Every person has a purpose

Over the Memorial Day Weekend I was with friends who work outside of health care. In talking about their work there were a number of times when they’d say things like "I just can't figure out where what I do fits into the bigger picture of the organization" or "I know what I do, but I can't figure out what the rest of 'those people' are doing."

It made me start to worry – do any members of the Children’s Specialized Hospital family feel that way?

Now, the one thing I pride myself on is not deceiving myself. I know every day won’t be perfect nor will we always hit 100 out of 100, but it would break my heart to think that some of our employees may not understand why we are here and just how important your personal role is in reaching our organizational goals.

Our goals may change each year but the “why” we are here is always the same. The why: our commitment, if you will, is to deliver patient- and family-centered care in every experience we deliver.

This is a hypothetical example for visual representation only.

Every single person in our hospital can help us achieve this goal. Whether you are in a clinical therapeutic involvement or if you are giving directions to someone who looks lost in our hallways, you are playing a role in delivering a patient- and family-centered experience.

Each year, during our APR, we all set individual E3 (Engage Every Employee) goals. E3 stands for Engage Every Employee. What does that mean? That every employee is engaged in reaching our departmental and organizational goals; that individual goals are linked to the larger goals. 

Take a look at the infographic on the right. This will help you visualize just how important your E3 goals are. Please note, this is a hypothetical example, and the goals listed under the department and the individual are not necessarily goals of one of our colleagues. However, our growth goal is our actual growth goal!

See that? Your individual goals are mapped out to help your department and the organization as a whole reach success!

Looking for a refresher on our 2015 Organizational Goals? Click here and open "2015 Corporate Goals."

The person you are interacting with should get the feeling that you are helping them the same way you would if they were a dear friend or family member. This kind of care you may not get in some health care settings.

While we all have many different tasks to accomplish in our day, it’s all about the alignment; alignment with our commitment to our patients and families, as well as to our goals – individual, departmental, and organizational. It’s also about being open and accessible to determining how to get children the services that help them reach their maximum potential.

After all, our organizational vision is to create a world where all children can reach their maximum potential. It’s the commitment to being encouraging to our patients and helping them and their families develop a unique plan that can be accomplished.

If you’re not in a clinical role, you’re probably thinking to yourself, “Yeah, but how does my position align with this?” Well it is simple, and I’ll tell you how.

Yes, in some cases you are actually delivering the care that we commit to. In other case, like me, you are playing a supporting role to make sure that all the people who are on the front lines giving information and providing care, or doing all the back office paperwork and research can do their work efficiently.

Every action that we do helps lead us to our mission to being preeminent and the best of the best and our commitment is that we do it by putting the child and family at the center of everything we do.

In a few weeks, when we begin our 2015 Employee Engagement Survey, you are going to let us know whether you understand your role and how it is aligned with the Children’s Specialized Hospital commitment to our patients and families. If you have any questions about this, ask them! Now is the time.

I can detail for you where every person fits into this picture. Yes, all 1,279 colleagues! I can see the result of your hard work – the good and joy that you provide every day – and I want to help you see that too.

Big, Hairy, Audacious Goals

Big, Hairy, Audacious goal (BHAG). 

Simply put, a BHAG is a goal that you didn’t think you could achieve, but once you do it makes a huge difference in your life.

In 2005, when the Senior Leadership team was meeting to set our own BHAGs, we set a goal to serve 25,000 children each year. When I asked the team what we would do if and when we hit that goal, both Warren Moore (Exec VP & COO) and Michael Dribbon (VP Business Dev & Chief Research Officer) simultaneously confirmed, “You set new goals.”

We have people throughout our hospital who have set personal BHAGs to focus on their weight, their family, and where they hope to be professionally and personally by a certain point in their life. 

Some of them are very close to achieving their goals and have asked me about what happens next? So much of their lives have been consumed with their determination to achieve their goal or goals that they are now worried about what happens once they succeed. 

One of the craziest times of my life was right before I got married. I was working in Washington, DC, my then fiancé and I were building a house together (mostly ourselves), and we were planning a wedding. Crazy, right? 

The house was a kit home, so all of the pieces were delivered by truck and then we had 9 months to put the entire thing together. Aside from digging the foundation and installing the electric and plumbing we built the home all ourselves, with help from friends and family. Yes, we built the entire house piece by piece.

I remember I would drive back from DC after work on Friday night and we would work all weekend on the house, only to drive back to DC on Sunday night. There was many a time I was so tired, I couldn’t recall making that trip back on the highway.

Did I mention that my first car was a 1976 Dodge Spirit? It ate a ton of oil and gas, in that order. In the snowstorms, I used to pray, “Just get me to April when we are getting married.” 

All the drama around home inspections, construction permits, and more – we lived through it. Then when we were married I had to find a job, so the next list of prayers began. After the job prayers were answered I started praying for a raise, then to let the Governor win the election, and so on. You get the point.

More and more prayers, and more and more goals. 

One of our Service Excellence Standards focuses on improving performance: I am committed to my purpose and strive to grow and improve my personal, departmental, and organizational performance. Achieving that  BHAG simply means that you have freed yourself up to tackling something else, setting a new BHAG! 

You changed, either personally or professionally, and you have an opportunity to focus on the next thing, regardless of what it may be. What matters is celebrating that you worked really hard, and accomplished something important to you, and now it is time to figure out what is next.

Are you currently working on a BHAG? Or have you completed a BHAG and have set a new one for yourself? Maybe you’re looking for help to figure out where to go now? Please share below!

Scheduling Department prepares for major improvements

We recently shared the great work we are doing through our Operation Excellence efforts. Step by step we are looking at all the moving parts in our organization and finding ways in which we can improve. 

One of the areas that showed remarkable improvements over the last year was in our Scheduling Department. This team has done an outstanding job looking for ways to increase our access for our children to get their much needed services. 

The Scheduling Department did the following in 2014:

• Reduced the answer speed:
• Answer speed in English went from 2:20 minutes to 1:26 minutes
• Answer speed in Spanish went from 7:20 minutes to 2:38 minutes
• Developed a formalized training program for new staff
• Expanded the staff by an additional 2 schedulers
• Implemented rescheduling process for text message cancellations
• Refined the text messaging system
• Re-structured the staff so that they have been given a specific job function

So what’s next for 2015?

• Expansion of staff by an addition of 2.5 schedulers
• Expansion of bilingual Spanish staff
• Build a scheduling dashboard to manage the department and ensure scheduling and rescheduling is completed in a timely fashion
• Automate the text messaging cancellations so they no longer need to be completed manually

Great job guys! We know that these efforts along with the other efficiency will help us reduce the current 66 days wait time to see a developmental pediatrician!

Stay tuned for a future blog post where we will go into greater detail about some of the projects from the Scheduling Department when they are completed. 

Is your department making big movements? Do you have a big project for 2015? Let us know in the comments below and you could be featured in an upcoming blog post!

Reaching for success with Operation: Excellence

Operation: Excellence. 

It is the management method we use to drive our efforts to meet our strategic goals laid out in our strategic plan. 

Think of it as a road map that helps us to chart our course throughout the year. Each location on the map is a goal we want to reach, and the route that we need to take to get to that location are the action steps we will take to meet that goal.

We have four categories that make up Operation: Excellence that help us strategize on how to reach our goals: 

Engagement: Have the best team that actively collaborates for the care of the child.

Finance: Help the child focus on their goals more than how to pay for their care.”  

Growth: Give the child access to state of the art models of care.”   

Quality: Treat the child like a member of the family and help them reach their full potential.”  

How we work towards meeting our goals

Each pillar has their own team of employees that focus on ensuring we meet our quarterly goals in that category. The team is responsible for developing a 90-day action plan to track our progress and make recommendations on how we can meet our goals. 

The Operation: Excellence group meets at the end of each quarter to regroup and review our progress. Each pillar team presents the information from their category, if we have met our goal for that quarter or not, and informs the group as a whole if there are any changes that should be made. 

Operation: Excellence is part of the way we hold each other accountable and ensure we all understand how all of the work we do each day is involved in reaching our long-term goals of increasing the number of children we serve, achieving our quality report card objectives, continuing our financial success, and reducing the wait time to see developmental pediatricians to name a few.   

Keeping you in the loop

Right now, we use the twice-yearly employee meetings to update everyone on our goals and the progress to meet them.  In addition, we post monthly updates on the Intranet under Statistics. Take a look if you have a few minutes.

The Strategic Improvement Department, in collaboration with the Engagement Team, is working on a new Intranet that will be interactive for all employees to keep apprised of the status of the goals and action plans. It’s going to be a great way to keep everyone updated on a regular basis, as well as enable you to provide immediate feedback directly to the Pillar teams. We are super excited about this HUGE improvement to our internal communication – more on that later.

Do you have ideas or questions?  

Feel free to ask your Senior Leader or anyone director or manager if you have any questions! 

2012 Highlights

Well, we have closed the books on 2012 and what a year it was! We have a whole lot to be proud of. I want to use this post to talk, in some detail, about our success and how we got there as well as discuss the goals for 2013.


Vision
Let's start with a refresher. We have a vision and a mission that drives our organization. Our vision is, "To create a world where all children can reach their maximum potential." For me, this means that every child deserves our absolute best to ensure they achieve all that is possible, regardless of how sick or challenged they may be. And we, as clinicians, are often the people that give them, and their parents, the tools to help on that journey. It may not come in conventional ways, but we must never stop looking for ways to innovate and give hope.

Mission
Our mission is that "we are going to be the preeminent provider for specialized health care services for children." There are two phrases in here that we selected deliberately but that we have a lot of feedback on and that is forcing us to review this.

First is, “preeminent” - people say what does it mean? To me, it means the best of the best. We are going to set the bar high and everyone else is going to be learning from us on how to get there. We are going to do this not just as the biggest, but by looking for innovation and examining what the families’ needs are, not just with clinical success. The second is, “specialized healthcare services.” We are not serving the "typical" rehab child anymore. Most of our children have habilitation needs - children with autism or with developmental delays - we are helping them achieve goals for the first time not as "rehabbing" them to regain a skill they had before. Although people continue to tell me that no one knows what those words mean, our efforts to clarify may be muddying the waters. Something we are actively looking at.

Four Pillars

We do all of this by breaking our annual corporate goals into four pillars that drive all of our work. Those pillars are Quality, Employee and Community Engagement, Service Excellence and Profitable Growth. The six corporate goals then fit into these categories, and then they cascade down to each of your individuals E 3 goals to help us achieve the corporate goals each year. Each of the corporate goals has metrics under them: threshold, target and maximum. The threshold is what we need to accomplish just to get through the year. Target helps us take a breath and say we did better than we thought, and then aspiration is just that - the goal we aspire to achieve in a year.

In 2012, we achieved five of our six corporate goals. Four at the aspiration level, one at target and one not at all. It is important to discuss how we achieved them as much as what was achieved.

Quality - We achieved the aspirational goal for our Quality goal in 2012. The Quality goal is measured by our Quality Report Card, which is located on the intranet LINK http://mtapsp10/Pages/Hospital-Announcements.aspx. We achieved the aspirational goal by achieving six out of seven of our quality goals established.

Goal #1
Flu vaccine - In 2010, the JCAHO, the federal agency that accredits us, said that hospitals must vaccinate 90 percent of all employees by 2020. Many hospitals instituted policies that said you can't work at the hospital if you aren’t vaccinated. Others did what we did which was to say that for new employees we would make it a condition of employment, therefore, telling people, right upfront it wasn't negotiable on a go forward basis. By achieving this goal early, we have demonstrated to JCAHO our achievement of their aspirational goal eight years early. I couldn't be prouder of achieving this goal.

Goal #2
WeeFim Score Change – We use a tool, WeeFim (Functional independent measure, Wee is for kids) to measure an effectiveness score. We use the tool to measure children’s functioning on admission and on discharge and the change score is measured against similar facilities. We achieved better than benchmark.

151,000 people die each year in hospitals from things that could have been prevented and even more acquire new illnesses in the hospital due to things the hospital or their staff did. The remaining four goals on our report card related to these issues, or preventing these issues: hand washing, blood stream infections, medical errors, and sentimental events (patient death).

Goal #3
Hand washing - I know this one seems like a "no brainer" but when you think about the fact that one nurse on a 12 hour shift might have to wash her hands hundreds of times on a busy day, you start to see how hard it can be. Every time you touch a child, you need to make sure you wash first. This is to reduce the spread of germs from one to the next. We have a very aggressive secret shopper program who observe what staff are doing and then calculate the percentage of times we achieve the hand washing goal. In 95 percent of the cases, we achieve our goal! We will continue to strive for 100 percent, but this is a great accomplishment. When JCAHO comes, they will be observing every interaction our children have with staff and they will track whether or not we accomplished this in 100 percent of the cases.

Goal #4
Medication errors - Of course we would like to say we have ZERO medication errors but the team of Pharmacy, Physicians and Nursing has driven the number to an astoundingly small number that we are almost there! Over 400,000 doses given on the inpatient unit, we only had 20 errors, and none caused harm to the patient! This is a phenomenal rate, and one we are so proud of.

Goal #5
Blood stream infection rate - We have been consistently working to drive down our blood stream infection rate. This is something that they call a “high risk, low volume” situation for us because we have very few children who could even get a blood stream infection because we virtually have no chance to cause an infection, except for children who are receiving a special type of nutrition through a TPN process. This means we don't do it very often, which means we are at greater risk for something going wrong. The children on TPN, are very, very fragile medically, and getting this blood stream infection could prevent them from getting a needed transplant or other life saving intervention. It is further complicated by the fact that the child could have picked up the infection in the sending hospital but it doesn't appear until the child gets to us. While we did not achieve our goal in this area for this year, we have redoubled our efforts to examine every opportunity to improve on this, including sharing our best practices with the referring hospital and partnering with them to keep the child infection free because we are both committed to the whole child - not just when they are within our care.

Goal #6
Sentinel Events - This means an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase “or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. The goal is to have none of these types of events. We had no sentinel events this year, and therefore, achieved our goal.

Goal #7
Reduction of trach decanulations - Nursing and Respiratory on LTC Mountainside did a great job of making considerable reductions, exceeding our goal. By working together they identified opportunities for both product improvement, (we ordered different trach ties) as well as examined how we transferred kids from their bed to their strollers or chairs, when we examined the data, it revealed this is when they occurred most frequently.

Reducing Cost Per Unit
Under profitable growth was reducing our costs per unit of service by 10 percent. We reduced our cost per unit by over 5 percent, which is a great accomplishment but below our goal. The cost per unit means we need to reduce what it costs us to see a child in all settings. This can happen by eliminating waste - meaning stop doing things that take time, but don't add any value. It also happens by increasing the number of children we are seeing and spending the same amount of money. An easy way to think about this is through all of the automation we have done. When we automate a process that used to take people hours to do, that allows those people to do other things at the same cost we were spending before. We need to be focused on this because we know that neither the government nor insurance companies are going to pay us anymore to provide services and in order to keep giving raises, doing more training, buy new equipment, we have to figure out how to live within a smaller budget, even though our expenses are going up. I often say I would rather be ready when the cuts come, then scrambling to figure it out. We are definitely doing the work now to be ready.

We achieved the aspirational goal under profitable growth for our combined operating margin. We measure this by combining the Hospital and the Foundations profit margins. It is important to look at these two numbers because we set up our processes very differently as a non profit hospital than a for profit, due to our charitable commitments. The work that we do in the hospital allows the Foundation to go out and inspire donors make us their charity of choice. The Foundation's ability to raise funds is directly related to how we care for our patients, the programs we offer and how we operate. Due to the success in eliminating waste from our hospital functions through the 100 Day Work Out process and an exceptional fund raising year by the Foundation, especially due to team Children’s Miracle Network Hospitals team, we made a 3.8 percent profit. This has allowed us to continue to expand our services and continue programs that we otherwise wouldn't have, including opening in Egg Harbor Township and soon to open Newark in the Summer. Our continued focus on the 100 Day Work Out process and on our path to Excellence will help us during the uncertainty of healthcare reform.

Profitable Growth
The second Quality goal besides the report card was achieving the aspirational goal of serving 20,495 children. We were able to reduce our neurodevelopmental wait list from 2,500 to 270 children waiting for an appointment today. This is an amazing accomplishment that was done by every part of the outpatient team working together. The physicians made dramatic changes to their schedules, we hired more docs, streamlined our authorizations, improved scheduling and it has resulted in improvements in this goal of improving access and profitability for the organization. This was truly transformational!

Employee Engagement
We achieved the target goal in our employee engagement. We ranked in the 88th percentile of all Children's Hospitals who take the same survey. While we are very proud of this score, increasing 2 percent over last year, you have told us there is still work to be done. We have been doing so many good things but you have told us that you want understand our direction and progress in a more uniform way. So we will be expanding our 100 Day Work Out process, focused on improving quality and eliminating waste into a process which we have named Operation:Excellence. This is adapted from GE's process they used to achieve great success. I will be telling you more about it during the employee meetings in June. Our effort is to address the direct feedback that you don't have context for the decisions that we make or how the work you are doing day to day fits in to our overall strategic goals.

Service Excellence
We achieved our aspirational goal of our net Promoter Score with Press Ganey. This is the score that the federal government looks at to determine the level of satisfaction of your customers. They look at one question - "Would you recommend this service to others?" They then apply a formula that subtracts your 1’s and 2’s from your 5’s and divides by your total number of surveys. The federal government says you need to be at minimum of 50%; we had an average of 80.3% which is an exceptional score! It also means there are still people who are not sure they would recommend us. For us, in examining the data, this comes from people giving us 4's instead of 5's. We will continue to pursue how to move those scores. While we are doing well, we know that the federal government will increase their score, and again, we want to be ahead of the curve.

So what does all of this mean? We should be very proud that our hard work paid off and we are achieving the goals that we set for ourselves. All of the goals are focused on preparing us for the future. A future where quality and price is going to decide whether we will get to even treat the child. We must be the provider with the highest quality and lowest cost in order to continue the excellent work and relationships we have with our children.

I look forward to sharing the goals with you for 2013 at the employee meetings in the coming months. Thank you for your continued dedication and hard work. It is an honor to work with each of you.

Please feel free to comment or ask questions below.

Amy

Reflections

So I have been spending a lot of time on vacation reflecting about the year that has passed and anticipating 2010. This isn't just the end of a year but the end of the decade.

I have personally reflected about the last ten years and realized there were some major changes: changed jobs 4 times - the last wonderful 6 years spent with you; experienced the loss of my 12 year marriage and am still standing; major health issues of loved ones, and the loss of my Grandmother. As I reflect on all this change I weigh all the blessings and honor the memories of the things and people lost.

Over the last 10 years, Children’s has grown from 4,000 children served, 500 employees, a 32 million budget to 17,000 children served and 1,000 employees and a 100 million budget. We built a brand new hospital, had the single most successful fundraising campaign topping 32 million dollars, with our first $5 million gift. We opened four new sites and renovated others. So much good and change has happened at a time when many hospitals have suffered closure and loss of services. We are positioned for continued success in the years to come.

I know this sounds sappy, but it's so true. One of the greatest things I cherish was the chance to work with each of you and the children we serve. I am constantly amazed at the lives we touch both our children and each other.

As I contemplate both my personal and professional hopes for 2010, I wonder if there are memories from this past decade, or any goals you have planned for 2010, that you would like to share?