Through the years, I have been in healthcare leadership positions located in settings that are as culturally diverse as they are geographically. Areas as different as the temperate and sunny but traffic congested city of Los Angeles; the quiet, and beautiful but often resource scarce, farm and ranchland of rural Oklahoma; and the exciting but very crowded international commercial center of Shanghai, China.

What I have found from living and working in these places and becoming acquainted with so many beautiful, but seemingly very different and diverse people, is that healthcare consumers are not as different as they first appear.

What I have discovered is that healthcare consumers are customers and that when you boil everything down, what they want is the same as any other customer. They all want convenience, short waiting times, cleanliness, comfort, safety, respect, courtesy, organization, competency, honesty, confidentiality, clear communication and good results.

I realize the aforementioned customer preference descriptors are very common and general in nature and maybe not very helpful unless they can be translated into understandable specifics which can then be implemented into the daily actions and behaviors of our organization. We want to put them on an operational improvement check list and then check them off one by one. If is tangible, concrete and it feels good to check those boxes; a feeling of tangible accomplishment. But I have found that as important as the tangible operational improvement check list is, what is more important are the intangibles and how do we make our customers feel. Because like it or not the bottom line for our organization’s brand and image and ultimately the very success of its mission is how do our customers feel after they use our services and how does this compare to how they felt before they entered our doors.

We are all emotional beings with numerous feelings inside, so how our customers feel after visiting us is not just about their physical condition but also about their emotional and mental well-being. Operationally there are many things we can do to address and improve the tangible parts of our facilities and make the lobbies more beautiful, the front desks and hallways tidier, the furniture more comfortable, the rooms quieter and more private, the medical information secure and confidential, etc., etc.., but what about the intangibles? How do we make our customers feel respected, feel cared for, feel heard, feel important? How do we make our customers feel that we will take care of them and thus make them want to come back again?

Healthcare is still a service industry, not a manufacturing industry. Operational efficiency will only take us so far. Customer Service is created by the people inside our facilities, by what we do and how we do it. In other words, it is dictated and driven by “Our Culture” and as the famous business management guru, Peter Drucker once said, “Culture eats Strategy for dinner every time.”

Culture drives everything and comes from the top down. Putting customers first, caring for them, respecting them, listening to them, must be exemplified by the leadership team not just in word, but in action. And not just shown by the way we as leaders treat our customers but also in how we treat our staff. I made a commitment to speak at every opportunity to all new hires in my hospital during their Orientation, and one thing I said I had learned is we must treat our staff the same way we want them to treat our patients. We cannot care for our patients if we do not care for each other. And our kindness and compassion must be genuine. People cannot be fooled with fake kindness or slight-of-hand courtesy. We must never be so busy that we do not make our customers - our patients and our staff the #1 priority in action and deed.

Creating an authentic customer service-oriented culture that genuinely cares is not easy, but it is what I have found to be the single most important and strongest driver for operational, financial and marketing success of every hospital team I have ever had the pleasure and privilege to lead, whether in Los Angeles, Rural Oklahoma or Shanghai, China.

We all know that the secret sauce to success is having the right ingredients of skills, knowledge and abilities. Skills and knowledge can be gained through educational training, work experience and mastery through practice. The abilities often revolve around the “soft” skills you possess. One definition sums it up for me – “Soft skills are the personal attributes, personality traits, inherent social cues, and communication abilities needed for success on the job. Soft skills characterize how a person interacts in his or her relationships with others.” (Source: The Balance)

Why are these skills important? Have you met a highly qualified and brilliant person who may be struggling in their career? Well, chances are that their EQ (emotional quotient) may not be as high as their IQ (intelligence quotient). Teamwork, communication, leadership, listening, negotiation, self-promotion, critical thinking, conflict management, innovation, flexibility, emotional regulation, persuasion - the list maybe endless depending upon your professional niche. But these skills help you better utilize your technical skills and be more effective and competent in what you do. Lack of these skills can also be “derailers” to your success. We spend years sharpening our “hard” skills through school and continuing education, certifications etc. But not enough attention is paid to investing in cultivating the soft skills which are much harder to master but can really differentiate you in a highly competitive market. Although some of these abilities maybe innate, most of them can be developed through awareness and deliberate practice.

Through heightened emotional intelligence, you can learn how to balance the rational and limbic systems in your brain and enhance your personal and social competence. The four core skills of emotional intelligence are – self-awareness, self-management, social awareness and relationship management. As you advance through the various domains, the soft skills become easier to master. The first step is to identify key skills that are necessary for success in your chosen field. You can do this by reviewing “job descriptions” for positions like yours, speaking with role models, mentors, industry stalwarts. The next step is a self- evaluation exercise to help you identify which of these skills you possess and how strong they are and, which skills are areas for opportunity. There are several tools out there that can be used like Myers-Briggs, DiSC, Stengthfinders, Hogan Leadership Assessment, Leadership Circle Profile 360. You can also work with a coach on this and the next step. The final step is reviewing the assessment results and laying out an action plan to address the gaps and strategize on improvement. Behavioral change takes time and baby steps will help you get there.

Over a series of blogs, we will explore several of these skills that can magnify your success, both personally and professionally. Stay tuned!

As a job-seeker, one of our biggest pitfalls is failing to align ourselves properly with the position. Simply put, we use our language and not their language, otherwise known as the wording used within the job description. Your accomplishments and job experiences may fulfill all they are asking for and then some, but if you fail to communicate it in the organization’s words, your cover letter and resume are likely to get tossed aside and overlooked.

How to properly align your cover letter and resume with the job description.

1. Read it. It may sound basic, but so many people don’t truly read. As you read it, highlight key responsibilities or recurring elements throughout the description. These are “their words” or the phrases that you need to use in your cover letter and resume.
2. Next, tweak your cover letter and resume to include those critical elements. Use your existing accomplishments to support their words. Often it helps to use their language as headers and even bold them, creating a bulleted list of your accomplishments beneath it. Your goal is to make it as easy as possible for them to see you are aligned perfectly for the position, even if you do not have the typical background.
3. Also important is to close your cover letter with a short paragraph showing you identify with the mission and culture of the organization. You may or may not be able to glean this from the job description. If you can’t, do further research online and through your own network connections.

Aligning yourself with the job description may give you the edge you are looking for, effectively separating yourself from the competition. It also sends the message to the hiring manager that you have given their position thoughtful consideration by taking the time to cater to their organization specifically. You can bet this personal touch is noted and appreciated.

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2017 has been a turbulent year for the healthcare industry. Not only have we seen tremendous disruption in technology and innovation, but also more consolidation and strained resources. Natural disasters across the country and the unstable economy have added to the mounting pressures. Leaders have been challenged to do more with less, like never before. You may be using predictive analysis tools in strategizing for your organization, but have you looked at your personal toolkit to see if you are ready for what’s in store in 2018?

At Wiederhold & Associates, we consider three key ingredients for success – history, process, and relationships. Here are some techniques to proactively and methodically plan for a successful 2018.

History:

• List of accomplishments - Do you have a list of professional achievements for the year? Grab a pen or type out a list, before you forget! It is important to keep track of any milestones, at work or outside, that have been proud moments for you. As time passes by and memories fade, you may lose track of things that may have significance in the future. Doing a quick year-in-review list of accomplishments will help you document and keep these fresh. Or even better, start a business journal and keep it updated throughout the year.
• Resume - When was the last time you updated your resume? You do not have to be actively looking for a job to keep your resume updated. In times like these when change is inevitable and happens at lightning speed, it is always a good idea to periodically update your resume especially with new skills, accomplishments or credentials that you may obtain along the way. The same applies for your LinkedIn or any other social media profiles.
• Self-assessment – Have you done a gap analysis for yourself lately? There are several assessment tools available but even a simple exercise of listing any new skills that you have learned or honed, assessing any areas that still need development, and identifying ways to work on these ensures that you are focusing on your professional growth. The core competencies for roles have steadily evolved, and what measures were used to assess your performance even five years ago may not be as relevant as what is needed in the future. Do you have a competency checklist for the types of roles you see yourself in and are you diligently working towards building/polishing those skills?

Process:

• Personal Brand – Have you “Googled” yourself lately? Always be aware of what is floating in cyberspace about you. Reputation management is an active and lifelong task of maintaining your personal brand. At times you may find yourself caught amid a media blitz not of your own doing or liking. Being aware, and taking necessary and proactive steps to protect your online brand is critical to your professional success.
• Goals – Do you have a SWOT analysis for yourself? Once you have identified strengths and areas of focus, set SMART goals for yourself. Ensure that your personal goals align with your organizational goals, if there is dissonance it is time to reflect! Where possible, have discussions with your boss to find synergies that will benefit all parties.
• Action Plans – Do you have clear action plans to achieve your goals? What skills/experiences are you missing in your toolkit and which ones do you plan to focus on in the coming year? How will you measure success?

Relationships:

• Networking - The holidays are a great time to reach out and reconnect with individuals in your network. It also offers a lot of social opportunities, holiday parties and gatherings to meet new people and expand your network. With work slowing down some, and the holiday cheer around, people tend to be more open to giving and receiving. A great time to nurture your relationships!

So, celebrate your accomplishments in 2017 and ring in the New Year with confidence and assertion. Cheers to your success in 2018!

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The holidays are the perfect time to reconnect with old friends and colleagues that you may not have spoken to in a long time. The season is full of celebrations and parties where you are in the presence of a lot of untapped potential. Potential to make a connection. Spark or rekindle a new or old friendship. Networking is all about finding connection points.

Finding that common ground that endears you to the other person and during the holidays, those connections come even easier with the added ingredients of warm fuzzies (eggnog anyone?) and a healthy dose of good cheer. So, when you are headed to the next holiday party, don’t groan and moan and count the hours until you can be home in front of the fire, look at it as an opportunity to widen your net and build up your network.

How to work a room:

1. Don’t stand by the front door. When people first arrive to a meeting or party they are nervous and looking for a place to put their things or visit a bathroom. Standing by the door is a sure way to get overlooked.
2. Spend only five minutes with each person you meet. This is long enough to listen to what makes them unique and for you to establish a connection within exchanged pleasantries. Get their business card and offer yours if asked in return.
3. Make notes on their business cards. Anything that will help you remember that person when you look them up later is invaluable. There is no way you can keep everyone you meet straight and that one detail about that person could be what gets you that future meeting. It adds the personal touch.
4. Follow-up. Think of how many times you given out your business card. Now think about how many times someone used that business card to reach out to you after the fact? Part of working a room successfully lies in the follow-up. Connect with the person on LinkedIn, shoot them a quick note telling them how nice it was to meet them and add the fun fact about them you jotted down on their business card.

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In lieu of mailing holiday cards, and in keeping with the spirit of giving during this time of year, Wiederhold & Associates has made a donation to a charity in honor of our clients, network members and friends for being a part of our lives this year. For 2017, due to the amount of natural disasters the U.S. faced this year, we have selected the Salvation Army as the recipient of our donation.

The Salvation Army helped with all the hurricanes that hit the U.S. this year and are currently assisting in California with the wildfires. More information on their efforts can be found at Salvation Army news.

We at Wiederhold & Associates hope and pray that you enjoy a happy and safe holiday season. As you enter the New Year, never forget what is most important: your faith, your family, and your friends.

Jim Wiederhold and

The Wiederhold & Associates Team

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Recently, I became certified in the Leadership Circle Profile, the most comprehensive leadership assessment system available. This is the second assessment I added to my tool chest focusing on leadership. The first was the Hogan Assessments. Together, these are a powerful measurement of where a leader is now and how he/she can improve. That decision has to be made around internal change.

The Leadership Circle Profile is a true breakthrough among 360 profiles. It is the first to connect a well-researched battery of competencies with the underlying and motivating habits of thought. It reveals the relationship between patterns of action and internal assumptions that drive behavior. Ultimately, the Leadership Circle Profile goes to a source of behavior to get greater leverage on change.

Second, the profile creates much more than just a list of behavior competencies. The Leadership Circle Profile Results are organized into a very powerful system for understanding human behavior and development, as well as for making sense of the interrelationships between the many dimensions of yourself. Unlike most profiles that take hours to interpret, the Leadership Circle Profile integrates all this information in a way that brings the key issues to the surface instantly.

The data in the Leadership Circle Profile reveals itself in seconds.

At a glance, the whole gestalt is accessible-putting leaders in touch with what is working, what is not, and why!

In most organizations, this treasure trove of information remains buried. Leadership Circle Profile makes it easily accessible

The Leadership Circle Profile provides you with a leadership MRI, giving you the entire picture in one diagram. I am proud to offer this tool to my clients who are ready to evaluate their inner leader and discover how to bring him/her into their everyday life.

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The most important thing to remember about employee engagement is that it is an emotion that drives employees to want to achieve more for the organization where they work. Now a lot of business leaders don’t like dealing with employee emotions and that is what makes it difficult. Wall street and corporate America knows that they must capture the hearts of their customers to achieve repeat business. Do you remember the Coke commercial with a diverse group singing in harmony? Do you remember the various Nike commercials with sports success as an emotional theme? Yet such campaigns to capture the hearts and minds of our employees is viewed as being a frivolous business strategy.

Quint Studer was making a key statement about employee emotions when he refers to the concept of “connecting to purpose”. Without a connection to purpose it is just work and there is no emotion to drive employees to achieve excellence for the patient, the customer and the organization.

There are three key factors to improving employee engagement. Communication, leader accountability for results and creating a culture of employee participation in making the organization the best it can be.

Communication is one of the keys to getting improved employee engagement. Everyone wants to be a part of something bigger than themselves. The fans of great sports teams always “brag” about how “we” beat this team or that team. At work, does your team talk about how much better they are than the competition? Or do they talk about how bad things are where they work. Great teams have lots of pride about what they do, how they are the best and how they do so much better than the other guys. Just like great sports teams, employees need to feel like they work for a great organization and they contribute to the outcomes of greatness. In order for employees to feel they are part of this greatness, the organization must be communicated how great “we are” and how “the employees make this happen”.

Too many leaders talk about how bad things are, and how hard it is to make budget, how many mistakes we make, etc.. Generally, there is too little talk about the accomplishments, the high performance of our staff, their caring attitude and how we cannot survive without these great people. We must communicate to our staff how great they are and build their self-image. One thing I have learned through over 30 years of HR Experience: Employees who feel worthwhile will always outperform those who feel unworthy. If you don’t think your team is great, get rid of them and get a great team (I have never been an advocate of keeping low performers). But, keep in mind, great organizations need great leaders, and great leaders are able to grow and support great teams. Teams that have great leaders will bring great results.

Leader accountability: Leaders must be held accountable for their department, unit, division, result that they have oversight for… In other words, RESULTS for financials, quality, growth, customer service and EMPLOYEE ENGAGEMENT. They must be held accountable for result for their area of responsibility. If the various pieces of the house: walls, foundation, floors, doors, etc. are not well constructed how can we expect to have a great home? Every department must focus on engagement for their team.

Employee participation. Have you heard the statement “people support the decisions they helped to make”? I think most people would agree that organizations that empower staff to make improvements to their jobs get better organizational results. Many performance improvement programs such as Lean, are built on the concept that employee participation is key to achieving lower cost, higher quality and better outcomes, and yes greater employee engagement… Why? Because I am proud of my contributions that create better outcomes for myself, my team and the organization.

“Imagine the personal and organizational cost of failing to fully engage the passion, talent and intelligence of the workforce. It is far greater than all taxes, interest charges, and labor costs put together.” STEPHEN R. COVEY

We are grateful for our clients, associates and friends.

Wishing you and your loved

ones a Happy Thanksgiving!

Jim

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Introductory Comments:

The healthcare industry is at a crossroads. Consumerism, regulatory requirements, payer requirements, employer demands and other factors are driving forces for change in service delivery. Now is the time to get it right. We need to reduce cost, control utilization, streamline delivery of care, deliver care in a manner that exceeds patient expectations at all times, manage the health status of the communities we serve and demonstrate continuous improvement in achieving best in class clinical outcomes.

The industry, as a whole, needs to focus on the “Triple Aim” (low cost, service oriented and high quality). In doing so, we cannot neglect that we can only navigate the course to achieving value based results with a high performing team of leadership representatives, management representatives, physicians, other clinical providers and staff, thus achieving the “Quadruple Aim.”

We must engage and empower our clinical and non-clinical workforce to maintain professional satisfaction and reduce the risk of burn-out from expecting more without addressing resource requirements. It is not easy, but it can be framed in a simplified philosophy of Performance Excellence. Performance Excellence (Operations, Service and Clinical) is the gold standard by which healthcare teams will be measured.

Is your physician enterprise designed to allow every member of your organization to autograph their work with excellence?

Workforce (physicians, advanced practice providers, clinical and non-clinical staff) engagement at all levels of your organization is essential to move forward in today’s ever-evolving healthcare market. A Performance Excellence Philosophy provides the systematic methodology to engage your workforce in achieving results.

The Baldrige Excellence Framework (Healthcare): As Systems Approach to Improving Your Organization’s Performance empowers your organization to reach its goals, improve results, and become more competitive. The framework consists of the criteria, the core values and concepts, and scoring guidelines to use as reference, to self-assess, or as a basis for external assessment. Whether or not your organization is “award and recognition oriented,” today’s ever-evolving healthcare environment creates to perfect opportunity to take a step back and assess your ability to achieve value based results.

Through active inquiry regarding your organization’s culture, you learn and develop your ability to accomplish what is important to your organization. A community/customer/patient centered philosophy, along with the critical aspects of: Leadership/Governance; Vision/Strategy; Measurement, Analysis, and Knowledge Management (through data analytics); and Operational Work Processes and Process Management, allows you to evaluate how prepared you are to achieve VALUE BASED RESULTS.

Through internal ASSESSMENT you may find that your organization needs external resources to develop the necessary structure and infrastructure to achieve your VISION. Experienced leadership with a demonstrated track record of achieving results within physician enterprise organizations may be difficult to find. You may need Interim Leadership and Management Advisory Services with the Resilience to do the “initial heavy lifting” of positioning your enterprise for high performance.

Today we explore ways to assess your systematic approach for delivering value in your communities.

Assess Your Physician Enterprise through a Systematic Approach

You need a systematic approach to assessing your physician enterprise ability to achieve results. You need a framework to deliver value. The challenge is to critically assess to learn how you are accomplishing your vision and strategic priorities. Today we pose several key questions to begin to assess your organization’s readiness to achieve value based results.

Has your organization set a strategic priority for achieving value based results in your physician enterprise?

How has your organization set a strategic priority for achieving value based results? “Value Based Care is Here to Stay”:

Vision and Strategy-Questions to consider:

Is it important to your organization?
Have you established a shared Vision of physician integration to achieve value based results?
Is your organization prepared to create greater value in the communities you serve?
Does your organization have the leadership with the demonstrated competency of RESLIENCE to navigate the path to value?
Do you need Interim Leadership or experienced external advisors to assess and develop your physician enterprise ability to deliver value based results

Please see Assessing Your Vision and Strategies, to begin your assessment: You may also request a copy from: This email address is being protected from spambots. You need JavaScript enabled to view it.

It all begins with LEADERSHIP:

Leadership must promote a systems perspective. A systems perspective means managing all the components of your organization as a whole to achieve ongoing success. A healthcare system has many inter-related, but not always highly integrated, components. Each component must be led and managed to function as a high performing organization within the context of the entire system. Most importantly, your physician enterprise (whether an employed network or Clinically Integrated Network) must demonstrate a successful track record of achieving results.

Assess your leadership and management structure to achieve results:

“Achieve Results-Leadership and Management”

Question to Consider-Leadership:

Do senior leaders lead the organization, consistent with your systematic approach?

Please see Assessing Your Leadership/Management, to begin your assessment: You may also request a copy from: This email address is being protected from spambots. You need JavaScript enabled to view it.

Governance:

How does your governance structure oversee your physician enterprise and address your organizational ability to achieve value based results?

Assess your governance structure to achieve results: "Governance”

Governance - Questions to Consider:

How does your organization ensure responsible governance of the physician enterprise?

How does your governing achieve accountability for:

• senior leaders’ actions
• strategic plans
• fiscal accountability
• transparency in operations
• selection of governance board members and disclosure policies for them, as appropriate
• independence and effectiveness of internal and external audits
• protection of stakeholder and stockholder interests, as appropriate
• succession planning for organizational leadership

Please see Assessing Your Governance, to begin your assessment: You may also request a copy from: This email address is being protected from spambots. You need JavaScript enabled to view it.

Knowledge Management/Transfer through Data Analytics:

How do you measure, analyze, and then improve organizational performance?

Assess your Performance Measures to achieve results: "Knowledge Management/Transfer through Data Analytics”

Questions to Consider - Performance Measures:

How do you track data and information on daily operations and overall organizational performance?

How do you select, collect, align, and integrate data and information to use in tracking daily operations and overall organizational performance; and track progress on achieving strategic objectives and action plans?

Please see Assessing Your Knowledge Management/Transfer through Data Analytics, to begin your assessment: You may also request a copy from: This email address is being protected from spambots. You need JavaScript enabled to view it.

Operations Management/Process Management:

How do you design, manage and improve your key health care services and work processes?

Assess your Work Processes/Process Management Methodology to achieve results: “Process Management-Achieve Value Based Results”

Questions to Consider-Work Processes/Process Management:

How do you design, manage, and improve your key health care services and work processes?

How do you determine key health care service and work process requirements?

Please see Operations Management/Process Management, to begin your assessment: You may also request a copy from: This email address is being protected from spambots. You need JavaScript enabled to view it.

Results:

A Performance Excellence Philosophy provides the systematic methodology to achieve results. Your organization will achieve value based results with unrelenting commitment from key stakeholders at every level.

You need a simplified approach to creating a culture of Performance Excellence to achieve results:

Question to Consider-Results

What are your health care and process effectiveness results?

What are your health care results and your results for your patient and other customer service processes?

Is your entire workforce engaged in achieving value based results?

Please see Assessing Your Results, to begin your assessment:

Key Take Aways and Next Steps:

• Assess and adopt a Vision of Value Based Care in your Physician Enterprise
• Implement a Culture of Performance Excellence
• Assess your Leadership/Management
• Assess your Governance
• Assess your Knowledge Management/Transfer (Data Analytics)
• Assess your Operations/Process Management
• Assess your Results
• You may need external resources to assist in assessment and development

Oregon's Eagle Creek fire along the Columbia River

Monday we reflected on the September 11, 2001 attack on the United States. It was a pivotal moment in the country’s history and Americans continue to recognize its importance in our lives on its anniversary each year.

Currently the United States is experiencing another significant chapter with wide ranging weather conditions that affect a large portion of the population. We have had two hurricanes since August 25, and Jose, a third storm following them could feasibly land in the Virginia area; there are dozens of forest fires in over ten western states; and as of Sunday night, 260 earthquakes have been registered in Idaho since September second.

The Wiederhold network extends nationwide, either as current or past clients or simply those we know as friends and colleagues. We continue to think of everyone in harm’s way and hope for the safety of them, their friends and families.

We wish you and your loved ones a safe and fun holiday weekend

High performing leaders in healthcare organizations of today are challenged with the uncertainty of healthcare delivery in the future. Many hospitals face a challenge among key stakeholders. That challenge is a brand/reputation shift toward value based care. Mission, Vision and Values typically reflect claims of high quality and customer service, but key stakeholders (physicians, patients, families, employers, payers and regulatory bodies) are not buying the slogans of the past. In today's world, healthcare providers must demonstrate that they are living up to the value based equation (low cost, seamless, patient-centric, high quality care). Stakeholder demand and regulatory requirements drive organizations to demonstrate measurable results in cost, service and quality.

Creating a performance excellence environment is a highly successful leadership approach to navigate the ever-evolving imperatives of service delivery. Value based results will be achieved through a leadership philosophy of performance excellence:

Engage your people: Develop Governance, Leadership and Management structures to engage your key players, especially physicians and other clinical thought leaders to lead the effort. Create a shared Vision of Achieving Value Based Results. Now it’s time to execute your shared Vision.

Evaluate your data; identify best practice: Engage all key players in identifying essential metrics to understand your current performance and identify opportunities for improvement in Operational/Financial, Service and Clinical performance.

Know your process and design your process (es): Utilize advanced process management methodologies to identify current processes that yield current results. Establish consistency in your process improvement methodology. Identify best practices. Design your processes to achieve results.

Hardwire/Standardize best practice, process design to ACHIEVE

Sustainable results will be achieved from your Action, if you are focused on Continuous Operating and Quality Improvement. Remember you may FAIL (“First Attempt In Learning”). Establish your culture of Performance Excellence. Start small, simplify, be resilient, be persistent and be unrelenting in your approach to achieving results. Be prepared to embrace “Polarity Thinking.” Every good conversation begins with good listening. Listen to your key stakeholders. Listen to understand, not to respond. Physician integration and value based strategies inherently present divergent opinions. Learn the power of leveraging Inquiry AND Advocacy: two critical leadership competencies. That’s how leaders achieve results.

Value Based Metrics:

The list of potential measures is endless. Identify what is important to your key players. Start with metrics that present and build a common understanding of current performance. Measure, monitor, report, analyse and improve your key metrics, focused on value: Operational/Financial Excellence, Service Excellence, and Clinical Excellence. A comprehensive list of potential metrics is available at: Mike Jones LinkedIn or This email address is being protected from spambots. You need JavaScript enabled to view it.

Key Takeaways:

• You have highly engaged employees, physicians, patients, family members, community representatives, employers and payers.
• You have defined a common and shared vision for your organization through gaining knowledge of your key stakeholders’ perspectives
• You have defined what outcomes you and your organization are trying to achieve in terms of Operations, Finance, Service and Clinical indicators
• You have measured your current performance
• Now you want to improve performance:

Everything is a process


Gain an understanding of your current processes


Identify your best practices


Design process to achieve best practice performance


Re-evaluate your performance to see if you are consistently achieving improved performance


Modify your processes when necessary to consistently achieve higher levels of performance


Hard-wire your processes to ALWAYS achieve best practice performance


Never stop monitoring to verify your preferred state performance/outcomes.


Never stop monitoring to verify your preferred state performance/outcomes.


Train for it (all Key Players)


Build consistency of approach

• Define your performance excellence culture
• Focus your leadership on the relentless pursuit of performance excellence
• Adopt your preferred methodology
• Formalize and standardize your methodology
• Listen to your key stakeholders
• Engage all parties in understanding improvement initiatives
• Gain understanding of performance through data analytics
• Design processes to achieve desired results
• Be prepared to Fail, but failing is your F (first), A (attempts), I (in), L (Learning).
• Achieve success in all you do
• Demonstrate that you are creating value based outcomes

Next Steps:

• View Additional Reference Information:
• In “Be an Inspirational Leader”, author Dan Nielsen portrays the incredible impact of inspirational leadership on your personal, professional, and organizational success. Read Dan Nielsen’s book: “Be An Inspirational Leader: Engage, Inspire, Empower”
• Management of healthcare providers’ reputation and brand dramatically changes with consumer demand for value. An organization’s reputation is subject to more than marketing campaigns. Social media and ratings services have significant impact on consumer perception of healthcare organizations. If you do not have on-going audits of your on-line presences and ratings, it is wise to complete and assessment and take corrective action, as necessary. To learn more about Reputation and Brand Management view the work of Claire Faucett with engage5w.
• Learn more about “Polarity Thinking” and the two essential leadership competencies of Inquiry and Advocacy. View the work of leadership coaches James McKenna and Cliff Kayser, sponsored by Wiederhold & Associates.

• For a deeper dive into fostering a culture of performance excellence with high levels of physician integration, alignment and engagement please read:
• Article #1: Value Based Care is Here to Stay
• Article #2: Achieve Results: Governance
• Article #3: Achieve Results: Leadership and Management
• Article #4: Achieve Results: Knowledge Management/Transfer through Data Analytics
• Article #5: Process Management-Achieve Value Based Results

We are facing a critical era of transformation in healthcare. As organizations strategize to find stability through turbulent times, managers, directors, and executives will feel added pressure to achieve continuous, dynamic results.

The success of each department will depend on a single crucial factor: Is there a "boss" or a "leader" in place?

A "boss" refers to an individual who is in charge of the employee or an organization. He exercises control over employees, orders, assigns tasks and duties to them and is entitled to take decisions on some matters. Bad bosses will motivate through fear tactics, defer blame to others, take credit for other's successes and bully members into producing results.

The term "leader" is defined as an individual who possesses the ability to influence and inspire others towards the accomplishment of goals. Communication coupled with integrity compel people to follow. Great leaders think about what their body language, facial expressions, and tone of voice communicate to their staff. They often take the time to say things face-to-face rather than through email in order to build trust, develop relationships, manage conflict, and encourage employees. Leaders pull the best out of each member and inspire group success.

It is important to note that the teams which produce the most effective and long-lasting results are the ones that are directed by leaders, not bosses.

"If your actions inspire others to dream more, learn more, do more and become more, you are a leader." - John Quincy Adams

Transform Bosses into Leaders

Where bosses fail, leaders prevail. If you've noticed that you have more bosses than leaders in your organization- all is not lost. Aspiring and current managers, directors or executives can begin improving their ability to lead. Wiederhold and associates offer specialized assessments as well as a number of training programs designed to develop quality leaders that are custom fit to your organization. If you are interested in learning more, just let me know.

Here's to your success,

Jim

Connect with us on LinkedIn and join our Active Network Program.

“If you can’t describe what you are doing as a process, you don’t know what you are doing.” Such a profound quote by W. Edwards Deming, largely recognized as the Father of the Quality Movement. Dr. Deming's famous 14 Points, originally presented in Out of the Crisis, serve as management guidelines. The points cultivate a fertile soil in which a more efficient workplace, higher profits, and increased productivity may grow. These management principles have a direct correlation to navigating the path to achieving results in the uncertain healthcare industry of today.

Deming’s 14 Points for Leadership/Management

While traditionally applied to product manufacturing, Deming theory has direct application across multiple industries, especially when rising consumer and regulatory requirements demand greater value. View healthcare service delivery as a product in high demand from consumers (patients, families and others). Expectations of lower cost and superb quality, delivered in a highly patient-centric and service-oriented environment, create an imperative healthcare systems must meet to remain relevant.

Healthcare leaders are served well when focusing on Deming’s 14 Points:
1. Create constancy of purpose toward improvement of product and service, with the aim to become competitive, to stay in business and to provide jobs.
2. Adopt the new philosophy. We are in a new economic age. Western management must awaken to the challenge, must learn their responsibilities, and take on leadership for change.
3. Cease dependence on inspection to achieve quality. Eliminate the need for massive inspection by building quality into the product in the first place.
4. End the practice of awarding business on the basis of a price tag. Instead, minimize total cost. Move towards a single supplier for any one item, on a long-term relationship of loyalty and trust.
5. Improve constantly and forever the system of production and service, to improve quality and productivity, and thus constantly decrease costs.
6. Institute training on the job.
7. Institute leadership (see Point 12 and Ch. 8 of Out of the Crisis). The aim of supervision should be to help people and machines and gadgets do a better job. Supervision of management is in need of overhaul, as well as supervision of production workers
8. Drive out fear, so that everyone may work effectively for the company. (See Ch. 3 of Out of the Crisis).
9. Break down barriers between departments. People in research, design, sales, and production must work as a team in order to foresee problems of production and usage that may be encountered with the product or service.
10. Eliminate slogans, exhortations, and targets for the work force asking for zero defects and new levels of productivity. Such exhortations only create adversarial relationships, as the bulk of the causes of low quality and low productivity belong to the system and thus lie beyond the power of the work force.
1. Eliminate work standards (quotas) on the factory floor. Substitute with leadership.
2. Eliminate management by objective. Eliminate management by numbers and numerical goals. Instead substitute with leadership.
11. Remove barriers that rob the hourly worker of his right to pride of workmanship. The responsibility of supervisors must be changed from sheer numbers to quality.
12. Remove barriers that rob people in management and in engineering of their right to pride of workmanship. This means, inter alia, abolishment of the annual or merit rating and of management by objectives (See Ch. 3 of Out of the Crisis).
13. Institute a vigorous program of education and self-improvement.
14. Put everybody in the company to work to accomplish the transformation. The transformation is everybody's job.

The focus of this article is to bring home the reality that EVERYTHING IS A PROCESS. “If you cannot describe what you are doing as process, you do not know what you are doing.”

Physician alignment, integration and engagement in integrated delivery systems are essential elements in navigating the complexity of healthcare service delivery. Healthcare organizations need a simplified approach to realize organizational vision of comprehensive and successful alignment and integration strategies. Creating a common Vision is essential. Healthcare organizations that focus on a vision of “maximizing success in the ever-evolving healthcare industry through physician alignment and integration” will ultimately build capability to meet and exceed consumer expectations in navigating the path to value-based care. Today’s ever-evolving healthcare industry requires a comprehensive Vision of Integration. Execution of the Vision is best achieved through a Leadership Philosophy of Performance Excellence.

The first key element in fostering a culture of performance excellence is to define the “WHAT” that constitutes excellence, frequently referred to as “the Triple Aim” of healthcare:

• Operating/Financial Excellence (low cost, highly efficient and cost effective service delivery),
• Service Excellence (service delivery exceeding patient and family expectations), and
• Clinical Excellence (best clinical outcomes for every patient and patient population).

The next essential element of a performance excellence culture is to define the “HOW” the organization will be led through:

• Stakeholder Engagement
• Knowledge Management/Knowledge Transfer
• Process Management

Organizations will not only achieve the “triple aim”, but will enhance performance through achieving the “quadruple aim” of healthcare. In addition to achieving traditional value-based results, a culture of performance excellence will yield higher levels of provider satisfaction and engagement while redefining service delivery. As highlighted in previous articles:

• Value Based Care is here to stay and healthcare organizations must overcome multiple organizational gaps that may contribute to not fully realizing a vision of success in a high performing integrated delivery system. Here
• Key Stakeholder Engagement is essential to execution of a common Vision:
• Physician Stakeholders (as well as others) should be engaged in organizational Governance, especially among healthcare providers, is essential to success in a value based environment. Here.
• Physician Stakeholders should also be engaged in Leadership and Management to achieve sustainable results. Here.
• Knowledge Management/Knowledge Transfer
• A common understanding of performance is best achieved through measuring, monitoring, reporting and analysis of key outcomes: Operational, Service and Clinical Metrics (Data Analytics) Here.
• Opportunities for performance improvement are quickly identifiable when using data analytics in evaluating current outcomes.Here.

This article expands on development of a Philosophy of Performance Excellence to achieve a vision of success through Performance Management. Measuring, monitoring, reporting, analyzing and improving performance begins with defining key metrics to create a common understanding. Internal and external benchmark measures are available through a variety of sources to build an improved understanding of: Operational/Financial, Service, and Clinical Performance. Now you need a methodology to achieve your desired outcomes.

Physicians and other care providers work within a defined process everyday of their lives when addressing and resolving patient needs for care. What is done when presented with multiple patients with complex healthcare needs? SOAP is a traditional approach to addressing patient needs:

The SOAP note (an acronym for subjective, objective, assessment, and plan) is a method of documentation employed by health care providers to write out notes in a patient's chart, along with other common formats, such as the admission note. Documenting patient encounters in the medical record is an integral part of practice workflow starting with patient appointment scheduling, to writing out notes, to medical billing. The SOAP note originated from the Problem Oriented Medical Record (POMR), developed by Lawrence Weed, MD.[1] It was initially developed for physicians, who at the time, were the only health care providers allowed to write in a medical record. Today, it is widely adopted as a communication tool between inter-disciplinary healthcare providers as a way to document a patient’s progress. SOAP notes are now commonly found in electronic medical records (EMR) and are used by providers of various backgrounds. Prehospital care providers such as EMTs may use the same format to communicate patient information to emergency department clinicians. Physicians, physician assistants, nurse practitioners, pharmacists, podiatrists, chiropractors, acupuncturists, occupational therapists, physical therapists, school psychologists, speech-language pathologists, certified athletic trainers (ATC), sports therapists, occupational therapists, among other providers use this format for the patient's initial visit and to monitor progress during follow-up care.

It is a well-defined thought process. Complete a SUBJECTIVE EVALUATION, an OBJECTIVE EVALUATION, an ASSESSMENT and a PLAN. Engage patients and family members when seeking to understand what is happening with a patient (Subjective). Gather facts/data regarding what is happening with a patient through diagnostic procedures (Objective). Review the information gathered and knowledge gained from the evaluations (Assessment) and take action to address what has been presented (Plan). Why not apply a similar process that is highly effective to leadership and management. That is a process management/performance management approach.

Performance Management

The days of simply making claims of high-quality, service-oriented and low cost care delivery are gone. Patients, families, communities, payers, regulatory agencies and other key stakeholders demand proof of performance. Measures of performance should focus on Operations/Financial, Service and Clinical Excellence. Internal and external benchmarking of performance is imperative. Once you understand current performance through data analytics, you need tools to achieve continuous improvement.

There are many theories of performance/process management. Theories and practices have evolved over time. Many are inter-related and draw on common practices. Process Management philosophies include, but are not limited to:

• Total Quality Management (TQM):
• Focus on the Consumer
• Continuous Improvement
• Quality Improvement
• Accurate Evaluation

• Continuous Quality Improvement (CQI):
• Analyse
• Refine
• Improve

• Plan Do Study Act (PDSA): Model for Improvement: What are we trying to accomplish? How will we know that a change in an improvement? What change can we make that will result in improvement?
• Plan: Objective, Questions and Predictions, Plan to carry out the cycle (who, what, where, when)
• Do: Carry out the plan. Document problems and unexpected observations. Begin data analysis.
• Study: Complete the data analytics. Compare data to predictions. Summarize what you have learned.
• Act: What changes are to be made? Begin the next cycle.

• Lean Management:
• Leadership Commitment to Project (s)
• Project Charter (Standardized for ease of understanding).
• Project Tracking (verify milestones)
• Assign Project Manager
• Engage Key Stakeholders
• Communicate Frequently
• Achieve Results

• Lean:
• Waste Reduction
• Continuous Improvement
• Respect for People

• Six Sigma-DMAIC:
• Define: Define project purpose and scope. Identify high level processes for improvement. Determine customer needs and benefits.
• Measure: Baseline data on current processes. Pinpoint problem locations and occurrences. Identify potential areas for improvement.
• Analyse: Identify root causes and validate root causes against captured data. Determine improvements that need to be made.
• Improve: Implement the improvements that have been determined to address the root causes.
• Control: Perform before and after analysis. Monitor processes/systems. Document results. Determine next steps/recommendations.

• Lean/Six Sigma:
• Lean: focuses on waste reduction by streamlining process
• Six Sigma: focuses on preventing defects through problem solving
• Lean/Six Sigma: Lean strengthens Six Sigma-Problem solving plus improving process delivers greater value-based results

The common thread in all methodologies is an unrelenting focus on seeking improved outcomes in everything we do:

• Cycles of improvement
• Engaging in a customer focus
• Understanding key stakeholder perspective
• Measuring current performance through data analytics
• Engaging those closest to the work:
• to define current processes (value stream mapping, flowcharting)
• to define desired outcomes of current processes
• to define undesirable outcomes (failures) of current process
• identify and define best practices
• identify and define outcomes
• identify and define preferred processes to achieve best practice performance and outcomes
• transfer best practices, best practice outcomes and preferred processes to:
• gain consistency across all players
• reduce variation in outcomes and results across all players
• meet and exceed customer expectations at all times
• reduce cost of service delivery
• increase throughput in service delivery
• provide consistent, high-quality outcomes

Performance Management Simplified

High performing leaders in healthcare organizations of today are challenged with the uncertainty of healthcare delivery in the future. Creating a performance excellence environment is the best to navigate the ever-evolving imperatives of service delivery. Value based results will be achieved through a leadership philosophy of performance excellence:

Engage your People

Evaluate your data; identify best practice

Know your process and design your process

Hardwire/Standardize best practice, process design to ACHIEVE

Key Take Aways:

• You have highly engaged employees, physicians, patients, family members, community representatives and payers.
• You have defined a common and shared vision for your organization through gaining knowledge of your key stakeholders’ perspectives
• You have defined what outcomes you and your organization are trying to achieve in terms of Operations, Finance, Service and Clinical indicators
• You have measured your current performance
• Now you want to improve performance:
• Everything is a process
• Gain an understanding of your current processes
• Identify your best practices
• Design process to achieve best practice performance
• Re-evaluate your performance to see if you are consistently achieving improved performance
• Modify your processes when necessary to consistently achieve higher levels of performance
• Hard-wire your processes to ALWAYS achieve best practice performance
• Never stop monitoring to verify your preferred state performance/outcomes.
• Pick a methodology for process management (they all work)
• Train for it
• Build consistency of approach

Next Steps:

• Define your performance excellence culture
• Relentless leadership focus on performance excellence
• Adopt your preferred methodology
• Formalize and standardize your methodology
• Listen to your key stakeholders
• Engage all parties in understanding improvement initiatives
• Gain understanding of performance through data analytics
• Design processes to achieve desired results
• Achieve success in all you do
• Demonstrate that you are creating value based outcomes

The Problem – Across the nation, health systems are reporting a sustained decline in Emergency Department utilization, resulting in decreased admission rates and reduced patient days. Regardless of the cause (Healthcare Reform, economic challenges, rising unemployment, etc.), the impact is clear – an average 3-5% drop in census and a significant loss of revenue.

The Emergency Department Imperative – On average, 12-15% of Emergency Department visits result in patients being admitted, which accounts for approximately 40-50% of a facility’s total admissions, and a contribution margin between $1k - $15k per admit. The direct connection between Emergency Department utilization, subsequent admissions and the resulting revenue indicates that the success of any facility in this changing healthcare landscape depends on increasing the number of times that new patients pass through the Emergency Department doors. Health systems operating Trauma Centers will have contribution margins exceeding the national average.

The Million Dollar Question – Understanding the concept of countering a declining census by increasing Emergency Department utilization is easy, but successfully operationalizing that strategy may not be. Simply put, how does one hospital or health system get more patients into their Emergency Departments than another? Although there are many potential answers to that question, experience shows that the most effective solution is for a facility or health system to develop a highly functional Regional Referral Program.

The Regional Referral Solution – Health systems should be able to successfully capitalize on its current Trauma status and market itself as regional destination, which will significantly increase patient admissions. A key to success will be aligning referring facilities, physicians, and transport providers through an efficient Transfer Center operation. Your organization will be able to benefit from those opportunities. Additionally, current successes show that facilities and health systems that have implemented Regional Referral Programs have grown their influence significantly garnering patient care and admission opportunities from facilities far outside of traditional referral patterns. This has proven beneficial because the payor mix of patients being referred from out-of-area tend to be equal to or better than the receiving facility’s current Emergency Department mix, resulting in a 15 to 1 return on investment.

Regional Referral Program Priorities – Numerous successful hospitals and health systems have developed very effective Regional Referral Programs by prioritizing the following:

Identification and Development of Key Service Lines – Determining which specialties (Trauma, Cardiology, Neurology, Pediatrics, etc.) the facility wishes to specifically solicit patients for. The goal is to develop a solid reputation as the “go to” receiving facility for the targeted service lines.

Aligning Physician Partners – The success of any Regional Referral Program depends on the participation and support of the facility’s physician partners, whether by promoting the program with regular visits to the region’s referring facilities, or by being consistently available and accepting patients. To achieve this, successful Regional Referral Programs have implemented effective Hospitalist Programs to receive the patients and specialist compensation programs that reward participation.

Transfer Center Utilization and Marketing – Effective Regional Referral Programs require three primary components; necessary specialties, physician participation, and a simple, consistent way for facilities to refer their patients. Structured Transfer Centers tie the entire referral program together with “one call does it all” ease, coordinating patient transfers from the initial request through completion of the transport. Mature Transfer Centers will also provide extensive operational reporting and key patient flow analytics for hospital administration. Focused marketing strategies can also convert the Transfer Center from a passive patient flow processing service into an aggressive volume builder for the facility or health system. Proven techniques can be employed to grow desired business through sound relationships with the referring parties.

Note: There are generally two methods of implementing a Transfer Center service; a facility can develop the service in-house or they can seek out a professional third-party Transfer Center service provider. An internal Transfer Center allows the facility or health system to maintain strict control of the staffing, customer interactions and processes, but a professional external Transfer Center will generally provide outstanding service delivery at a fraction of the cost.

Regional Referral programs are showing exceptional returns in the form of increased Contribution Margins per referral. The chart below – based on actual Regional Referral Programs – highlights the benefits:

Transfer Center Costs – Studies of current successful internal Transfer Center services show that the average cost per transfer request is approximately $230 for new centers and $190 for established centers (assuming a daily request volume of ~12). For facilities or health systems that prefer to forego the expense and coordination of operating their own Transfer Centers in favor of utilizing the expertise of a professional external service, the cost is obviously significantly lower – with no associated reduction in the contribution margin per transferred patient.

Conclusion – For hospitals or health systems seeking to counter the downward trend in Emergency Department utilization and subsequent census declines, it is essential that they develop a Regional Referral Program. By establishing themselves as “centers of excellence” in key service lines, partnering with their physician specialists, and easily facilitating patient flow through efficient Transfer Centers, facilities can continue to thrive even in today’s constantly shifting healthcare environment.

Solution - We can provide a comprehensive assessment of the opportunity for your organization to expand your market as a Regional Referral Center with a state of the art Transfer Center.

✔ Current situation
✔ Market potential for referrals
✔ Business plan for the recommended approach with a Return on Investment analysis
✔ Sensitive issues
✔ Hospital capacity readiness
✔ Medical Staff readiness
✔ Hospitalist Program effectiveness
✔ Case management strategies
✔ Nursing coordination
✔ Administrative and Medical Leadership buy-in

Please let us know if you would like to explore the assessment of the potential for your health system. We look forward to possibly assisting you with this important project.

Thank you,

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LinkedIn

Connectdoc

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Wishing you and your loved ones a happy
and safe Fourth of July

Because you've been a part of the Wiederhold & Associates Network, we wanted to share some exciting news with you first.

As you know, networking/connecting is essential to your success both while in transition and gainfully employed. Networking with a purpose is a vital component of anybody's career success but is often terribly neglected. Being intentional is necessary.

Therefore, we have formalized a streamlined process to make it easier for you to expand your network through Wiederhold Intentional Networking (WIN) program. Becoming an active WIN participant will enable you to:

• With limited effort, expand your own network with quality connections
• Exchange key information about market and industry trends
• Increase ability for quality transitions through network connections
• Affect others in a positive way

Are You Ready to WIN?

The WIN strategy gathers key information from each premium active network member and targets meaningful matches within our client list. As an active member in our program, W&A will introduce you to key members of our current network, helping you gain significant connections that you would not otherwise have access to. Remember, most of our clients are Vice President through C-level executives.

Once you have made the connection, we will send you a short anonymous evaluation form. Each member's feedback will bring value to helping our clients grow their skills in effective networking/connecting as well as passing along current industry trends.

If you want to know more about expanding your network with little effort while affecting others in a positive way, contact This email address is being protected from spambots. You need JavaScript enabled to view it. and she will let me know of your interest and follow up.

Here's to your success!

Jim

Connect with us on LinkedIn and join our Active Network Program.

During a recent goal-setting cycle, I worked on setting reasonable, although loftier, strategic goal metrics due to significant LEAN expert resourcing for my management team to focus on making transformative leaps in process improvements rather than small, incremental changes. In analyzing the strategic goal area of preventable patient harm, the Patient Safety Composite observed to expected ratio baseline was 0.629. A ratio above 1 is undesirable and a ratio below 1.0 is highly desirable. So, 0.629 is excellent, correct? Instead of improving the stretch goal by 5%, we considered 10% improvement. That is stretch goal, chest pounding, we are doing a fantastic job material!

Amid this goal setting, I was at the beach watching the news and drinking a cup of coffee readying myself for a day of fellowship, bocce ball, and sun. The local station in Myrtle Beach, SC ran a story with some interviews regarding the Target Zero – South Carolina’s Highway Safety Plan 2015 -2018. The plan was developed by the SC Departments of Public Safety and Transportation with many stakeholders including the SC Highway Patrol.

At the time, South Carolina’s 5-year average highway mortalities were ~800 per year. Immediately, I thought what an audacious goal considering they do not have control of every aspect of the events – human error, human disregard for rules, or processes/design flaws/mechanical failures. Think about this strategy compared to preventable patient harm with a Just Culture mindset as illustrated below:

If South Carolina is setting a target of zero highway fatalities, what is preventing me/us from setting a target of zero for preventable patient harm? The way we analyze data with observed to expected ratios with results below 1.0 informs us we are doing better than expected and inadvertently depersonalizes this issue. At 0.629, we were knocking it out of the park. At the end of the day, it is about perspective. The interviews shown on the newscast drove this point home for me. The interviewers asked residents around South Carolina two separate questions regarding goal setting for decreasing highway fatalities. Please view the video for about 2 minutes (from WMBF News in Myrtle Beach, SC) here.

Connect with us on LinkedIn and join our Active Network Program.

Physician alignment, integration and engagement in integrated delivery systems are essential elements in navigating the complexity of healthcare service delivery. Healthcare organizations need a simplified approach to realize organizational vision of comprehensive and successful alignment and integration strategies. Creating a common Vision is essential. Healthcare organizations that focus on a vision of “maximizing success in the ever-evolving healthcare industry through physician alignment and integration” will ultimately build capability to meet and exceed consumer expectations in navigating the path to value-based care.

Today’s ever-evolving healthcare industry requires a comprehensive Vision of Integration. Execution of the Vision is best achieved through a Leadership Philosophy of Performance Excellence.

The first key element in fostering a culture of performance excellence is to define the “WHAT” that constitutes excellence, frequently referred to as “the Triple Aim” of healthcare:

• Operating/Financial Excellence (low cost, highly efficient and cost effective service delivery),
• Service Excellence (service delivery exceeding patient and family expectations), and
• Clinical Excellence (best clinical outcomes for every patient and patient population).

The next essential element of a performance excellence culture is to define the “HOW” organization will be led through:

• Stakeholder Engagement
• Knowledge Management/Knowledge Transfer
• Process Management

Organizations will not only achieve the “triple aim”, but will enhance performance through achieving the “quadruple aim” of healthcare. In addition to achieving traditional value-based results, a culture of performance excellence will yield higher levels of provider satisfaction and engagement while redefining service delivery.

As highlighted in previous articles:

• Value Based Care is here to stay and healthcare organizations must overcome multiple organizational gaps that may contribute to not fully realizing a vision of success in a high performing integrated delivery system. Here
• Key Stakeholder Engagement is essential to execution of a common Vision:
• Physician Stakeholders (as well as others) should be engaged in organizational Governance, especially among healthcare providers, is essential to success in a value based environment. Here.
• Physician Stakeholders should also be engaged in Leadership and Management to achieve sustainable results. Here.

This article expands on development of a Philosophy of Performance Excellence to achieve a vision of success through Knowledge Management/Knowledge Transfer. Measuring, monitoring, reporting, analyzing and improving performance begins with defining key metrics to create a common understanding. Internal and external benchmark measures are available through a variety of sources to build an improved understanding of:

• Operational/Financial Performance,
• Service Performance, and
• Clinical Performance.

Knowledge Management/Knowledge Transfer Through Data Analytics

The days of making claims of high-quality, service oriented and low cost care delivery are gone. Regulatory requirements and consumers of healthcare demand demonstrated proof. On October 14, 2016, the Department of Health and Human Services (HHS) issued its final rule with comment period implementing the Quality Payment Program that is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Quality Payment Program is intended to improve Medicare by helping you focus on care quality and focusing on making patients healthier (population health management). The Quality Payment Program’s purpose is to provide new tools and resources to help organizations to provide patients with the best possible, highest-value care. The Quality Payment Program has two tracks to choose from:

• The Merit-based Incentive Payment System (MIPS), and
• Advanced Alternative Payment Models (APMs).

Healthcare providers are required and must report key measures of performance in order to maintain a competitive edge and to maximize reimbursement for services rendered. Measures of performance should focus on Operations/Financial, Service and Clinical Excellence. Internal and external benchmarking of performance is imperative. The best place to start is to define your measures, based on industry standards. Engaging your Governance, Leadership and Management representatives, as well as other key stakeholders, in defining performance metrics is essential to gain a common understanding. Begin by gathering potential sources of industry standards (see table).

Knowledge Management/Knowledge Transfer Process:

The quest for appropriate data analytics to measure, monitor, report, analyze, improve and control can be challenging. Once sources of industry standards have been identified, engage stakeholders in organization-wide effort to define your measures of Operational, Service and Clinical metrics:

• Review and select meaningful measures:
• Verify the organizational capacity to measure, monitor and report measures:
• Be sure all metrics of performance are measurable.
• Operational and Financial Metrics are typically readily available, but may not be reported in an intuitive format with full-transparency across the organization and among key stakeholders.
• Service Metrics (patient engagement) should be standardized using a formal survey tool, administered by a vendor approved for use by The Centers for Medicare & Medicaid Services (CMS).
• Measures of Clinical Performance may present the greatest challenge:
• While sources of key measures are readily available, the ability to measure performance across all providers may be limited.
• Desperate systems in multiple healthcare settings increase complexity of data collection.
• Clinical information may be captured as free form text and may require manual/human intervention for interpretation.
• Manual data abstraction may present a high cost alternative to automated reporting.
• Lack of interoperability of information systems creates complexity.
• Clinical and claims data are not typically consolidated.
• The good news is: multiple vendors are available with advanced tools to aggregate data to support your efforts to measure, monitor, report, analyze, improve and control clinical performance.

• minimum level of performance,
• expected/goal level of performance, and
• Level of performance exceeding goal.

• A simple “stop light analysis” provides ease of review (see below):