line staff. Over the next decade, following their plan, the hospital rose to the 99th percentile in patient satisfaction; the hospital became the most financially successful in the state; and a new 200 bed replacement facility was approved and built. Later, four additions to the new, growing organization were also approved and completed.

Improving Customer/Patient Experience

This client’s need was to develop criteria to establish an “Ideal Customer Encounter” within multiple ambulatory care sites across a large metropolitan service area.

The Client: A 500-bed hospital system flagship hospital and its ambulatory network.

The Situation: A clinic based ambulatory care network associated with a multi hospital system realized that it was operating in an increasingly competitive marketplace. It recognized that both customers and payers were becoming more demanding as they became more sophisticated in understanding and expecting excellent customer service. The network understood that proactively responding to these new demands could provide a competitive advantage to the ambulatory care sites.

The Results: After extensive assessment of the existing operations and working with staff to develop targets for improvement and a defined protocol for the “Ideal Customer Encounter”, the delivered plan included steps to:

• Strengthen the Patient Access Initiative already in progress and redesign the access system by the end of the year.
• Draft a detailed, prioritized information technology (I.T.) plan for ambulatory that should be undertaken as soon as possible, since many of the ideal customer encounter initiatives require IT support.
• Transition to coordinated, consistent, ambulatory-care focused leadership, and move away from the current structure under which individual ambulatory site services reported only to their hospital based department, with no ambulatory function based leadership.
• Use templates supplied by the consultants to continue internal work on developing specific, measurable customer service standards.
• Improve wayfinding through the use of preregistration information and telephone calls.

Organizational Change

This client’s need was to develop a comprehensive approach to joining three organizations to build a new medical center that maximized the benefit to all parties, including the citizens of the community.

The Clients: Three organizations, an academic medical center, a 40-physician group practice owned by the academic medical center and a 100-bed community hospital.

The Situation: Each of the three organizations had been independently exploring the possibility of developing its own replacement facility or facilities in a community of 25,000 located 60 miles from a major city and 40 miles from a nationally known tertiary and research hospital. Options discussed included building two separate buildings on the same land, building a replacement clinic on the existing site, providing separately owned operations in one building or integrating hospital and clinic operations and facilities at a new site. Prior to our involvement, three other consulting firms had completed prior studies that had been deemed unsatisfactory.

One unusual aspect of this consulting assignment was that two of the major parties involved in the study (the group practice and the local hospital) each believed that the project could go forward with no financial or programmatic “sacrifice” on its own part, only the “other” party must sacrifice and absorb the changes.

The Results: After working over a protracted period with the Board, leadership from the hospitals and the group practice, and community leaders, we delivered recommendations to:

• Understand the significant cost of the new facility.
• Postpone plans for construction of a new, joint facility for at least a year.
• Establish a building fund.
• Move some physicians into the existing hospital building to solve short-term space issues.
• Develop several joint (hospital-physician) projects to gain additional experience working together.
• Reduce costs in specific identified areas.

Management and Operations Assessment

This client’s need was to assess their management, staffing and customer service levels.

The Client: A Research and Clinical Specialty Institute of a Medical School.

The Situation: While it had established a worldwide reputation for innovation and clinical quality, the Institute was also known for its poor customer service. This poor service was occurring at a time when other Medical Schools and individual physician specialists (many of whom had trained at the Institute) were beginning to compete with the Institute on many patient procedures.

The Results:

Specific operational recommendations included:

• Put Institute policies and procedures in writing and distribute them.
• Update all CPT codes to reflect codes currently in use.
• Create and distribute a list of insurance companies that have a relationship with the institute.
• Create a “One Call” center to resolve patient and insurance company questions on billing.
• Set a goal of dramatically lowering the existing error rate on patient bills from its estimated 50% to 1%
• Create a process whereby each patient receives financial counseling and the option of a payment plan prior to treatment and see to it that the plan is carried out through the course of treatment.
• Create, with physician input, a list of standard charges.
• Establish an Institute-wide policy on discounts from standard charges, who can authorize discounts, for what reasons, etc.
• Develop a process to reward physician referrals and to inform referring physicians of clinical results obtained.

Service Quality Improvement Project

In this project, a children’s hospital required the creation and facilitation of a retreat for the Board of Directors to define their direct role and accountability in badly needed quality improvement efforts.

The Client: A major children’s hospital with teaching and research missions.

The Situation: Over a two year period, a number of serious breaches in patient quality and safety had resulted in multiple sanctions and fines by the state Department of Public Health, lawsuits by families, the termination of a long-serving CEO, growing employee turnover and public questioning of the quality of care provided by the hospital.

The Results: Following the intense retreat, the Board of Directors took a more active role in their responsibilities regarding quality improvement. They enabled hospital executive leadership to involve physicians and employees in quality improvement goal setting and implementation, and in measuring its success. With Board backing, the new measures would keep a visible focus on improving quality of outcomes, would be proactive, and would encourage buy-in at all levels throughout the organization.