Professional Documents
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Creating A Culture of Performance Excellence at Henry Ford Health System
Creating A Culture of Performance Excellence at Henry Ford Health System
Henry Ford Health System (HFHS) of Detroit, System’s patients, its health plan members, and its
Michigan, has earned industry-wide recognition by communities.
engaging its leaders to align the organization’s
strategic objectives with Malcolm Baldrige National With more than $4 billion in revenues, HFHS is one
Quality Award criteria and craft a comprehensive of the largest health care systems in the United States
program to integrate performance to drive sustain- and a respected leader in clinical care, research, and
able growth. One of the largest health care systems education. HFHS has more than 23,000 employees
in the United States, HFHS developed a performance serving 4.5 million people in southeast Michigan
management approach that backed up standards at more than 140 care delivery sites, with a total
of excellence with comprehensive training and de- of 102,000 admissions, 418,000 emergency depart-
velopment, established a performance improvement ment visits, 3.2 million office visits, and 88,000 surg-
framework that emphasized analysis and review, in- eries annually. The System’s core components are:
tegrated its communications systems with a renewed
focus on innovation, and fine-tuned its performance r the Henry Ford Medical Group, with 1,200
strategy to stoke agility throughout the organi- physicians and scientists;
zation. Results included a reduction in in-patient r 2,200 private practice physicians;
mortality, innovations in health care best practice, r four acute care medical-surgical hospitals, includ-
enhanced employee engagement patient satisfaction, ing the 802-bed Henry Ford Hospital in Detroit,
savings of almost $10 million over four years in rela- which is a tertiary care, level 1 trauma center, as
tion to harm-reduction efforts, and five national per- well as an education and research complex;
formance awards, including the Malcolm Baldrige r Community Care Services, which includes a di-
National Quality Award in 2011. © 2013 Wiley versified portfolio of post-acute and retail ser-
Periodicals, Inc. vices;
r Behavioral Health Services with two behavioral
Lowered reimbursements and increasing uncompen- hospitals; and
sated care across the 1990s led to decreased in- r the Health Alliance Plan (HAP), a health insurer.
vestments in infrastructure and clinical programs at
many hospitals and health systems in the United In 2000, with organization-wide input, HFHS
States. The rising crisis in health care and a call leadership recrafted the System’s mission, vision,
for improved quality and patient safety became a and values. They recommitted themselves to their
national discussion. At Henry Ford Health Sys- base in Detroit and their academic mission, and
tem (HFHS) in Detroit, part of the discussion in- they determined to relentlessly pursue organiza-
volved how to integrate performance to drive smart tional integration to deliver the best care to HFHS
growth while focusing on what matters most: the patients and drive sustainable growth. Leaders and
was responsible for improving patient satisfaction at to achieve this objective became HFHS’s “No Harm
each business unit. Campaign,” with an aggressive goal set at a 50 per-
cent reduction in harm events by 2013. Results were
The seven-pillar framework became the basis for measured at the System level and compared to tar-
strategic planning, measurement and review, prior- gets in 27 categories of harm. Each business unit
itization and resource allocation, and improvement also had targets in each category of harm where im-
and innovation across HFHS. The pillar framework provement was required. A department would focus
served to align System strategic objectives, strategic on something that was important to it. For example,
initiatives, and related performance measures and the housekeeping department might focus on imple-
targets for the System and within business units, menting proper cleaning protocols to decrease infec-
from the top of the organization to the individual tions. An individual employee in the housekeeping
employee. This provided a synchronization and con- department might have a goal focused on the re-
sistency of plans and processes against which key sponse time to clean a room with an identified spill,
decisions were made. A three-year, rolling strate- or the frequency and method for cleaning isolation
gic plan was developed for the System, guided by rooms. As a result, by 2011, HFHS was more than
the seven pillars as the basis for goal categories and halfway to its 50 percent harm-reduction goal and
alignment. earned national recognition for its accomplishment.
The National Quality Forum and The Joint Com-
For instance, the Quality and Safety strategic objec- mission recognized the No Harm Campaign with
tive aimed for HFHS to become a national leader in the 2011 John M. Eisenberg Award for Innovation
delivering safe, reliable care. The strategic initiative in Patient Safety and Quality at the Local Level.
Center for Patient Safety & Quality. For example, control charts, and trend lines. Graphical displays
HFHS hospitals participate in the MHA Keystone with control limits or data trending on run charts
Center’s Obstetrics Collaborative, which aims to help identify when variation is “common cause”
reduce harm to mothers and infants by tracking (requiring no action) or “special cause” (requiring
compliance with two evidence-based care bun- action be defined and taken). The defined owners
dles known to improve perinatal outcomes. The of work processes use customized dashboards with
care bundles include no elective deliveries (that is, data on customer, supplier/partner, and operational
labor induction or scheduled Caesarean section) requirements. Managers review System dashboard
before 39 weeks of gestation and a standardized measures monthly to assess performance against
order set for the administration of oxytocin (that strategic objectives and action plans. “Stoplight”
is, labor induction or augmentation). Results of color schemes on these dashboards identify metrics
this initiative raised compliance levels with these at or better than the target (green), within 5 percent
two bundles to almost 100 percent at HFHS hos- of target (yellow), or more than 5 percent behind tar-
pitals. get (red), allowing focus on strategic initiatives that
are behind target. A sample dashboard is shown in
Stepping Up Performance Analysis and Review Exhibit 4. System dashboards are available monthly
Teams use a variety of analytic techniques, such to the workforce on the HFHS intranet and through
as fishbone diagrams, Pareto charts, run charts, postings in work areas.
Dashboards are widely deployed across business access dashboards at Henry Ford Medical Center
units and pillar teams, and managers use the data sites across southeast Michigan, a Contact Cen-
they contain to make day-to-day operational deci- ter was created to improve access. This centralized
sions related to work processes. For example, all the appointment process for primary care and most
hospital leaders and managers review dashboards specialty services, streamlining appointment-setting
with quality and safety indicators as well as census, processes and standardizing appointment types. The
volumes, revenue, bed availability, and productiv- Contact Center both improved the service (for ex-
ity data; ambulatory medical centers’ leaders review ample, call response times) and made it easier for
dashboards of patient access/appointment availabil- patients to make an appointment.
ity, phone access, and timely response and clo-
sure of patient telephone messages. Process own- Organization performance review (OPR) occurs in
ers often supplement such data with real-time input all HFHS entities. The OPR process provides a fo-
from internal customers, patients and families, and rum for transparency, mutual accountability, and
supplier/partner input from performance reviews. access to assistance with initiatives as needed. The
For example, as a result of reviewing appointment OPR process involves:
systematically rolled them out by providing leaders Q12© survey database has doubled since 2008, and
with a toolkit and key messages for modeling the the number of leaders with scores in the bottom
standards of excellence. Senior leaders role model quartile decreased by almost half. The System’s Ser-
the standards through open-door policies, leader vice Excellence Steering Committee subsequently de-
rounds, and thank-you notes, among other be- veloped Team Member Standards of Excellence for
haviors. Self-assessments, 360-degree assessments, all employees and embedded them in performance
Myers-Briggs and Gallup Strengthfinders person- management goals. All employees are expected to
ality assessments, and supervisor evaluations dur- meet the following eight standards:
ing the Performance Management Program support
evaluation against the competency model. Leaders r Display a positive attitude.
use results in collaboration with their supervisors to r Take ownership and be accountable.
create personal development plans to address gaps r Respond in a timely manner.
in leadership competencies and behaviors. Actions r Commit to team members.
may include course work and development opportu- r Be courteous and practice established etiquette.
nities available through the Henry Ford Health Sys- r Respect patient privacy.
tem University’s leadership development curriculum r Foster and support innovation.
and/or external opportunities that align with and r Honor and respect diversity.
support expected leadership competencies.
For continuous improvement and clarity, these ser-
As a result of this initiative, the number of leaders vice standards were updated in 2011 and cas-
who have scores in the top quartile of the Gallup caded to all employees. Although the content of the
Despite a challenging economic environment and percentile level from 2007 to 2010. HAP has been
yearly increases in uncompensated care expenses, rated by J.D. Power and Associates as among the
HFHS is the market leader for the tri-county area “highest in member satisfaction among commer-
of southeast Michigan and continues to demon- cial health plans in Michigan” for four consecutive
strate increasing marketplace performance levels years, and in 2011 it was rated the “highest in the
and trends. Market share growth in 2010–2011 oc- state.” HFHS ambulatory and community hospitals’
curred in increases in births (6.5 percent), urgent satisfaction levels meet or exceed the 90th percentile
care visits (10 percent), emergency department vis- level in Press Ganey patient surveys. For employee
its (3.8 percent), Community Care Service volumes engagement scores, the Gallup Q12© survey showed
(20 percent over two years), and inpatient market that Henry Ford Hospital rose from the 18th per-
share (3.9 percent). The Pharmacy Advantage unit centile in 2008 to the 43rd percentile in 2010 to
has a compound annual growth rate of 25 percent the 76th percentile in 2012. The Henry Ford Medi-
for the last four years and is contributing the major- cal Group rose from the 18th percentile in 2008 to
ity of net income in the highly profitable Community the 35th percentile in 2010 to the 85th percentile
Care Services business unit. nationally in 2012.
Some components of HFHS’s integrated system Clinically, HFHS efforts have resulted in national
demonstrate best-in-class customer-focused out- best practice safety innovations. Insulin protocols
comes. HFHS’s engagement and satisfaction results for glycemic control, first piloted in 2003, were
for its Health Alliance Plan have met or exceeded spread throughout the System by 2006 (Horst et al.,
the National Committee for Quality Assurance 90th 2010), with refinement efforts continuing and new
Additional Resources
References Baldrige Performance Excellence Program, www.baldrigepe
Coffey, C. E. (2007). Building a system of perfection depres- .org
sion care. Joint Commission Journal of Quality and Patient Institute for Healthcare Improvement, www.ihi.org
Safety, 33, 193–199.
Michigan Health and Hospital Association’s Keystone Center
Conway, W. A., Hawkins, S., Jordan, J., & Vout-Goss, M. for Patient Safety & Quality, www.mhakeystonecenter.org
(2012). The Henry Ford Health System No Harm Campaign:
HFHS No Harm Campaign, www.hfhs.com/noharm
A comprehensive model to reduce harm and save lives. Joint
Commission Journal of Quality and Patient Safety, 38, 319–
327.
Susan S. Hawkins, senior vice president of performance ex-
Horst, H. M., Rubinfeld, I., Mlynarek, M., Brandt, M. M.,
cellence for Henry Ford Health System in Detroit, Michigan,
Boleski, G., Jordan, J., Gnam, G., & Conway, W. (2010).
leads strategic planning, process engineering, operational an-
A tight glycemic control initiative in a surgical intensive care
alytics, and clinical quality and safety initiatives across the
unit and hospitalwide. Joint Commission Journal of Quality
System. Hawkins has applied engineering, business, and qual-
and Patient Safety, 36, 291–300.
ity improvement methods to projects throughout HFHS since
Moore, C. L., Ajluni, M., Soi, V., Johnson, L., Adams, B., 1986. She has served as faculty for corporate quality man-
Amburn, L., Sykes, J., Besarab, A., Zervos, M., & Yee, J. agement courses, is a trained facilitator for rapid-cycle im-
(2011). Reduction of catheter-related bacteremia (CRB) and provement workshops, and has an ongoing role in teaching
healthcare utilization by use of a prophylactic gentamicin- HFHS leadership development courses on project manage-
citrate lock solution. American Journal of Kidney Diseases, ment, mentoring, and quality and safety. She holds a bach-
57(4), B69. elor’s degree in industrial engineering from the University
of Michigan and a master’s in business administration from
Rivers, E., Nguyen, B., Haystad, S., Ressler, J., Muzzin, A., Wayne State University. Hawkins is a member of the Baldrige
Knoblich, B., Peterson, E., & Tomlanovich, M. (2001). Early Performance Excellence Program’s Board of Examiners. She
goal-directed therapy in the treatment of severe sepsis and can be reached at shawkin1@hfhs.org.
septic shock. New England Journal of Medicine, 345, 1368– Rose Glenn is the senior vice president of communications
1377. and chief marketing officer for Henry Ford Health System.