| The Challenge |
 | In 1995, Sentara Health System, a five-hospital system in Norfolk, Virginia, created Reinventing Sentara, a system-wide Performance Improvement effort dedicated to reducing costs, integrating the health system, and improving processes. One early initiative was a benchmarking effort that was intended to be the foundation for Performance Improvement across the system. |
| In 1998, after an initial failure with benchmarking, attributed to moving too aggressively with data that wasn't "apples to apples", Sentara turned to HMC's Functional Cost Review and adopted a more measured "Go Slow Approach" to help implement Performance Improvement across the system. |
| Sentara adopted a more realistic goal of achieving 20% of the cited opportunity (to the 65th percentile) in seven system-wide functional areas in the first year. For the second year, they assigned an additional 20% of the variance in the original seven functional areas and added three new areas (20% of the variance). |
The underlying principles of Sentara's improvement efforts include: |
| Identify functions with the largest opportunity and assign reasonable Performance Improvement goals. |
| Assign accountability to operations managers with the support of the Reinventing staff.
- Use existing teams where possible.
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| Adopt Performance Improvement methodology and mindset across all levels of the organization.
- Investigate internal best practices among Sentara's facilities first.
- Use multiple sources for identifying good ideas and solutions, including HMC's KnowledgeWebä, a web-based vehicle designed to promote peer-to-peer networking and the sharing of knowledge.
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| In keeping with Sentara's overall mission, identify ways to improve quality, service and patient safety-not just how to reduce costs. |
| Using data as a tool, not a hammer: "The HMC data is directionally correct and the best that's out there."
Doug Thompson,
Senior Vice President of Reventing and Decision Support
Sentara Health Systems |
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Implementing the Process |
| In this third year of the process, Sentara evaluated ongoing PI Teams and stopped those that had met their two year goals and gave those which hadn't more modest 10% goal for this year. Integral to the success is that all participants in the improvement process understand and fulfill their assigned roles: |
| Operational Vice Presidents' Role:-
Organize the teams
- Participate and/or review progress (Steering Committees)
- Present cases and solutions to COO's Work Group
- Hard wire savings strategies into the budget
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| Operational Directors'/Managers' Role:
- Understand the data
- Understand the current situation
- Explore internal best practices
- Search for external best practices
- Find solutions to reduce costs, improve quality and safety
- Hard wire the solutions into the budget
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| Reinventing's Role:
- Support operational leaders (help them organize the teams)
- Accept challenges to data and get explanations
- Set up networking and develop hypotheses (how to improve performance)
- Help operational leaders take responsibility and help them be successful
- Facilitate teams through the performance improvement process
- Prepare presentations/ " help" operational leaders to do so
- Walk a fine line:
- Help teams find explanations
- Help teams to realize that COO wants results, not excuses
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See the Results |
| As a result of Sentara's "Go Slow Approach" to Performance Improvement, the following are documented savings: |
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