1. CLEAR 2008 Annual Conference Anchorage, Alaska Case Study – Case Processes to Meet Mandated Targets Sandra Whitley Ryals Director Virginia Department of Health Professions

2. CLEAR 2008 Annual Conference Anchorage, Alaska October 2006 Governor Kaine, assigned the Department of Health Professions (DHP) the performance goal of 250 days to close 90% of all patient care cases. Performance on October 2006 Closure by day: 734.4 days Closure by percentage of cases : 57%

3. CLEAR 2008 Annual Conference Anchorage, Alaska Performance Toward Goal Made Visible to Public Quarterly reports on performance web site Electronic Access for Citizen Review Emphasis on Reaching the Right Results Securing Virginia’s AAA Rating http://vaperforms.virginia.gov /

4. CLEAR 2008 Annual Conference Anchorage, Alaska Getting to Goal: 7 Steps Rapid introduction to qualitative information Solid strategies Unique core strengths Supporting structures Consistent systems Well connected culture Inspired leadership

5. CLEAR 2008 Annual Conference Anchorage, Alaska Rapid introduction to qualitative information 13 Boards examined individually for closure performance baselines; Trend analysis provided to each board, executives, disciplinary units, with periodic real-time snapshots of case information; Closure performance reported weekly to boards, units.

6. CLEAR 2008 Annual Conference Anchorage, Alaska Solid strategies Examine “patient care” definitions Determine how many cases (5259) currently open Determine oldest cases for blitz in closing Identify the bottlenecks (disciplinary caseload 59%; Intake/investigation 46%; Probable cause 33%)

7. CLEAR 2008 Annual Conference Anchorage, Alaska Unique core strengths DHP has a deep understanding of its processes due to stability of management; DHP has a record of excellence in state government and wanted that branding to endure; DHP’s cultural lifeblood is doing it well; now it had to be done well and more efficiently

8. CLEAR 2008 Annual Conference Anchorage, Alaska Supporting structures Establish multidisciplinary performance action teams: –Intake & Investigation; –Old Cases; –Probable Cause. Network with specialist consultants (VRI) for data verification and reporting clarity. The company had worked with U.S. court systems for similar performance accountability.

9. CLEAR 2008 Annual Conference Anchorage, Alaska example of team recommendations 250 Day Measure Recommendation 1. Create a tiered system for investigations where more work is done upfront “in-house” before a case is assigned to field Tier 1 - Intake& preliminary investigation Tier 2- Initial probable cause review Tier 3 - Full investigation, either field or administrative

10. CLEAR 2008 Annual Conference Anchorage, Alaska Consistent systems adopted Data reporting modified to separate into 3 measures, from the original 1 measure, to show a clearer, more balanced focus: Added a Clearance Rate performance measure; Added an Age of Active Pending Caseload performance measure; Modified the Time to Disposition to incorporate a moving window.

11. CLEAR 2008 Annual Conference Anchorage, Alaska Well connected culture * Changed approach from silo board mentality to agency wide consistency; * Actively partnered with other boards, discipline, adjudication to implement systems improvements & process efficiencies. A corporate culture that is well connected takes loads of time and effort. Culture is how people act everyday so you have to change behavior. This is one of the proudest things we accomplished!

12. CLEAR 2008 Annual Conference Anchorage, Alaska Inspired leadership Agency Director championed the effort; Goal success considered a team sport; Governor’s & Secretary’s Office encouraged improvement efforts; Performance reported continuously; Leaders identified early on; Persons who added value openly recognized.

13. CLEAR 2008 Annual Conference Anchorage, Alaska Here we are - today Today we can show the public a concise, balanced, and data-based way to measure DHP's disciplinary case processing: clearance rate = 200%; age of pending caseload = 29% time to disposition = 75%.

14. CLEAR 2008 Annual Conference Anchorage, Alaska Conclusion: teamwork and data transparency translate purpose into action Thank you. Questions? Contact Sandra Whitley Ryals Department of Health Professions 804- 367-4648 sandra.ryals@dhp.virginia.gov