MultiCare Health System: Performance Excellence by the Numbers

Added on Jul 21, 2017

MultiCare Health System: Performance Excellence by the Numbers

​By Diana Mahoney

To achieve its vision of being the “highest value system of health in the Pacific Northwest,” Tacoma, Washington-based MultiCare Health System has adopted a unique rally cry: “10-10-10-25.”

These numbers are the backbone of the performance excellence road map that leaders of the integrated health network—the largest community-based, locally governed health system in the state—charted three years ago. They represent performance excellence goals for workforce engagement, clinical quality, service and value.

Specifically, according to Stacy Parkin, director of Service Excellence at MultiCare, the three 10s reflect the organization’s objective to achieve performance in the top 10% of the nation in measures of physician and employee engagement, clinical outcomes and patient experience. And the 25 signifies a two-part financial objective: to be in the top quartile in the region for revenue and the lowest quartile for health care costs.

“Everyone in the organization, from housekeepers to front-line nurses to executives, knows that 10-10-10-25 stands for performance excellence at MultiCare, and that it’s what we strive for every day,” Parkin explained.

While the three 10s share top billing, the first 10 is in a larger font on materials that describe the initiative “because it refers to our people, our team,” Parkin said. “High employee engagement is foundational to achieving performance excellence across all the other measures, so we make that a top priority.”

The numbers are more than symbolic. They are the yardstick against which organizational performance is consistently measured, and progress toward them is celebrated while movement away from them triggers a call for action.

“We have a performance excellence dashboard, and the senior leadership team meets once a month to review performance against it,” Parkin explained. “In particular, we focus on areas where we are not meeting our target so that we can identify barriers and address them collectively, as a team.”

The performance excellence dashboard is “live and active,” according to Parkin, “so anyone can go into it at any time to see how their work unit is trending,” she said, noting that the 10-10-10-25 goal applies throughout the organization. “Every business unit, every hospital, every unit within each hospital, every team within a business unit knows that they are a part of the 10-10-10-25 and what they need to accomplish each year to be able to deliver on it.”

This insight is achieved through the development of goals for embedded leaders of individual teams, business units and facilities that align with the system-level goals. “For each of these entities, we look at what their 90-day action plan is for each pillar of performance,” Parkin said. During monthly meetings, each entity reviews its progress toward the 90-day goal, with the understanding that if they are on target with their action plan, they are positioned to deliver on their portion of the 10-10-10-25 by the end of the year.

“If a group is not on track, they can check and adjust—see where they are falling off and consider ways to get back on track,” Parkin said.

Because the dashboard is fully transparent, it serves as a virtual best-practice watercooler for sharing insights and ideas, whereby teams or units that are underperforming in certain areas can identify others that are performing well in those areas and reach out to them to find out what they are doing. For example, Parkin said, “our Allenmore Hospital has had outstanding performance in the clinical quality area of CAUTIs [catheter-associated urinary tract infections]; in fact, they have not had any in years. They have shared their best practices with the organization so other hospitals can replicate them.”

On the flip side, one of the hospitals in the network was having problems meeting its financial goals. “The hospital leadership brought forward their challenges in one of the monthly meetings to seek the collective wisdom of the larger group to try to solve them,” Parkin said.

Some teams are particularly proactive when it comes to righting their course. “If they recognize they’re having a problem, they don’t wait for the monthly meeting to reach out. They go to the dashboard to see who is performing well and they reach out beforehand,” Parkin said. “Then they will come to the monthly meeting reporting that they’ve been struggling with that area and have reached out and are working with another unit or group, and they will discuss ideas.”

The performance excellence dashboard also serves as an accountability framework. “If I am running a hospital, I can see, for example, what my environment of care folks are doing and how their goals contribute to the 10-10-10-25 of my hospital,” Parkin explained. “Even though it may not be my direct line of accountability, the performance of the department is going to influence my business unit, so it’s in my best interest to be aware of their performance.” Because of this structure, “we find that people are not just looking up and down their lines of accountability, but also across to see how other areas that could have an impact on their own outcomes are performing,” she said.

Because this horizontal view can lead to some “tough conversations” about performance expectations, “all of our leaders have gone through communication training focusing on the importance of transparent, open, honest discussions,” said Parkin. “We also do a lot of work in building up trust, and as we bring up the level of trust between our leadership bodies, it paves the way for some of the more difficult conversations so we can work together as a team for the good of the overall organization.”

Trust is also the keystone for high workforce engagement and, by association, high performance across the 10-10-10-25 pillars. “When engagement is stronger, the other outcomes, especially patient experience, improve more consistently,” Parkin said.

Similarly, poor engagement is an anchor to other outcomes. One case in point within the MultiCare network was the decision by a group of hospitalists for one facility in the system to unionize. “They felt like they were not part of the discussion. It was a sign that we had not done enough to engage them and make them feel like the valued partners that they are in the care we deliver,” Parkin said. Not surprisingly, the engagement, patient experience, quality and financial outcomes for this facility were also low.

This scenario has led to leadership coaching around the drivers of engagement and what can be done at the organizational level to improve engagement. There is no one-and-done fix, Parkin noted, especially in a changing health care landscape, but “it’s worth the effort because so much depends on it, particularly in the service excellence area.”

Keeping All Eyes on the Prize

The flip side of the 10-10-10-25 mantra being so well-known across the organization is the possibility of it becoming part of the woodwork. To prevent this, MultiCare leadership have adopted a number of strategies to keep the concept fresh and meaningful.

“We have what we call our leadership engagement forums each quarter to talk about 10-10-10-25,” Parkin said. “We frame these discussions as the head, the heart and the hand.” The head, she said, refers to understanding what the system’s performance is against the 10-10-10-25 as a communication vehicle. The heart aspect involves motivating the leaders around the performance goals, often by bringing in outside speakers to share what others in the industry are doing to improve in the various performance areas. And the hand component involves giving the leaders the tools and resources to help them achieve the 10-10-10-25, which happens during breakout sessions or best-practice discussions.

“Even though we don’t make these leadership forums mandatory, we actually have greater than 90% participation, so we know that we are providing value to our leaders,” Parkin said.

And the value can be seen in MultiCare’s performance, which has mostly been trending in the right direction. The service area, in particular, has seen positive movement. “Recently, for the first time since we began using Press Ganey surveys, we saw improvement across every patient experience item and we’ve been able to sustain that,” Parkin said. “And we are doing really well with our clinical quality outcomes.”

Progress on the engagement and financial fronts has been slower. With respect to engagement, “our organization is growing, so we face the challenge of integrating multiple organizational cultures,” Parkin said, noting that the system, which operates five hospitals and more than 130 clinics in the southern Puget Sound region, recently purchased two additional hospitals in the Spokane area. “When you merge with a new organization you inherit its culture, and it takes time to understand what they bring to the table so you can combine the best of what you already have with what the new partner delivers.”

Financially, the changing reimbursement and payer mix continues to make the revenue/cost goal more challenging, “so we are continuously looking to improve there,” Parkin said. “We are confident that meeting our goals in the other performance areas will allow us to hit our financial targets faster. Improvement across all of the pillars is built upon improvement in each of them. By maintaining our focus on the overarching goal, we will get there.”