As leaders, we must keep a steely focus on the future of our organizations as we continually strive toward our objectives amidst the whirlwind of day to day activity. Streams of data grab our attention with greater frequency than ever before; without taking the occasional step back, one can lose the big picture perspective that only time can provide.
I was recently reminded of the importance of taking that long look back as our team took a moment to reflect on our Hospital’s journey over the past five years.
Like many hospitals in Ontario, Orillia Soldiers’ Memorial Hospital (OSMH) has spent the past several months struggling to find ways to balance our 2013/14 budget while maintaining services and our commitment to our values and to safe, quality care. The hurdle for us was even higher as OSMH is currently participating in the provincial Working Capital Relief program that requires us not only to balance, but to achieve a surplus equal to one percent of our total budget.
While we’ve been successful in building a plan to achieve our objectives, it wasn’t easy. And it won’t be easy in the months to come. There are impacts to staff and many changes with the most significant being a reduction in the number of beds. We are also moving forward with process changes that require a cultural shift in the organization and in the community.
The primary change revolves around the designating of patients as ALC (Alternate Level of Care) to Long-Term Care, a practice that was quite common before but often led to lengthy hospital stays for ALC patients. By working more closely with patients, families, physicians, care teams, CCAC and other health and social service providers, we are in many cases able to avoid those designations. We assist patients to get care at home or quicker access to other community resources.
Our goal is to provide the right care in the right place and to improve patient flow throughout the hospital. We learned from other successful organizations and will now only designate a patient as ALC to Long Term Care with Senior Team involvement. We have patient navigators who work with the CCAC to avoid admissions and expedite discharges. We have already seen early encouraging results with fewer ALC patients, many days with zero admitted patients waiting in the ED and empty beds which will soon be closed as part of the plan to balance the budget.
With change comes uncertainty and doubts from the staff and the community, “Is this plan doable?” When we started to look back we realized that the gains our hospital had made over the past five years were really quite remarkable, and the evidence was all there in front of us in the form of performance indicators, balance sheets and external feedback.
From a financial perspective, the hospital posted four consecutive deficits from 2007/08 to 2010/11 and struggled with an accumulated debt in excess of $25 million. Today, we’ve just completed two years in the black, reduced our debt by nearly $7 million and are on track for nearly $10 million more in debt relief in the years ahead. For the first time in the past several years, the hospital’s Total Margin (deficit surplus) is better than the average of Large Community Hospitals in Ontario.
Starting with Board leadership, steady and significant improvement in Quality and Safety is also clearly reflected in the results of our past three Accreditation surveys. In 2007, our hospital met just 65.5 per cent of 180 patient safety standards. By 2010, in an analysis of approximately 2,000 standards, OSMH achieved a score of 91.5 per cent, which improved to 96.8 per cent by March 2013, and led surveyors to comment how they would all enjoy working or having a loved one cared for here at OSMH.
Participating in Accreditation surveys enables hospitals to evaluate their performance against national standards of excellence, and is seen as one of the most effective ways to improve quality.
We’re also showing improvement in many of our publicly reported indicators, most notably, hand hygiene where are compliance has shifted dramatically from just over 50 per cent in 2008/09 to consistently over 80 per cent over the past year and a half. Our surgical safety checklist compliance moved from 85 per cent in 2010 to more than 97 per cent today and our HSMR (Hospital Standardized Mortality Ratio) has moved significantly below the 100 plateau on a consistent basis.
Of course, none of our success would have been possible without the Board, leaders, physicians and front line staff who have chosen to be part of the work of performance improvement and focus on goals. The true barometer of successful change is what happens at the front line of care. After a significant organizational change in 2007/08, the hospital needed time to rebuild trust within the organization and the community and we were grateful to receive the Silver Quality Healthcare Workplace award from the OHA for the past two years in a row.
So, to what do we attribute our progress? The adage ‘how can you expect different results if you keep doing things the same way’, certainly applies. Starting with sound principles of governance, the Board of today looks very different as a skills-based board with a high functioning committee structure. As an organization we started doing things differently by becoming one of the early hospital adopters of Performance Improvement based on LEAN methodology and most importantly the recognition that as leaders we needed to change how we lead.
Much of our recent change has revolved around the book ‘The 4 Disciplines of Execution’ and are now into our second year of identifying WIGS (Wildly Important Goals), along with the appropriate lead and lag indicators to influence them. One of the clear lessons learned has been to limit the number of WIGS to just two or three. An organization with too many big goals will have limited success at best. Aligning your WIGS to the strategic plan is critical.
Build on past successes or “Do more of what got you there,” is a quote from the book ‘Peaks and Valleys’, a valuable book that teaches the reader to get out of valleys sooner and stay on the peaks longer. Recognizing the variables that influenced your peaks and applying them to new challenges can also improve results.
The changes today are achievable because of the solid foundation built over the past few years both within the hospital and in the enhancements to the Home care and Community Sectors. Sharing this can be a real eye-opener for the community and the hospital as we face this new and challenging fiscal environment.