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Online Communities Improve Performance, Quality, and Efficiency
Twelfth National Forum on Customer Based Marketing StrategiesApril 23, 2007 Orlando
Holly Pendleton
Manager Knowledge Management
Catholic Health Initiatives
Denver CO
Janet Guptill
Consultant
Health Evolutions, Inc.
St Louis MO
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.
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?
Who has expertise inthis area?
Is anyone else working on this same problem?Is anyone else working on this same problem?
What ideas have been tried and
tested?
What ideas have been tried and
tested?
Who else faces similar challenges to mine?
Is there a recommended way to do this?
Is there a recommended way to do this?
How can I share what I have learned?
How can I share what I have learned?
Creating Community: people connecting through shared
needs
What are online communities? Online communities are social networks
They are supported by web technologies
They exist to solve problems
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
Online communities are it!
MySpace Generation
Collaboration Expectations
Customer Interactions
Engagement
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
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
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.org
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
CHCA Case Study
Background of CHCA Overview of Forums, Collaboratives,
Race for Results Strategic Impact to date Lessons Learned
Improving the Performance of Children’s Hospitals
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
CHCA’s 3-pronged strategy
Peer Networking Performance 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
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
Peer Networking Forums are Highly Active
Ambulatory 22 Materials Management 33
Cardiac 28 OR Directors 31
CFO 40 PACT 34
CHAPs 17 Patient Financial Services 21
CIO 36 Payor Contracting 33
CNO 40 Pediatric Practice Exec. 22
COO 40 Pharmacy Buyers 40
Corporate Compliance 28 Pharmacy Directors 39
Customer Service 20 PHIS 37
Dietary 33 Physician Relations 22
Executive Dialogue 40 Quality and Safety Leaders
42
Facilities Management 33 Radiology Directors 33
Health Information Mgmt 33 Respiratory Directors 32
Home Care 17 Risk Managers 25
Human Resources 32 SMAC 30
JCAHO 35 Social Work Community 15
Lab Directors 32 SPBD 28
Overall 2006
satisfaction5.24 of 6.0
(87%)
2006 Hospital Participation in Forums
Peer Networking Forums webpage example
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)
Performance Improvement CollaborativesExample: 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
BE
TT
ER
Avg.
CHCA Hospitals with reduction in ADE rate
Goal
Collaboratives have own web-sharing spaces
Adverse Drug Event Collaborative webpage
Blood Stream Infection Collaborative webpage
Surgical Infection Prevention Collaborative
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
RACE for Results Awards Program
2004 2005 2006 2007
Little Rock: Reducing Catheter-Related Bloodstream Infections through Repeated Rapid Cycle Improvements
Cincinnati: Reducing Cost through Improving Quality
Palo Alto: Decreasing ADEs By Implementing Safety Best Practices
Washington DC: Using PHIS to Target Reducing Infections in VP Shunt Surgeries
Omaha: "Asthma Attack“
Dayton: Reducing Catheter-Associated Bloodstream Infections in Children
11 Entries 12 Entries 17 Entries 30 Entries
RACE Results in Performance Improvement
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 children’s hospitals participate in 30 peer networking forums, regularly sharing
improvement tools and resources, exchanging best practices and learning from industry experts
18 children’s 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
CHI Case Study
Background of CHI KT&L Strategy and Scope Relay Report results to date Lessons Learned
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)
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.
CHI Strategic Plan: 2007 - 2011
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
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
Knowledge Transfer & Learning at CHI
StrategicPriority
Consulting
Knowledge Communities
Formal Education
Practice in Action
Communication& Collaboration
CHI’s KT&L StrategyCommunication & Collaboration
Knowledge Transfer Integrated 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
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
Value of Pharmacist
as part of bedside
patient care team proved
and $53 Million saved
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
Making it Easier to Connect with Knowledge Communities
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
Accelerate the
implementation of
clinical imaging
technology, resulting
in accelerated
NPSR of $1.5 - $3.0 M
Practice in Action: Transfer Critical KnowledgeIncrease 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.
Avoided medication
errors through
improved reconciliation
of home and hospital
medications.
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
Accelerate the
implementation of
ERP technology
(Lawson) and the
realization of
projected savings
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
Avoid dangerous /
deadly events in OB
through a targeted
Advanced Fetal
Monitoring curriculum
Knowledge Transfer is both Organic AND Strategic
Practice in Action
StrategicPriority
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
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.”
Conclusions for CHI
Knowledge Leadership is at the core of CHI’s 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
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
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
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 organization’s 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 someone’s 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
Let’s Connect!Janet GuptillConsultant, Health [email protected]
Holly PendletonManager, Knowledge Management, [email protected]
Kate CollinsDirector, Knowledge Management, [email protected]
Carol DobiesPresident, Dobies Healthcare [email protected]
