1. AHCA Quality Symposium St. Louis, Missouri February 6, 2009 Sustaining The Gain

2. from Tom Peters: “Excellent firms don’t believe in excellence – only in constant improvement and constant change.” In Search of Excellence: Lessons From America’s Best Run Companies

4. The Human Factor  Quality does not improve on its own  People tend to look at people when things go wrong (94% of problems are related to systems)  People tend to jump to solutions  People forget to check if their solutions worked

5. Models to Model  Models that provide a framework for organizational quality:  International Organizations for Standardization ISO 9001  Malcolm Baldridge National Quality Award  Models that provide methods for improving quality processes:  The Deming System (PDCA/PDSA)  Toyota Production System (LEAN/Just in Time)  Six Sigma (Eliminate Defects) (5 Whys)

6. Disclaimer! I Only Know What I Know

7. Our Challenges  Silos  Data  Processes

8. Silos  Vertical, Horizontal  Not my Job  Learning to Integrate  Voicing Expectations

9. Data:  Too Little/Too Much…  Too Confusing! How Do I… Acquire, Present, Use, Crunch, Understand, Validate, Compare…?

10. Processes: Why? (Why, Why, Why, Why?) Who?What?When?Where?How?

11. I USED TO RUN A BETTER NURSING HOME! Our Journey

12. Processes:  SIPOC  Critical to Quality Attributes  PDCA

13. Processes - SIPOC The things necessary to perform the value-added tasks of the process. Process Performers: The individuals or groups who perform the value adding tasks in the process. The individuals or groups who receive the outputs of the process; they do define the requirements of the outputs. The products or services that the process delivers. Key Performance Measures: The measures used to determine the “goodness” of the performance of the process; i.e., quality, cost, cycle time, satisfaction, value. Stakeholders: The individuals or groups that have a vested interest in the performance of the process but do not define the requirements of the outputs. Process Owner: The person who is responsible for the goodness of the process irrespective of whether they own all of the resources performing the process t (start): the most significant starting or triggering event that starts the process t (done): the most significant completion event of the process cycle Process frequency (volume): The rate of repetition of the process; i.e., how often the process occurs I nputs: C ustomers: P rocess Name: the working name of the process O utputs: S uppliers: The individuals or groups that provide the inputs for the process.

14. Processes – Critical to Quality AttributesWho Says This (which customer?) Relative Importance Level? How We Measure It? What is Current Value/Level? Product Reliability Service Quality Price

15. Processes - PDCA Act CheckDo Plan

16. Data  Developed In House “Experts”  Analysis and Presentation tools – using Excel  More Vigorous Search for Valid Comparison Data Sources

17. Departmental Quality Plans  Indicators High Volume High Risk Problem Prone Sentinel  Thresholds  Action Plans Quarterly Plans, IDT Plans

18. Sustaining the Gain Can It Be Done ?

19. 20 Leaders Said: An impromptu ask, 2 responses each:  Leadership: 7 responses  Strategy: 6 responses  Work Force: 8 responses  Customer Focus: 7 responses  Process: 12 responses

20. Leadership n Our leaders challenge us to strive for excellence n Leaders do what they need to do, no one waits to be told what to do n Our different styles of leadership work well together n We want to follow our leaders n High Accountability Factor

21. Strategy n We follow our plan n We take time out to plan our future n We think outside the box n We plan our role as a facility, and for our community. n We have a balanced plan

22. Work Force n Our staff “get” and live out our Mission and Values n What we do, we are all doing well n We work well together n We all get after ourselves when things slip, we don’t hide problems, or wait for someone to point out problems

23. Customer Focus n Everyone comes together for what our residents want and need n Every Resident is an Individual n We look at residents’ quality of life holistically, not just medically n We know whose home this is, and everyone works together to respond to what our residents’ want and need

24. Processes n Our processes work – we are proactive instead of reactive n We look for problems to fix, and not wait until they become “real” problems n A well oiled machine – each department does their job well n We challenge the normal acceptable standard, to make our own high standards

25. Results – Over Time n Health Care: 5 of 5 still excellent results – 4 of 5, no longer on “the radar” n Customer: 7 of 7 still excellent n Finance/Market: 10 of 10 still excellent n Work Force: 4 of 5 still excellent n Organization Effectiveness: 3 of 3 excellent n Governance/Social Responsibility: 9 of 9 still excellent

26. Jon Frantsvog, Administrator/CEO St. Benedict’s Health Center & Benedict Court & Benedict Court 851 4th Avenue East Dickinson, ND 58601 701 456 7305 jon.frantsvog@bhshealth.org Thank You! Questions?