John F. Talbot, PhD Executive Vice President and Senior Associate, OPEN MINDS Pre-Institute Seminar sponsored by Credible Behavioral Healthcare

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1 John F. Talbot, PhD Executive Vice President and Senior Associate, OPEN MINDS Pre-Institute Seminar sponsored by Credible Behavioral Healthcare Software October 16, :30pm

2 I. Creating A Culture Of Organizational Measurement II. The Four Cornerstones Of Metrics-based Management III. Management Dashboards And Alerts 2

3 I. Creating A Culture Of Organizational Measurement 3

4 Whatever gets measured Gets attention Gets done If you don t measure it, you can t manage it Essential in a turbulent environment 4

5 Metrics-based management is a performance management system that relies on three components, each of which must be quantitatively and qualitatively expressed. Current state: baseline measures of your organization s current performance Desired state: where your organization wants to be regarding key priorities Bridging the gaps: a definitive plan for how you'll move your organization to achieve the desired performance 5

6 Opinions Decisions Decisions Opinions 6

7 Data Decisions Analysis 7

8 Stage 1: Data Collection Identifying the Key Performance Indicators for the organization as a whole and for each department. Determining what data needs to be captured and setting up the data reporting procedures Stage 2: Data Analysis Process of analyzing the data to ensure that the organization is meeting performance targets Using data analysis for continuous improvement Stage 3: Benchmarking Using appropriate benchmarks from customer/marker/regulatory expectations Benchmarking best-in-class across industries Benchmarking industry peers as appropriate Stage 4: Decision Making & Process Improvement Take decisions based on data collected to alter your processes and also look at improvements in data being collected and ensuring quality of data.. Stage 5: Follow-Up & Continuous Improvement Follow up on the decisions taken for process improvement and measure effectiveness of the decisions after new numbers are available. Do this repetitively. 8

9 Measure the metric Launch the improvement Learning about markets, customers, competitors, and processes Analyze the metrics Design and develop improvement Identify improvement opportunities 9

10 Cultural shift toward accountability for performance metrics executive team, program managers, and supervisors Role of the manager is to ensure the targets are met planning, human capital, processes, policies, etc. Metrics at all levels are used to for performance measurement 10

11 II. The Four Cornerstones Of Metrics-Based Management 11

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13 Routine Operational & Management Reports Key Performance Indicators Benchmarking & Performance Targets Management Dashboards & Alerts 13

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15 Start your metrics management approach by ensuring that staff have access to data via routine reporting to manage day-to-day operations and supervise staff. 15

16 These ensure that all staff has access to the accurate, up-to-date information that they need to do their jobs on a daily basis. With roughly ninety percent of the reporting needs for organizations being planned and predictable, this simply means producing and using meaningful reports from the management information system and making certain that staff know how to use them. 16

17 1. Caseload report 9. No-show and cancellation report 2. Staff productivity report 10. Discharge report 3. Care access measures reports 11. Consumer demographics reports 4. Waiting list 12. Mandated treatment monitoring reports 5. Closed case notification 13. Medication profile and report 6. Care provider and program admissions report by client 14. Daily census 7. External referral report 15. Tickler report 8. Internal referral report 16. Crisis call tracking 17

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19 Internal reports are reports identified for use by the agency staff to manage operations. External reports are those required periodically by outside parties (such as state agencies). Additionally, reports are given a preliminary priority level by the management team. The priority levels are as follows: Priority 1 An essential report that must be operational on the day the organization begins to use its new software application Priority 2 A non-essential report, but highly desired as soon as possible after the new software implementation Priority 3 A non-essential report, but anticipated as part of a longer term expansion of management reporting and enhanced operations 19

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22 Key Performance Indicators (KPIs) Are financial and nonfinancial measures used by management team to ensure that organization is on track with strategic objectives KPIs represent those data points that measure the health of your organization KPIs are typically tied to an organization's strategy using concepts or techniques such as the Balanced Scorecard Ideal Performance Indicators A ideal KPI is a key part of a measurable objective, which is made up of a direction, KPI, benchmark, target, and time frame. For example: "Increase average revenue per customer from $30 to $50 by 2008." In this case, 'Average revenue per customer' is the KPI. 22

23 A KPI should follow the SMART criteria. S The measure has a Specific purpose for the business. M It is Measurable to really get a value of the KPI. A The defined norms have to be Achievable. R The KPI has to be Relevant to measure (and thereby to manage). T It must be Time-Phased, which means the value or outcomes are shown for a predefined and relevant period. 23

24 Coincident indicator Leading indicator Lagging indicator 24

25 Provide a quantifiable measure to monitor strategic objectives Focus attention the attention of staff on performance required for success Allow measurement of accomplishments, not just of the work that is performed Provide a common language for communication Are explicitly defined in terms of owner, unit of measure, collection frequency, data quality, expected value (targets), and thresholds Increases accountability Are valid, to ensure measurement of the right things Are verifiable, to ensure data collection accuracy 25

26 Monitor representative metrics of organization s performance To stretch to better performance! Proactively address problems ( leading indicator concept) Use as guide to selecting issues for further exploration 26

27 Overall Organizational Level Strategic Objectives Department/Program Level Finance IT HR Programs/Clinical 27

28 Organization Strategic Plan & Objectives Organization-Wide Performance Indicators Operating Unit Plan & Objectives Operating Unit Performance Indicators Program Plan & Objectives Program-Specific Performance Indicators Individual Staff Performance Objectives 28

29 Revenue (overall and by service line) Expenses (overall and by service line) Profit/loss (overall and by service line) Unit cost by service by site Cash reserves Accounts receivable Number/$ amount of denied claims, by payer 29

30 Number of referrals by referral category Conversion rate for referrals Number of complaints 30

31 Human Resources Number of new hires Number of terminations Rolling turnover rate (3- month) by site 31

32 Clinical Quality of care measures Client satisfaction Sentinel events Adherence to documentation and other compliance requirements Percent of staff who met clinical productivity requirements by site No-show rate for MDs Readmissions to hospital 32

33 Number of new programs implemented Internal process innovations resulting in better service to customers and/or greater efficiencies 33

34 34

35 The third cornerstone is using benchmarks and performance targets to challenge and drive continuous improvement in service quality and operations. 35

36 Establish your KPIs Continued measurement Conduct research to find appropriate benchmarks Modify your KPIs as needed Incremental versus stretch targets Compare your KPIs with benchmarks Analyze gaps 36

37 Best in class within behavioral health Best in class in healthcare Best in class in other industries Beware the benchmarking mediocrity trap!! 37

38 38

39 III. Management Dashboards & Alerts 39

40 The last phase in implementing metrics-based management is to make certain that your managers and staff cannot miss key performance information by using some form of a management dashboard. Typically, management dashboards or alerts include discrete performance metrics that measure critical operational components of your organization. Warn you about problems before it is too late! 40

41 A computer interface that organizes key performance indicators in an easy to read format, displaying the information that executives need to run an organization. 41

42 Step One: Determine what dashboards are needed, and who will receive them, and at what frequency Step Two: Design the prototype dashboards Step Three: Test drive the dashboards and train staff how to use them Step Four: Use the dashboards! 42

43 Organization Strategic Plan & Objectives Organization-Wide Performance Indicators Operating Unit Plan & Objectives Operating Unit Performance Indicators Program Plan & Objectives Program-Specific Performance Indicators Individual Staff Performance Objectives 43

44 Dashboard Contents Audience Frequency Organizational Strategic Plan Objectives KPIs for each strategic objective Executive team, Board of Directors Minimum: monthly Organizational Operations Measures Critical organization operational KPIs (usually selected department/program measures Executive team, Department program directors Minimum: monthly (some could be weekly / daily: P4P contract indicators, cash flow) Department Program Measures Department / program KPIs Department / program directors Minimum: monthly (some could be weekly / daily: P4P contract indicators, cash flow) 44

45 For Financial Managers For Clinical Managers Revenue (overall, and by program) Key compliance requirements, especially documentation Margin (overall, and by program) Unit cost by program/productivity Cash flow No-show rate Days in A/R Sentinel events Billings Rejected (by dollars or %) Billings Rejected (by dollars or %) Any financial P4P measures Any clinical P4P measures Outcome/quality measures 45

46 An intuitive graphical display that is thoughtfully laid-out and easy to navigate A logical structure that makes information easily accessible Little or no user training is required Data displays that can be customized and categorized to meet the specific needs of each user. Regular and frequent updates of dashboard information for accuracy and relevance to current conditions Information from multiple sources, departments, or markets can be viewed simultaneously 46

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55 Root cause analysis (RCA) A process designed for use in investigating and categorizing the root causes of events with negative safety, quality, reliability and operational impacts. Simply stated, RCA is a tool designed to help identify not only what and how an event occurred, but also why it happened. You can only correct the problem when you are able to determine why the problem occurred. 55

56 Root causes are specific underlying causes Root causes are those that can reasonably be identified Root causes are those management has control to fix Root causes are those for which effective recommendations for preventing recurrences can be generated The more specific the team can be about why an event occurred, the easier it will be to arrive at recommendations that will prevent recurrence Pareto principle: roughly 80% of the effects come from 20% of the causes The entire healthcare system is in chaos is not a root cause Recommendations should directly address the root causes identified during the investigation If the team arrives at vague recommendations such as, Improve adherence to written policies and procedures, then they probably have not found a basic and specific enough cause and need to expend more effort in the analysis process 56

57 Define the problem Implement and monitor the recommendation Data collection Development of recommended solution Causal factor charting Root cause identification 57

58 The problem must be clearly operationally defined Rather than: Our documentation is terrible Instead: 80% of the treatment plans in the children s outpatient clinic were not completed within the required timeframe of 72 hours after intake 58

59 Without complete information and an understanding of the problem, the causal factors and root causes associated with the event cannot be identified. The majority of time spent analyzing an event is spent in gathering data. For our problem with treatment plans not being completed on time, data that could be gathered includes: Completion rate by team, therapist Data about what elements of the plan are not completed on time Other? 59

60 Causal factor charting Provides a structure for investigators to organize and analyze the information gathered during the investigation and identify gaps and deficiencies in needed data as the analysis progresses A sequence diagram with logic tests that describes the steps in a process Begin with a skeleton flow chart that is modified as more relevant facts are uncovered Data collection continues until the team is satisfied with the thoroughness of the chart Allows the team to identify causal factors Those contributors (human errors and system problems 85% of problems are system problems 60

61 Start Consumer Arrives For Appointment Payment Collected & Receipt Given Therapist Sees Consumer Data Entered Charge Tickets Complete? Charge Tickets Turned In Weekly Charge Ticket Completed End Returned To Therapist Chart Ticket Corrected 61

62 Track the effectiveness of the solution through the KPIs 62

63 Identify solution(s) based on the results of the analysis that will address control root cause(s) of the problem 63

64 From Electronic File Cabinet To: Development of organizational strategy using data to assess internal resources and performance against external environment Design of operating unit plans to support strategy implementation using data to conduct operational business unit gap analysis and set performance standards Management of performance using data to manage the organization s operations to the performance metrics required for strategic success Evolution of market positioning using data to compare organizational performance against competitors to gain competitive advantage through refined market positioning Participation in performance-based contract arrangements using data to prospectively estimate (and manage) performance 64

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66 2013 Performance Management Institute February 14-15, 2013 Clearwater Beach, Florida 2013 Planning & Innovation Institute June 11-13, 2013 New Orleans, Louisiana 2013 Executive Leadership Institute September 11-13, 2013 Gettysburg, Pennsylvania 2013 Technology & Informatics Institute October 24-25, 2013 Philadelphia, Pennsylvania 66

67 The market intelligence to navigate. The management expertise to succeed York Street, Gettysburg, Pennsylvania 17325

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