Creating a Culture of Performance

Excellence at Henry Ford SUSAN S. HAWKINS,

ROSE GLENN,
KATHY OSWALD,
Health System AND WILLIAM A. CONWAY

Henry Ford Health System (HFHS) of Detroit, System’s patients, its health plan members, and its
Michigan, has earned industry-wide recognition by communities.
engaging its leaders to align the organization’s
strategic objectives with Malcolm Baldrige National With more than $4 billion in revenues, HFHS is one
Quality Award criteria and craft a comprehensive of the largest health care systems in the United States
program to integrate performance to drive sustain- and a respected leader in clinical care, research, and
able growth. One of the largest health care systems education. HFHS has more than 23,000 employees
in the United States, HFHS developed a performance serving 4.5 million people in southeast Michigan
management approach that backed up standards at more than 140 care delivery sites, with a total
of excellence with comprehensive training and de- of 102,000 admissions, 418,000 emergency depart-
velopment, established a performance improvement ment visits, 3.2 million office visits, and 88,000 surg-
framework that emphasized analysis and review, in- eries annually. The System’s core components are:
tegrated its communications systems with a renewed
focus on innovation, and fine-tuned its performance r the Henry Ford Medical Group, with 1,200
strategy to stoke agility throughout the organi- physicians and scientists;
zation. Results included a reduction in in-patient r 2,200 private practice physicians;
mortality, innovations in health care best practice, r four acute care medical-surgical hospitals, includ-
enhanced employee engagement patient satisfaction, ing the 802-bed Henry Ford Hospital in Detroit,
savings of almost $10 million over four years in rela- which is a tertiary care, level 1 trauma center, as
tion to harm-reduction efforts, and five national per- well as an education and research complex;
formance awards, including the Malcolm Baldrige r Community Care Services, which includes a di-
National Quality Award in 2011. © 2013 Wiley versified portfolio of post-acute and retail ser-
Periodicals, Inc. vices;
r Behavioral Health Services with two behavioral
Lowered reimbursements and increasing uncompen- hospitals; and
sated care across the 1990s led to decreased in- r the Health Alliance Plan (HAP), a health insurer.
vestments in infrastructure and clinical programs at
many hospitals and health systems in the United In 2000, with organization-wide input, HFHS
States. The rising crisis in health care and a call leadership recrafted the System’s mission, vision,
for improved quality and patient safety became a and values. They recommitted themselves to their
national discussion. At Henry Ford Health Sys- base in Detroit and their academic mission, and
tem (HFHS) in Detroit, part of the discussion in- they determined to relentlessly pursue organiza-
volved how to integrate performance to drive smart tional integration to deliver the best care to HFHS
growth while focusing on what matters most: the patients and drive sustainable growth. Leaders and

c 2013 Wiley Periodicals, Inc.

Published online in Wiley Online Library (wileyonlinelibrary.com)
6 Global Business and Organizational Excellence • DOI: 10.1002/joe.21469 • January/February 2013
subsequently all employees participated in “Re- division heads of the Henry Ford Medical Group
newal,” a cultural training workshop focused on the and hospital chief medical officers.
values and behaviors of a healthy, high-performing
organization. Four years later, the new chief exec- From the 1990s, HFHS’s strategic planning pro-
utive officer (CEO) for HFHS set the path toward cess was a business unit–based model that rolled up
improving performance throughout the System, se- to the System level. In 2005, the planning process
lecting to embark on the Baldrige Performance was changed to a top-down model, focusing on the
Excellence Program (Baldrige PEP) and adopt its Baldrige criteria and the System’s mission, vision,
Criteria for Performance Excellence. The Baldrige and values. Senior leaders defined the System’s core
PEP provided a self-assessment roadmap with con- competencies (a Baldrige criteria requirement) and
sultant feedback and challenged HFHS leaders to developed a new strategic framework.
compare their results against the top-performing or-
ganizations in the United States.
The early steps of organizational self-assessment
The System’s eight years of experience in using the using the Baldrige criteria led to a new focus on en-
Baldrige criteria have included a series of steps in
gaging senior leadership across the many business
cultural transformation and continual improvement
units of HFHS.
in organizational integration and performance, from
the board of trustees and senior leaders to front-
line employees. Several key changes, challenges, and
turning points that occurred from 2004 to 2011 Turning Point: A Seven-Pillar Strategic Framework
highlight the organization’s continuing quest for The new strategic framework identified seven per-
performance excellence. formance areas (“pillars”): people, service, quality
and safety, growth, research and education, commu-
nity, and finance (see Exhibit 1 on page 8). Compris-
ing the Henry Ford Experience—which is defined
Key Change: Engaging Leadership as a consistent, remarkable experience for all HFHS
The early steps of organizational self-assessment us- customers—these seven pillars are the foundation of
ing the Baldrige criteria led to a new focus on en- the HFHS strategic planning process. The organiza-
gaging senior leadership across the many business tion’s strategic objectives, which are aligned across
units of HFHS. Realigned in 2004 to drive commu- all business units, flow from them.
nication and integration of strategic development,
the System’s board of trustees began to communi- System-level teams were developed for the areas rep-
cate regularly with affiliate and advisory boards at resented by the pillars, with each pillar team led by
the business-unit level through quarterly meetings a member of the Cabinet and composed of senior
of all board chairs. The HFHS CEO communicated and other leaders across business units to increase
regularly with senior leaders via four committees: a System integration. Pillar teams became responsi-
5-member Executive Cabinet; 15-member Cabinet; ble for establishing strategic objectives and initia-
a 25-member Strategy and Execution Team (SET) tives within their respective performance dimension,
composed of all Cabinet members and key System aligning action plans to meet performance targets,
and business-unit leaders, including physicians; and and tracking performance against goals. For exam-
a 110-member Leadership Execution and Planning ple, the People Pillar team became responsible for
(LEAP) team composed of all SET members and strategies throughout the System that were aimed at
their direct reports, including physician chairs and reducing employee turnover. The Service Pillar team

Global Business and Organizational Excellence DOI: 10.1002/joe January/February 2013 7

 Exhibit 1. “The Henry Ford Experience”: 7 Pillars of Performance

was responsible for improving patient satisfaction at to achieve this objective became HFHS’s “No Harm
each business unit. Campaign,” with an aggressive goal set at a 50 per-
cent reduction in harm events by 2013. Results were
The seven-pillar framework became the basis for measured at the System level and compared to tar-
strategic planning, measurement and review, prior- gets in 27 categories of harm. Each business unit
itization and resource allocation, and improvement also had targets in each category of harm where im-
and innovation across HFHS. The pillar framework provement was required. A department would focus
served to align System strategic objectives, strategic on something that was important to it. For example,
initiatives, and related performance measures and the housekeeping department might focus on imple-
targets for the System and within business units, menting proper cleaning protocols to decrease infec-
from the top of the organization to the individual tions. An individual employee in the housekeeping
employee. This provided a synchronization and con- department might have a goal focused on the re-
sistency of plans and processes against which key sponse time to clean a room with an identified spill,
decisions were made. A three-year, rolling strate- or the frequency and method for cleaning isolation
gic plan was developed for the System, guided by rooms. As a result, by 2011, HFHS was more than
the seven pillars as the basis for goal categories and halfway to its 50 percent harm-reduction goal and
alignment. earned national recognition for its accomplishment.
The National Quality Forum and The Joint Com-
For instance, the Quality and Safety strategic objec- mission recognized the No Harm Campaign with
tive aimed for HFHS to become a national leader in the 2011 John M. Eisenberg Award for Innovation
delivering safe, reliable care. The strategic initiative in Patient Safety and Quality at the Local Level.

8 January/February 2013 DOI: 10.1002/joe Global Business and Organizational Excellence

Exhibit 2. HFHS Model for Improvement (MFI) r The use of a variety of improvement tools, cho-
sen according to the aim of each project. These
include Lean (adapted from the Toyota Pro-
duction Method), Six Sigma, and Kaizen ap-
proaches; Failure Modes and Effects Analysis
(FMEA); root cause analysis; International Or-
ganization for Standardization (ISO) and other
accreditation processes; pilots and rapid tests of
change; statistical process control; and project
management.
r The use of the Influencer Model for change man-
agement that emphasizes understanding personal,
social, and structural motivations to change.

Deployed throughout HFHS, the MFI is also used in

the organization’s leadership system (see Exhibit 3
Key Change: Establishing a Performance on page 10) and strategic planning process; in de-
Improvement System signing and redesigning new work systems, such as
To drive performance across and within pillars, in building a new hospital, which opened in 2009;
HFHS leaders developed a model for improvement in dozens of Kaizen and rapid redesign events held
(MFI) and emphasized accountability for results annually; and in daily improvement work. Manage-
through dashboard reports and organization per- ment encourages and invests in opportunities for
formance reviews. the workforce to develop and test new ideas and
approaches. For example:
Working With a New Model for Improvement
Whether at the System, pillar, business unit, depart- r Hospital “innovation units.” Here teams develop
ment, or work-unit team level, teams are trained and pilot new approaches, often supported by
to use the MFI (see Exhibit 2). The MFI is a flex- specially trained internal experts, or participate
ible plan-do-check-act (PDCA)–based methodology in care design teams that include patients. In one
with a companion toolkit of methods and tools ap- instance, nurses developed an evidence-based,
propriate for a wide range of change initiatives, nurse rounding protocol designed to prevent
from informal work-unit improvement projects to harm events, such as falls and pressure ulcers.
innovative breakthrough design and redesign. This Nurses used a standardized checklist for each pa-
model has been systematically improved over many tient during hourly rounds. Based on pilot results,
years to incorporate new methodologies and best the protocol was spread to all System hospitals.
practices. The MFI currently incorporates four key Patient falls were reduced by 23 percent through-
areas of focus to help ensure successful improvement out the System between 2008 and 2011. Inno-
results: vation teams include many national and state
partnerships and collaboratives. Employees de-
r Employee engagement in improvement, redesign, velop and test new ideas and benchmark with
and innovation through multidisciplinary teams. high performers, such as the Institute for Health-
r An acute focus on exceeding patients’ and cus- care Improvement’s 100,000 Lives and 5 Mil-
tomers’ needs and wants and encouraging their lion Lives campaigns and the Michigan Health
engagement. and Hospital Association’s (MHA’s) Keystone

Global Business and Organizational Excellence DOI: 10.1002/joe January/February 2013 9

 Exhibit 3. HFHS Leadership System

Center for Patient Safety & Quality. For example, control charts, and trend lines. Graphical displays
HFHS hospitals participate in the MHA Keystone with control limits or data trending on run charts
Center’s Obstetrics Collaborative, which aims to help identify when variation is “common cause”
reduce harm to mothers and infants by tracking (requiring no action) or “special cause” (requiring
compliance with two evidence-based care bun- action be defined and taken). The defined owners
dles known to improve perinatal outcomes. The of work processes use customized dashboards with
care bundles include no elective deliveries (that is, data on customer, supplier/partner, and operational
labor induction or scheduled Caesarean section) requirements. Managers review System dashboard
before 39 weeks of gestation and a standardized measures monthly to assess performance against
order set for the administration of oxytocin (that strategic objectives and action plans. “Stoplight”
is, labor induction or augmentation). Results of color schemes on these dashboards identify metrics
this initiative raised compliance levels with these at or better than the target (green), within 5 percent
two bundles to almost 100 percent at HFHS hos- of target (yellow), or more than 5 percent behind tar-
pitals. get (red), allowing focus on strategic initiatives that
are behind target. A sample dashboard is shown in
Stepping Up Performance Analysis and Review Exhibit 4. System dashboards are available monthly
Teams use a variety of analytic techniques, such to the workforce on the HFHS intranet and through
as fishbone diagrams, Pareto charts, run charts, postings in work areas.

10 January/February 2013 DOI: 10.1002/joe Global Business and Organizational Excellence

Exhibit 4. System Dashboard

Dashboards are widely deployed across business access dashboards at Henry Ford Medical Center
units and pillar teams, and managers use the data sites across southeast Michigan, a Contact Cen-
they contain to make day-to-day operational deci- ter was created to improve access. This centralized
sions related to work processes. For example, all the appointment process for primary care and most
hospital leaders and managers review dashboards specialty services, streamlining appointment-setting
with quality and safety indicators as well as census, processes and standardizing appointment types. The
volumes, revenue, bed availability, and productiv- Contact Center both improved the service (for ex-
ity data; ambulatory medical centers’ leaders review ample, call response times) and made it easier for
dashboards of patient access/appointment availabil- patients to make an appointment.
ity, phone access, and timely response and clo-
sure of patient telephone messages. Process own- Organization performance review (OPR) occurs in
ers often supplement such data with real-time input all HFHS entities. The OPR process provides a fo-
from internal customers, patients and families, and rum for transparency, mutual accountability, and
supplier/partner input from performance reviews. access to assistance with initiatives as needed. The
For example, as a result of reviewing appointment OPR process involves:

Global Business and Organizational Excellence DOI: 10.1002/joe January/February 2013 11

 r review of current results, including financial status.” A new team was launched, led by the
health, relative to target; System’s chief financial officer, to understand and
r review of action plans and action plan monitors; standardize reporting and process around the use of
r celebration of progress; observation beds, as well as to lead an effort to stan-
r review of root causes of stagnated or declining dardize reporting across all health organizations in
results; southeast Michigan.
r discussion of action plan adjustments and assis-
tance needed from other areas; and
r documentation to spread innovations and oppor- Key Change: Developing a Performance
tunities for improvement. Management System
The performance management strategy at HFHS
As-needed communication of OPR findings to im- aims to create workforce engagement that fosters re-
provement teams, workforce members, partners, tention, safety, productivity, and profitability. The
and collaborators ensures ongoing dialogue about Performance Management Program (PMP) of an-
lessons learned and opportunities to change direc- nual appraisals and individual goal-setting for the
tion or spread successes. In addition, comparisons coming year, midyear reviews, corrective actions,
to targets, prior period trends, competitors, other and career development provides opportunities to
external benchmarks, and like organizations (inside support high-performance work and workforce
and outside HFHS) help ensure that conclusions and engagement. Developing this performance manage-
any changes are based on valid assessments. Fre- ment system meant identifying standards of excel-
quency of reviews at all levels, identification of cor- lence for employee behaviors, integrating the PMP
rective actions, and communication and follow-up process throughout the System, and offering learn-
allow the organization to respond rapidly to chang- ing opportunities and coursework to provide em-
ing needs and challenges at all levels and facilities. ployees with the tools to excel.

Setting Workforce Standards of Excellence

The performance management strategy at HFHS When HFHS leaders developed the performance pil-
aims to create workforce engagement that fosters lars in 2006, they also created a Leadership Compe-
retention, safety, productivity, and profitability. tency Model (see Exhibit 5) that included standards
of excellence aligned to the Baldrige criteria. These
standards require all leaders to model specific
For example, a few years ago OPRs showed that ser- behaviors:
vice scores had not improved at the System level or
business-unit level. This launched a new approach r Listen and communicate effectively.
to service that focuses on customer engagement. A r Coach and mentor others.
new System-level team and leader expectations were r Motivate and inspire others.
created. All employees were required to complete r Have the courage to innovate.
customer engagement training. In late 2012, execu- r Be accessible to others.
tive leaders began rounding at hospitals to talk with r Reward and recognize the accomplishments of
patients and employees about customer engagement others.
and service improvement. In another example, re- r Be accountable for achieving desired results.
view of both admission and financial data at various
business units highlighted a potential inconsistency Management communicated the standards at the
in the use of and coding for “observation bed first annual All Leadership Meeting in 2007 and

12 January/February 2013 DOI: 10.1002/joe Global Business and Organizational Excellence

Exhibit 5. Leadership Competencies and Standards: Aligned to Baldrige Criteria

systematically rolled them out by providing leaders Q12© survey database has doubled since 2008, and
with a toolkit and key messages for modeling the the number of leaders with scores in the bottom
standards of excellence. Senior leaders role model quartile decreased by almost half. The System’s Ser-
the standards through open-door policies, leader vice Excellence Steering Committee subsequently de-
rounds, and thank-you notes, among other be- veloped Team Member Standards of Excellence for
haviors. Self-assessments, 360-degree assessments, all employees and embedded them in performance
Myers-Briggs and Gallup Strengthfinders person- management goals. All employees are expected to
ality assessments, and supervisor evaluations dur- meet the following eight standards:
ing the Performance Management Program support
evaluation against the competency model. Leaders r Display a positive attitude.
use results in collaboration with their supervisors to r Take ownership and be accountable.
create personal development plans to address gaps r Respond in a timely manner.
in leadership competencies and behaviors. Actions r Commit to team members.
may include course work and development opportu- r Be courteous and practice established etiquette.
nities available through the Henry Ford Health Sys- r Respect patient privacy.
tem University’s leadership development curriculum r Foster and support innovation.
and/or external opportunities that align with and r Honor and respect diversity.
support expected leadership competencies.
For continuous improvement and clarity, these ser-
As a result of this initiative, the number of leaders vice standards were updated in 2011 and cas-
who have scores in the top quartile of the Gallup caded to all employees. Although the content of the

Global Business and Organizational Excellence DOI: 10.1002/joe January/February 2013 13

 standards remained the same, the words used to ex- including online documentation, for each leader’s
press them were more concise, and the phrasing was direct reports. This web-based system sends auto-
changed to “I am . . .” statements in order to make mated reminders of in-process evaluations and ap-
the service standards more meaningful to employees. proaching PMP deadlines to employees and leaders,
and has led to significant improvement in on-time
Deploying the Performance Management Program performance reviews throughout the system.
The PMP process outlines and reviews individual
employee results and behaviors to support both
high-performance work and workforce engagement. Focusing on Workforce Learning and Development
Individual results are categorized around the seven Established in 2004, the Henry Ford Health Sys-
pillars and account for 60 percent of an employee’s tem University (HFHSU) provides a high-quality and
annual review; adherence to behavior standards ac- convenient education and training platform across
counts for the other 40 percent. The behaviors eval- HFHS. The HFHSU includes classroom and on-
uated for leaders directly correlate to the Leadership line coursework, its web-based learning manage-
Competency Model; for all other employees, to the ment system provides online course registration, and
Team Members Standards of Excellence. The PMP each employee has access to a personal learning
includes three main steps: site that tracks assigned courses, course completion,
transcripts, and certificates.
r Employees meet with managers before January
1 to identify individual goals and performance
plans, aligned with System, pillar, and business- The PMP process outlines and reviews individual
unit goals. employee results and behaviors to support both
r By July 31, a midyear review is completed to
high-performance work and workforce engagement.
review progress to date, refine performance ob-
Individual results are categorized around the seven
jectives and action plans, and focus on career
pillars and account for 60 percent of an employee’s
development.
r An annual performance review of goal attainment annual review; adherence to behavior standards ac-
is completed and documented by year-end. The counts for the other 40 percent.
annual review is used as input for merit increases
and annual incentive plan awards, with the lat-
ter aligned to and dependent on achievement of Leadership training sessions include the New Leader
HFHS financial and other goals. Academy for newly promoted leaders, the Lead-
ership Academy for selected high-potential man-
It became clear that a systematic approach was agers, the Advanced Leader Academy for potential
needed to deploy the PMP throughout the organi- successors of senior leaders, and the Physician
zation in a way that assured PMP timelines were Leadership Academy for future physician chairs
being met for all employees. Management selected and division heads. “Leadership development” is
an online, best-practice software tool for identify- a specific curriculum within the HFHSU and in-
ing and evaluating performance goals and imple- cludes detailed courses in strategic planning; cre-
mented the system in 2008 for nearly 1,400 leaders ating specific, measureable, attainable, realistic, and
throughout the System and then to all employees. timely (SMART) goals; strengths, weaknesses, op-
In 2009, the HFHS CEO cascaded a new goal portunities, and threats (SWOT) analysis; action
to all leaders worth 10 percent of leaders’ perfor- plan deployment; and motivating teams toward ac-
mance scores: on-time completion of all PMP steps, complishing strategic goals. In addition to specific

14 January/February 2013 DOI: 10.1002/joe Global Business and Organizational Excellence

training, Leadership Execution and Planning meet- mean score placed HFHS in the 81st percentile of
ings and retreats serve to build skills in planning, Gallup’s health care company-level database, a sig-
performance review, and other areas of business lit- nificant increase from the 53rd percentile in 2010
eracy and leadership development. and from the 25th percentile in 2008.

Through internal and external courses, confer-

ences, and seminars, HFHS employees access numer- Key Change: Integrating Communications Systems
ous job-specific learning opportunities addressing The role of HFHS’s communications experts in-
process improvement, technology changes, and in- cludes developing and deploying messages through-
novation. In 2007, management launched a state- out the System. The structure of the communications
of-the-art Simulation Center, which allows clinical system at HFHS in the middle of the first decade
team members to practice critical skills and tech- of the 2000s was not ideal for integrated messag-
niques, such as surgical procedures and team ing. Each hospital had its own public relations and
communication approaches, in an interactive and marketing teams with no formal relationship to the
feedback-rich simulation environment. For those corporate team, which often resulted in competi-
who need training on the model for improvement, tive media and marketing efforts. In 2007, HFHS
a fundamental overview of the PDCA improvement plans to acquire an existing hospital and build a new
cycle and other elements of the MFI are incorpo- one prompted reorganization of the organization’s
rated into leadership training sessions. Numerous communications structure. The new, integrated or-
other employees are provided “just in time” train- ganizational structure, a matrix approach, improved
ing and coaching on MFI tools and concepts as they alignment in professional media services and created
work on projects and daily process improvements. a common system approach to communications and
Training and coaching is provided by System lead- messaging.
ers, as well as by process improvement engineers and
clinical quality improvement specialists at the cor-
porate offices and embedded in business units and Through internal and external courses, conferences,
product lines. and seminars, HFHS employees access numer-
ous job-specific learning opportunities address-
Shifting From Employee Satisfaction to Workforce ing process improvement, technology changes, and
Engagement innovation.
In 2008, in partnership with the Gallup Organiza-
tion, HFHS embarked on shifting from a culture
focused strictly on employee satisfaction to one of To communicate with and engage the entire work-
full workforce engagement. The Gallup Q12© sur- force, the HFHS CEO meets monthly with the
vey, deployed every two years since 2008, provides System Communications team to evaluate, design,
an assessment of both engagement and satisfaction and improve communication and engagement ap-
by workforce area. HFHS leaders receive results seg- proaches. To ensure systematic deployment, the
mented by business unit, work unit/department, and team utilizes a communicators’ roundtable, com-
key workforce segment. HFHS’s overall grand mean posed of each business unit’s chief communication
score increased to 4.12 in 2012, an increase of 0.15 officer, to plan and execute key communications.
from 2010. An increase of 0.1 is statistically signif- Essential messages are integrated into face-to-face,
icant and often associated with an increase in prof- print, and e-communications, including social me-
itability, decreased turnover rates, higher patient en- dia. These mechanisms reinforce the mission, vi-
gagement, and better/safer patient care. This grand sion, and values; pillar goals, strategies, and metrics;

Global Business and Organizational Excellence DOI: 10.1002/joe January/February 2013 15

 team standards of excellence; and achievements and The effectiveness of the integrated communications
recognition. process passed a major test in 2010 with the de-
velopment of a new vision statement for HFHS that
Senior leaders embed communication tactics into the involved all HFHS employees. Employee suggestions
action plans of every strategic initiative, and per- were synthesized to make draft vision statements on
formance improvement tools are used to increase which employees were then asked to vote; two-thirds
effectiveness of communications. For example, mes- of voting employees supported the vision statement
saging for deployment of the employee Health adopted. The new vision statement was then de-
Engagement program was developed and tested ployed, and a subsequent survey of employees found
through the MFI and then rolled out to employees. that 87 percent of respondents were aware of the
new vision.
To measure and improve the effectiveness of com-
munications, senior leaders conduct a comprehen-
sive evaluation every three years using surveys, Senior leaders embed communication tactics into
interviews, and focus groups, with annual pulse sur- the action plans of every strategic initiative, and
veys repeated in the off years. For example, follow-
performance improvement tools are used to increase
ing a 2008 survey that reflected the need to improve
the effectiveness of sharing System messages, se- effectiveness of communications.
nior leaders developed a weekly “Take Five” toolkit
(including System news, quality and safety mes-
sages, service messages, business-unit messages, and The vision that had been created ten years earlier
a space for local stories or recognitions). Leaders was “To put patients first by providing each pa-
throughout the System share this and other appro- tient the quality of care and comfort we want for
priate information with their teams during weekly, our families and ourselves.” Now it reads “Trans-
face-to-face, five-minute meetings called “huddles.” forming lives and communities through health and
In addition, because employees identified e-mail as wellness—one person at a time.” This change repre-
the preferred way to receive organizational news, sents the following:
the System Communications team developed a daily
news service called HFHS Morning Post, which is r “transforming lives and communities”: to contin-
e-mailed to all employees. A communications pulse ually improve the delivery of health care to ensure
survey repeated in April 2009 showed significant im- it is patient-centered, integrated, equitable, high-
provement in satisfaction with communication from quality, safe, and efficient.
senior leaders. r “health”: to improve health through innovative
clinical excellence, medical education, and re-
Behavioral standards and the HFHS mission, vision, search/discovery.
and values are deployed to the workforce through r “wellness”: to be a leader in optimizing health
various approaches, including new-hire orientation, and well-being for all the people served, provid-
with messages that are amplified by manager tool ing the same quality experience and leveraging
kits, training, daily or weekly huddles, and key mes- the System’s unique strengths—through culture,
sages. Other approaches to messaging deployment practice, programs, training, environment, and
include pocket cards, badge attachments, work area policy.
posters, and senior leaders’ open-door policies and r “one person at a time”: to have a renewed fo-
rounding. cus on creating The Henry Ford Experience for

16 January/February 2013 DOI: 10.1002/joe Global Business and Organizational Excellence

 every patient, customer, employee, volunteer, and ing a “Main Street” featuring weekly farmers’ mar-
physician, and to strive for excellence in each en- kets and a line of retail shops, a Culinary Wellness
counter. Program, and a beautiful atrium with a tea kiosk and
meditation area. Before building the patient rooms
Turning Point: Renewed Focus on Innovation at the hospital, more than 2,000 people (medical
Given the key changes that were made in lead- staff, patients, families, and community members)
ership engagement and the developments in the toured the prototypes of patient rooms to test room
performance improvement system and performance configurations, fixtures, furniture, and equipment;
management system, HFHS leaders began to ap- more than 70 design changes were made based on
ply to the local and national levels for the Baldrige their extensive feedback. The new hospital has one
award. At first try, in 2007, HFHS was awarded of the highest patient satisfaction rates in the System.
the Michigan Quality Council Leadership Award.
This important win gave staff members energy, op- To support innovation across HFHS and in Detroit,
timism, and possibly too much confidence. Yet, the Henry Ford Innovation Institute was established
that confidence spurred them to renew their focus in October 2011. The Innovation Institute pioneered
on innovation and entrepreneurism throughout the a unique model of multidisciplinary collaboration
System. to develop medical products, devices, and therapies
that improve patient outcomes, as well as the cost-
Multiple approaches were used to foster innova- effectiveness of health care. The founding partners
tion, including culture, workforce strategy, setting of the Institute include Detroit’s leaders in medicine
high goals that required breakthrough change, and and science, technology, product design, and educa-
creating incubators for innovation, such as the insti- tion: the Henry Ford Medical Group, Wayne State
tution’s Simulation Center. The model for improve- University’s College of Engineering and the Smart
ment was applied to promising new ideas to develop, Sensors and Integrated Microsystems Program, the
refine, deploy, and spread innovations. College for Creative Studies, and The Henry Ford
Museum.
Two examples of best-in-class innovations that were
made during this time are the HFHS No Harm Cam-
paign, launched in 2008, and the Henry Ford West Multiple approaches were used to foster innovation,
Bloomfield Hospital, opened in 2009. including culture, workforce strategy, setting high
goals that required breakthrough change, and cre-
The No Harm Campaign focuses on reducing both ating incubators for innovation, such as the institu-
preventable and unpreventable harm to patients,
tion’s Simulation Center.
with an aggressive goal to reduce harm by 50 percent
throughout the System from 2008 to 2013. In the
first three years of the campaign, the harm rate for
HFHS dropped by 24 percent across seven categories
of harm, compared to a maximum of 2 percent per Key Change: Fine-Tuning Performance Strategy
year according to benchmarking from the Institute for Improvement at All Levels
for Healthcare Improvement and elsewhere. In 2009, multiyear feedback from the Baldrige ap-
plication process showed that we had incomplete
The new Henry Ford West Bloomfield Hospital was strategic planning steps, deployment, and align-
built with active involvement of the community, re- ment. Many performance targets and results re-
sulting in an innovative building design incorporat- mained the responsibility of a few versus everyone.

Global Business and Organizational Excellence DOI: 10.1002/joe January/February 2013 17

 Senior leaders evaluated all current leadership teams r be reportable at necessary frequency;
by membership, roles and responsibilities, meeting r have sound comparative benchmarks or histori-
frequency, and perceived effectiveness. They deter- cal trends;
mined that the 25-member SET was too large to keep r be aligned with key initiatives or work processes
discussion focused and decision making timely. so progress on the System strategic initiative can
be readily accessed and communicated;
r have defined owners;
The Performance Council sets aggressive strategic r have a defined audience for reports and reviews;
objectives and strategic initiatives for all pillars, and
r have clear accountability.
and senior leaders deploy strategy by implementing
action plans and making data-driven decisions.
Using the model for improvement, the Performance
Council revised the annual cycle for the strategic
planning process to better integrate with the capital
Turning Point: Performance Council and New Strategy and operational planning processes, include a review
Process of the HFHS business model, and confirm the key
A Performance Council was created, composed of inputs and outputs of each step. The strategic plan-
business-unit CEOs, pillar team leaders, and leaders ning process became a seven-step cycle that spans
of key corporate areas. The revised structure simul- an entire year of scheduled, facilitated meetings (see
taneously streamlined and better integrated strate- Exhibit 6). The Performance Council sets aggressive
gic direction. The Performance Council was charged strategic objectives and strategic initiatives for all
with overseeing the strategic planning process and pillars, and senior leaders deploy strategy by imple-
organizational performance reviews, with the aim to menting action plans and making data-driven deci-
provide a clear direction and rapid decision-making sions.
process to those seeking approval of or input to
projects, policies, and initiatives.
Results Fuel the Drive to Performance Excellence
A new Metrics Committee also was established, Since 2006, Henry Ford Health System has been
composed of operational, financial, and pillar lead- recognized by peers in five different national pro-
ers, to provide oversight and expertise to pillar teams grams that have carefully reviewed its performance.
and the Performance Council on the best way to de- No other hospital or health system in the nation has
fine, display, compare, and analyze organizational received all five awards:
performance measures. The Metrics Committee’s
structure covers data stewardship, analytics deliv- r Malcolm Baldrige National Quality Award,
ery, and—new for HFHS—knowledge management. 2011.
The Metrics Committee uses nine criteria to guide r National Quality Forum/The Joint Commission
selection of measures. All measures must: John M. Eisenberg Patient Safety and Quality
Award, Local Level, 2011.
r align with internal/external customer require- r American Hospital Association McKesson Quest
ments; for Quality Prize, 2010.
r be readily collectible (automated collection is r National Business Group on Health/Veterans
ideal), balancing utility with the ease of data col- Health Association Foundation National Health
lection; System Patient Safety Leadership Award, 2008.
r be easily understood and consistently defined; r The Joint Commission Codman Award, 2006.

18 January/February 2013 DOI: 10.1002/joe Global Business and Organizational Excellence

Exhibit 6. Key Changes to Strategic Planning

Despite a challenging economic environment and percentile level from 2007 to 2010. HAP has been
yearly increases in uncompensated care expenses, rated by J.D. Power and Associates as among the
HFHS is the market leader for the tri-county area “highest in member satisfaction among commer-
of southeast Michigan and continues to demon- cial health plans in Michigan” for four consecutive
strate increasing marketplace performance levels years, and in 2011 it was rated the “highest in the
and trends. Market share growth in 2010–2011 oc- state.” HFHS ambulatory and community hospitals’
curred in increases in births (6.5 percent), urgent satisfaction levels meet or exceed the 90th percentile
care visits (10 percent), emergency department vis- level in Press Ganey patient surveys. For employee
its (3.8 percent), Community Care Service volumes engagement scores, the Gallup Q12© survey showed
(20 percent over two years), and inpatient market that Henry Ford Hospital rose from the 18th per-
share (3.9 percent). The Pharmacy Advantage unit centile in 2008 to the 43rd percentile in 2010 to
has a compound annual growth rate of 25 percent the 76th percentile in 2012. The Henry Ford Medi-
for the last four years and is contributing the major- cal Group rose from the 18th percentile in 2008 to
ity of net income in the highly profitable Community the 35th percentile in 2010 to the 85th percentile
Care Services business unit. nationally in 2012.

Some components of HFHS’s integrated system Clinically, HFHS efforts have resulted in national
demonstrate best-in-class customer-focused out- best practice safety innovations. Insulin protocols
comes. HFHS’s engagement and satisfaction results for glycemic control, first piloted in 2003, were
for its Health Alliance Plan have met or exceeded spread throughout the System by 2006 (Horst et al.,
the National Committee for Quality Assurance 90th 2010), with refinement efforts continuing and new

Global Business and Organizational Excellence DOI: 10.1002/joe January/February 2013 19

 protocols being developed for special populations Baldrige framework to help HFHS become a bet-
such as obstetrics. The pharmacist-directed antico- ter organization—not just to win an award. They
agulation service, developed in 2007 to improve an- integrated the framework into their strategic plan-
ticoagulant medication selection, dosing, and mon- ning and business operations to ensure it would be-
itoring, and transition from inpatient to outpatient come part of everyday work. If they had not adopted
treatment, resulted in a 35 percent decrease in pa- the framework, the organization’s culture would not
tients with international normalized ratios (INRs) > have changed. The Baldrige criteria added a strict
5 (Schillig et al., 2011; To et al., 2011). (The blood’s discipline to how performance is planned, executed,
INR level indicates whether high risk exists for and evaluated.
blood clots—high INR level—or hemorrhage—low
INR level.) HFHS Pharmacy Services received the Performance excellence remains an ongoing effort.
2009 American Society of Health-System Pharma- The years 2004 to 2011 presented many challenges,
cists Safety Award. The Perfect Depression Care particularly in obtaining and measuring data and
Model (Coffey, 2007) helped save up to 180 lives finding or creating comparator sets of data for anal-
from suicide from 2002 to 2011 and was cited by ysis of outcomes and progress. The System’s leaders
the Health and Human Services National Suicide needed to understand that the organization and their
Action Alliance in 2011. The sepsis bundle research innovative efforts were not unique. Dashboard and
developed at Henry Ford Hospital by Rivers and organization performance review results have been
Ahrens (2008) and Rivers et al. (2001), officially be- critical in helping them identify how they are per-
came the national standard of care in 2001 and is forming at any given time in any pillar or on any
estimated to have saved 60,000 lives in the United project. This information, in turn, provides the im-
States in one year alone. An antibiotic lock protocol petus for timing and rapidity of required change.
for dialysis catheters serves to prevent 80 catheter Agility has improved—HFHS employees are better
infections annually (Moore et al., 2011); these ef- at shifting gears when results show trends moving
forts received the National Kidney Foundation of in the wrong direction.
Michigan Innovations Award in 2011. Deployment
of the National Surgical Quality Improvement Pro-
gram at HFHS hospitals has resulted in 1,000 fewer System leaders started the journey toward per-
procedural harm events each year (Velanovich et al.,
formance excellence with the intent of using the
2009).
Baldrige framework to help HFHS become a better
All these efforts and others are part of the HFHS No organization—not just to win an award.
Harm Campaign, which resulted in a 31 percent re-
duction in harm events and an 18 percent reduction
in in-patient mortality throughout the System from HFHS’s defining characteristic is its people. The cul-
2008 to 2011 (Conway, Hawkins, Jordan, & Vout- ture that has been created among the workforce has
Goss, 2012). A financial model created to assess cost resulted in a unique energy and a can-do spirit that
savings of reducing harm events has shown early re- is the foundation of Henry Ford Health System. Em-
sults totaling nearly $10 million in four years. ployees at all levels share a passion for engagement
in order to deliver better, safer patient care. Sys-
This performance demonstrates HFHS’s commit- tem leaders recently established new HR trending
ment to excellence and to the communities it serves. metrics to examine employee retention rates and
System leaders started the journey toward per- improve performance in this area. A new effort
formance excellence with the intent of using the that is under way, to better listen to patients and

20 January/February 2013 DOI: 10.1002/joe Global Business and Organizational Excellence

employees, involves all senior leaders rounding on Rivers, E. P., & Ahrens, T. (2008). Improving outcomes for
patients in HFHS hospitals, asking questions of pa- severe sepsis and septic shock: Tools for early identification
tients, families, and employees about how they can of at-risk patients and treatment protocol implementation.
Critical Care Clinics. 24(3 Suppl), S1–47.
better serve them.
Schillig, J., Kaatz, S., Hudson, M., Krol, G. D., Szandzik, E.
As applied at HFHS, the Baldrige criteria were G., & Kalus, J. S. (2011). Clinical and safety impact of an in-
patient pharmacist-directed anticoagulation service. Journal
instrumental in transforming the System’s culture
of Hospital Medicine, 6, 322–328.
to focus on performance excellence in every area.
Alignment and engagement of leaders and employ- To, L., Schillig, J. M., Desmet, B. D., Kuriakose, P., Szandzik,
ees helped to improve integration of processes within E. G., & Kalus, J. S. (2011). Impact of a pharmacist-directed
anticoagulation service on the quality and safety of heparin-
and across business units with an ongoing focus on
induced thrombocytopenia management. Annual Pharma-
measureable results. Disappointing results as well cotherapeutics, 45, 195–200.
as imperatives or market influences may alter the
Velanovich, V., Rubinfeld, I., Patton, J. H., Jr., Ritz, J., Jor-
course, but not the direction forward toward im-
dan, J., & Dulchavsky, S. (2009). Implementation of the Na-
provement. The quest for performance excellence at tional Surgical Quality Improvement Program: Critical steps
HFHS is not to attain perfection, but to continually to success for surgeons and hospitals. American Journal of
improve, to transform lives and communities—one Medical Quality, 24, 474–479.
patient, one person at a time.

Additional Resources
References Baldrige Performance Excellence Program, www.baldrigepe
Coffey, C. E. (2007). Building a system of perfection depres- .org
sion care. Joint Commission Journal of Quality and Patient Institute for Healthcare Improvement, www.ihi.org
Safety, 33, 193–199.
Michigan Health and Hospital Association’s Keystone Center
Conway, W. A., Hawkins, S., Jordan, J., & Vout-Goss, M. for Patient Safety & Quality, www.mhakeystonecenter.org
(2012). The Henry Ford Health System No Harm Campaign:
HFHS No Harm Campaign, www.hfhs.com/noharm
A comprehensive model to reduce harm and save lives. Joint
Commission Journal of Quality and Patient Safety, 38, 319–
327.
Susan S. Hawkins, senior vice president of performance ex-
Horst, H. M., Rubinfeld, I., Mlynarek, M., Brandt, M. M.,
cellence for Henry Ford Health System in Detroit, Michigan,
Boleski, G., Jordan, J., Gnam, G., & Conway, W. (2010).
leads strategic planning, process engineering, operational an-
A tight glycemic control initiative in a surgical intensive care
alytics, and clinical quality and safety initiatives across the
unit and hospitalwide. Joint Commission Journal of Quality
System. Hawkins has applied engineering, business, and qual-
and Patient Safety, 36, 291–300.
ity improvement methods to projects throughout HFHS since
Moore, C. L., Ajluni, M., Soi, V., Johnson, L., Adams, B., 1986. She has served as faculty for corporate quality man-
Amburn, L., Sykes, J., Besarab, A., Zervos, M., & Yee, J. agement courses, is a trained facilitator for rapid-cycle im-
(2011). Reduction of catheter-related bacteremia (CRB) and provement workshops, and has an ongoing role in teaching
healthcare utilization by use of a prophylactic gentamicin- HFHS leadership development courses on project manage-
citrate lock solution. American Journal of Kidney Diseases, ment, mentoring, and quality and safety. She holds a bach-
57(4), B69. elor’s degree in industrial engineering from the University
of Michigan and a master’s in business administration from
Rivers, E., Nguyen, B., Haystad, S., Ressler, J., Muzzin, A., Wayne State University. Hawkins is a member of the Baldrige
Knoblich, B., Peterson, E., & Tomlanovich, M. (2001). Early Performance Excellence Program’s Board of Examiners. She
goal-directed therapy in the treatment of severe sepsis and can be reached at shawkin1@hfhs.org.
septic shock. New England Journal of Medicine, 345, 1368– Rose Glenn is the senior vice president of communications
1377. and chief marketing officer for Henry Ford Health System.

Global Business and Organizational Excellence DOI: 10.1002/joe January/February 2013 21

 She leads a team responsible for marketing and public rela- “100 Most Influential Women” in 2007. She can be reached
tions strategies to further the growth, preference, and cus- at koswald1@hfhs.org.
tomer engagement of the $4 billion health system and its sub- William A. Conway , MD, is senior vice president and chief
sidiaries. A summa cum laude graduate of Indiana University quality officer of Henry Ford Health System, chief medical
of Pennsylvania, Glenn received her master’s degree in strate- officer of Henry Ford Hospital, and Breech Chair for Health
gic public relations from George Washington University. She Care Quality Improvement. Dr. Conway is a pulmonary-
is accredited by the Public Relations Society of America and critical care physician and has championed many quality in-
certified by the Society for Healthcare Strategy and Market novations at HFHS, including the No Harm Campaign. He
Development. She can be reached at rglenn1@hfhs.org. has developed processes at Henry Ford Hospital that have
Kathy Oswald is senior vice president and chief human re- markedly improved outcomes in the critical care and post-
sources officer for Henry Ford Health System. She started her operative settings and reduced hospital-acquired infections.
career as a secretary at the Chrysler Corporation’s Jefferson Dr. Conway was recognized in 2004 as a Health Care Hero
Assembly Plant in Detroit in 1972 and became Chrysler’s top by Crain’s Detroit Business for his leadership in surgical in-
female executive as chief administrative officer before retiring fection prevention, and received the Keystone Center Patient
in 2000. Oswald then joined Right Management as president, Safety and Quality Leadership Award by the Michigan Health
Great Lakes Region, and joined Henry Ford Health System and Hospital Association in 2006. A graduate of Creighton
in her current role in 2008. Throughout her career, Oswald University Medical School in Omaha, Nebraska, Dr. Conway
has received numerous awards for her professional achieve- joined Henry Ford Hospital as a resident in 1973. He can be
ments and was recognized among Human Resource World’s reached at wconway@hfhs.org.
“Top 50 HR Executives in the World” in 2000 and Crain’s

22 January/February 2013 DOI: 10.1002/joe Global Business and Organizational Excellence