1. Online Communities Improve Performance, Quality, and Efficiency Twelfth National Forum on Customer Based Marketing Strategies April 23, 2007 Orlando Holly Pendleton Manager Knowledge Management Catholic Health Initiatives Denver CO Janet Guptill Consultant Health Evolutions, Inc. St Louis MO

2. Seminar Description Virtual communities can be used to accelerate the ability of healthcare organizations to deliver safe, effective, and efficient care. Hear how a hospital alliance and a large healthcare system are sharing evidence- based practices and data-driven results. Identify the difference they are making.

3. Creating Community Online What is a community? Why are they moving online? Why should this matter to you? What is hard about it? What makes it easier?

4. Who has expertise in this area? Is anyone else working on this same problem? What ideas have been tried and tested? Who else faces similar challenges to mine? Is there a recommended way to do this? How can I share what I have learned? Creating Community: people connecting through shared needs

5. What are online communities? Online communities are social networks They are supported by web technologies They exist to solve problems

6. What are online communities in healthcare? Consumer communities – Disease support groups, weight loss/stop smoking, connect patients and families Professional communities – Professional societies, physician networking, hospital business alliances, software users Employee communities – Best practice adoption, process improvement teams, peer networking

7. Online communities are it! MySpace Generation Collaboration Expectations Customer Interactions Engagement

8. Why use online communities? Virtual Communities are used across hospitals to: Create relationships across time and space for peer learning and experience sharing Identify successful practices, lessons learned, and critical success factors for achieving better results Encourage and reward adoption of innovative practices and data-driven business processes

9. Why use online communities? Virtual Communities are used within hospitals to: Collaborate across roles, departments, or functions to solve operational problems Simplify access to experts and expertise, encourage new ideas Save time and money by re-using work done in another department or area

10. What are key building blocks for effective communities? Value Add – both the individual and the organization have to see it as useful Culture – a new way of working – inherently more open and collaborative Infrastructure – making it look simple is hard work to begin with Communicating Impact – stories drive change IHI Profiles in Improvement Who's improving health care? People are. Listen to the story of Jennifer Dunscomb of Columbus Regional Hospital. Source: www.IHI.orgJennifer Dunscomb of Columbus Regional Hospital.www.IHI.org

11. Who is doing this now? CHCA 3 pronged approach to virtual communities: Peer Networking Forums, Performance Improvement Collaboratives, Race for Results Awards Program CHI Embedded knowledge transfer and learning: Knowledge Communities, Practice in Action, Calls to Learn, Relay Reports, LEARN

12. CHCA Case Study Background of CHCA Overview of Forums, Collaboratives, Race for Results Strategic Impact to date Lessons Learned Improving the Performance of Childrens Hospitals

13. Knowledge Transfer to Improve Performance: A Case Study 42 non-competing hospitals US, Canada $14 billion combined revenue (1) Average per member revenue of $330 million If Fortune 500 would be ranked 142 IDN influence: 500,000 inpatients; 10 million outpatients (2) 102,000 employees (2) >20,000 pediatric physicians (5,162 medical specialists;1,985 surgical specialists(2) Top 5 among U.S. health systems/IDNs Sources: (1) Estimated from Goldman Sachs report to CHCA, July 2004; (2) Estimated from personnel report in AHA Guide 2003/ 2004

14. CHCAs 3-pronged strategy Peer NetworkingPerformance Improvement Spread TECHNOLOGY Online communities Peer group meetings Collaboratives C, C, c RACE for Results Juried annual award PEOPLE & PROCESS Teleconferences List serves Forum directors Special reports Benchmarking PDSA approach Results reported to peers and executives Dedicated PI staff Awards process with external judges Peer reviewed publication Ambassador program External published results Real time tools and resources STRATEGIC IMPACT Individual employee improvement in productivity Satisfaction + individual hospital improvement in results Organization-wide improvement, e.g., cost reduction, error reduction, safety improvement Accelerate improvement Safe, efficient and effective Focus on spread Knowledge available when you need it Best practices Peer assistance

15. 1 - Peer Networking Forums Internet site for Forum members only Exclusivity, confidentiality, knowledge of colleagues Dedicated staff facilitator – Supports 3-5 Forums depending on content knowledge and required expertise Share documents, post weblinks, initiate discussions, find resources Technology combined with meetings keeps the group connected Teleconferences, webcasts, bi-annual meetings Ad hoc conversations, focused research, group problem-solving Rapid response to posted questions Benchmarking and identifying variation

16. Peer Networking Forums are Highly Active Ambulatory22Materials Management33 Cardiac28OR Directors31 CFO40PACT34 CHAPs17Patient Financial Services21 CIO36Payor Contracting33 CNO40Pediatric Practice Exec.22 COO40Pharmacy Buyers40 Corporate Compliance28Pharmacy Directors39 Customer Service20PHIS37 Dietary33Physician Relations22 Executive Dialogue40Quality and Safety Leaders 42 Facilities Management33Radiology Directors33 Health Information Mgmt33Respiratory Directors32 Home Care17Risk Managers25 Human Resources32SMAC30 JCAHO35Social Work Community15 Lab Directors32SPBD28 Overall 2006 satisfaction 5.24 of 6.0 (87%) 2006 Hospital Participation in Forums

17. Peer Networking Forums webpage example

18. 2 - Performance Improvement Collaboratives Dedicated Performance Improvement staff and resources Trained in IHI improvement methodology Hospitals agree to share results, post data and publish results Use industry and hospital expert panels to validate clinical direction Combine research and rapid cycle - essential for academic engagement Technology tools and partners integral to success Knowledge repository available real time improvements, tool kits, lessons learned, comparative data, audios of webcasts and lessons learned Strategic partners essential to spreading results and gaining credibility AHRQ Partnership for Quality Grant helped fund participation and training for all 42 hospitals Data-sharing agreements developed to expand comparative data sets (Vermont Oxford Neonatal Network and others)

19. Performance Improvement Collaboratives Example: Reduced Adverse Drug Events Hospital Teams: Atlanta Birmingham Buffalo Cincinnati Columbus Corpus Christi Dayton Fort Worth Kansas City Miami Nashville New Orleans New York/ Morgan-Stanley New York/ Komansky Center Orange Palo Alto Pittsburgh St. Petersburg 16 teams (89%) had a reduction in ADE rate Average among teams with a reduction: 64% reduction Average for all teams: 49% reduction 11 teams (61%) had at least a 50% reduction in ADE rate BETTER Avg. CHCA Hospitals with reduction in ADE rate Goal

20. Collaboratives have own web-sharing spaces

21. Adverse Drug Event Collaborative webpage

22. Blood Stream Infection Collaborative webpage

23. Surgical Infection Prevention Collaborative

24. 3 - Awards Program Encourages Spread Formal RACE for Results awards program Formal application process with strict submission requirements External judges panel representing industry experts in quality and patient safety Results announced at award ceremony during annual Quality & Safety Meeting Winners required to serve as Ambassadors during subsequent year to teach techniques and encourage adoption of proven practices Formal marketing campaign to publicize event Emails, posters, web notices to promote the competition and publicize winners Email-based Relay Report to report progress as proven practices are replicated across the alliance Resources and contacts posted on the intranet to facilitate connections and encourage adoption Benchmarking reports regularly published to document improvements Improve Today Webcasts connect colleagues

25. RACE for Results Awards Program 2004200520062007 Little RockLittle Rock: Reducing Catheter- Related Bloodstream Infections through Repeated Rapid Cycle Improvements CincinnatiCincinnati: Reducing Cost through Improving Quality Palo AltoPalo Alto: Decreasing ADEs By Implementing Safety Best Practices Washington DCWashington DC: Using PHIS to Target Reducing Infections in VP Shunt Surgeries Omaha:Omaha: "Asthma Attack Dayton:Dayton: Reducing Catheter- Associated Bloodstream Infections in Children 11 Entries12 Entries17 Entries30 Entries

26. RACE Results in Performance Improvement

27. Conclusions for CHCA Strategy Drives Approach Informal peer networking builds a culture of sharing and collaboration Formal collaboratives are needed to create immediate results Systematic rewards and support are needed to spread initial results Knowledge Transfer involves Technology, People/Process, and Strategy Technology enables information sharing and people directories People processes ensure productive interaction and knowledge exchange Strategy determines impact measures and ensures organizational momentum CHCA Case Study Results: 42 childrens hospitals participate in 30 peer networking forums, regularly sharing improvement tools and resources, exchanging best practices and learning from industry experts 18 childrens hospitals averted 13,478 adverse drug events (ADEs), representing $2.7 million in net savings, and reduced PICU blood stream infections (BSIs) by 57% More than 60 intensive care units are working to sustain and spread improvements in ADEs and BSIs based on the initial collaboratives work

28. CHI Case Study Background of CHI KT&L Strategy and Scope Relay Report results to date Lessons Learned

29. CHI Fast Facts Multi-institutional System of Catholic Healthcare Providers Dedicated to the healing ministry of the Catholic Church National Offices: Denver, Northern KY, and Minneapolis Market Based Organizations (MBOs) 19 states 68 rural and urban communities 71 hospitals (63 acute care, 5 behavioral, 2 rehabilitation, 1 long term acute care) 43 long-term care, assisted living facilities and residential units 5 Community Health Services Organizations Licensed acute care beds range from 15 to 1,546 $7.1 Billion in Annual Revenues 66,000 Employees (and growing)

30. Vision for CHI Catholic Health Initiatives Vision is to live out its Mission by transforming health care delivery and by creating new ministries for the promotion of healthy communities.

31. CHI Strategic Plan: 2007 - 2011

32. Leveraging the Knowledge Within Our goal is for CHI to become known as an innovative organization. That will be our legacy for the future health care system – that CHI learns to leverage the wisdom of the whole, efficiently, effectively, and humanely. - Kevin E. Lofton, FACHE, CEO, Catholic Health Initiatives

33. Knowledge Leadership Knowledge Leaders are Leaders who are effective at… Embracing and driving change Sharing experiences and applying learning Modeling the expected behaviors grounded in the culture of the organization … in order to tap into the intellectual capital of the organization and harness it to innovate and grow

34. Knowledge Transfer & Learning at CHI Strategic Priority Consulting Knowledge Communities Formal Education Practice in Action Communication & Collaboration

35. CHIs KT&L Strategy Communication & Collaboration Knowledge TransferIntegrated Learning TECHNOLOGY Knowledge Communities Relay Report Live Meeting web- conferencing List serves Practice in Action - Proven Practices database Pathfinders collection of expert resources Calls to Learn Annual Events & Conferences System-wide LMS - LEARN PEOPLE & PROCESS Calls to Learn National office sponsors KC Chartering process KC metrics reports Integrated into Annual Planning Budget Review process Formal process to confirm a proven practice KT&L staff support system-wide initiatives e.g., CHI Connect, service line development Centralized calendar of Calls to Learn across the organization and beyond LMS intended to address CHI-wide practices Integration of organizational effectiveness research with delivery of new education STRATEGIC IMPACT Enable innovation Focus on strategic priorities Defined and implemented new standards of practice Organization-wide improvement, e.g., cost reduction, error reduction, safety improvement Accelerate improvement Safe, efficient and effective Strategic Priority Consulting Compliance adherence Enable delivery of education in support of strategic priorities across the system

36. Knowledge Communities: Collaborate and Innovate An environment that enables innovation, supports the development and spread of new ideas and builds the organizational social network to save time and reduce costs. Value of Pharmacist as part of bedside patient care team proved and $53 Million saved

37. Why CHI uses online communities Connect peers and experts across CHI Common space across space and time Supports the work of the Knowledge Community: Enable and leverage knowledge sharing Learn before doing Problem solving: find, innovate, and accelerate solutions Reduce costs, save time, and increase social fabric A strategic resource

38. Making it Easier to Connect with Knowledge Communities

39. Relay Report: Communicate, Connect, Celebrate Improve connectivity, celebrate successes and increase awareness and utilization of KT&L resources. Accelerate the implementation of clinical imaging technology, resulting in accelerated NPSR of $1.5 - $3.0 M

40. Practice in Action: Transfer Critical Knowledge Increase adoption of reliable, evidence based practices, identify organizational expertise, and recognize facilities that have achieved success. Avoided medication errors through improved reconciliation of home and hospital medications.

41. Strategic Priority Consulting: Support Organizational Priorities Accelerate achievement of strategic priorities by creating a plan to leverage available knowledge transfer and learning resources. Accelerate the implementation of ERP technology (Lawson) and the realization of projected savings

42. Formal Education: Sustain Change Coordinate and share system resources to insure that education and training help employees learn the skills, behaviors and competencies they need to move strategic priorities forward. Avoid dangerous / deadly events in OB through a targeted Advanced Fetal Monitoring curriculum

43. Knowledge Transfer is both Organic AND Strategic Practice in Action Strategic Priority Consulting Knowledge Communities Formal Education Communication & Collaboration Accelerate Learning & Enable Innovation through… …leading to new models of care delivery and creative solutions… …resulting in improved outcomes: Quality & Patient Safety Employee Satisfaction & Engagement Increased Operating Margins

44. Communities Are Here! A 2001 best practice study (Using Communities of Practice to Drive Organizational Performance and Innovation) found: …strong evidence that communities are the next step in the evolution of the modern, knowledge-based organization. Communities … are a legitimate way to spend time, engage an amazing percent of employees, are held accountable for producing and stewarding business-critical knowledge (and often results), and are assuming a formal voice in the organization, based on the power of their knowledge, not their position.

45. Conclusions for CHI Knowledge Leadership is at the core of CHIs business strategy New Leadership competencies are based on collaboration & change Knowledge communities build a culture of sharing and innovation KT&L team has become core resource for national strategic initiatives Knowledge Transfer has become the way CHI works Web tools support connectivity and facilitate communicating about key knowledge resources and success stories New roles have evolved as collaboration has become embedded in the way CHI works Strategic initiatives rely on knowledge tools to speed adoption CHI Case Study Results: A total of 48 knowledge communities involve over 1600 associates across the system Knowledge communities have yielded both hard and soft dollar savings, impact patient outcomes through improved practices, increase reuse of proven practices After 5+ years, CHI leadership expect KT&L resources to be utilized as part of strategic priority projects and leaders will be held accountable to Knowledge Leadership competencies

46. Online Communities – Key Takeaways Charter the community and know why it exists – connect it to the core strategy continually deliver value build a structure for care and feeding Build the web tools and support structure facilitate effective collaboration combine people, content, and context make it easy to use

47. Online Communities – Key Takeaways Continually bring people into the conversation use both push and pull marketing tactics link the website with other daily work tools (email, work scheduling, news) remind people of the resources available celebrate the success stories Redesign how work gets done reward collaboration share lessons learned simplify knowledge re-use

48. Online Community Building Blocks Social Networking Link to Strategy Ongoing Marketing TECHNOLOGY Create MySpace for your employees, physicians, and customers Identify the communities needed to fulfill the organizations strategic objectives and charter them Use push and pull tactics to continually engage people in the conversation of collaboration PEOPLE & PROCESS Create online people directories, create peer group moderator roles, highlight personal success stories Make it someones job to ensure that collaboration is integrated into the organization; create a process for connecting related efforts Incorporate proven practice sharing into annual awards ceremonies, dept budget reviews, employee performance reviews STRATEGIC IMPACT Enhanced employee satisfaction and productivity, strong customer satisfaction scores Define and track the impact measures, e.g., patient safety, financial performance, wait times, turnover, market share, etc. Faster decisions, quicker adoption of proven practices, rapid innovation absorption

49. Lets Connect! Janet Guptill Consultant, Health Evolutions 314.378.6612 JGuptill@healthevolutions.com Holly Pendleton Manager, Knowledge Management, CHI 303.383.2736 HollyPendleton@catholichealth.net Kate Collins Director, Knowledge Management, CHCA 913.262.1436 Kate.Collins@chca.com Carol Dobies President, Dobies Healthcare Group 816.753.3336 cdobies@dobies.com