My first mentor, and now long-term
dear friend, always said, “a plan is
better than no plan.” This is
probably the best advice that I have ever received in my professional life. I
have always kept his words in mind when taking on any project. After working
with this mentor for almost six years, I always make a plan for just about
everything. However, “the plan” was
not the key focus for him. What was important to this leader was that the end
goal should always be kept in mind and at the forefront of our daily work. We remained
focused on pursuing long-term goals while tackling the current objectives that
we were charged to accomplish.
Through his leadership, we would
breakdown huge undertakings into small action steps. The action steps were our
ideas. He gave us freedom to tackle the project as we thought best, empowered
us to take ownership of the project and encouraged us to perform at our highest
level. As a tradeoff for the freedom to manage our projects, we had to show
that our objectives were completed through measurable outcomes.
He made sure that the team received
praise for a job well done when we accomplished milestones and demonstrated
positive outcomes. If we were struggling to meet a milestone or outcomes were
not as desirable as anticipated, he simply redirected the approach to put us
back on the right track. He worked with us to apply these “lessons learned” to modify the project to improve future services.
Regardless of the level of success, we had data, at least to some degree, that allowed
us to make program management decisions for redirecting our approach.
Other key management lessons he emphasized
1) top leadership should be actively involved in order for a project to be
successful; and 2) strategic planning is but only an academic exercise if it’s
not executed and lessons learned aren’t applied to improve performance. While
these concepts seem so simple now, it was then as is now, quite a challenge! I
have learned that there are system approaches that assist executives and
managers with simplifying these challenges. Such systems include, for example,
the Balanced Scorecard and Studer-Pillar model. In general, each of these
approaches provides a mechanism for executives and managers to track measures
in various categories for a holistic approach to performance improvement. These
systems seem to be very effective as demonstrated through many of the hospital
projects that were supported through the Rural Hospital Performance Improvement
(RHPI) Project. The RHPI Project is a financial, operational, and clinical
performance improvement program for rural hospitals that are located in the
Delta region and is funded by the Federal Office of Rural Health Policy (HRSA,
DHHS) through a contract to The National Rural Heath Resource Center (The
Center).
Another system approach that guides
organizations in thinking strategically about performance improvement is the
Baldridge framework for performance excellence. As previous mentor made very
clear, if you want measurable outcomes, then one must have “a plan” for it and
“be ready for change”! The plan by itself is not enough to be effective. A good
strategic plan should include a process to support the execution phase. If it
is a project plan, it should clearly outline action steps for staff to
implement the recommendations. In addition to having “a plan”, we need
additional methods to assist executives and managers in taking a holistic
approach to performance management.
However, hospital executives and
clinical managers are not the only ones that need these tools! It is time for
rural health care program managers to utilize these system approaches to
improve performance of our services. Applying a system to performance
improvement would assist us in demonstrating the impact of our programs, and in
some cases, assist managers in obtaining outcomes. Our “business” is program
management. We must have data to drive our business decision-making to improve
our program services and demonstrate its impact. We need outcomes data along
with a system approach to assist us with effective program management. These
concepts came easy to my mentor because of the way he naturally thought and
reasoned through issues, but also it was due to his training. It definitely
does not come easy for the majority of us, and especially to those that are new
to program management. By utilizing a Baldridge framework, health care program
managers could improve their strategic planning for their own projects and
increase the possibility of meeting program goals and demonstrating measurable
outcomes. Overall, program managers would have a tool to assist them in utilizing
federal funds more wisely and effectively while building accountability.
In very simple terms, the Baldrige
framework outlines seven (7) key areas that organizations’ should consider if their
executives want to improve performance. Rural health program managers may also
apply these 7 key areas to increase effectiveness and build accountability in
their own projects. To illustrate this concept, I will highlight how the RHPI
Project applies the Baldrige framework to support project development and
process improvement. The Baldrige key performance excellence categories are
listed below with examples of how the RHPI project develops and manages
projects under each area.
1)
Leadership - RHPI
requires that the hospital Chief Executive Officer (CEO) to be actively
involved and engaged in the performance
improvement project recommendations. RHPI on-site consultations are
large projects that provide valuable services to eligible hospitals. The CEO
role and involvement is critical to the overall success of the project.
2) Strategic
Planning - RHPI works directly with the CEO and
the consultant to develop the project scope of work (SOW). The SOW is required
to clearly defined purpose, objectives, strategies, sustainability plan, and
anticipated outcomes with a work plan and timeline. The SOW is the guide for
the project and requires extensive upfront planning, which is a critical start
to obtaining measurable outcomes.
3) Customers,
Partners and Community – RHPI considers
financial operational assessments (FOA) a priority as these projects directly
impacts the program goals. The primary purpose of the FOA is to improve the
financial and operational performance of the hospital by identifying strategies
and tactics to increase patient volume, increase payments for services
provided, and manage operating expenses. Operational assessments targeting care
management and transition of care target reductions in re-admission rates,
increase patient safety, and improve HCAHPS scores and core measures. All of
which directly affects patient care, the financial viability of the hospital,
and overall well-being of the community.
4) Knowledge
Management, Measurement and Feedback –
The SOW should drive the project and define the project outputs and anticipated
outcomes. During the planning process, we list the anticipated outcomes in
general terms. As the project moves forward to completion, the hospital
administrator works with the consultant to 1) clarify the anticipated outcomes
and define them as measurable outcomes, and 2) identify indicators to measure
the outcomes. Measures should be standard industry accepted financial ratios,
operational indicators, and/or quality measures. The recommendations are the
“intervention”, which takes time to implement and thus, see performance gains.
5) Workforce and
Culture – Project recommendations are expected
to flow down to management levels to be implemented within the hospital and
become part of the culture. The CEO should build awareness of the project with
their Board members and staff. Best
practice recommendations should be shared with the Board, management team, and
front-line staff. The executive and management team should develop an action
plan to support the implementation of best practices recommendations.
6) Operations and
Processes - RHPI projects use a variety of
methods and approaches to improve performance, initiate the implementation
process and sustain projects. Majority
of RHPI project specifically target operations and quality improvement
processes that increase business efficiency. All RHPI project include coaching
calls, hands on training and education to staff, and an action planning session
with the executive, management and champion teams. Many projects utilize a train
the trainer model to embed the improved process in the culture and thus sustain
it over time.
7) Outcomes and
impact – The RHPI Project is a federally funded
initiative that supports performance and quality improvement projects in
eligible rural hospitals in the Mississippi Delta. As such, the RHPI Project is
required to report outcomes for both hospital projects and the program to the Office
of Rural Health Policy (HRSA/ DHHS). Therefore,
in Fiscal Year 2010 the RHPI project adopted a new process and report, called
the Recommendation Adoption Progress (RAP) report. The purpose of the RAP is to
gather information on the adoption of consultant recommendations, and
ultimately project outcomes, by interviewing CEOs approximately 9 –12 months
post project. The goal of RAP is to demonstrate a hospital’s progress over time
by showing the extent to which a facility has implemented consultant recommendations,
which are performance improvement best practices. The process has also shown
that most hospitals require at least 2 years implementing recommendations. However,
because the hospitals are tracking indicators developed in conjunction with the
strategic plan, they can justify and explain those variables that could enhance
or impede performance gains and losses.
Again, there
are at least three (3) well-known system approaches to performance improvement.
These 3 systems include the Balanced Scorecard, Studer-Pillar, and Baldridge
framework to performance excellence. Each approach has its strength, but organized
a little differently to assist managers in accomplishing strategic plans. Regardless, all 3 could be used by health
care program managers to assist them with improving performance of their
programs, thus increase the possibility of showing how their program positively
impact the beneficiary. I encourage rural health care program managers to apply
some sort of systems approach to assist them with performance management since
we are responsible for how federal dollars are being utilized through our
programs.
I sincerely appreciate my long-term
friend and mentor for his ongoing coaching and support over the years. Because
of him, I have had the wonderful opportunity to participate in the RHPI Project
for 6 years now. He has taught me that it is my responsibility as a program manager
to build accountability with those that benefit from the program. Moreover, it is my duty to demonstrate how
the program is utilizing federal funding. I am just now starting to understand
how Baldridge could assist me as a program manager. It motivates me to continue to seek how it
could possibly increase the effectiveness of the RHPI project, and thus, better
assist hospitals with their performance improvement efforts.
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