Kaiser Permanente\'s Large Scale Implementation Of Performance Improvement

$: Kaiser Permanente\'s Large Scale Implementation Of Performance Improvement$
Kaiser Permanente’s Large Scale Implementation of Performance Improvement

Lisa Schilling, RN MPH, VP, Healthcare Performance ImprovementWCBF Lean Six Sigma and PI in Healthcare Summit

New Orleans, LAMay 12, 2011

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Top

dow

nR

educ

e va

riatio

n

Learning system

• Economic and social context for change

• Models of workplace learning

• Team performance

• Define organizational needs • Create system view• Plan/ manage improvement

• Align with strategy • ID drivers and portfolios • Build capability to improve

• Engaging the hearts and minds of the front line

• Creating “line of sight” to strategic goals

• Define high performing unit-based teams

Bottom

upLearning and im

provement

High Performing Organizations Build Culture and Capability

Principles What we “do”

© Kaiser Permanente 2010 reproduce by permission only

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Big Aim

Strategy

Dashboard

Targets

Domain 2011 2012 2013

Population Health Self perceived health status data for 15% of members

Self perceived health status data for 20% of members

Self perceived health status data for 25% of members

Population Care Management - Chronic Conditions

HEDIS composite at 90th percentileAll CV, diabetes, and cancer screening

metrics at 90th percentile

Prevention screening 90%Diabetes/CVD metrics 90%

Inpatient HSMR TJC Composite

Reduce HSMR: Below US Medicare average, crude mortality 10% from 2010 baselineTJC Composite at national 90th percentileReadmit rate<15% of all cause readmissions

Reduce HSMR: Below US MedicareTBD - May shift to inpatient outcomesReadmit rate<10% of all cause readmissionsTJC Composite at national 90th percentile

Reduce HSMR: Below US MedicareTJC Composite at national 90th percentile

Safety Never Events 10% less events than 2010 10% less events than 2011 10% less events than 2012

Workplace Safety 10% reduction from 2010 goals Per regional targets Per regional targets

Clincal Risk Management 5% reduction in claims from 2010 0 to 5% reduction in claims from 2011

0 to 5% reduction in claims from 2012

Service Hospital

At national 75th percentile (final quarter)

At national 75th percentile (rolling 12 months)

Above National 75th percentile(Rolling 12 months)

Service Outpatient & Health Plan

75th percentile in local or national in x of 8 regions (pending benchmark

data)

75th percentile in local or national in x of 8 regions (pending benchmark

data)

Above 4 Stars on Medicare Overall Service Measures

Equitable CareReduction of gap in race-based

clinical disparities for the 8 HEDIS signature measures examined

Same as 2011, in addition, assess the applicability and utility of other

socioeconomic factors in the measurement of equity

Same as 2012, in addition, assess the applicability and utility of other

socioeconomic factors in the measurement of equity

Id tif i t ti t d th D th b % D b % 2012

Add goal to maximize the CMS Quality bonus?


From Strategy to Execution

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HOW: Mortality & Inpatient Effectiveness Driver


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Quality Goals Timeline – 2011 – 2013


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Aligning Strategy: Data to Monitor Variation

Range 85% - 95%

Range 94% - 98%

The Joint Commission Index Across Hospitals: Demonstrated Progress in Reducing Variation

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Our system is based on the attributes of high performing organizations

Best qualityBest service

Most affordableBest place to

work

KP needs to build capability in these six areas in order to achieve breakthrough performance


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Kaiser Permanente’s Performance Improvement System

AIM: Assist regions and facilities in developing, testing and implementing a

KP-wide performance improvement system that builds the capacity to

execute on high priority initiatives in each KP region by 2010.


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Achieve Breakthroughgoals

Manage Local Improvement

Develop Human Resources

Spread and sustainProvide Leadership forLarge system Projects

Provide Day-to-DayLeaders for Micro Systems

Execution in KP’s System

Source: IHI 2008


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Lets look at the far left side: Manage local improvement

Moving from a project by project mentality to looking at system level improvement (end to end process with sequencing)Creating clear lines of accountability and oversightInsure the right portfolio of initiatives to assure ourselves that we are doing enough to move the Big Dot


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Building Improvement Capability

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We can build our capacity to improve by developing our skills

Delivering Improvement Advisor through front line skills development program focused on 4 audiences Using common language for the organization based on MFI, Lean, six sigmaAligning executive through front line capability by matching infrastructure with new skills

Source: API 2006


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Experts Operational

Leaders (Executives)

ChangeAgents

(Middle Managers, Stewards,

project leads)

Everyone

(Staff, Supervisors,

UBT lead triad)

Continuum of PI Knowledge and Skills

Deep Knowledge

Many People Few People

Our approach will be to make sure that each group receives the knowledge and skill sets they need

when they need them and in the

appropriate amounts.

A key operating assumption of

building capacity is that different groups of people will have different levels of

need for PI knowledge and skill.

Content: What Skills Do We Need?

SharedKnowledge


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On-boarding

Dev

elop

and

Test

the

Syst

em

at a

Fac

ility

leve

l

Developing deeper capability to achieve big results over time

Expa

ndIm

prov

emen

t sys

tem

to

all

faci

litie

s

Dee

pen

impr

ovem

ent

know

ledg

e w

ithin

faci

litie

s

September 2008 June 2009 2010 & 2011Waves of Improvement Institute

Learning and sharing systems regionally and program-wide Improvement Institute

Implementation Expansion ContinuousImprovementComplete

We are here

Level of Project

Difficulty

• All Regions• 500 IA’s• 15 internal faculty

Mentors• 3,000+ Operations

Managers• 20,000+ Front line staff• IHI Forum and courses

• 7 regions• 300 Improvement

Advisors • 35 UBTC’s• 1,250 Operations

managers• 8,000 Front line staff• IHI Forum and courses

• 5 regions• 65 Improvement Advisors• 300 operations managers• 3,500 Front line staff• IHI Forum


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KP’s Improvement Model has Four Phases

•Process map•Baseline data•Charter project•Create portfolio•Data collectionplan

•Training•Policy & procedures

•Feedback loops•Error proofing•Control charts•Spread plan

•Standardizeand simplify

•Reduce waste•6S•Reduce defects•Apply evidence-based practices

AssessDevelop/ Identify

Change Test Implement/Control

What are we trying to accomplish?

How will we know that change is an improvement?

What change can we make that will result in improvement?

Source: API© 2006

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Case Study: Improving CHF Readmission Rates

Problem statement: CHF 30 day readmission rates at 16% want to

decrease as much as possible while improving health outcomes

Where would you start?What would you measure?Whom would you involve?

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Where we started

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Where? KP-SCAL w/CMIHow? •Coordinated concurrent medication

reconciliation by Home Health RN, PharmD, and Patient in the patients home.

•Improved identification of Heart Failure patients in the Hospital

•Increased reliability of Home Health visit within 48 hours

•Increased reliability of Out-patient Heart Failure Clinic follow up in one week

•Implemented readmission diagnostic tool to identify system gaps

Results •Reduced 30-day re-hospitalization rate to 9% (and 90 day readmission to 20%).•Improved the reliability of the Transitions Care Program component bundle measures from 61%-95%•$ value estimated at $1,800,000

Goal: Reduce all cause 30-day Heart Failure readmissions from 15.7% to 10% by 4/1/08

Case Study: Readmission Reduction CHF

At South Bay, it takes a village to manage our heart failure patients, with the help of our local, regional and national leadership teams and the strength of our administrative infrastructure, we have been able to make an improvement with 3 key components: real time medication reconciliation at the home health visit, home health visits in a timely manner and the use of the diagnostic readmission tool. Joan Fredella, Pharm. D., Clinical Pharmacist

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How we know we are better: Organizational Capability Tool

0.0

1.0

2.0

3.0

4.0

5.0

Leadership

Learning

Systems & Process

Measurement

Capacity & Sustainment

Culture & Communication

2009Q4 Target

January 2008 December 2009

Regions and Medical Centers are more capable of achieving better performance


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“The future of healthcare is ours to imagine.”

-Institute for Healthcare Improvement

Change your thoughtsand you change your world.

-Peale

Kaiser Permanente\'s Large Scale Implementation Of Performance Improvement

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