Performance Improvement – Tools of Transformation

When I introduce myself, I sometimes mention my graduate training in industrial engineering at Georgia Tech and describe how that part of my education and career helped shape some of the ways I think about leading and managing. In every organization where I’ve held a senior leadership position, I’ve been known as someone who likes to measure performance. There’s a simple reason for that: without a measurement and data, it is really tough to know if we’re making progress.

Here at GHS, we collect data and measure performance in lots of different ways including our organizational goals related to people, service, quality, growth and finance. We’re also measuring performance to improve quality and efficiency, enhance effectiveness of processes, and boost productivity.

Two approaches that I believe we’ll be talking about more and more are Lean and Six Sigma. Lean has its origins in the auto industry (specifically, Toyota Motors) in the 1940’s and focuses on elimination of “waste” from a process – making things more efficient. Lean focuses on reducing seven different types of waste: 1. defects; 2. overproduction; 3. excessive inventories; 4. excessive motion; 5. excessive processing; 6. transportation; and 7. waiting. In recent years, Lean approaches have been successfully used by many health systems to improve operations and processes.

Six Sigma focuses on measuring how well a process is performed and zeroing-in on opportunities to eliminate defects and variation from the process. The ultimate goal is to reach a level of process performance that is consistent and error free.

So why is it worth knowing about these methods of performance improvement? In recent months, I’ve been writing to you about our vision to transform healthcare for the benefit of the people and communities we serve. I have also been talking about the challenges GHS and other health care providers face in light of current economic conditions and an evolving health care environment. Bottom line: we are anticipating and experiencing change. I believe that the best way to deal with change is to prepare for and embrace it. One thing we can do is make sure that our performance is highly efficient and consistent. Performance improvement methods like Lean and Six Sigma will help us get there.

Back to AIDET. I’ll tell you that I think the duration for embracing performance improvement is the long haul – we’ll be continuously looking for ways to do our work more efficiently and effectively. I’ll also thank you for joining me in embracing change rather than resisting it. Working together, we’ll help GHS fulfill its mission to heal compassionately, teach innovatively, and improve constantly.

Last week I finished another round of Town Hall Meetings. I thought these meetings may be of interest from an employee engagement and a content perspectives.

My belief is that an engaged workforce comes from ensuring that the staff knows what leadership and the organization are doing and why. It is important for everyone to understand the context for the decisions and to hear the rationale behind various actions – even if there is disagreement it is good for employees to have a voice. As a result, we started a systematic way for me to communicate and interact with employees. The Town Hall Meetings are one example of that practice. Here is a brief overview. I conduct 10 – 12 sessions each quarter and total attendance ranges from 1,500 – 1,800 employees with sessions held on each campus, including the night shift. The agenda includes updates on strategy, system-wide goals (Pillars: People, Service, Quality, Growth, Finance, and Academics – the same information reported to the Board) and other timely topics. In addition, we close-the-loop on open issues or questions from previous meetings and request feedback via the Town Hall Surveys which include a subset of key questions from the annual Employee Opinion Survey – this provides a quarterly “pulse” of the organization. Preparation for the meeting has been very valuable for me. My experience is that whenever I have to teach or explain something, I learn it more deeply. That learning has helped me better understand the organization.

I invite you to take a look at the information we discussed at the last set of Town Hall Meetings. The format is fairly standardized and this was the 16th time I have held these sessions. Here is a link to the August Town Hall Meeting presentation. In particular, take a look at the presentation by Howell Clyborne dealing with the South Carolina economy. That is an example of giving employees a context for what is happening at GHS. I also believe that for the next several years the economy is the bigger story than Health Care Reform.

Please let me know if you have any thoughts or reactions to either topic.

I love this picture of Ethan, even though it is a couple of years old….there is something angelic about that little devil. Ethan is our Type 1 diabetic, that makes his mom, Susan, and me Type 3 diabetics – the affectionate term given to the care givers of Type 1′s. In my family, the majority of the work falls on mom. I have my place as the official shot giver and skin pincher and when needed the 3am blood glucose checker, but for the vast majority of work that needs to be done – it is Susan. I am grateful for Susan and it was her appeal letter that prompted this blog entry. I have included a copy of her letter.

August 20, 2010

Dear Family and Friends,

I am writing to ask you all to be a part of an event that is coming up on October 23, 2010: The Juvenile Diabetes Research Foundation Walk to Cure Diabetes. There are two ways to take part: walk with us here in Greenville and raise money from supporters, or donate money to those of us who will walk that day.

As you all know, our Ethan is a beautiful, bright, energetic 7-year-old who was diagnosed last year with Type 1 Diabetes. He has recently started using an insulin pump, which will make managing his diabetes much easier- eventually. Right now we are still working to make sure the right information is entered into this incredibly advanced piece of machinery so that it functions to take the place of his pancreas.

Come on, diabetes isn’t that big a deal, is it?

When he was diagnosed with Type 1 Diabetes on October 2, 2009, Ethan began having two to three shots of insulin a day, and had his finger pricked to test his blood at least 5 times a day. Since he got his insulin pump on August 3, he hasn’t had to have the shots every day, just a needle put into his body every three days that stays there 24/7. He can take it out for, at most, an hour a day. He still does the finger pricks 6 to 10 times a day, and we have to calculate the carbohydrate count of every bite of food that goes into his mouth in order to give him the right insulin dose. If we give him too much insulin, he could go “low” and pass out, even go into a coma. We don’t go out of the house without a blood glucose meter, glucose tablets, and a glucagon pen, which we would use should he have a serious low and pass out.

If we give him too little insulin, he can feel sick and have headaches in the short run, but in the long run, he runs a much higher risk of heart disease, kidney failure, eye disease, including blindness, and nerve disease- the part of the illness that necessitates limb amputation. We haven’t even tried to talk to Ethan about the long-term implications of his disease, but I think about them every day.

How does giving money to a JDRF Walk help?

All of the money collected at the more than 200 JDRF Walks worldwide goes toward helping to find a cure for Type 1 Diabetes. Scientists funded by JDRF grants are:
*creating new, faster acting insulins that will mimic the human pancreas;
*researching how to negate the autoimmune process that causes both Type 1 Diabetes and Multiple Sclerosis;
*developing a vaccine which will reverse the immune attack that causes Type 1 Diabetes;
*finalizing work on the Artificial Pancreas, which is on track to be in patients by 2013;
*developing drugs that will regenerate insulin producing cells in hopes of restoring the body’s ability to produce insulin again.

All of this research and all of the advancements in Diabetes treatment has come from research that could not be advanced without private donations.

Ethan will live a long and healthy life because he has people who love him and will do whatever it takes to keep him healthy. He will do anything he wants in his life: climb Mt. Everest, dive with sharks, skydive from an airplane, play football for the Gators, be a racecar driver, or a private investigator, or a husband, or a dad. And he will live to a ripe old age. My wish is that he could do all that without having to worry if his pump malfunctions or if his insulin has gotten overheated or if he has enough glucose tablets or if that numbness in his feet is neuropathy.

Our whole family has taken an active role in Ethan’s care. In some ways, his diabetes has been a blessing in that it has brought us even closer. I know that we are very lucky to have the best medical treatment available and luckier than most in our access to it. But no matter how much money you have, no matter how many people you know, there is still no cure for Ethan or any other Type 1 Diabetic. Please help us find a cure for Type 1 Diabetes. Even a small donation will go a long way towards finding the cure.

Go to http://walk.jdrf.org/register.cfm?id=87737732

Can’t come to Gville? Donate at https://www.jdrf.org/index.cfm?page_id=100903

With Thanks and Love,

Susan

I recently sent an email to Robyn Zimmerman, Director of Community Affairs at GHS, to understand our level of involvement with the Greenville School System. Our partnership with the school system is long standing and personally important to me. Here is what she sent me – I was blown away:

GHS and Greenville County School District Partnership

GHS Adopt A School program with Berea Middle School
Spring 2008- current
• Donated over a thousand books over the past two years for the Summer Reading program
• Donated thousands of school supplies and copy paper over the past two years
• Sponsored awards ceremony
• RCP “Think First” program administered during two summer school sessions to high risk students
• GHS athletic trainer assigned to BMS
• Free sports physicals provided to those students on free and reduced lunch
• RCP donation of a new wheelchair
• NGH donated ice chest for school nurse’s office
• Helped start Hispanic PTA meetings
• Safe Kids donated Halloween safety bags and reflective stickers
• Purchased “Red Ribbons” for every student during “Red Ribbon Week” with Greenville Family Partnership to help keep kids off drugs
• GHS employees sponsored 3 homeless students during the holidays
• Sponsored celebratory parties for those students who participated in national “Walk to School Day”
• Sponsored GHS advertisement in the required school folders given to each student
• Sponsored a Beautification Day, painting and planting the entrance of the school
• Introduced the “Girls on Track” program
• Provide corporate and clinical speakers for Career Day

Safe Kids
• Consultant to principals, counselors, social workers, and nurses on safety related topics.
• For 10 years we hosted “Meet Your Health Care Neighbor”, a large seminar and health fair on resources available to schools.
• Safe Kids Upstate has a “Safety Leader” in each of the Elementary Schools and several Middle Schools in Greenville County.
• Through our partnership with Michelin North America ($25,000 yearly sponsorship for the past 5 years), we have safety patrols in all of our elementary schools in Greenville County. We provide yearly training on safety issues, provide assistance in setting up safe car pool lines, and give thousands of dollars worth of safety patrol equipment (vests, stop signs, hats, rain coats, and handbooks) to all 52 participating schools. A recent survey indicated that our safety patrol program develops leaders for tomorrow by reducing tardiness, improving grades, and increasing student participation in community volunteer events. This involves more than 2700 patrols promoting safety each day as students arrive and depart from school.
• Safe Kids Upstate also sponsors “Safe Kids Safe Schools” each year . We now have 42 schools that participate.
• Safe Kids Upstate presents seminars to children and their parents through PTA meetings on bike safety, car seat safety, dangers of ATV and the internet, and many other safety topics.
• Over the past 15 years we have taken Buddy’s Safety House, an interactive home safety exhibit, to more than 300,000 school children.
• Safe Kids Upstate is a sponsor for the yearly Technology Conference that focuses on dangers of the internet.
• During the last 2 years a member of our staff that is a Certified Playground Inspector, has inspected 7 school playgrounds and has provided feedback to principals for improvement.
• Seminars on healthy eating provided to over 2000 students and their teachers.
• Through a grant from Safe Kids Worldwide we have provided sports injury prevention training and resources to school coaches.

Athlete Trainer Network
The Greenville County (GC) ATC’s School Program covers:
(14) High Schools
(18) Middle Schools
(3) Private Schools

The GC ATC Program uses the following staff:
(22) Athletic Trainer Certified (ATC’s)
(15) Orthopedic Surgical Doctors
(2) Primary Care Orthopedic Doctors
(2) Orthopedic Surgical Fellows
(3) Primary Care Orthopedic Fellows

The current yearly investment for the GC ATC Program:
Salaries (ATC’s, (2) ATC Coordinators, (1) Director): $1.4 million
Supplies (Cell Phone): $2,200.00
NOTE: One time investment for the following items:
AED: $28,000.00
Laptops: $44,000.00

School/Field services provided by ATC:
• Supervising all daily practices (week and weekend)
• Injury and Rehabilitation care during the school week
• Coordinating/maintaining injury tracking system (ATS) and database
• Supervising all game day/night activities (home/away)
• Supervising all tournament (weekend/holiday) practices/games
• Develop all policies and procedures relating to injury/sports illness treatment (i.e. Heat exhaustion, wrestling weight certification, baseline – return to play concussion screening)

The following are Educational programs the ATC’s deliver various times during the year for the coaches, parents, and athletes:
• ATC Coaches Clinic – specific coaches only series that relates to topics from injury prevention to sports specific conditioning
• Nutrition Seminar – nutritional information regarding, general healthy guidelines, in-season, out of season, and game day nutrition habits/programs.
• Nutritional Supplementation – information regarding best uses/how to use/what to avoid with supplementation
• Injury Prevention/Performance – series with Steadman Hawkins doctors and Acceleration Sports Institute – various topics
• Athletic Conditioning and Training – series with Acceleration Sports Institute for coaches – sports specific and general
• CPR Certification – certification program for coaches

Specific Medical Services
• On-Site Orthopedic doctor at home/away games
• Bump and Bruise Saturday Clinic – no cost clinic provided to athletes serviced by the ATC program
• Preferred entry into orthopedic clinic (general hours) and SHIFT clinic (after hours Mon-Fri)

Other
• ATC video/article database – the ATC’s and Orthopedic doctors are putting together education (in various forms) that will be provided to schools to provide their coaches, parents, and students reinforcing the above education programs and on/off field services.
• Greenville County Career Day Presentations
• EMS Training Courses

The following are NON-school related programs the ATC’s participate/staff in the Greenville County. These specific programs have been noted because they involve many of the athletes as the ATC GC Program and/or the school system is involved with their function.

• Greenville Park and Recreation Program
• Simpsonville Parks and Recreation Program
NOTE: 16,000 participants ages 5-55, sports involved: Football, Lacrosse, soccer, hockey, rollerblade, curling, tennis, and basketball.
• SAFE Kids
• Southern Conference Tournament (Golf, Cross Country, Tennis)
• AAU Wrestling
• Blade (Jr. Golf Championship)
• Roper Mountain Science Center (Olympic Center)
• Greenville YMCA Athletics (Lacrosse and Soccer)
• Carolina Summer Development Basketball League
• Highland Games

Workforce Development
• GHS and GCSD partner to provide student observations and related student activities to high school juniors and seniors enrolled in a healthcare course/program. These activities are coordinated through the GCSD Department of Career Technology and the GHS Department of Education. The MedEx Academy with Carolina Academy just completed the pilot program this summer. The plan is to expand this program next summer to include students from all district high schools.

The following message was sent to all employees on Friday August 6th. The action clears the way for work to continue on our goal of completing and submitting the document needed for accreditation. I will keep you up to date on our progress.

In the first sentence I call it an historic day. That is true, but it has been in the making for decades and is the work of prior administrators like Bob Toomey and Frank Pinckney as well as many former medical staff leaders like Drs. DeLoach and Ashmore and many others. For all of their work and vision, I am grateful.

Please feel free to comment about this announcement or anything else that may be on your mind.

Mike

———

To: GHS Physicians and Staff

This is an historic day for both Greenville Hospital System and the state of South Carolina. Earlier today, both Boards of Trustees of Greenville Hospital System and University of South Carolina voted to approve a plan to expand medical education at GHS to include first- and second-year medical students. As you know, approximately one third of USC’s third- and fourth-year students already train at GHS.

This expansion is good news for our community because it will help mitigate the long-standing physician shortage in the state and improve health care across South Carolina, particularly in rural areas. It will also spur job growth and help make Greenville and the entire state more attractive to corporations and businesses considering expansion or relocation.

For GHS, this expansion helps reinforce our mission to heal compassionately, teach innovatively and improve constantly. Education has always been an integral part of our mission. Many of you know that GHS accepted its first nursing student just three days after Greenville General Hospital first opened its doors in 1912. In the nearly 100 years that have followed, GHS has helped train thousands of physicians, nurses and other health-care professionals.

In the August issue of The View, I’ve used my column, The Riordan Report, to further describe how our commitment to academics is good for both GHS and our community. What I wrote applies to today’s announcement as well as to our many other academic programs and initiatives. I encourage you to look for that article when you receive your issue of The View.

In recent months, I’ve talked and written about the importance of balancing current organizational challenges with longer term investments in our future to ensure that GHS continues to be a strong health care resource and partner with and for our community. Today’s vote represents one of those future-focused decisions – building on a solid historical foundation in academics and consistent with the GHS Strategic Plan. I want to assure you that a rigorous planning process took place before the decision to expand was made. This process included a detailed feasibility study, which determined expansion is the most efficient and cost-effective way to generate more physicians in South Carolina, as well as development of a sound business plan to ensure financial support for the expansion.

Our organization’s vision is to transform health care for the benefit of the people and communities we serve. Today’s decision will be transformational for GHS and it promises to support our continued growth as the Upstate’s leading academic health system, resource for specialty care, and community provider of choice . For more information on the expansion, visit http://bit.ly/dgpCnt

As always, I welcome your feedback.

Michael C. Riordan
President and CEO

I spent the first part of last week in Washington, DC at the National Urban League Conference. I serve as the Chair for the Urban League of the Upstate (ULUS) and this is the annual meeting for Board members and leaders of Urban League affiliates throughout the country. Serving on the Board of the ULUS fits well with our Mission and my personal commitment to the community. It also relates to one of my individual work goals of developing a more inclusive approach to who we work with and who we buy from. We track the amount of money we spend on Minority and Women owned business. Through a more inclusive process of putting out bids we have increased competition and helped our community.

I can come back to my goals at a later time, for now I want to focus on the convention and why I am glad I attended.

1. It was different being the visible minority – not bad or good, just different. About 4,000 people attended and the majority were African-American. I had a similar experience in Chicago where the Hospital had a Float in the Bud Billiken Parade – a parade that marks the return to school for the communities of the south side of Chicago. We had the entire family on the float and it was a great time. I remember one of my kids saying how she was aware that we were the minority and she wondered about the black kids at school and how they felt.

2. The meeting included a Who’s Who of African-American leadership. From Vernon Jordan to President Obama, with Reverends Sharpton and Jackson, Chairman of the Republican Party Michael Steele and other elected officials in between. It was fascinating to listen to the panels and be reminded that the black community has many voices and many opinions.

3. The importance of jobs and the economy. This was a consistent theme and one that resonates well with me here in Greenville.

4. Healthcare concerns. The unemployed and the poor utilize a lot of healthcare resources while at the same time not having great access to primary care. In addition the rates of HIV/AIDS for the young African-Americans is far in excess of any other group. There are real disparities that exist.

5. The importance of education. In a future entry I will talk about how we established a MedEx Academy to reach into high school and start attracting students into healthcare. The reinforcement of education in the black community is critical – especially for young men. I believe I heard that we have more young black men in prison than in college. It also made me think about why it is important for us to Adopt-a-School – Berea Middle School.

6. The important role of Faith and Church in the African-American community. It is a real asset and a place to build for the future.

7. Community involvement and in particular mentorship.

8. Vernon Jordan’s speech – he was impressive and I was amazed how little I knew about him. I have not read it yet, but I did go ahead and order “Vernon Can Read.”

9. The need for courage to make changes.

10. My wife Susan and I had the chance to eat breakfast at the White House Mess with Susan Sher, Chief of Staff for the First Lady and Valerie Jarrett, Special Advisor to the President and both friends from Chicago.

I plan to continue on as Chairman of the Urban League of the Upstate for another year and I look forward to going to next year’s conference as well.