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Improving Quality through Evidence-Based Management

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1 Improving Quality through Evidence-Based Management
Derek M. Larkin, JD, MBA CEO Boston IVF

2 Learning Objectives 1. Understand the basic principles of evidence-based management 2. Witness the application of evidence-based management through reporting 3. Be able to create systems that foster evidence-based management 4. Be able to create a culture of continuous improvement No conflicts to disclose. 1

3 EVIDENCE-Based Management
Demand Evidence – look for supporting data Examine Logic – look for faulty cause & effect reasoning Encourage Experimentation – test viability of proposed strategies Reinforce Continuous Learning – expand knowledge & increase reliable evidence with which to make decisions “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” Dr. David Sackett 1 Pfeffer, Jeffery, Sutton, Robert. (2006). Evidence-Based Management. Harvard Business Review. January, 2006. 2

4 EVIDENCE-Based Management
GOAL: Go from Data Driven Decision Making to Evidence Based Management 3

5 EVIDENCE-Based Management
GOAL: Go from Data Driven Decision Making to Evidence Based Management Honest, Objective assessment of what works Expose dangerous half truths & assumptions Make smart decisions on the most relevant issues The great tragedy of science is the slaying of a beautiful hypothesis by an ugly fact. - Thomas H. Huxley   4

6 EVIDENCE-Based Management
Increase or decrease our cycle price? Establish a satellite office? Offer partnership to our physician? Extend our lease or move? Implement a shared risk program? Hire a new physician? 5

7 Factors Affecting Decisions: TIME
Increasing Time Pressure Factors Affecting Decisions: TIME Compare Options Rule Based Intuitive Creative ADVANTAGES: Produces solutions to unfamiliar problems New solutions may have wider application DISADVANTAGES: Requires time Untested solutions Difficult under stress ADVANTAGES: Compares alternatives Can be justified Often successful DISADVANTAGES: Requires time Affected by stress May be costly Analysis paralysis ADVANTAGES: Good for novices Can be rapid if the rule applies and is known Easy to justify DISADVANTAGES: Time consuming Rules may not apply (out of date, irrelevant) ADVANTAGES: Very Fast Requires little thought Workable option Useful in routine situations DISADVANTAGES: Experience required May be difficult to justify after 1http://davetgc.com/Decision_Making.html, March 16, 2014. 6

8 Factors Affecting Decisions: Data FILTERS
7

9 Factors Affecting Decisions: Psychology
Narrative Bias: There is no perfect transmission of information through people. 8

10 Factors Affecting Decisions: analysis
The cumulative pregnancy rates above represent total pregnancies from total patients in cycle. There seems to be an inverse relationship between the increase in cumulative pregnancy rates and a decrease in the number of cycles per new patients. This data when plotted in an XY Scatter plot graph shows a linear relationship with an R- Square value of 9

11 Factors Affecting Decisions: analysis
In 2004 – 2,372 patients yielded 3,480 cycles. In 2008 it would take about 1,000 more patients (3,445) to yield 3,480 cycles. If we conservatively estimate a 1% increase in cumulative success rates through 2010, it would take about 500 more patients just to yield the same number of cycle starts we had in 2007. If the cumulative pregnancy rates were to jump another 10% in four years, we would likely see the total cycle starts drop below 2,000 – or to a point of equilibrium where IUI:IVF ratio limits cycle starts. Therefore, patient attraction and retention needs to be a strategic focus if Boston IVF is to maintain market leadership. Further, smart business expansion will also accomplish this goal. 10

12 Evidence-based management: Objectivity
Are You Part of the Problem?1 Stop treating old ideas as if they were brand-new. Be suspicious of “breakthrough” ideas and studies. Celebrate and develop collective brilliance. Emphasize drawbacks as well as virtues. Use success (and failure) stories to illustrate sound practices, but not in place of a valid research method. Adopt a neutral stance toward ideologies and theories. Critical Self-Analysis: 90% of people believe they are in the top 50% when it comes to looks, intelligence, charisma and artistic ability. 1 Pfeffer, Jeffery, Sutton, Robert. (2006). Evidence-Based Management. Harvard Business Review. January, 2006. 11

13 Evidence-based management: Systems
Business Performance Measurement (BPM) systems provide: Insight into different units of the company Align different levels of analysis Drive synergies between different units Allows the organization to recognize its competitive advantage – and strategize Coherence among performance metrics and scorecards throughout organization BPM Frameworks Balanced Scorecard1 Economic Value Added Activity-based costing Quality Management Total Quality Management (TQM) LEAN/Six Sigma European Foundation Quality Management (EFQM) Customer Value Analysis ISO = quality system - Quality manual, Control of documents & records, process maps, quality objectives, job descriptions, external audits ISO 9001:2008 1 Kaplan, Robert S. & Lamotte, Gaelle. (2001). The Balanced Scorecard and Quality Programs. Balanced Scorecard Report. March 15, 2001. 12

14 Evidence-based management: Systems
ISO 9001:2008 Principles Balanced Scorecard Principles Customer focus Leadership Involvement of People Process Approach System Approach to Management Continual Improvement Factual Approach to Decision Making Customer Perspective Financial Perspective Internal Business Perspective Learning & Growth Perspective Balanced Business Scorecard transforms strategic vision into strategic direction which can successfully be implemented and delivered. The fundamentals are simply: good inputs produce good outputs. Financial perspective - these are the financial ratios These indicators in Balanced Scorecard measurement terms are 'lagging indicators'. Learning and Growth - the right people with the right skills, the right tools and the right technology as inputs to successful operational process optimisation. Process - Key Performance Indicators (KPIs) against processes are not only on the critical path for understanding the targets for best performance but also the outputs being delivered to customers and therefore acknowledgement of the relationship and influence of the external world. Customer - this perspective, to provide true balance, is wider than just the customer - it also considers markets and competition. At this point, if customers are not buying, the impact is immediate in financial terms. 13

15 Evidence-based management: Systems
6 Principles of LEAN1 Attitude of continuous improvement Value creation Unity of purpose Respect for the front-line workers Visual tracking Flexible regimentation Balanced Business Scorecard transforms strategic vision into strategic direction which can successfully be implemented and delivered. The fundamentals are simply: good inputs produce good outputs. Financial perspective - these are the financial ratios These indicators in Balanced Scorecard measurement terms are 'lagging indicators'. Learning and Growth - the right people with the right skills, the right tools and the right technology as inputs to successful operational process optimisation. Process - Key Performance Indicators (KPIs) against processes are not only on the critical path for understanding the targets for best performance but also the outputs being delivered to customers and therefore acknowledgement of the relationship and influence of the external world. Customer - this perspective, to provide true balance, is wider than just the customer - it also considers markets and competition. At this point, if customers are not buying, the impact is immediate in financial terms. 1 Toussaint, John S., MD, Berry, Leonard, PhD, The Promise of Lean in Health Care. Mayo Clinic Proceedings. January, 2013 14

16 Evidence-based management: Systems
Employee Satisfaction Survey VIP Team Planning Implementation Patient Satisfaction Survey Administrative Leadership Team Implementation Customer feedback systems Policy issues that need to be addressed go to our Executive Committee OB/GYN Satisfaction Survey Sales & Marketing Team Implementation 15

17 Evidence-based management: Culture
Understand the movement of information through your organization. CEO = 40,000 ft. “Patients come first.” Manager = 15,000 ft. “Patients come first. Collect the money.” Corporate Disconnect: Patients come first = nebulous Collect the money = actionable When your corporate disconnect reaches your patients, you have a problem. ISO = quality system - Quality manual, Control of documents & records, process maps, quality objectives, job descriptions, external audits Staff = 1,000 ft. “Collect the money.” 16

18 Evidence-based management: Culture
Blue Ocean Leadership, April 2014: “Just 30% of employees are actively committed to doing a good job. According to Gallup’s 2013 State of the American Workplace report, 50% of employees merely put their time in, while the remaining 20% act out of their discontent in counterproductive ways, negatively influencing coworkers, missing days and driving customers away because of poor customer service.” SLOW FAST ISO = quality system - Quality manual, Control of documents & records, process maps, quality objectives, job descriptions, external audits 17

19 Evidence-based management: Culture
Annual Performance Appraisal Company Performance Bonus Performance Professionalism Attitude Compliance Initiative Team work Business knowledge % to Budget Forecast, accounts for market conditions Contribution (full-time v. part-time) Tenure ISO = quality system - Quality manual, Control of documents & records, process maps, quality objectives, job descriptions, external audits Hire attitude and teach skills, don’t hire skills and think you can teach attitude. 18

20 Evidence-based management: Culture
Who? What? Evidence-based management: Culture Look down the ladder for the solution. Look up the ladder for the cause. ISO = quality system - Quality manual, Control of documents & records, process maps, quality objectives, job descriptions, external audits 19

21 Evidence-based management: Summary
Form an executive committee Become data-driven and measure the important things Create feedback systems for ongoing management Implement BPM and process improvement systems Communication. Accountability. Reward. ISO = quality system - Quality manual, Control of documents & records, process maps, quality objectives, job descriptions, external audits 20

22 Questions? Thank you.


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