Mayo Health System: Developing 65 Points of Excellence

1. Mayo Health System:Developing 65 Points of Excellence Deb Fischer Mayo Clinic October 10, 2007

2. Presentation Objectives • Baldrige National Quality Program framework • Mayo Health System’s journey to performance excellence

3. Topics • Susan • Need for a checkup • Baldrige National Quality framework • Mayo Health System’s Baldrige journey • What we learned • Implications for you

4. Meet Susan • She is a patient at Franciscan Skemp Healthcare – Mayo Health System in La Crosse, WI • She has been a patient there for more than 20 years, before it became a Mayo Health System practice

5. Susan’s not alone • She’ll have at least one of our 2.5 million system-wide patient visits this year • She’ll also be one of the 18,000 patients referred to Mayo Clinic this year for highly specialized care

6. Susan has a choice • She can choose to visit us or a competitor -we’re within miles of each other in La Crosse • She could also seek care at any of our 65 locations throughout Minnesota, Iowa and Wisconsin, or at Mayo Clinic in Rochester

7. Barron Cameron Prairie Farm Chetek Bloomer Glenwood Colfax City Chippewa Falls Menomonie Eau Claire Elmwood New Prague Cannon Falls Mondovi Osseo Lake City Le Sueur Northfield Lamberton St. Peter Wabasha Waterville Alma Arcadia Faribault Springfield Mankato Plainview Janesville Galesville Owatonna Sparta Tomah Madelia Lake Crystal Waseca Rochester Holmen Blooming St. James Onalaska New Richland Prairie Truman La Crescent West Salem Austin Grand Meadow Alden Wells Fairmont Houston La Crosse MINNESOTA Sherburn Mabel Kiester LeRoy Albert Lea Adams Caledonia IOWA Lake Mills WISCONSIN Decorah Armstrong Waukon Charles City Prairie du Chien CP1199837-1 CP1199837-8

8. A chance encounter • Susan often travels to Mankato, MN to visit her son • During a recent visit she had a heart attack … • She’s okay, but was surprised to learn that even though she was still in the “system”, her medical information wasn’t readily available

9. Barron Cameron Chetek Prairie Farm “Silo Thinking” Glenwood Bloomer City Colfax Chippewa Falls Menomonie Eau Claire Elmwood New Prague Osseo Cannon Falls Lake City Mondovi Le Sueur Northfield Lamberton St. Peter Faribault Wabasha Waterville Alma Arcadia Mankato Plainview Springfield Janesville Galesville Owatonna Madelia Sparta Tomah Lake Crystal Waseca Rochester Holmen Blooming St. James Onalaska New Richland Prairie Truman La Crescent West Salem Austin Grand Meadow Alden Fairmont Wells Houston La Crosse MINNESOTA LeRoy Sherburn Adams Albert Lea Caledonia Kiester Armstrong Mabel IOWA WISCONSIN Decorah Lake Mills Waukon Charles City Prairie du Chien CP1199837-1 CP1199837-8

10. A learning experience • Susan, and others like her, are one reason Mayo Health System chose Baldrige for system optimization

11. MayoHealth System – 15 years Merger and acquisition 1992 – 1997 Structure and organizational relationships 1998 – 2003 Alignment 2004 – 2007

12. Mayo Health System • Pride in physician leadership • Enjoy local autonomy • Organizations are accountable for quality and financial performance How they succeed is up to them

13. A checkup is needed • All health care organizations need to do something – quick • Fraught with waste • Quality not where it should be • Fierce competition • Medicare’s future in doubt • Baby boom means fewer workers • It’s the right thing to do

14. A checkup is needed • Crossing the Quality Chasm Institute of Medicine, 2001 Urgent call for redesign of the American health care system • performance expectations • align $ and quality incentives • rules to guide relationships • evidence-based practice • information systems • Fundamental change isnecessary

15. How does one create and replicate Excellence in 65 locations?

16. One Option • Wait • Let others lead the way • Allow others (government and other payers) to dictate your future

17. Another Option:Create excellence in health care • Know your patients • Align with your partners • Optimize all processes • Assess your results Improve every aspect of your business

18. Improve every aspect of your business A model clearly working in industry and now it’s working in health care

19. What is Baldrige? • Malcolm Baldrige National Quality Program • Award created by public law, 1987 • Assessment and improvement framework • Criteria based • Leadership • Strategic Planning • Customer • Information management • Workforce • Process Management • Results

20. What Baldrige is not • A way for “corporate” to take control • Something that the “Quality” people do • Quick • A season

21. Baldrige Criteria for Performance Excellence Systems Perspective Strategic Planning WorkforceFocus Performance Results Leadership Process Management Customer Focus & Markets Measurement, Analysis & Knowledge Management

22. Baldrige Health Care Awards 2002 • SSM Health Care (St. Louis, MO) 2003 • Baptist Hospital, Inc. (Pensacola, FL) • Saint Luke’s Hospital (Kansas City, MO) 2004 • Robert Wood Johnson University Hospital (Hamilton, NJ) 2005 • Bronson Methodist Hospital, (Kalamazoo, MI) 2006 • North Mississippi Medical Center (Tulepo, MS)

23. Minnesota Health Care Recognition Winona Health Allina Hospitals and Clinics Mayo Health System Benedictine Health System Mayo Clinic Radiology Mayo Clinic Cardiovascular Diseases

24. Excellence is catching on Malcolm Baldrige Award Applicants All sectors Health care

25. Why Baldrige works for Health Care Sr. Mary Jean Ryan - President/CEO, SSM Health Care “Baldrige is the best way to get better faster.” Frank Sardone - President/CEO, Bronson Methodist Hosp. “This [Baldrige] achievement places a spotlight … on everyone at Bronson who has worked so hard to be the best, because it is the right thing to do for the patients and families we serve.”

26. Baldrige will help MHS assure: A uniform patient experience Optimized performance Alignment with Mayo Clinic direction A strategy-driven future Clear goals / objectives linked to strategic priorities Reliable performance measurement & analysis systems Operating strategy & infrastructure to drive results

27. How do we do Baldrige? • Baldrige Health Care Criteria for Performance Excellence - 2007 • Attend national / regional Baldrige conferences • Oversight committee & seven category teams • Research current state to address the questions • Formulate responses • Write & rewrite responses

28. How do we do Baldrige? (2) • Combine / edit into a written application • Submit to state award program • Site visit • Extensive feedback • Strengths • Opportunities for Improvement (OFI) • Continuously work toward addressing OFIs

29. Mayo Health System Journey 2006 • Prioritize opportunities, update MHS strategic plan • 2nd MN Quality Award application 2007 • Site visit & feedback report • Prioritized opportunities, update MHS strategic improvement plan 2004 • MHS Board of Directors endorsement • Criteria training 2005 • 1st MN Quality Award application • Site visit & feedback report

30. How did Mayo Health System fare? Commitment • Early stages of implementing systematic approaches and obtaining results • Committed to promoting organizational excellence through self-assessment Advancement • Demonstrate good progress in building and deploying systematic approaches especially in the leadership, strategic planning and customer focus areas • Many good results Achievement • Generally aligned and demonstrates evaluation and improvement • Good results and trends in most areas with no major faults Excellence • Refined, fully deployed, systematic approaches, with positive trends in all key measures and results • Well integrated and can serve as national and global role models MN Council for Quality

31. 2006 Executive Summary Strengths • Leadership:physician leadership supports the Baldrige core value of patient-focused excellence • Transparency:data transparency supports the Baldrige core value of management by fact • Community focus:locally available health care and high quality align with the Baldrige core value of social responsibility and improved community health

32. 2006 Executive Summary Opportunities for Improvement • Leverage best practices: determine and spread best practices across the system • Strategic planning: lack some targets and performance measures making it difficult to achieve alignment across the system. Evaluate and improve the strategic planning process • Business and support processes: need approach for identifying key processes, their requirements and measures

33. System observations • Rigor forces learning & acknowledgement of strengths plus opportunities • Focus on PROCESS • Focus on RESULTS • Unifying experience • External reviewers add credibility • Valuable consulting

34. Personal observations • Hard work … but worth it • Cannot delegate Baldrige … must lead from the top • Communicate, communicate, communicate • Journey will take many years

35. Gaining momentum 7 of 12 Mayo Health System organizations have begun a local Performance Excellence effort

36. What’s next? • Concentrate on key system operations • Consistently “Manage to Baldrige”… no “Baldrige Season” • MHS Performance Report

37. External drivers MHS Performance Report Health Care Outcomes Customer Outcomes MHS Strategic Improvement Plan Board driven Internal drivers Financial & Market Workforce Outcomes what needs to get better Process Effectiveness Leadership Outcomes • Measures • Performance targets • Current levels / trends • Performance targets Creates Improves Management driven The Baldrige framework to manage MHS Action Plans • Measures • Performance targets

38. Thanks to Baldrige We’re able to more methodically work toward achieving Susan’s vision of what Mayo Health System should be

39. How do YOU create and replicate excellence in your organization? • How do you create dramatic change and increase quality? • Keep a focus on the customer • Create services and delivery based on customer needs • Manage processes • Are your partners or competitors pursuing Baldrige?

40. Questions