Signature Healthcare says on their website: “Our team approach is the way healthcare should be: medical professionals across many locations communicating and collaborating, taking advantage of technologies and resources to make a difference in the lives of our patients.”
The organization includes 550 affiliated physicians and other direct care providers, 150 employed physicians and a total of 2,200 associates operating from locations in Abington, Bridgewater, Brockton, Hanson, Easton, Randolph, and Raynham.”
Signature includes both Brockton Hospital and Signature Medical Group. The hospital has 245 licensed beds, including a 29-bed hospital-based skilled nursing unit. Operation of this Transitional Care Unit began in 1997. In addition to providing medical/surgical, pediatric and obstetric services, the hospital offers inpatient and outpatient psychiatry, radiation oncology, cardiac catheterization, Level II nursery, and magnetic resonance imaging.
In 2013, Signature Healthcare was named Top Performer on Key Quality Measures® by The Joint Commission, the leading accreditor of health care organizations in America. We were one of only 8 hospitals in Massachusetts to be recognized for exemplary performance in using evidence-based clinical processes shown to improve care in all four of the following measure sets: heart attack, heart failure, surgery and pneumonia and the only hospital in Southeastern MA.
Adams Strategy Group has been Signature Healthcare’s primary lean (operational excellence) system architect for several years. Signature started with broad executive education aimed at jump-starting their lean management system. Adams Strategy Group is Signature’s coaching team, connecting into the C Suite and their internal continuous improvement team. Adams Strategy delivers education and direct coaching at those levels causing Signature to “make it their own” system. Signature has a robust lean management system today with approximately 110 operational teams using daily, monthly, quarterly and annual plan-do-check-act cycles to lead through continuous improvement. Setting aside the myth of continuous improvement by projects, Signature has adopted the “culture first” model. Today, Signature has posted impressive, sustained, operational gains and is a market leader in safety and employee engagement.
Kim Hollon, Signature’s CEO says, “ David Adams and Adams Strategy have been key partners to improving our health care delivery through the use of lean as an operating system. With David’s guidance we have dramatically reduced employee injuries; reduced defects in hundreds of process each year; improved patient experience; and improved our financial performance. The basic lean management system’s stabilization across our organization has allowed us to quickly establish a cross functional team to manage improvements under the new bundled payment initiative. The cross functional team quickly established a new care process for COPD patients that resulted in reducing readmission from greater than 24 percent to under 10 percent in just a few months. The team is now expanding this process to additional diagnosis, using our lean management system for stabilizing the new processes and daily continuous improvement.”
Signature Chief Strategist, Marie Gross says, “David is one of the best instructors I have encountered – engaging, articulate and able to motivate his students.”
CEO Hollon, when commenting on the effect of operational excellence (lean) on safety said, “From a metric perspective, our employee injury rate for lost work has fallen to around 2.4 from 8 over the past three years. This past year we had a number of injuries in our parking lots during the snowstorms where we had employees lose time. We did a lot of problem solving related to that, but at times the snow was coming so fast we struggled to keep up with sand and other measures during the peak of the storms. Exclusive of snow related injuries, our rate is well under 2, with the national and I think state average around 4.”
Hollon says about employee engagement: “Our employees implemented over 4600 suggestions this year, with about 63% of the employees implementing at least one suggestion. Their participation in daily improvement through suggestions has increased every year. We implemented reduced defects in over 200 different processes across the organization by more than our goal rate which has taken a lot of employee engagement for that pervasive a level of change. We have also trained about 70+% (not sure of exact number) in lean and by the end of this month will have trained all employees and all doctors in culture of safety). In our culture of safety class, we have over 30 different staff and managers leading the training).
Our employee satisfaction scores are measured on a number of questions and we set goals on the questions of: my opinion counts, I am recognized for doing a good job during the past week, (and) I am treated with dignity and respect. Our percentage of strongly agree scores (highest level) increased by 50 to 100% last year depending on the question, and we sustained that level of improvement this year and increased it by over 2%. Our annual giving to the foundation has increased and our annual giving to United Way has increased over the past few years, which I think are also an indicator of engagement.”
Hollon also remarks: “We have dramatically improved our readmission rate in a focused area of COPD and CHF patients over the last month from the establishment of a cross functional team that meets daily in a huddle around their Pathways (focused on readmissions and standardization of care) managing a balanced series of metrics across the patient value stream. This team is comprised of: hospitalist team, case management, CMO, lean, pharmacy; nursing, respiratory, pulmonary rehab, Brockton VNA. They meet on their own during the week in small teams to work on problems that need solving that are raised across the handoffs during the meeting. This cross functional team is directly connected to the department balanced score cards and problem solving lean process and is an additional layer of involvement. The strength of the involvement and engagement of this team was made possible by the lean system that functions at a level below them and sustains the program. We are adding our 12 Medicare bundles to this team for the coming year). This team is so engaged, when they ran out of money in the patient advocacy fund they raised money internally to add money to the fund to bridge the gap until our annual fund raising event when we usually get significant gifts from the community. You can’t get more engagement than self-led teams that give their own money and do their own self-directed fund raising.
We now have a number of our managers trained as internal coaches and trained in leading their own multi-week focused improvements. Those improvements all engage team members at the site of service.
This weekend I was just looking at notes from the OR where our OR team has improved Time Out compliance (we added several new elements to our OR time out to raise the bar) from 36% about 3 months ago to about 99% compliance. The PACU in 3 months improved compliance with a bundle of “discharge from PACU measures from 5ish % to 95% in just a few months with the nurses doing much of the heavy lifting. We are a unionized hospital and the OR and PACU have had our union leaders in their units. Previously this level of improvement was much slower to accomplish.
The lean management system we are using is aimed directly at employee engagement. The fundamental philosophy is that we have to honor the value of our staff, who know our processes, they know their internal customer and our patients, and they have the best insight into what adds value. And the best insight into how they need to change their own process for improvement.
In a prior life, when I attempted to align all employees to our enterprise goals, I struggled with communication, real engagement and this level of sustained changes across the entire organization. This system has allowed us as a team to move together, communicate, problem solve and accomplish a lot during unprecedented change. It is also worth stating from my vantage that I lead Signature; the hospital and the physician group without a COO at either the corporate level, the hospital or the group. The system allows us to push decision making and engagement down into the organization and bring top problems up through the organization for our engagement at the senior level.”