9.12 Aurora Health Care

Aurora Health Care is a not-for-profit health-care provider, with an extensive network of doctors, physicians and hospitals serving Wisconsin and northern Illinois.

Faced with intense competition, Wisconsin's largest employer and healthcare provider saw the need for reorganization, specifically to further integrate its services about an efficient patient-centered model in which knowledge management played an important role.

This analysis is less a case study than an example of business intelligence in action, demonstrating the dependence of large companies today on knowledge management and Internet technologies.

Background

Aurora Health care was created in 1984, aiming to provide:

1. People with the care they need in settings that were convenient and comfortable.
2. Families with services and support they needed to lead healthier lives.
3. Physicians with the latest technology and treatment for their patients.
4. Talented staff the opportunity to fulfill their professional callings.
5. Employers with cost-effective health care options for their employees.
6. Citizens with healthy communities.

Twenty or so years later, Aurora Health Care was serving a large geographic area with sites in more than 90 communities throughout eastern Wisconsin — including 13 hospitals, more than 100 clinics and over 130 community pharmacies. Over 3,400 physicians were affiliated with Aurora Health Care, including some 700 who comprised the Aurora Medical Group. Some $25 million was being provided in community outreach and free preventive services.

Business and Knowledge Management Strategies

Initial assessment can be summarized with a SWOT analysis:

Strengths

A: Leadership: Aurora Health Care was noted for:

1. Multidisciplinary councils providing leadership and input on strategy, policy, clinical operations.
2. System-wide clinical leadership through collaboration with other senior leadership teams.
3. Rapid adoption of best practices based on quality, patient loyalty, employee engagement, and financial performance.

B: Growing financial assets: Aurora Health Care revenue 2007-8:

1. Increased in total net service from $3.2 billion to $3.5 billion.
2. Outpatient hospital and clinic visits rose by 25.5%.

C: Extensive human assets: Aurora Health Care:

1. Aurora was Wisconsin's largest employer, with 28,000 employees.
2. Employed a mix of highly mobile skilled, unskilled, and professional employees.
3. Inculcated a 'responsible freedom' concept to maximize problem-solving, learning and respect for cultural diversity.
4. Maintained qualified and motivated employees through annual assessments and agreed goal achievements.

D: Continual training: Aurora Health Care:

1. Was committed to continual staff training.
2. Recommended an induction course to new employees.
3. Required newly-hired leaders to attend the 'Aurora Quest' program.
4. Supplied very extensive courses in many disciplines.

E. Effective IT infrastructure: Aurora Information Services:

1. Worked closely with the business groups.
2. Supported regional and departmental projects.
3. Provided key infrastructure and operational support: system support, networking, help desk, user access and security, and desktop support.
4. Supplied key information for business and staff.

In detail, these included:

1. Aurora iConnect: the internal intranet linking all caregivers to information.
2. Employee Connection: giving individuals access to information on compensation, benefits and emergency notification.
3. Learning Connection: monitoring mandatory and elective education and training programs.
4. My Aurora: allowing electronic communication between patients and caregivers.
5. Web Budgeting: monitoring budget trends and variances.
6. Web Management Reporting: supplying financial applications
7. Brass Ring: managing employment postings, applications and the applicant reviews.
8. CERN: accessing patient medical records, with approved applications, security clearance levels and defined processes.
9. IREQ: a program that manages supply and services expenses.
10. AFE: software managing capital item purchases.
11. Data Warehouse: software combining different data sources through a repository.
12. Biorepository: managing all biological products and related clinical information for clinical research and genetic knowledge enhancement.

F. Consistent Patient Care: Aurora Health Care:

1. Followed best practices in health care consistently throughout the region.
2. Integrated care practices for patients.
3. Supported standardized practices that clearly benefit patients.
4. Improved services without undue competition for patients and revenue.
5. Worked with patients to provide care when, where, and how wanted.

Weaknesses

A. Overcentralized: Aurora Health Care was sometimes:

1. Unable to respond quickly to local needs.

B. Varied Business Practices. Aurora Health Care sometimes found:

1. Mission statements were less understood in outlying areas.
2. Application of best practices could be fragmented.

C. System Interface: Geographical spread Aurora Health Care sometimes caused:

1. Misalignment between divisional functions.
2. Poor integration of patient needs when these involved physicians, nurses, behavioral health therapists, pharmacists, social workers and other experts.
3. Data entry errors in codification, knowledge oversight, selective encoding, and knowledge purging.

Opportunities

A. Innovation: Aurora's strategic positioning as a systematic innovator provides increased opportunities to

1. Encourage staff to develop new and better practices.
2. Recognize opportunities as they arise.
3. Establish innovation tools for idea generation based on a deep understanding of established strategy and goals.
4. Implement innovations in a seamless manner.
5. Anticipate patient needs.
6. Review best practices continuously.

B. Knowledge Access: Opportunities existed to improve:

1. Review of patient, financial and employee data.
2. Leadership's role in active data review.
3. Data collection, analysis, review, communication, and action.

C. Customer Service: Opportunities existed to further improve:

1. Individualized and personalized care developed from the patient's point of view and designed around what patients need to heal.

D. Knowledge Reward System: Opportunities for improvements exist:

1. For front line staff, who felt excluded from the knowledge management reward measures.

Threats

A. Competition from other care-providers was intense, and threatened:

1. Decreased market share.

B. Knowledge Loss caused by failure to:

1. Rapidly adopt the 'One Aurora' solution.
2. Get new employees to use the provided information, tools, and resources.

Solutions: Knowledge Management Culture

The recommendations based on this assessment were:

Medical care is knowledge-intensive, and any management system must ensure that knowledge is shared between individuals, teams members, organizations, and outside bodies. By knowledge is meant not only clinical studies but data on staff performance and rewards, quality of treatment, outcome reviews and financial implications.

Evaluation, reward and further training were to be founded on accountability, teamwork and respect. Specifically that:

Staff:

1. Should be accountable to each other, patients, and communities.
3. Work with each other, patients and families.
4. Welcome diversity of ideas and opinions.
5. Respect their patients' wishes.

Leaders:

1. Instill confidence, creativity and passion in others.
2. Keep promises and treat all fairly.
3. Accentuate abilities and not other's weaknesses.
4. Provide opportunities for growth, special projects, etc.
5. State expectations clearly.
6. Define objectives and time frames.
7. Explain necessities when outlining responsibilities.
8. Encourage staff to go beyond their expected potential.
9. Provide guidance in times of uncertainty.
10. Give consistent, fair and timely feedback.
11. Listen to all sides and decide impartially.
12. Separate poor behavior needing correction from the staff member responsible
13. Take a genuine interest in staff.

These were to be assessed by a battery of methods, including:

1. Six Sigma: Six Sigma is a disciplined and rigorous analytical approach to quality improvement.
2. Flawless Implementation: a model that draws on shared lessons and best practices.
3. Tools for Innovation: a model with four phases: plan, brief, implement and debrief.
4. Trends and Convergences: a tool that helps staff recognize and take advantage of trend convergences.
5. Idea Generation: a tool that clusters related ideas, allowing larger opportunities to emerge.
6. Idea Elaboration: a tool that more clearly assesses the scope, risks and benefits of an idea before implementation.
7. Statistical Process Control and other time-sequence modeling and business evaluation tools.
8. Lean: a tool to eliminate waste and ensure all activities create value to the customer.

Implementation

Aurora Health Care's 2007 Strategic Plan focused on four areas of improvement.

Advance Care Management

Aurora adopted:

1. Premier clinical performance measures, a database of the top performing hospitals in the country.
2. Tracking by a 'Care Management Impact Score' system.
3. A single accurate medication list to all Aurora care providers, improving patient safety and simplifying care.

Adoption of 'One Aurora' Outlook

Specifically:

1. More integrated service: reducing differing prioritization by doctors and confusion for patients.
2. Streamline patient care through integrated registration, billing and length of stay for patients.
3. Provide more clinical innovation or advanced techniques.

Further development of the 'Patient Point of View'

To be achieved by:

1. Adopting 'Planetree' (a philosophy of patient-centered care in a healing environment).
2. Providing care to a defined patient group in ways that more meet their needs.
3. Integrating retail into care delivery locations.
4. Increasing the system-wide 'Employee Engagement Index' by 5%.

Continued strengthening of Aurora's Financial Performance

Specifically:

1. Increasing the operating margin by 0.1% in 2009.

Success Indicators

Three success indicators were singled out as most important:

1. Patient loyalty: not only retention of Aurora as the primary health care deliverer, but also referrals, increased use of other Aurora services, and donations.
2. Patient outcomes: monitored in some 27 care management initiatives, safety schemes and the quality improvement efforts.
3. Aurora Health Care profitability.

Points to Note

1. Importance of business intelligence systems.
2. Focus on the customer.

Questions

1. What was Aurora Health Care set up to do, and what challenges was it facing by the twenty-first century?
2. Use a SWOT analysis to explain the workings of Aurora Health Care.
3. What areas did Aurora Health Care's 2007 Strategic Plan focus on?
4. What elements of Osterwalder and Pigneur's business model seem relevant, and why?

Sources and Further Reading

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