leveraging six sigma to improve organizational performance
DESCRIPTION
TRANSCRIPT
LEVERAGING SIX SIGMA TO IMPROVE
ORGANIZATIONAL PERFORMANCE
Dale Wood, C.A.M.C.,Vice President System Improvement and Chief Quality Officer
CAMC Leadership Team
Provide system leadership in achieving performance excellence – Connecting hearts and minds to raising the bar in system-level results.
Will all of our efforts and projects add up to great quality and value for those we serve?
So…. How Is It Going?
Heart Failure: Cost Vs Composite Quality Percentile Rank ComparisonsPremier Hospital Quality Demonstration Project Participants
October 1, 2003 - December 31, 2003N of Hospitals =270
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Wage and Severity Adjusted Cost Percentile Rank
Co
mp
osi
te Q
ual
ity
Sco
re P
erce
nil
te R
ank
Inc
rea
sin
g Q
ua
lity
Top Decile = 85.64%
2nd Decile = 80.38%
Decreasing Cost
Charleston Area Medical Center
IOM Dimensions Measures 1. Safe Adverse drug events
Work days lost 2. Effective & Equitable Hospital specific mortality
Functional outcomes 3. Patient-centered Inpatient satisfaction
% Patients dying in hospital
4. Timely ED Wait Time, Discharges <Noon
5. Efficient Hospital costs per discharge
Health care costs per capita
Organization Transformation?
What is the “Right Recipe”, Sequence and Alignment for Organization Transformation
Why – “It’s What You Do andWhen You Do It That
Produces The Most Leverage”
“Deg
ree
of
Ch
ang
e”4
2. Have the skills to do what’s required. 2
1. Agree with Change1
3. See people they respectmodel the changes.
The “champion” effect
4. Consistent practicesapplied over time.
Discipline + Habit = philosophy
3
“Deg
ree
of
Ch
ang
e”4
2
1
3
Average organization = minimal change Program level
4. Consistent practicesapplied over time.
Discipline + Habits = Philosophy
3. See “leaders” and thepeople they respectmodel the changes.
The “Champion” effect.
2. Have the skills todo what’s required.
1. Agree with “Change” andwill at least “give it a try.”
“Deg
ree
of
Ch
ang
e”4
2. Have the skills to do what’s required. 2
1. Agree with Change1
3. See people they respectmodel the changes.
The “champion” effect
4. Consistent practicesapplied over time.
Discipline + Habit = philosophy
3
Program Focus
Time and Difficulty
“Deg
ree
of
Ch
ang
e” 4
2
1
3
Su
stai
nab
le P
erfo
rman
ce
Low
HighPerformance Culture
Average organization = minimal change Program level
2. Select systemic framework. Expand healthy and fit culture dialogue.
1. Programs to address immediate needs.
Initiate healthy and fit culture dialogue.
3. Align management systems. Leaders model healthy and fit cultures.
4. Integrated performance, healthy and fit cultures applied over time.
Program Orientation Organization
OrientationPerformance
Culture
CAMC Creating Performance Excellence
What are the differencesProgram Orientation Performance Culture
What is CAMC’s Strategy for Changing the System?
•Clearly communicate system-level strategy and goals
•Align strategy, measures and projects
•Focus leadership time on improvement work
•Connect the hearts and minds of all to improvement
•Increase improvement capability (skills and infrastructure)
CAMC’s Strategy
WHO WE ARE (Mission)
WHAT WE WILL BECOME (VISION 2010)
We provide the best health care to every patient, every day-
• Best place to receive effective, efficient, timely, safe, equitable and patient-centered
care.
• Best place to work
• Best place to practice medicine.
• Best place to learn.
• Best place to refer patients.
WHAT WE WILL ACCOMPLISH
Charleston Area Medical Center, the best health care provider and academic medical center in West Virginia.
Clearly communicate system-level strategy and goals
Mission: To improve the total health of our communities working in partnership with the people we serve.
StrategicInitiatives
FinancialReach and sustain alevel of financialperformance that assures our long-term viability and enables us to investin strategies to achieve our mission.
Patient SatisfactionEnsure and energizea patient-focused culture.
Employee RelationsBe the best place towork.
SafetyGrow and sustain a patient safety focused environment.
Medical StaffCreate and sustaina “Best Place to Practice Medicine”environment.
Quality ImprovementImprove key clinicaland operational processes that significantly enhanceCAMC’s reputationfor assuring qualityoutcomes.
2005 Charleston Area Medical Center Strategic Initiatives
Goals Goals Goals Goals Goals Goals
Build market share.
Reduce expense per discharge.
Improve patient satisfaction scores with a focus on improving “definitely recommend.”
Strengthen leadership.
Improve Human Resourceprocesses.
Grow the next generation.
Promote an environment for sharing information and lessons learned.
Assure compliance with National Patient Safety Goals.
Foster effective teamwork regardless of a member’s position of authority.
Ensure adequate Medical Staff.
Enhance Medical Staff retention and satisfaction.
Ensure Medical Staff clinical quality involvement and leadership.
Improve CAMC standardized mortality rate and standardized complication rate.
Achieve effective care by embedding clinical science into care processes.
Design processes for safety,efficiency and timeliness asa function of Siemen’s implementation to ensureCAMC can derive themaximum benefit from information system investments.
Improve hospital throughput.
Indicators
•“Definitely” Recommend•“Excellent” Overall Experience
•Patient Safety Culture Survey•National Patient Safety Goals and National Quality Forum Projects
•Employee Satisfaction Survey•“For me, this is a good organization to work for.”•“I would recommend my organization to friends as a good place to work.”•Voluntary Turnover
•Medical Staff Appointments•Number of Active and Associate Physicians on Medical Staff
•Inpatient Discharges•Outpatient Visits•Excess of Revenue over Expense•Expense Per Adjusted Discharge•FTE per AOB
•CMS Composite Indicators•Gross Mortality Rate•Patient Discharges Before Noon
IndicatorsIndicators Indicators Indicators Indicators
Clearly communicate system-level strategy and goals
Communication Plan
Meeting Timing Presenter Data thoughts
monthly Dale Wood current CAMC numbers
2 X year QIC'sprojects/outcomes associated
with Indicatorsmonthly Dale Wood current CAMC numbers
2 X year QIC'sprojects/outcomes associated
with Indicators
monthlyClinical Director/ Assoc
Administrator current CAMC numbers
PRN Assoc Administratorprojects/outcomes associated
with Indicators
monthly Manager/Chairperson current CAMC numbers
Initial education to Case Coordination for initiation into this process
PRN Manager/Chairpersonprojects/outcomes associated
with Indicators
monthly Nurse Managers/ Case Coordinatorscurrent CAMC numbers/ current
unit specific numbers
data drilldown taken to each unit on a monthly basis by Martha/Lisa
PRN Nurse Managers/ Case Coordinatorsprojects/outcomes associated
with Indicators
New Hires at orientation Debbie Kisereducation on indicators:
importance and what is counted
MIMseach meeting
(quarterly) Dale Woodcurrent CAMC numbers + projects around indicators
Case Coordination Staff Meeting
every other month/ quarterly Debbie Kiser
Questions/concerns/projects /general education
Case Coordinators get data monthly electronically
Med Exec monthly Dale Wood current CAMC data
monthlyClinical Director/ Assoc
Administrator current CAMC dataprojects of interest presented PRN
PRN Assoc Administratorprojects/outcomes associated
with Indicatorsquarterly Clinical Director physician specific numbers
monthly Clinical Director compliance issuesContacted directly by Clinical Director
New Residents at orientation Clinical Director (?)education on indicators:
importance and what is counted
Vital Signs newslettermonthly to quarterly Dale/Deb/Kim
Positive recognition of units related to indicator work
CAMNetmonthly to quarterly Dale/Deb/Kim
Positive recognition of units related to indicator work
PIC
Board on Quality
QIC
CELEBRATIONS
Collaborative Practice
Physicians
Medical Department Meetings
Nursing Units
Clearly communicate system-level strategy and goals
Align Strategy, Measures and Projects
How will we achieve the goals?What is my part?
How is it connected?How will we know if we are making progress?
Q Projects in a unit, office, or department…
Strategically important system-level performance measure
Will these projects, in aggregate, move that Big Dot?
© 2001 Institute for Healthcare Improvement
AIMReduce mortalityrate 25% below
baseline
6. Improve Key clinical and operational processes that significantly enhance Charleston Area Medical Center'sreputation for assuring quality outcomes.
6.1 Improve CAMC standardised mortality rate and standardized complication rate
How will weknow ...
DriversMeasures of
DriversInitiatives
Measures ofInitiatives
Inadequate clinicalcommunication
Failure to identify,monitor and rescuevulnerable patients
Patient placementat appropriate level
of care
Inappropriatevariation in
management
Appropriatetreatment of highrisk populations
Inconsistant end oflife care
Mortality asmeasured
internally andcompared to
externalbenchmarks
What do wewant toachieve
Number oftransfers to higher
level of care
Percent ofcompliance with
guideline(VAP)
Number of non ICUcodes
Number of unitsparticipaing in
rounds with dailygoal sheets
Appropriate use ofclinical protocols
LOS of referrrals topaliative care or
hospice
Staff satisfaction
MET
Vent Bundle
Risk Assessment
CMS/SIPPSIndicators
Pallative CareTeam
Communication /SBAR
MedicationReconciliation
Mortality Review
Rounds/ goalsheets
Intensivist / e-ICU
weaning protocol
Bed Management
Stroke Protocol
Glycemic Control
Sepsis Bundle
Improve use ofAdvanceDirectives
Survey's
Increased use ofIPOC
Number of MET Calls
Review of codesresulting in death
Number of UnitsParticipating
Box 3/4 reviews
Percent bundleuse
Percent ofCoverage
Percent of use
Number ofpatients
transferred to ICUwithin 72 hours of
admission /readmissions
Improved rankingof indicattorNumber of
patients usingprotocols and
bundles
Reduce day toconsult/ number of
consults
Decrease inadmits from
nursing homesand increased
advance directives
IPOC
Central Line
Six Sigma Online Project Manager Application – SI Report
•Align strategy, measures and projects
Six Sigma Online Project Manager Application – SI Report
Financial Projects
Align strategy, measures and projects
Six Sigma Online Project Manager Application – SI Report
Financial Projects Continued
Align strategy, measures and projects
Six Sigma Online Project Manager Application – SI Report
Financial Projects ContinuedAlign strategy, measures and projects
Six Sigma Online Project Manager Application – SI Report
Safety Projects
Align strategy, measures and projects
Six Sigma Online Project Manager Application – SI Report
Medical Staff Projects
Align strategy, measures and projects
Six Sigma Online Project Manager Application – SI Report
Quality Improvement ProjectsAlign strategy, measures and projects
Six Sigma Online Project Manager Application – SI Report
Quality Improvement Projects ContinuedAlign strategy, measures and projects
Charleston Area Medical Charleston Area Medical Center – Clinical Center – Clinical
Performance Initiatives GoalPerformance Initiatives Goal
CAMC will focus on Clinical Performance Initiatives in specific focus areas with a goal to achieve top decile
performance in quality, cost, and safety through focused collaborative efforts to bring
evidence-based best practices into widespread use.
Align strategy, measures and projects
CAMC will focus on Clinical Performance Initiatives in specificfocus areas with a goal to achieve top decile performance in
quality, cost, and safety through focused collaborative efforts tobring evidence-based best practices into widespread use.
Heart Failure CABG AMIPneumonia Hips/Knees
Assumptions:Structured teams will be in place for each focus group.Non-Administrative Physician involvement is critical.Groups will use Premier Perspective to identify opportunities.Black Belt resource needed to help scope opportunities and track team progress.Cost data for 2004 must be available.Change Agent available in each focus group.
Strategic Goal - Financial1.3.1 and Quality
Improvement 6.2.1
Strategic Goal -Quality Improvement
6.2.2
Strategic Goal -Quality Improvement
6.2.1
Strategic Goal -Quality Improvement
6.2.1
Strategic Goal -Quality Improvement
6.2.1
AA - Karen StewatClinical Director -
Kathleen MimnaghBlack Belt - Kim
KendrickClinical QualitySpecialist - Deb
KiserClinical ChangeAgent - Martha
Taylor
AA - Karen StewatClinical Director -
Kathleen MimnaghBlack Belt - Kim
KendrickClinical QualitySpecialist - Deb
KiserClinical ChangeAgent - Martha
Taylor
AA - Ron MooreClinical Director -
James BolandBlack Belt - Karen
MillerClinical Quality
Specialist - BarbaraWhite
Clinical ChangeAgent - Joan Reed
AA - Josh FlorenClinical Director -
Constantino AmoresBlack Belt - Steve
CunninghamClinical Quality
Specialist - TeresaHill
Clinical ChangeAgent - DebbiRectenwald
AA - Tiny ArthurClinical Director -
Kathleen MimnaghBlack Belt - Glen
MartinClinical Quality
Specialist - AnneMatthews
Clinical ChangeAgent - ?
Align strategy, measures and projects
DefineDefine MeasureMeasure AnalyzeAnalyze ImproveImprove ControlControl
Standardization
Redundancy
Critical Failure Mode
ReliabilityModel
By using a combination of DMAIC
and Reliability we can identify gaps in our process and implement/
validate tests of change
Align strategy, measures and projects
RolesAssociate Administrator•Process Owner•Leads team•Agenda Planning and Coordination•Approves Changes and removes barriers•Reports progress to Steering Committee
Black Belt•Tool Facilitation •Assists with tracking tests of change•Analysis of data•Agenda planning
Quality Nurse•Data Abstraction•Outcomes Review•Analysis of data
Clinical Director•Brings Physician Perspective•Physician Change Agent•Physician Champion
Case Coordinator•Assist with Education on units•Identify process variation on real-time bases
Clinical Change Agent•Education on Units•Coordination of changes•Follow up non-compliance with Nurse Managers
Align strategy, measures and projects
Project ToolsDefineDefine MeasureMeasure AnalyzeAnalyze ImproveImprove ControlControl
• Project Charter• Stakeholder Analysis• Communication Plan• Elevator Speech
• Current State Process Map• Sigma Level• Understand Process Capability
• Reliability Model Questions answered• Variation analyzed• FMEA
• Impact/Effort Matrix• Best Practice/Benchmark
• Control Charts• Control Plan
Align strategy, measures and projects
Define the Project: This team will focus on Clinical Performance Initiatives Related to Heart Failure with a goal to maintain top decile performance in quality and safety through focused collaborative efforts to bring evidence-based best practices into widespread use. Based on 4th Q 2003 comparative data CAMC was in the top decile with a composite score of 93.48%.
Measure the Process: 1st 6 months – Top Decile = 85% we were at 93%
Set a Goal: 98-100% Composite Score and top decile composite performance.Is there a Std Protocol/Order Set/Process? Yes – Standard ProcessUsage Rate of Process? 90-95%
Analyze variances (From FMEA and Survey of Case Coordinators related to Heart Failure): • Failure to Identify as Heart Failure patient – Sample showed that 96% of patients were admitted to the unit with admit diagnosis of HF.• Inconsistency between units• Physician Resistance• Lack of Communication
Improve: • Smoking Cessation Education/Counseling – added to Our Commitment” brochure and Patient Agreement for all Patients.• Case Coordination follows up with Physician via Case Coordinator Notes (LVF Assessment and ACE Inhibitor)• Case Coordinator pull old Echo reports• Discharge Sheets updated to combine Worsening Symptoms and Weight Monitoring check box• Dr. Mimnagh to follow-up on Physician Outliers
Process Owner: Karen Stewart
Next Steps:• Notification of Unit Managers/AA’s of defect results• Analyze results from Case Coordination Survey • Research using IPOC as the standard Nursing/Case Coordination check list for indicator completeness• Special Education/Communication for Nursing Units – Mardi Gras theme
Timeframe
Pro
port
ion
1.0
0.9
0.8
0.7
0.6
_P=0.9262
UCL=0.9827
LCL=0.8698
1 2
1
Tests performed with unequal sample sizes
P Chart of Heart Failure Composite Score
Top Decile
CMS Indicators - Heart Failure Composite
Align strategy, measures and projects
Timeframe
Pro
port
ion
Jun-
04
Apr-0
4
Jan-
04
Oct-
03
Jul-0
3
Apr-03
Jan-
03
Oct-
02
Jul-0
2
Apr-02
Jan-
02
1.0
0.8
0.6
0.4
0.2
0.0
_P=0.947UCL=1
LCL=0.752
1 2
11
Tests performed with unequal sample sizes
P Chart of Compliance with Smoking Cessation Education (Heart Failure)
Align strategy, measures and projects
Timeframe
Pro
port
ion
Jun-
04
Apr-0
4
Jan-
04
Oct-
03
Jul-0
3
Apr-03
Jan-0
3
Oct-
02
Jul-0
2
Apr-02
Jan-
02
1.00
0.95
0.90
0.85
0.80
0.75
0.70
_P=0.9200
UCL=1
LCL=0.7603
1
Tests performed with unequal sample sizes
P Chart of Compliance with ACE at Discharge (Heart Failure)
Align strategy, measures and projects
Timeframe
Pro
port
ion
Jun-0
4
Apr-04
Jan-
04
Oct-
03
Jul-0
3
Apr-03
Jan-
03
Oct-
02
Jul-0
2
Apr-02
Jan-
02
1.0
0.9
0.8
0.7
0.6
0.5
0.4
_P=0.8901
UCL=1
LCL=0.7763
1 2
22
1
1
Tests performed with unequal sample sizes
P Chart of Compliance with Discharge Instructions (Heart Failure)
Align strategy, measures and projects
Timeframe
Pro
port
ion
Jun-
04
Apr-0
4
Jan-
04
Oct-
03
Jul-0
3
Apr-03
Jan-0
3
Oct-
02
Jul-0
2
Apr-02
Jan-
02
1.00
0.95
0.90
0.85
0.80
0.75
0.70
0.65
_P=0.9704UCL=1
LCL=0.9114
1 2
11
1
Tests performed with unequal sample sizes
P Chart of Compliance with LVEF Evaluated (Heart Failure)
Align strategy, measures and projects
Define the Project: This project is dedicated to meeting the CMS quality standards for patients undergoing Hip and Knee surgeries.
Measure the Process: See control chart for composite score.
Set a Goal: 100% compliance (6 for each individual indicator.
Analyze variances: Reliability ModelA)Preop order sets have been in place since January. Orthopedic order sets have been in place since March.
B) Nursing staff is responsible to place the order sets on the charts in PACU and CRNAs assure that appropriate antibiotics and timing occurs.
c) Failures are caused when order sets don’t get put on the chart, physicians refuse to use appropriate antibiotics or when delays in case cause the case to start after the 1 hr timeline.
Improve: Tests of Change?
Currently team is evaluating the order set compliance and waiting to see the data on charts that fail to meet the standards. These charts will lead us to better understand which circumstances lead to failure and then to the development of an FMEA. The result will be a second cycle test of change to eliminate the failure modes.
Hips and Knees
Timeframe
Pro
port
ion
Oct-04Sep-04Aug-04J ul-04J un-04May-04Apr-04Mar-04Feb-04J an-04
1.00
0.95
0.90
0.85
0.80
_P=0.9500
UCL=0.9978
LCL=0.9022
1 2
Tests performed with unequal sample sizes
P Chart of Hip/ Knee Composite Score
Top Decile
Align strategy, measures and projects
DSS Manager Portal
Align strategy, measures and projects
DSS Manager Portal
Main Menu – Click on “+” sign on left navigation to expand list of available reports.Align strategy, measures and projects
DSS Manager Portal
Seen below is an example of the Quality Dashboard Report.Align strategy, measures and projects
DSS Manager Portal
Seen below is an example of how to run the Indicator graphs.Align strategy, measures and projects
Allocate Leadership attention to improvement
Project sponsors
Project owners
Project report outs
Hiring and Promotions (Administrators and Managers)
Performance Planners
Teachers Facilitators
Black Belts and Green Belts
What is CAMC’s Strategy for Changing the System?
•Clearly communicate system-level strategy and goals
•Align strategy, measures and projects
•Focus leadership time on improvement work
•Connect the hearts and minds of all to improvement
•Increase improvement capability (skills and infrastructure)
Connecting the Hearts and Minds
Power of the OverlapThe power of an
organization to realize its goals is directly
related to the amount of overlap between
Healthy and Fit
The power of an organization to realize
its goals is directly related to the amount of overlap between
Healthy and Fit
Economic StrengthReduced expenses, increased revenues, competitive returns,
economies of intellect, decreased turnover, increased
intellectual capital.
Reduced expenses, increased revenues, competitive returns,
economies of intellect, decreased turnover, increased
intellectual capital.
Fit:The organizations ability to meet the demands of
the marketplace with high performance
metrics and increased value to its
stakeholders.
Fit:The organizations ability to meet the demands of
the marketplace with high performance
metrics and increased value to its
stakeholders.
Healthy:The organizations
ability to support the needs of its
stakeholders and improve the
environment in which services are provided.
Healthy:The organizations
ability to support the needs of its
stakeholders and improve the
environment in which services are provided.
FitHealthy
Connect the hearts and minds of all to improvement
Fit Cultural
Practices
Healthy Cultural
Practices
The underlying health of the organizational culture. Attributes that impact it’s capacity to achieve
optimum fitness and support sustainable performance.
The operational capacity of the organization to perform and execute on it’s strategies that create sustainability.
Practices dependent upon the underlying organizational health.
Either/or or Both? Where should we focus for the greatest impact?
Balanced Approach
Connect the hearts and minds of all to improvement
Increase Improvement Capability and Infrastructure
• Firm up project methods to get even better results• Use the DMAIC Model consciously and actively• Link PDSA tests to conceptual models• Use run charts, and learn Statistical Process
Control• Use DFSS to design Six Sigma into the process• Find the “bar,” meet it, then raise it
Why Integrate DFSS?
• Value of the integration is a more comprehensive roadmap
• Supports CAMC visions
• Used with excellent results
• Best of both: Siemens Implementation Methodology enhanced with Six Sigma tools
• Acts as a solution accelerator
• Can “Fill in the blanks…”
• Additional Business Case Benefits
• Improved Performance Levels
• Prioritization of Business Requirements
DFSS Methodology
• What is the end result ?– Complete and well designed solution– Clear linkage to the Business Case (lagging indicators)– Voice of the Customer (VOC) requirements identified
and met– Critical To Quality (CTQ) indicators tied to processes
(leading indicators)– Prioritization of System Requirements / GAPS– Risk identification and mitigation strategies– Confidence in the outcome
Typical Pattern
ResourcesCommitted
Time
Release
Release
Why Use Six Sigma - DFSS?
• Six Sigma - DFSS is different than the typical project in that it requires more up-front work to be done.
• Which curve is more efficient?• It requires more time in the planning stages, but the
project finishes sooner and with less overall work!
Soarian/Six Sigma Integration
Kickoff
DFSS Training
Verify / Validate
DesignAnalyzeMeasureDefine Control
Six Sigma DFSS Methodology
Integration Plan
Go Live ClosurePlanning & Initiation
Define Implementation
Soarian Methodology
Kickoff
Timeline
Today
127 8 9 10 111 - 6
Training Training
Soarian/Six Sigma Tool Integration
Initial project planning and preparation
Understand requirements and develop process
designs
Configure processes and test the system
Move from a pre-production to a productive
operation
Process flow diagrams and mapping
SIPOC User Requirements Gap Analysis System Requirements Benchmarking Brainstorming Process baselining on
key processes Implementation Plan Data Standards System Interfaces Voice of the Customer Quality Function
Deployment (QFD) Creativity Tools Score Cards Pugh Matrix MGPP –2 Stage Gate –2 & 3
Tool/Templates Sorian DFSS
X x
X X X X X XX x XXX X X X X X X X
Validation Testing Gap Analysis System Requirements Benefits Validation Control Charts Score Cards MGPP – 3 Stage Gate -5
Tool/Templates Sorian DFSS
X X XX x X X X X
Business Case Project Goals &
Objectives System Requirements Process baselining on
key processes Team Charters Scope Project Plan MGPP – 1 Stage Gate -1
Tool/Templates Sorian DFSS
X xX x
X xX x x X x XX x X X
Process flow diagrams and mapping
SIPOC Gap Analysis System Requirements Pilot Test & Verify Validation Strategy Training Plan Documentation Plan Communication Plan Capability Analysis Fault Tree Simulation Robust Design FMEA/EMEA Mistake Proofing Score Cards MGPP –2 Stage Gate -4
Tool/Templates Sorian DFSS
X x
X X X X xX x X X X x X X X X X X X X X
Verify / Validate
DesignAnalyzeMeasureDefine Control
Go Live ClosurePlanning & Initiation
Define Implementation
PE / DEx Methodology
Soarian Methodology
LegendX (Bold) - Preferred Template/Tool
x (Small) - Similar Template/Tool
X -Common/Customized Tool or Template
What is CAMC’s Strategy for Changing the System?
•Clearly communicate system-level strategy and goals
•Align strategy, measures and projects
•Focus leadership time on improvement work
•Connect the hearts and minds of all to improvement
•Increase improvement capability (skills and infrastructure)