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1. NESHS Webinar Series Sponsored by Gold Sponsors : Berkshire Marketing Group “Plan, Measure & Act!” Best Practices in Linking Strategic Planning and …
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  • 1. NESHS Webinar Series Sponsored by Gold Sponsors : Berkshire Marketing Group “Plan, Measure & Act!” Best Practices in Linking Strategic Planning and  Business Intelligence to Improve Performance December 17, 2009 MACNULTY CONSULTING, LLC 2 1
  • 2. Presentation Collaborators & Colleagues Amy MacNulty President MACNULTY CONSULTING, LLC 781.405.2298 amy@macnultyconsulting.com Pat Salem, M.B.A. Vice President, Healthcare Planning & BI BITadvisors 860.508.1865 psalem@BITadvisors.com Mitch Ocampo, MCSD, MCDBA, MCT Practice Director, Microsoft BI BITadvisors 617.359.8194 mocampo@BITadvisors.com 3 Agenda 1. Results Oriented Enterprise Planning and Implementation 2. Closed‐Loop Planning – BI: “Plan, Measure & Act!” 3. Best Practices of BI and Dashboards: Tools, Techniques &  Mindset: “One Stop Reporting Platform” 4. Partners Case Study Questions & Answers 4 2
  • 3. ?? ?? ?? ?? If you have questions during the presentation, please submit them using the Q&A option at the top of your screen. We will address them at the conclusion of today’s event. 5 Organizing a Strategic Planning Process:  Typical Phases Phase 1 Phase 2 Phase 3 Strategic Assessment Strategic Thinking Strategic Planning Build the fact base to  Evaluate strategic  Define means to  support decision‐making alternatives & define  achieve desired  a preferred future future position  Interviews, surveys  Identification of key  Definition of goals and  and focus groups issues and critical  strategies Assessment of  success factors Framework for tactical  current position Review of mission/  planning Portfolio model vision/values Strategic financial plan Planning assumptions  Development of future  Communications plan and key uncertainties vision and metrics 6 3
  • 4. Planning process will result in the  Planning process will result in the  Why Plan? development of a plan document. development of a plan document. Understanding of key uncontrollable issues  likely to impact the organization in the future Environment, market, competition Establish position in light of these key uncontrollables Strengths and weaknesses Determine optimal alternative strategic directions Build consensus for an appropriate strategic direction among  stakeholders Identify measures for success  Plan, Measure and Act! 7 Raising the Bar: Best Practices for Healthcare  Strategic Planning How would you rate your organizations strategic planning  performance against following best practices?  Linked to all parts of organization Evolving, flexible and continuously improving Communication throughout the process Adherence to essential strategic planning components Financial analysis and outcomes secondary to strategic thinking Diverse competencies (vs. single core competency) drive the planning  process, i.e. key areas of competitive advantage Action  plans and strategic thinking at business unit level are emphasized Innovation and creativity are emphasized Performance management and knowledge management programs  are incorporated into strategic planning process Strategic planning changes from static to dynamic process Source: Raising the Bar: Best Practices for Healthcare Strategic Planning, Alan M.Zuckerman, HS&S, SHSMD Benchmarking Study, 2007. 8 4
  • 5. Strategic Thinking and Strategic Planning are Not the Same Thing Strategic Thinking Strategic Planning Conceptualizing the end Getting from here to there game Evaluating alternative Future state definition paths to reach future state Naming assumptions Resource allocation Combination of dialogue, Laying the course discussion, and debate 9 Strategic Planning Continuum Goal  Scenario  Traditional Alignment Dynamic Oriented Planning Models of Strategic Planning Linear‐ Top  Match  Environmental  Align Mission  Collaborative  Down Resources to  Scan and  and  with focus on  Capabilities Optimize  Performance Strategic  Response Thinking Opportunities for Success: Opportunities for Success: Focus on dynamic process than solutions will increase commitment Focus on dynamic process than solutions will increase commitment Link to management cycle for effective implementation Link to management cycle for effective implementation Combine planning discipline with increased capacity for creative thinking Combine planning discipline with increased capacity for creative thinking Build on strengths and identify opportunities to differentiate: “we are the Build on strengths and identify opportunities to differentiate: “we are the best because…” best because…” Source: HBR, Putting Leadership Back into Strategy 10 5
  • 6. Understanding  Strategic Issues 11 Where Do You Get Information? What are your biggest data challenges? Where have you been “creative?” How do you decide what information to share  with others in a planning process? When do you report back on progress? 12 6
  • 7. Quantitative Data Problems and Pitfalls Problem Potential Solution Data limited to inpatient services “Connect the dots” Lacking primary market research Just do it Out of date data Use what you have Reluctance to believe what the  Involve the right people information tells us Analysis paralysis Agree “what you need  to know” Inability to turn data into  Import expertise information 13 13 Qualitative Perspectives Method Benefits Limitations More "confidential" Interviewer bias is than focus groups possible One-on-One Allows for in-depth Time intensive Interviews exploration of topics (expensive) with each participant Limited number of people can be involved Allows more to Potential for “group participate think” Can begin process of Not possible to explore Focus Groups building consensus topics in depth with Can explore reasons each participant behind responses Good way to get input Biased sample from large numbers of Typically low response internal or external rates Written Surveys: constituents Generally not possible On-line/ Telephone On-Line can be less to explore reasons expensive than phone behind responses surveys and easy to tabulate 14 7
  • 8. Developing Elements of  the Strategic Plan 15 Planning Horizon Reach agreement about your planning timeframe Time Mission Vision 3 years? Goals 5 years? 10 years? Strategies Tactics Tactics Tactics 1 Year  Operating Plan 16 8
  • 9. Working Definitions Mission A long-standing statement describing an organization’s core purpose or reason for being. Values Intrinsic beliefs an organization cherishes above all others. Vision A statement describing an organization’s desired future position. Goals Desired end results toward which effort is directed. Strategic Metrics Measures and targets used to create clarity around desired outcome of the strategic plan and to monitor progress. Strategies Carefully designed plans for deploying resources to attain a favorable position. Tactics Specific steps to achieve strategies. Management Metrics Indicators that management monitors to measure performance on tactical steps. Resource Requirements/Budget Financial and non-financial needs to support implementation. 17 Strategic Metrics Strategic Metrics Measures and targets used to create clarity around desired outcome of the strategic plan and to monitor progress Strategic Management metrics can be metrics are developed developed at the at the strategy and vision or goal level tactic levels 18 9
  • 10. Competing on Analytics Champion Analytics from the Top “Use sophisticated Create a Single Analytics Initiative data-collection Focus Your Analytics Effort technology and analysis to Establish an Analytics Culture wring every last Hire the Right People drop of value from all your Use the Right Technology business processes.” Source: Competing on Analytics, Thomas H.Davenport, HBR, 2005. 19 Performance Management Balanced Scorecard ◦ Measures to help monitor strategy implementation and  performance Link Performance to Strategy Healthcare Executive Dashboard ◦ Financial Perspective ◦ Patient Perspective ◦ Internal Processes ◦ Learning & Growth 20 10
  • 11. Strategic Metrics Helpful Hints Limit the number of measures Emphasize outcome measures over process measures Use a balanced set of measures Ensure that measures are clear and the data are readily available Recognize data limitations Avoid measure “creep” 21 Translating the Plan  Into Action 22 11
  • 12. Tactical Planning Even good strategy isn’t enough Must determine capability for implementing strategy ◦ Timeliness – Is there so much to do  that effective plan implementation  is unlikely?  ◦ Affordability – Can we afford the plan,  in terms of operating expense and  capital expense? ◦ Availability of human resources – Do  we have the people with the right skills  to implement the plan?   Who will do What by When With What Resources to produce What Results 23 After the Plan is Done 24 12
  • 13. Three Types of Links Needed 1.  Functional links ◦ Strategic plan with long‐term financial plan Critical for avoiding the dreaded “Shelf‐itis” 2.  System plan to operating entity plan 3.  Links of plans with varying time horizons Strategic Annual Service Functional Plan Business Plan Line Plans Plans 25 Communicating the Plan Provide feedback to all stakeholders involved in the  process Provide sufficient information to support plan  implementation Protect key strategic information from competitors  ◦ How much of the plan is shared?  Support employee morale Everyone does NOT need ◦ Employees often the best  to receive the same level of plan detail! ambassadors ◦ Use multiple communications vehicles 26 13
  • 14. Monitoring Plan Implementation Frequency of reviews a function of plan time horizons  and the level at which the review is taking place Remember, this is a strategic plan ◦ Reviews in the early stages of the planning horizon  focus on actions, not outcomes ◦ Later reviews assess both actions and outcomes Management reviews typically occur on a semi‐annual  basis Board reviews should occur at least annually 27 Questions to Ask Do we have the correct goals categories? Are they still  realistic? Do they need to be changed? Is appropriate progress towards goal achievement being  made?  If not, is the issue one of strategy or execution?  How do you know? Do the strategies  or timelines require adjustment?  Are action steps being implemented in a timely and  effective fashion? If not, is the issue one of resources, execution, inappropriate steps  or unforeseen issues/complexity? 28 14
  • 15. Is your Plan on Target? Using Business Intelligence to ACT  like a metrics‐driven organization  Pat Salem, VP Planning & BI, BITadvisors 29 “Closing the Planning Loop” From strategy to execution & measurement Strategy Performance Management Dashboards, & Scorecards Insight Decisions Ad Hoc Reporting & Analytics Real-time “actionable” information; aligning actions with strategy Monitor key strategic metrics, quality, financial & operational Any Business Application performance. Report across data sources Execute across the continuum Any Data Source care network 30 15
  • 16. What is Business Intelligence? Business Intelligence (BI) technologies help an  organization collect, integrate, analyze and interpret  business information to support better decision‐making.  BI often uses metrics or key performance indicators (KPIs)  to assess the present state of business and to prescribe a  course of action, such as % Operating Margin, ALOS, FTE /  Adjusted Occupied Bed. 31 How we “do” reporting today….. “The Report Life Cycle” Call IT 911!! Get data extracts Into Power Point Into Access… Access… Out to Excel..& Pivot 32 16
  • 17. Schematic of BI Tool Set 33 Information Discovery and Delivery BI Creators Executive Management Business User Dashboards, Scorecards, KPIs Business Analysts Business User Ad-Hoc Queries, On-line Analytical Processing (OLAP) Front Line Employees IT Operational or Standard Reports 34 17
  • 18. DASHBOARDS and AD HOC Reports – What can they do? DASHBOARDS and AD HOC Reports – Dashboards provide organizations the ability to track performance of KPIs Visualizations align actions with strategy Alerts organizations to exception conditions Users can drill down to detail to see root cause Ad hoc reports provide users with a self-service environment Mangers can create reports from scratch or simply update existing reports Intuitive analysis via ad-hoc reports “on the fly” Quick adoption rate …ease of use 35 Data Lineage & Consistency ce ial rvi rt nc Se po a Fin port Re Re TRUST... Business Intelligence provides accurate & consistent information, for users to make timely business decisions Nursing Log Sheets 36 18
  • 19. Healthcare Drivers for BI ARRA & HITECH act provide incentives to stimulate EMR adoption. Economic challenges  / capital constraints – focus on financial performance & dashboards. Healthcare consumerism is fueling the need for transparency of hospital quality & cost data. Cost shifting spurs patients to become more involved in the healthcare purchasing decision. Hospitals face growing demand for services and declining reimbursements. CMS & private payers are moving toward “value‐driven healthcare.” The number of P4P initiatives is increasing. New emphasis on public reporting of quality data via “report cards”. HCAHPS / patient satisfaction used as a proxy for quality performance.  Hospitals face increased competition from new “retail” providers, e.g. Minute Clinic, Wal‐ Mart, Target,  Rite Aid….  37 BI for the “Continuum of Care” Retail  MD  Ambulatory Care Clinic Office CHC SDC s Acute Care Acute  LTC Hospital Hospital Post Acute Care Rehab Home  SNF Hospice Care 38 19
  • 20. BI Portal for Health Information Exchange  SUPPLIERS REGULATORY AGENCIES MDS & OTHER PROVIDERS PAYERS 39 BI for “Disparate” HC systems Clinical Ancillary External Finance IT Physician HR Initiatives Depart Data • GL / AR • Decision • Quality • ED • Credentialing • Budgeting • Time and • Utilization Support Measures • O.R. • Scheduling • Planning Attendance • Mkt. analysis • BI /Data • EMR • Pharmacy • MD Billing • Medical Warehouse • CPOE • Radiology • MD A/R Records • BPOC • PACS • RVU • Registration • Disease • Cath Lab • PQRI • Materials Surveillance • Laboratory (Supply Chain) • Laboratory • Pathology • Payroll • Patient Billing • Pharmacy Diverse Applications and Systems • Meditech • SAP • TEIC • McKesson • IDX • Kronos • WebMD/ • Eclipsys • BOBJ • Midas + • Siemens • Siemens • ADP Healthshare • Siemens • Eclipsys • Eclipsys • Cerner • McKesson • API • Press Ganey • McKesson • McKesson • Siemens • Emergsoft • Meditech • HCAHP • IDX • Trendstar • Cerner • Meditech • AHRQ • Lawson • Peoplesoft • Allscripts • MISYS • Claritas • Cognos • Eclinical • Mediware • Solucient • GE Centricity • IDX • GE 40 20
  • 21. Enterprise Healthcare Dashboards Quality Management  Strategic Initiatives  Volume Tracking  Financial Performance Patient Satisfaction  Supply Chain Management Staffing Productivity Operations/Business  Processes  Emerging trends in the healthcare industry  have accelerated the need to access more  timely, accurate and reliable data. 41 Executive Balanced Scorecard  Provides: Board level insight into key strategic  metrics Actual vs. Goal for: financial, patient,  internal  processes and growth Automated data collection / analytical  processes for organizational performance  scorecard. Historical trends and ability to drill down  into hierarchical detail to conduct root  cause analysis.  42 21
  • 22. Disease Management ‐ Diabetes Surveillance Provides: Conduct real‐time diabetic surveillance Connect directly to your EMR, practice  management, and financial systems Monitor alerts for patients with elevated  HgA1c levels (Hg A1c>9%) Facilitates UDS reporting under HRSA Identify patients that  have not had an annual  eye / foot exam or flu shot. Drill‐down  by site, provider & payer to view  patient clinical detail “on the fly” Track Hg A1c historical trends and quality  performance by payer Improve diabetic patient quality outcomes by  identifying high‐risk patients   Track and reduce healthcare racial disparities 43 Patient Census Tracking Provides: Patient census, occupancy, and bed  tracking data. The ability to connect to the hospital's  ADT system, and real‐time inpatient and  ED census monitoring Automated inpatient census tracking,  %  occupancy, and emergency department  volume by service. Census alerts anticipate patient flow  bottlenecks, identify pending discharges,  and improve staffing efficiency. 44 22
  • 23. Case Study ‐ Radiology Mitch Ocampo, MCSD, MCDBA, MCT Practice Director, Microsoft BI 45 MGH Imaging Imaging in four main locations 10 Radiology Divisions (Neuro, Body, Chest) 10 Main imaging groups (CT, MR, US, Xray…) 2000 Employees in Imaging 23
  • 24. MGH’s Goals  Strategic Planning Where are we gaining or losing business and why How can we serve patient population and referring physicians Tactical Operations Utilization trends Technologist & resource productivity Physician productivity Goals Cont…………. Monitor patient quality outcomes Comply with patient safety & regulatory  requirements Adhere to quality and safety programs Track compliance  Conduct research on utilization & patient  outcomes Innovation and best practices for Radiology “BI” 24
  • 25. Challenges Multiple data‐sources Multiple versions of truth Hard to gain access and use data Resource bottleneck for report writers Technology Decisions Build Radiology centric view of the world Cost vs benefits of owning the technology IMAP Buy Cost of Product/solution Missing functionality Cost of Consultants 25
  • 26. Roadmap Build the data model Determine the look and feel of dashboard Determine how to fill the “quadrants” of the  dashboard Develop graphs and scorecards MGH Radiology Dashboard MACNULTY CONSULTING, LLC 26
  • 27. Hand Hygiene MACNULTY CONSULTING, LLC MACNULTY CONSULTING, LLC 27
  • 28. MACNULTY CONSULTING, LLC MACNULTY CONSULTING, LLC 28
  • 29. MACNULTY CONSULTING, LLC MACNULTY CONSULTING, LLC 29
  • 30. MACNULTY CONSULTING, LLC MACNULTY CONSULTING, LLC 30
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  • 33. Question & Answer Session ? ? ? ? ? ? ? If you have questions, please submit them using the Question’s Pane in your GoToWebinar toolbar. If we are unable to address your question during today’s live session, a presenter will follow-up with you afterward. 65 Handouts Case Studies & Dashboard Examples 66 33
  • 34. Boston Medical Center uses BI to Analyze Nursing Operations, Outpatient metrics, and Quality of Care The Challenge Major changes in the healthcare industry ◦ Pay‐for‐performance ◦ Transparency of quality and safety data ◦ Patient empowerment Driving cost down ◦ Improve quality and safety of care ◦ Avoid healthcare associated infections ◦ Reduce length of stay Using data and analysis for improving process and outcomes Solution CDW for integrated data analysis Strategic and Operational Dashboards with Business Objects 67 Boston Medical Center uses BI to Analyze Nursing Operations, Outpatient metrics, and Quality of Care Benefits / Impact BMC Corporate Dashboard (VSSC) ◦ Individual Physician scorecard for credentialing Nursing Dashboard ◦ Hospital, specialty group and unit levels ◦ Insight to staffing costs ◦ 10 key metrics Outpatient Dashboard ◦ Department, clinic group, location, service, major billing code levels ◦ 3 key metrics ◦ Los, discharges, empty beds Access to care ◦ Department, clinic location, provider group, provider levels ◦ 6 key metrics Financial reports ◦ About 40 financial reports of Lawson data 68 34
  • 35. Gaylord Hospital & MEDITECH EDGE deployment for “Real-Time” Patient Real- Time” Census & Bed Tracking Dashboard The Challenge Execut
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