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Successful outsourcing: Improving quality of life through integrated support services
ORIGINAL ARTICLE
Successful outsourcing: Improving quality of life through integrated support services Jason Bates, BA, FMP; Martin Sharratt, BA Hons, TESL; John King, MHA, CHE
Abstract—This article examines the way that non-clinical support services are provided in healthcare settings through outsourcing partnerships. The integrated support services model and benefits to patient experience and safety as well as organizational efficiency and effectiveness are explored through an examination of services at a busy urban community hospital.
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oday’s hospital Chief Executive Officer (CEO) makes decisions related to the clinical requirements of patient care. They must ensure the hospital has the necessary staff, medical practitioners, and equipment to keep hospital-wide systems safe and compliant with legislated and legal requirements. The list of clinical responsibilities is expansive and grows daily. The CEO must also make decisions about the hospital’s physical operation and the non-clinical support services that have a significant financial impact on budgets. Senior hospital management, who are trained in clinical services, end up spending their time discussing boiler selection instead of direct patient care. The clinical responsibilities and expectations placed upon hospital management are, therefore, downloading non-clinical services to specialized service providers. This article describes the outsourcing solutions available to healthcare facilities, the potential effect on the patient experience, and describes a case study of the current business outsourcing partnership between Mackenzie Health (formerly York Central Hospital), a large community hospital, and Sodexo, a global outsourcing service provider with 10,000 Canadian employees. The development of the support services outsourcing model is reviewed, and the different procurement styles and contract delivery models are examined. The article concludes that maximum benefits are achieved through an integrated support service model like those delivered by Sodexo at Mackenzie Health.
OUTSOURCING FOR SOLUTIONS Even as demand is placed upon shrinking resources, there is an expectation of hospitals not only to develop exemplary healthcare services but also best practices based on From Sodexo Canada, one of the sponsors of this edition. With input and support from the Mackenzie Health Executive Team, Sodexo Canada Integrated Support Services Team at Mackenzie Health, and Sodexo Canada Senior Leadership Team. Corresponding author: Jason Bates, 3350 South Service Road, Burlington, Ontario, Canada, L7N 3M6. (e-mail: [email protected]) Healthcare Management Forum 2014 27:S58–S67 0840-4704/$ - see front matter & 2014 Published by Elsevier Inc. on behalf of Canadian College of Health Leaders. http://dx.doi.org/10.1016/j.hcmf.2014.01.009
innovative solutions. In fact, it is these innovative practices that are improving the way patients receive care today and for tomorrow. In healthcare facilities across Canada, the operational model for patient care is changing; senior managers are beginning to adopt private sector management methods, such as LEAN and Six Sigma, to manage hospitals. CEOs are breaking with tradition as they look beyond hospital walls to source examples of operational success in private sector workplaces, which could be applicable to their situation. Solutions are being identified in once unthought of markets. For example, practices used to provide food services to students at universities can be adapted to deliver nutritious and cost-effective resident and patient meals that result in improved satisfaction rates, shorter hospital-stay times, and lower costs in long-term care facilities. Canada’s hospitals are partnering with outsourcing companies who can provide proven operational models and experienced staff. Outsourced partners begin to implement change on day one of a partnership. The outsourced business partner is able to immediately provide access to resources, which the local facility may not have had. Access to shared knowledge and best practices can be facilitated through the contractor’s management team. The results of these efforts are leading to increased patient satisfaction rates, a shorter admit to discharge rate for patients, and successful facility budgets. The decision to outsource non-core processes and services is constantly evaluated by senior managers. Outsourcing represents a powerful service industry that continues to gain strength. Outsourcing is estimated as a $6 trillion global industry used by more than 90% of companies.1 There is a consensus that, given the economy and the future economic forecasts, both private and public sector industries will continue to contract services to outside service providers. Perceptions of outsourcing, moreover, appear to be generally more favourable than not. Internal stakeholders, in several commonly outsourced functions, were more likely to support outsourcing than to oppose it.2 The fiscal constraints placed on hospitals mean that a shrinking pool of funding must be stretched even further. The Conference Board of Canada identifies an aging demographic and a slower labour force growth as healthcare funding challenges.3 In the face of these economic
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challenges, outsourcing partners can provide these healthcare facilities with innovation, quality, a skilled workforce, and, ultimately, lowered operating costs.4 Currently, in healthcare, the range of services provided by outsourcing service providers is increasing. Companies like Sodexo provide complete facility management and food services and, in Canada, they now also provide the management of clinical technology equipment and facilitywide communication systems.5 It is expected that the size and value of outsource contracts in healthcare will continue to increase. The global market for information technology outsourcing alone is expected to reach $50.4 billion by 2018, up from $35 billion in 2013.6
OUTSOURCING TO IMPROVE PATIENT CARE The role of modern healthcare facilities is changing from a place where diseases are diagnosed and treated to multipurpose facilities serving diverse needs and users. Healthcare facilities support the science and art of promoting health, preventing disease, prolonging life, and improving quality of life through the organized efforts of society.7 At the core of every process is the care of patients. They are often physically and psychologically vulnerable, caused by separation from the comfort of family and daily routine. It is commonly understood that anxiety can adversely affect the patient’s healing process, and that increased quality of life issues are essential to improving the hospital experience.8 Outsourcing partners are uniquely positioned to deliver patient services utilizing a non-traditional or hybrid service models. Outsourced services provide multiple benefits that extend beyond cost savings. A strategic partnership enables hospital staff to focus on core processes; they provide access to skills; facilitate improved quality; and they provide ready access to marketplace innovations.4 Patients have increasing expectations of the often overburdened healthcare system, and senior managers are expected to produce more with less. As senior managers attempt to address multiple service priorities, they risk the hazard of multitask distraction and overload, where program development never advances because managers have too many responsibilities. Outsourcing responsibility for non-medical services, such as food services or facilities management, begin to have a profound effect on the way that patients perceive service and receive healthcare. Senior managers, who are able to divest control of nonessential services, are able to provide a greater focus on program improvements. Through outsourcing, managers are given additional time to focus on outcomes and opportunities to build relationships with the staff and patients. Managers can now harvest wins and identify areas for more process improvement.9 When healthcare professionals trust that essential support services are competently provided, they are better equipped to keep pace with maximizing the hospital’s resources.
OUTSOURCING MODELS The procurement of facility deliverables, which have traditionally been performed internally but now contracted to a third party, requires a careful and detailed examination of all benefits, risks, and effects. Specific performance objectives must be identified, and the outcomes must move the healthcare facility closer to strategic objectives. CEOs and senior managers must carefully select the outsourcing partner, who can best provide the services identified as priorities. Hospital leaders are encouraged to use the same model and approach to outsourcing as the one used to recruit and select a senior executive.10 Outsourcing is a mature practice used by manufacturers whose needs must exploit efficiencies and economies of scale to maintain marketplace competitiveness. However, in the 1970s as the country shifted away from a post-war economic boom and entered into turbulent and unstable economic times, hospitals and other healthcare institutions began to contract out a variety of different independent services, such as environmental services, laundry and linen, patient, and retail food services.11 Outsourcing services have historically been provided through two service models: a single-service contract (ie, linen and laundry or environmental services) and bundled multiservice contracts (ie, food services and environmental services). Depending on the type of service contract, the successful implementation of services may present a set of complex lists of tasks from the initial planning of outsourcing goals to contract management techniques. To address these challenges, companies such as Sodexo have invested heavily in on-boarding strategies. They have the ability to send teams of dedicated engineers and managers, who possess years of experience initiating service contracts and change management, to the client’s site to ensure a smooth transition. Successful transition and outsourcing relationships are best facilitated when the outsourced partner participates in senior management decisions and gains membership in various hospital governance committees (finance, health and safety, infection control, security, nutrition, strategy, planning and risk management).
INTEGRATED OUTSOURCING Recently, the benefits of larger multiservice contracts, that offer bundled services under a single contract, are gaining attraction. Larger outsourcing companies possess the required talent and resources to offer large-scale integrated outsourcing services that combine multiple service lines across multiple facility types and locations. The standardization of practices across entire funding districts (Local Health Integration Networks, provincial health authorities) can develop opportunities for fully exploiting economies of scale while improving control over quality, operational costs, and patient satisfaction.
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When there is a large integrated service contract, communication is best managed through a Single Point Of Contact (SPOC). The SPOC should be present at the senior table and should have accountability for the multiple touch points occurring between hospital clinical services and the contracted services. The SPOC is critical to creating a successful alignment of services. The SPOC ensures that the capital (human and non-human) is correct and sufficient to meet facility needs, is responsible for taking required corrective action, and holds people accountable for the completion of service delivery.12 A successful SPOC creates a business partnership, that blends a wide array of internal and external resources and competencies, which has been founded on the trust of senior managers.13 Trust is created when risk and reward is mutually shared with the outsourced partner. This SPOC leader and the support services management team are fully integrated into the hospital leadership structure and are actively engaged and working to drive strategy and overall outcomes for the organization. The support services leadership team is fully integrated and involved in the committees related to operations and finance and health, safety, security and environment, infection control, and human resources as well as committees involved in all aspects of organizational strategy, planning, and risk management. It is this last aspect of integration with hospital leadership that truly differentiates an integrated support services outsourcing model from the traditional bundled multiservice contract model. For example, Sodexo’s management team is active in 42 of Mackenzie Health’s committees and leadership teams, including the planning and priorities committee, corporate policy and review committee, corporate real estate planning, LEAN planning, hospital quality coordinating committee, redevelopment champions, and even senior team huddles. By integrating the outsourcing company’s SPOC and management team with hospital leadership, both organizations can work in a true collaborative partnership to achieve the hospital’s overarching goals and objectives of an efficient, effective, and patient-centric environment. By combining and integrating various service contracts, hospital administrators generate ease of process and cost efficiency. In a traditional hospital operating structure, many of the support services are managed separately in their own silos with their own managers, incentives, and drivers for success. This can result in missed opportunities to leverage each other and to create additional value. For example, sometimes support services, such as plant engineering and maintenance and environmental services, can find themselves with misaligned priorities through a lack of communication, overlaps, and gaps in responsibility. These challenges can be exacerbated in organizations that outsource only one of these integrated pieces, such as environmental services. To prevent silo management, the S60
hospital administration must communicate with both contractors’ representatives. This duplication of effort can be found throughout administrative and financing functions. Barry Telford, Senior Vice President of Healthcare at Sodexo, comments that when the co-dependencies and incentives are all aligned, plant operations’ success becomes dependent upon cooperation from housekeeping, and so on. The objective is to create an environment where everyone is functioning cohesively to provide a better support services program, and in-turn drive better clinical outcomes. A SPOC removes these duplicated efforts from hospital staff, and can communicate directly with the relevant service managers. The integrated contracted management model delivers communication across all services lines, so that each manager is aware of activity in adjacent departments. Timing or modification of the service delivery can be adjusted to accommodate changing requirements. Increased procurement and purchasing power is enhanced when healthcare facilities combine purchases with outsourced partners. In 2012, Sodexo’s purchase volume was $3.5 billion in North America. Through access to secure advantageous pricing and service delivery, by outsourcing with companies with extensive buying power such as Sodexo, senior hospital managers gain greater budget control and compliance. This level of integration and partnership requires a transparent and open-book relationship between both the service provider and the healthcare institution (Fig. 1). As federal and provincial healthcare funding becomes more stringent based on patient-centred care and quality
Figure 1. Integration value proposition. (Colour version of the figure is available on-line.)
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outcomes, for example, in Ontario’s Action Plan for Health Care and Health System Funding Reform, hospitals and healthcare institutions will be competing for even more limited healthcare funds.14 Reliance on outsourcing, best practices, and new ways of managing business will continue to escalate. Opportunities for enhanced partnerships that drive quality of life outcomes for patients, their families, and the healthcare professionals will become more enticing and important. The relationship that exists between Mackenzie Health and Sodexo is evidence of a successful integrated outsourcing model. The relationship illustrates success through alignment of overall risks and rewards, integration of staff and management, and access to global best practices.
MACKENZIE HEALTH AND SODEXO: A SUCCESSFUL INTEGRATED MODEL Sodexo’s integrated support services model for the Canadian healthcare marketplace delivers a host of benefits. Sodexo’s model is currently delivering greater overall outcomes and efficiency to Mackenzie Health. Sodexo has improved the facility’s productivity, enhanced enduser satisfaction, and created service reliability, all while maintaining the flexibility and supporting an environment of innovation.
Background Mackenzie Health is a large full-service community hospital near Toronto in Richmond Hill, Ontario, Canada. Serving a population of 500,000 people in one of the country’s fastest growing regions, the hospital provides diagnostic and medical services, including surgery and obstetrics, recovery and long-term care.15 Since 1990, Mackenzie Health has implemented alternate service delivery models and leads both Ontario and Canadian hospitals in the number and range of services provided through external partners. In 2001, Mackenzie was the first hospital in Canada to outsource coding and abstracting of patient charts, and they were early to contract with another organization to provide rehabilitation services. Mackenzie Health has long recognized the value of outsourcing to find the necessary skills and expertise to provide the full range of services expected by patients and their families. In 2007, Mackenzie Health launched a strategy to contract a single partner to manage all the outsourced services. Mackenzie’s strategy was to transition from eight vendors to one with a SPOC at the executive level. The goal was to create synergies that would improve the quality of services, maximize the use of an aging infrastructure, and optimize budgets. By outsourcing the services, the hospital would also create additional time for management to focus on patient care.
Integrated support services: A good fit for Mackenzie Health In 2008, Mackenzie Health partnered with Sodexo for the implementation of an integrated support services model. Multiple services were merged together and placed under Sodexo management. Mackenzie Health entered into a multiyear agreement that outlined commitments by both parties. Mackenzie Health pursued an integrated approach for reasons other than bottom line budgets. “If the main objective for outsourcing was to just reduce cost, we would have pursued a different strategy,” says Mackenzie Health Chief Financial Officer, Richard Tam. Tam states “Indeed, it is sometimes possible to achieve short-term financial savings by frequently opening up contracts to the market. However, these savings can come at the expense of quality and increased administrative effort related to procurement and contract management. It is more difficult for a hospital to manage multiple vendor contracts and relationships compared with one deep relationship with a single provider.” Outsourcing is streamlining the hospital’s administration and allowing leadership to focus on managing the hospital’s strategic direction.
Mackenzie Health’s scope of services An integrated support services model specific to Mackenzie Health’s needs was created and successfully implemented. A structured project management approach was used, and a Sodexo Project Manager was assigned to the initial transition process. Today, Sodexo manages 26 support services across all the 5 service categories: a $20.7 million budget, 370 employees (310 Mackenzie Health staff members and 60 Sodexo staff members), more than 54 third-party service contracts, and 4 local unions. The integrated support service implementation encompasses 7 previously separate but related departments. An overview of each service area is provided. The level of integration at Mackenzie Health requires Sodexo to accept responsibility and accountability for service outcomes. Sodexo’s on-site team possesses multiple disciplines and trades that come in contact with almost every aspect of facility operations (Table A).
Mackenzie’s strategic objectives To fully benefit from the opportunities created through an integrated support services model, Mackenzie Health and Sodexo worked collaboratively to create strategic objectives. They are as follows:
Implement the hospital’s vision to become a best
demonstrated hospital within the LHIN and Canadian healthcare marketplace. Be accountable for outcomes on the balanced scorecard and the NRC Picker reports. Engage Mackenzie Health support service employees in understanding the balanced scorecard initiatives to include an accountability commitment.
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Table A. Mackenzie Health’s outsourced services by department
Execute best practices to ensure available and timely
service while remaining flexible and responsive to Mackenzie Health growth and capacity building initiative. Develop a skilled workforce through an integrated training program. Instill a compassionate care hospitality culture that places the patient and customer first in the delivery of program services to support Mackenzie Health capacity building initiatives. Upgrade the retail service program, which will contribute to an increase in staff, patient, and customer satisfaction. Provide year over year savings, through a long-term commitment, with access to capital to deliver innovative and value-added solutions.
Open and transparent relationships, built on mutual trust, continue to support the Mackenzie Health-Sodexo partnership to achieve positive results. Sodexo now plays a vital role at Mackenzie Health by creating an awareness of the assets and resources available for the accomplishment of strategic objectives. Sodexo is helping Mackenzie Health achieve strategic objectives by creating a hospitality culture, providing access to new technologies and processes, and providing access to capital investment.
1. Creating a hospitality culture Sodexo provides fresh and customer-oriented strategies for the development of healthy and positive workplace cultures. A dedicated on-site Sodexo trainer works with support services staff to improve teamwork and renew the emphasis on the patient’s experience. Sodexo has determined that, with 511 beds, non-medical support services staff interact with patients approximately 3,200 times each day, S62
almost 1.2 million touch points annually including 1,533 through food service, 1,404 through environmental service, and 310 through patient transport (Supplementary Fig. S1). Sodexo’s integration services have successfully accommodated a hybrid staffing and management model. Some Mackenzie Health support services are managed and staffed by Sodexo (retail food services), and other services are managed by Sodexo and staffed by hospital employees (environmental services). The blend of staffing models facilitates a greater bundling and integration of services requirements. Hospitals are often financially strained to supply the training required for support staff. However, Mackenzie Health has successfully leveraged Sodexo’s comprehensive customer-service training programs to create a customerservice focus throughout the facility’s culture. As a result of Sodexo’s training programs, support services employee polling demonstrates increases in overall satisfaction levels as evidenced in the following measured employee satisfaction results from 2010 to 2012:
Job satisfaction improved 27% from 2010 (61%) to 2012 (88%).
Ability to communicate improved 20% from 2010 (60%) to 2012 (80%).
Differences are valued improved 12% from 2010 (61%) to 2012 (73%).
Appropriate training improved 53% from 2010 (33%) to 2012 (86%).
2. Accessing technology and processes Sodexo’s outsourcing capacity was engaged to develop Mackenzie Health–specific outcomes.
Mackenzie Health’s infection control team and Sodexo’s on-site trainer have collaborated to develop
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Figure 2. Mackenzie-Sodexo technology and process performance outcomes. (Colour version of the figure is available on-line.)
environmental services and patient transport department infection control–specific training. Mackenzie Health and Sodexo are both committed to measuring performance and demonstrating value to their respective stakeholders. Mackenzie Health, environmental services, and patient transport services have achieved a 92% hand hygiene auditing compliance rate. New process developments and technology have been implemented in the environmental services program (eg, glo-germ and an infection control process). A state-of-the-art service response centre (call centre) that provides detailed triage and tracking and reporting of requests. Patient food services were redesigned to address a growing diversity of cultural requirements. Sodexo’s Expressly for You food and nutrition program (which includes equipment, technology, and training) was implemented to manage the complex list of diets and provide individualized food care. MinuteMan biomedical engineering management program has been implemented to improved maintenance of clinical technology equipment (Fig. 2).
3. Providing access to capital investment As Mackenzie Health continues to evolve and grow, there is continued competition for limited financial resources. Sodexo has access to capital that can be leveraged in support of Mackenzie Health’s initiatives. Sodexo has already invested over $2 million at Mackenzie Health as a direct result of its integrated support service partnership with the hospital—funds that may have otherwise been
diverted from other components of Mackenzie Health’s redevelopment program.
INTEGRATED OUTSOURCING SUCCESS FACTORS Mackenzie’s integrated support services model is governed by a comprehensive system of Service Level Agreements (SLAs). Properly structured, SLAs form the framework of accountability for the services managed and performed by Sodexo. The Mackenzie-Sodexo SLAs define how risks and rewards are mutually shared. The SLAs and performance outcomes are the basis of trust between partners. They were developed jointly by Mackenzie Health management and Sodexo and while they cannot exist independent of a changing healthcare environment, they must be flexible enough to meet the changing requirements. These agreements articulated the services, responsibilities, and expectations of each party and required the collection and reporting of detailed metrics on a daily, monthly, quarterly or annual basis. SLAs place accountabilities on both the parties for achieving outcomes. SLAs are constantly reviewed and adjusted to reflect changing environments and conditions. Sodexo and Mackenzie Health have developed a detailed scorecard of performance measures—enabled through technology—that contains specific indicators of productivity, efficiency, and specific performance thresholds. Many of these indicators are rolled up into reports used by senior management and the Board of Directors. This framework is presented in the graphics (Fig. 3). The outsourcing partnership is having a positive impact at the hospital. Together Mackenzie Health and Sodexo are
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Figure 3. (A) Sodexo and Mackenzie scorecard of performance measures. (B) Sodexo and Mackenzie scorecard of performance measures. (Colour version of the figure is available on-line.)
achieving tactical goals, which include the following: the development of SLAs for each service; significant investment in capital such as new technology, a new café, and a new service response centre; improvements in exterior safety and aesthetics; the implementation of a proactive building maintenance and upgrade plan; and a onenumber call centre for all services (Table B). S64
Demonstrated value The outsourcing model used by Mackenzie Health is delivering positive outcomes for the health, safety, and well-being of patients, staff, and hospital visitors. Every component of the integrated support service program is reporting on successes and envisioning future strategy (Fig. 4).
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Table B Service Area
Environmental services
Facilities services
Outcomes to Date
Average age of work orders performance indicator—consistently below the 7 day target; actual average 2 days ¼ issue resolved in a timely manner and increased
Patient transport/logistics
Trakkar Quality Assurance rating—achieving more than 90% target performance indicator Double cleaning for contact precaution rooms Developed/implemented First Impression Improvement Plan Implemented Glow Germ Inspection System þ monthly reporting—more than 90% Average discharge completion time meeting 60 minutes target from call to completion
customer satisfaction Average number of work orders per day performance indicator—consistently above the 33 target; actual average 37 ¼ improved output per FTE Replaced two 27,500 volt transformers without interruption to patient care Implemented building preventative maintenance program Developed an exterior building improvement plan Developed safer and more cost-effective grounds and snow removal procedures
Average transport time performance indicator—consistently below 30 minutes target ¼ consistency in service delivery and increased patient/ department customer satisfaction
Developed predictive model for porter requirements Re-organized med/surg. supply system/distribution Better linen utilization processes Patient and resident food services
Retail food services
Service response centre
Safety
Training
Biomedical engineering
Food cost/meal day performance indicator—consistently reduced food costs to less than the target per patient meal day (which includes supplements New service equipment to the LTC program Implemented Simply Thick products to help swallowing disorder patients Fully revamped kitchen for on-site patient food preparation (all from scratch) ○ Reduced meal day costs ○ Improved patient and staff satisfaction ○ Reduced food waste Implementation of Expressly for You program—hostess personally visits EVERY patient—9 touch-points daily 10.9% increase in food satisfaction rates $1.00 decrease in food costs 17.1% increase in job satisfaction 13.9% increase in quality of service 12.8% increase in client service levels
Average cheque performance indicator—consistently more than $3.45 target; current average $3.69 Designed and built new Central Bistro (Starbucks, Booster Juice, Induction cooking, Grill, Deli, Salad Bar, Pizza Pizza, and Tim Horton’s, separate location) Added credit and debit card payments in retail operations Pilot Mackenzie Health swipe card payroll deduction for retail services Implemented CaterTraxTM online catering ordering system
Implemented a modern central call centre that is the main point of contact for dispatching non-clinical services Now able to measure call volumes and report response times Centralized calling system—390 calls per day Comprehensive tracking system for hospital service and maintenance Quick response to the various needs of hospital staff and departments Formally trained call centre representatives focused on client service satisfaction Efficient, dependable service Added 9 additional processes
Implemented Sodexo Health and Safety program into environmental Services Created and external grounds slips trips and falls program – 0 falls to date and reduced service costs by $40,000
Implemented MinuteManTM technology to track work orders, preventive maintenance schedules, scorecard, and SLAs for all the clinical technology
Central equipment distribution
Sodexo orientation program Mackenzie health–specific orientation Customer-service training Scripting program
equipment 15.7% improvement—life support PM completion 37.6% improvement—General PM completion 42% improvement—corrective maintenance completion Number of jobs requiring 2 staff members decreased by 20% Average age of work orders decreased by 10% Overall PM compliance increased by 30%
3 additional standardized processes ○ Red—Repair ○ Green—Clean ○ Centralized Request
3 additional locating/monitoring systems through RFID ○ Equipment locating ○ Quota management ○ Condition monitoring
Patient watches
Introduced ComfortKeepersTM to efficiently and effectively manage patient watches Increase in watches—140/week 100% CPI Trained Improved patient satisfaction 98% fill rate within 2-hour response time Centralized request system
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LEARNED OUTCOMES
Successful facilities environments
The Mackenzie Health-Sodexo partnership has demonstrated that an integrated support service outsourcing model helps to improve patient experiences and staff engagement, create balanced budgets, and drive innovation. Future outsourcing models will offer even greater advantages to the healthcare system.
Visits with family and friends can have a positive impact on the healing process and, when appropriate, family members may be encouraged to participate in patient care. Maintaining facilities that are inclusive and that encourage interaction and collaboration between healthcare professionals, patients and families can lead to shorter patient stays and healthier outcomes. Successful environments create warm and receiving atmospheres that empower visitors and comfort patients, foster nurturing behaviours through friendly and understanding staff, and uphold patient dignity by creating privacy and providing multi-purpose spaces.
Better quality of life for patients through integrated support services 1. Support: A friendly welcome and orientation can reduce patient stress. For example, throughout a hospital visit, Sodexo’s human touch reduces patient and family stress. Each employee goes through a series of customer-service training sessions to help them deliver the very best care to all who enter the facility. 2. Comfort: Meals to improve patient well-being and aid in a quick recovery. For example, Sodexo offers a range of customized food options that are adapted to the nutritional requirements and preferences of patients. 3. Privacy and dignity: Hygiene, clean linen, and minimal noises and odours are all vital to well-being. The patient’s belongings and privacy are worthy of respect. For example, Sodexo has developed specific behavioural training after extensive healthcare research and observation. The training focuses on understanding patient habits and vulnerabilities and instituting a culture of compassion and respect. 4. Safety: Patient risks are minimized when a comprehensive and managed approach is used to drive infection control and to manage the healthcare facilities’ air quality, temperature, and level of hygiene.
Better quality of life for healthcare professionals through integrated support services A hospital’s most important resources are the people who work there. Increasing staff satisfaction and reducing stress with a pleasant and thoughtfully structured work environment helps the hospital attract and retain the best talent. Ensuring quality of life in healthcare facilities means guaranteeing that functioning medical equipment is provided in the right place at the right time; using a single provider to integrate processes and optimize interaction, reduce time lost, and promote clarity and accountability; and enhancing employee benefits and services to alleviate pressures that can affect work-life balance. Sodexo’s programs - expressly tailored for healthcare professionals - improve motivation, enhance the attractiveness of hospitals, and help reduce employee turnover. Putting quality of life at the heart of its processes is an excellent performance guarantee for outsourcing partnerships with healthcare facilities. And as a Canadian leader in services that improve quality of life, Sodexo is helping
Figure 4. Key reasons for using Sodexo’s value. (Colour version of the figure is available on-line.)
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healthcare providers meet the needs of patients, family members, and employees.
APPENDIX.
SUPPLEMENTARY INFORMATION
Supplementary material associated with this article can be found in the on-line version at http://dx.doi.org/10.1016/j. hcmf.2014.01.009.
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6. Hall S. Health information technology. FierceHealthIT. August 8, 2013. Available at http://www.fiercehealthit.com/story/globalhealth-it-outsourcing-market-reach-504-billion-2018/2013-08-08; 2013 Accessed 14.01.14. 7. Unknown. The role and organization of public health. Public Health Agency of Canada. November 8, 2004. Available at http://www.phac-aspc.gc.ca/publicat/sars-sras/naylor/3-eng.php; 2004 Accessed 14.01.14. 8. Treiber P, Charles L. Individualized patient care. The Nurse Leader Handbook. Gulf Breeze, FL: Fire Starter Publishing; 2014: [p. 179]. 9. Crouch L, Ketelsen L, Baker S. Rounding on staff. The Nurse Leader Handbook. Gulf Breeze, FL: Fire Starter Publishing; 2014: [p. 18]. 10. Corbett M. The Outsourcing Revolution. Chicago, IL: Dearborn Trade Press; 2004: [p. 117]. 11. Corbett M. The Outsourcing Revolution. Chicago, IL: Dearborn Trade Press; 2004: [p. xiii]. 12. Studer Q. Straight a Leadership. Gulf Breeze, FL: Fire Starter Publishing; 2009: [p. 4]. 13. Corbett M. The Outsourcing Revolution. Chicago, IL: Dearborn Trade Press; 2004: [p. 200]. 14. Sutherland J. Hospital payment mechanisms: an overview and options for Canada. Ontario Ministry of Health and Long Term Care. March 2011. Available at http://www.cfhi-fcass.ca/Libra ries/Hospital_Funding_docs/CHSRF-Sutherland-HospitalFunding ENG.sflb.ashx; 2011 Accessed 14.01.14. 15. Unknown. About the Organization. Mackenzie Health. Available at http://mackenziehealth.ca/about_theorg.php Accessed 14.01.14.
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Successful outsourcing: Improving quality of life through integrated support services Jason Bates, BA, FMP; Martin Sharratt, BA Hons, TESL; John King, MHA, CHE
Abstract—This article examines the way that non-clinical support services are provided in healthcare settings through outsourcing partnerships. The integrated support services model and benefits to patient experience and safety as well as organizational efficiency and effectiveness are explored through an examination of services at a busy urban community hospital.
T
oday’s hospital Chief Executive Officer (CEO) makes decisions related to the clinical requirements of patient care. They must ensure the hospital has the necessary staff, medical practitioners, and equipment to keep hospital-wide systems safe and compliant with legislated and legal requirements. The list of clinical responsibilities is expansive and grows daily. The CEO must also make decisions about the hospital’s physical operation and the non-clinical support services that have a significant financial impact on budgets. Senior hospital management, who are trained in clinical services, end up spending their time discussing boiler selection instead of direct patient care. The clinical responsibilities and expectations placed upon hospital management are, therefore, downloading non-clinical services to specialized service providers. This article describes the outsourcing solutions available to healthcare facilities, the potential effect on the patient experience, and describes a case study of the current business outsourcing partnership between Mackenzie Health (formerly York Central Hospital), a large community hospital, and Sodexo, a global outsourcing service provider with 10,000 Canadian employees. The development of the support services outsourcing model is reviewed, and the different procurement styles and contract delivery models are examined. The article concludes that maximum benefits are achieved through an integrated support service model like those delivered by Sodexo at Mackenzie Health.
OUTSOURCING FOR SOLUTIONS Even as demand is placed upon shrinking resources, there is an expectation of hospitals not only to develop exemplary healthcare services but also best practices based on From Sodexo Canada, one of the sponsors of this edition. With input and support from the Mackenzie Health Executive Team, Sodexo Canada Integrated Support Services Team at Mackenzie Health, and Sodexo Canada Senior Leadership Team. Corresponding author: Jason Bates, 3350 South Service Road, Burlington, Ontario, Canada, L7N 3M6. (e-mail: [email protected]) Healthcare Management Forum 2014 27:S58–S67 0840-4704/$ - see front matter & 2014 Published by Elsevier Inc. on behalf of Canadian College of Health Leaders. http://dx.doi.org/10.1016/j.hcmf.2014.01.009
innovative solutions. In fact, it is these innovative practices that are improving the way patients receive care today and for tomorrow. In healthcare facilities across Canada, the operational model for patient care is changing; senior managers are beginning to adopt private sector management methods, such as LEAN and Six Sigma, to manage hospitals. CEOs are breaking with tradition as they look beyond hospital walls to source examples of operational success in private sector workplaces, which could be applicable to their situation. Solutions are being identified in once unthought of markets. For example, practices used to provide food services to students at universities can be adapted to deliver nutritious and cost-effective resident and patient meals that result in improved satisfaction rates, shorter hospital-stay times, and lower costs in long-term care facilities. Canada’s hospitals are partnering with outsourcing companies who can provide proven operational models and experienced staff. Outsourced partners begin to implement change on day one of a partnership. The outsourced business partner is able to immediately provide access to resources, which the local facility may not have had. Access to shared knowledge and best practices can be facilitated through the contractor’s management team. The results of these efforts are leading to increased patient satisfaction rates, a shorter admit to discharge rate for patients, and successful facility budgets. The decision to outsource non-core processes and services is constantly evaluated by senior managers. Outsourcing represents a powerful service industry that continues to gain strength. Outsourcing is estimated as a $6 trillion global industry used by more than 90% of companies.1 There is a consensus that, given the economy and the future economic forecasts, both private and public sector industries will continue to contract services to outside service providers. Perceptions of outsourcing, moreover, appear to be generally more favourable than not. Internal stakeholders, in several commonly outsourced functions, were more likely to support outsourcing than to oppose it.2 The fiscal constraints placed on hospitals mean that a shrinking pool of funding must be stretched even further. The Conference Board of Canada identifies an aging demographic and a slower labour force growth as healthcare funding challenges.3 In the face of these economic
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challenges, outsourcing partners can provide these healthcare facilities with innovation, quality, a skilled workforce, and, ultimately, lowered operating costs.4 Currently, in healthcare, the range of services provided by outsourcing service providers is increasing. Companies like Sodexo provide complete facility management and food services and, in Canada, they now also provide the management of clinical technology equipment and facilitywide communication systems.5 It is expected that the size and value of outsource contracts in healthcare will continue to increase. The global market for information technology outsourcing alone is expected to reach $50.4 billion by 2018, up from $35 billion in 2013.6
OUTSOURCING TO IMPROVE PATIENT CARE The role of modern healthcare facilities is changing from a place where diseases are diagnosed and treated to multipurpose facilities serving diverse needs and users. Healthcare facilities support the science and art of promoting health, preventing disease, prolonging life, and improving quality of life through the organized efforts of society.7 At the core of every process is the care of patients. They are often physically and psychologically vulnerable, caused by separation from the comfort of family and daily routine. It is commonly understood that anxiety can adversely affect the patient’s healing process, and that increased quality of life issues are essential to improving the hospital experience.8 Outsourcing partners are uniquely positioned to deliver patient services utilizing a non-traditional or hybrid service models. Outsourced services provide multiple benefits that extend beyond cost savings. A strategic partnership enables hospital staff to focus on core processes; they provide access to skills; facilitate improved quality; and they provide ready access to marketplace innovations.4 Patients have increasing expectations of the often overburdened healthcare system, and senior managers are expected to produce more with less. As senior managers attempt to address multiple service priorities, they risk the hazard of multitask distraction and overload, where program development never advances because managers have too many responsibilities. Outsourcing responsibility for non-medical services, such as food services or facilities management, begin to have a profound effect on the way that patients perceive service and receive healthcare. Senior managers, who are able to divest control of nonessential services, are able to provide a greater focus on program improvements. Through outsourcing, managers are given additional time to focus on outcomes and opportunities to build relationships with the staff and patients. Managers can now harvest wins and identify areas for more process improvement.9 When healthcare professionals trust that essential support services are competently provided, they are better equipped to keep pace with maximizing the hospital’s resources.
OUTSOURCING MODELS The procurement of facility deliverables, which have traditionally been performed internally but now contracted to a third party, requires a careful and detailed examination of all benefits, risks, and effects. Specific performance objectives must be identified, and the outcomes must move the healthcare facility closer to strategic objectives. CEOs and senior managers must carefully select the outsourcing partner, who can best provide the services identified as priorities. Hospital leaders are encouraged to use the same model and approach to outsourcing as the one used to recruit and select a senior executive.10 Outsourcing is a mature practice used by manufacturers whose needs must exploit efficiencies and economies of scale to maintain marketplace competitiveness. However, in the 1970s as the country shifted away from a post-war economic boom and entered into turbulent and unstable economic times, hospitals and other healthcare institutions began to contract out a variety of different independent services, such as environmental services, laundry and linen, patient, and retail food services.11 Outsourcing services have historically been provided through two service models: a single-service contract (ie, linen and laundry or environmental services) and bundled multiservice contracts (ie, food services and environmental services). Depending on the type of service contract, the successful implementation of services may present a set of complex lists of tasks from the initial planning of outsourcing goals to contract management techniques. To address these challenges, companies such as Sodexo have invested heavily in on-boarding strategies. They have the ability to send teams of dedicated engineers and managers, who possess years of experience initiating service contracts and change management, to the client’s site to ensure a smooth transition. Successful transition and outsourcing relationships are best facilitated when the outsourced partner participates in senior management decisions and gains membership in various hospital governance committees (finance, health and safety, infection control, security, nutrition, strategy, planning and risk management).
INTEGRATED OUTSOURCING Recently, the benefits of larger multiservice contracts, that offer bundled services under a single contract, are gaining attraction. Larger outsourcing companies possess the required talent and resources to offer large-scale integrated outsourcing services that combine multiple service lines across multiple facility types and locations. The standardization of practices across entire funding districts (Local Health Integration Networks, provincial health authorities) can develop opportunities for fully exploiting economies of scale while improving control over quality, operational costs, and patient satisfaction.
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When there is a large integrated service contract, communication is best managed through a Single Point Of Contact (SPOC). The SPOC should be present at the senior table and should have accountability for the multiple touch points occurring between hospital clinical services and the contracted services. The SPOC is critical to creating a successful alignment of services. The SPOC ensures that the capital (human and non-human) is correct and sufficient to meet facility needs, is responsible for taking required corrective action, and holds people accountable for the completion of service delivery.12 A successful SPOC creates a business partnership, that blends a wide array of internal and external resources and competencies, which has been founded on the trust of senior managers.13 Trust is created when risk and reward is mutually shared with the outsourced partner. This SPOC leader and the support services management team are fully integrated into the hospital leadership structure and are actively engaged and working to drive strategy and overall outcomes for the organization. The support services leadership team is fully integrated and involved in the committees related to operations and finance and health, safety, security and environment, infection control, and human resources as well as committees involved in all aspects of organizational strategy, planning, and risk management. It is this last aspect of integration with hospital leadership that truly differentiates an integrated support services outsourcing model from the traditional bundled multiservice contract model. For example, Sodexo’s management team is active in 42 of Mackenzie Health’s committees and leadership teams, including the planning and priorities committee, corporate policy and review committee, corporate real estate planning, LEAN planning, hospital quality coordinating committee, redevelopment champions, and even senior team huddles. By integrating the outsourcing company’s SPOC and management team with hospital leadership, both organizations can work in a true collaborative partnership to achieve the hospital’s overarching goals and objectives of an efficient, effective, and patient-centric environment. By combining and integrating various service contracts, hospital administrators generate ease of process and cost efficiency. In a traditional hospital operating structure, many of the support services are managed separately in their own silos with their own managers, incentives, and drivers for success. This can result in missed opportunities to leverage each other and to create additional value. For example, sometimes support services, such as plant engineering and maintenance and environmental services, can find themselves with misaligned priorities through a lack of communication, overlaps, and gaps in responsibility. These challenges can be exacerbated in organizations that outsource only one of these integrated pieces, such as environmental services. To prevent silo management, the S60
hospital administration must communicate with both contractors’ representatives. This duplication of effort can be found throughout administrative and financing functions. Barry Telford, Senior Vice President of Healthcare at Sodexo, comments that when the co-dependencies and incentives are all aligned, plant operations’ success becomes dependent upon cooperation from housekeeping, and so on. The objective is to create an environment where everyone is functioning cohesively to provide a better support services program, and in-turn drive better clinical outcomes. A SPOC removes these duplicated efforts from hospital staff, and can communicate directly with the relevant service managers. The integrated contracted management model delivers communication across all services lines, so that each manager is aware of activity in adjacent departments. Timing or modification of the service delivery can be adjusted to accommodate changing requirements. Increased procurement and purchasing power is enhanced when healthcare facilities combine purchases with outsourced partners. In 2012, Sodexo’s purchase volume was $3.5 billion in North America. Through access to secure advantageous pricing and service delivery, by outsourcing with companies with extensive buying power such as Sodexo, senior hospital managers gain greater budget control and compliance. This level of integration and partnership requires a transparent and open-book relationship between both the service provider and the healthcare institution (Fig. 1). As federal and provincial healthcare funding becomes more stringent based on patient-centred care and quality
Figure 1. Integration value proposition. (Colour version of the figure is available on-line.)
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outcomes, for example, in Ontario’s Action Plan for Health Care and Health System Funding Reform, hospitals and healthcare institutions will be competing for even more limited healthcare funds.14 Reliance on outsourcing, best practices, and new ways of managing business will continue to escalate. Opportunities for enhanced partnerships that drive quality of life outcomes for patients, their families, and the healthcare professionals will become more enticing and important. The relationship that exists between Mackenzie Health and Sodexo is evidence of a successful integrated outsourcing model. The relationship illustrates success through alignment of overall risks and rewards, integration of staff and management, and access to global best practices.
MACKENZIE HEALTH AND SODEXO: A SUCCESSFUL INTEGRATED MODEL Sodexo’s integrated support services model for the Canadian healthcare marketplace delivers a host of benefits. Sodexo’s model is currently delivering greater overall outcomes and efficiency to Mackenzie Health. Sodexo has improved the facility’s productivity, enhanced enduser satisfaction, and created service reliability, all while maintaining the flexibility and supporting an environment of innovation.
Background Mackenzie Health is a large full-service community hospital near Toronto in Richmond Hill, Ontario, Canada. Serving a population of 500,000 people in one of the country’s fastest growing regions, the hospital provides diagnostic and medical services, including surgery and obstetrics, recovery and long-term care.15 Since 1990, Mackenzie Health has implemented alternate service delivery models and leads both Ontario and Canadian hospitals in the number and range of services provided through external partners. In 2001, Mackenzie was the first hospital in Canada to outsource coding and abstracting of patient charts, and they were early to contract with another organization to provide rehabilitation services. Mackenzie Health has long recognized the value of outsourcing to find the necessary skills and expertise to provide the full range of services expected by patients and their families. In 2007, Mackenzie Health launched a strategy to contract a single partner to manage all the outsourced services. Mackenzie’s strategy was to transition from eight vendors to one with a SPOC at the executive level. The goal was to create synergies that would improve the quality of services, maximize the use of an aging infrastructure, and optimize budgets. By outsourcing the services, the hospital would also create additional time for management to focus on patient care.
Integrated support services: A good fit for Mackenzie Health In 2008, Mackenzie Health partnered with Sodexo for the implementation of an integrated support services model. Multiple services were merged together and placed under Sodexo management. Mackenzie Health entered into a multiyear agreement that outlined commitments by both parties. Mackenzie Health pursued an integrated approach for reasons other than bottom line budgets. “If the main objective for outsourcing was to just reduce cost, we would have pursued a different strategy,” says Mackenzie Health Chief Financial Officer, Richard Tam. Tam states “Indeed, it is sometimes possible to achieve short-term financial savings by frequently opening up contracts to the market. However, these savings can come at the expense of quality and increased administrative effort related to procurement and contract management. It is more difficult for a hospital to manage multiple vendor contracts and relationships compared with one deep relationship with a single provider.” Outsourcing is streamlining the hospital’s administration and allowing leadership to focus on managing the hospital’s strategic direction.
Mackenzie Health’s scope of services An integrated support services model specific to Mackenzie Health’s needs was created and successfully implemented. A structured project management approach was used, and a Sodexo Project Manager was assigned to the initial transition process. Today, Sodexo manages 26 support services across all the 5 service categories: a $20.7 million budget, 370 employees (310 Mackenzie Health staff members and 60 Sodexo staff members), more than 54 third-party service contracts, and 4 local unions. The integrated support service implementation encompasses 7 previously separate but related departments. An overview of each service area is provided. The level of integration at Mackenzie Health requires Sodexo to accept responsibility and accountability for service outcomes. Sodexo’s on-site team possesses multiple disciplines and trades that come in contact with almost every aspect of facility operations (Table A).
Mackenzie’s strategic objectives To fully benefit from the opportunities created through an integrated support services model, Mackenzie Health and Sodexo worked collaboratively to create strategic objectives. They are as follows:
Implement the hospital’s vision to become a best
demonstrated hospital within the LHIN and Canadian healthcare marketplace. Be accountable for outcomes on the balanced scorecard and the NRC Picker reports. Engage Mackenzie Health support service employees in understanding the balanced scorecard initiatives to include an accountability commitment.
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Table A. Mackenzie Health’s outsourced services by department
Execute best practices to ensure available and timely
service while remaining flexible and responsive to Mackenzie Health growth and capacity building initiative. Develop a skilled workforce through an integrated training program. Instill a compassionate care hospitality culture that places the patient and customer first in the delivery of program services to support Mackenzie Health capacity building initiatives. Upgrade the retail service program, which will contribute to an increase in staff, patient, and customer satisfaction. Provide year over year savings, through a long-term commitment, with access to capital to deliver innovative and value-added solutions.
Open and transparent relationships, built on mutual trust, continue to support the Mackenzie Health-Sodexo partnership to achieve positive results. Sodexo now plays a vital role at Mackenzie Health by creating an awareness of the assets and resources available for the accomplishment of strategic objectives. Sodexo is helping Mackenzie Health achieve strategic objectives by creating a hospitality culture, providing access to new technologies and processes, and providing access to capital investment.
1. Creating a hospitality culture Sodexo provides fresh and customer-oriented strategies for the development of healthy and positive workplace cultures. A dedicated on-site Sodexo trainer works with support services staff to improve teamwork and renew the emphasis on the patient’s experience. Sodexo has determined that, with 511 beds, non-medical support services staff interact with patients approximately 3,200 times each day, S62
almost 1.2 million touch points annually including 1,533 through food service, 1,404 through environmental service, and 310 through patient transport (Supplementary Fig. S1). Sodexo’s integration services have successfully accommodated a hybrid staffing and management model. Some Mackenzie Health support services are managed and staffed by Sodexo (retail food services), and other services are managed by Sodexo and staffed by hospital employees (environmental services). The blend of staffing models facilitates a greater bundling and integration of services requirements. Hospitals are often financially strained to supply the training required for support staff. However, Mackenzie Health has successfully leveraged Sodexo’s comprehensive customer-service training programs to create a customerservice focus throughout the facility’s culture. As a result of Sodexo’s training programs, support services employee polling demonstrates increases in overall satisfaction levels as evidenced in the following measured employee satisfaction results from 2010 to 2012:
Job satisfaction improved 27% from 2010 (61%) to 2012 (88%).
Ability to communicate improved 20% from 2010 (60%) to 2012 (80%).
Differences are valued improved 12% from 2010 (61%) to 2012 (73%).
Appropriate training improved 53% from 2010 (33%) to 2012 (86%).
2. Accessing technology and processes Sodexo’s outsourcing capacity was engaged to develop Mackenzie Health–specific outcomes.
Mackenzie Health’s infection control team and Sodexo’s on-site trainer have collaborated to develop
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Figure 2. Mackenzie-Sodexo technology and process performance outcomes. (Colour version of the figure is available on-line.)
environmental services and patient transport department infection control–specific training. Mackenzie Health and Sodexo are both committed to measuring performance and demonstrating value to their respective stakeholders. Mackenzie Health, environmental services, and patient transport services have achieved a 92% hand hygiene auditing compliance rate. New process developments and technology have been implemented in the environmental services program (eg, glo-germ and an infection control process). A state-of-the-art service response centre (call centre) that provides detailed triage and tracking and reporting of requests. Patient food services were redesigned to address a growing diversity of cultural requirements. Sodexo’s Expressly for You food and nutrition program (which includes equipment, technology, and training) was implemented to manage the complex list of diets and provide individualized food care. MinuteMan biomedical engineering management program has been implemented to improved maintenance of clinical technology equipment (Fig. 2).
3. Providing access to capital investment As Mackenzie Health continues to evolve and grow, there is continued competition for limited financial resources. Sodexo has access to capital that can be leveraged in support of Mackenzie Health’s initiatives. Sodexo has already invested over $2 million at Mackenzie Health as a direct result of its integrated support service partnership with the hospital—funds that may have otherwise been
diverted from other components of Mackenzie Health’s redevelopment program.
INTEGRATED OUTSOURCING SUCCESS FACTORS Mackenzie’s integrated support services model is governed by a comprehensive system of Service Level Agreements (SLAs). Properly structured, SLAs form the framework of accountability for the services managed and performed by Sodexo. The Mackenzie-Sodexo SLAs define how risks and rewards are mutually shared. The SLAs and performance outcomes are the basis of trust between partners. They were developed jointly by Mackenzie Health management and Sodexo and while they cannot exist independent of a changing healthcare environment, they must be flexible enough to meet the changing requirements. These agreements articulated the services, responsibilities, and expectations of each party and required the collection and reporting of detailed metrics on a daily, monthly, quarterly or annual basis. SLAs place accountabilities on both the parties for achieving outcomes. SLAs are constantly reviewed and adjusted to reflect changing environments and conditions. Sodexo and Mackenzie Health have developed a detailed scorecard of performance measures—enabled through technology—that contains specific indicators of productivity, efficiency, and specific performance thresholds. Many of these indicators are rolled up into reports used by senior management and the Board of Directors. This framework is presented in the graphics (Fig. 3). The outsourcing partnership is having a positive impact at the hospital. Together Mackenzie Health and Sodexo are
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Figure 3. (A) Sodexo and Mackenzie scorecard of performance measures. (B) Sodexo and Mackenzie scorecard of performance measures. (Colour version of the figure is available on-line.)
achieving tactical goals, which include the following: the development of SLAs for each service; significant investment in capital such as new technology, a new café, and a new service response centre; improvements in exterior safety and aesthetics; the implementation of a proactive building maintenance and upgrade plan; and a onenumber call centre for all services (Table B). S64
Demonstrated value The outsourcing model used by Mackenzie Health is delivering positive outcomes for the health, safety, and well-being of patients, staff, and hospital visitors. Every component of the integrated support service program is reporting on successes and envisioning future strategy (Fig. 4).
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Table B Service Area
Environmental services
Facilities services
Outcomes to Date
Average age of work orders performance indicator—consistently below the 7 day target; actual average 2 days ¼ issue resolved in a timely manner and increased
Patient transport/logistics
Trakkar Quality Assurance rating—achieving more than 90% target performance indicator Double cleaning for contact precaution rooms Developed/implemented First Impression Improvement Plan Implemented Glow Germ Inspection System þ monthly reporting—more than 90% Average discharge completion time meeting 60 minutes target from call to completion
customer satisfaction Average number of work orders per day performance indicator—consistently above the 33 target; actual average 37 ¼ improved output per FTE Replaced two 27,500 volt transformers without interruption to patient care Implemented building preventative maintenance program Developed an exterior building improvement plan Developed safer and more cost-effective grounds and snow removal procedures
Average transport time performance indicator—consistently below 30 minutes target ¼ consistency in service delivery and increased patient/ department customer satisfaction
Developed predictive model for porter requirements Re-organized med/surg. supply system/distribution Better linen utilization processes Patient and resident food services
Retail food services
Service response centre
Safety
Training
Biomedical engineering
Food cost/meal day performance indicator—consistently reduced food costs to less than the target per patient meal day (which includes supplements New service equipment to the LTC program Implemented Simply Thick products to help swallowing disorder patients Fully revamped kitchen for on-site patient food preparation (all from scratch) ○ Reduced meal day costs ○ Improved patient and staff satisfaction ○ Reduced food waste Implementation of Expressly for You program—hostess personally visits EVERY patient—9 touch-points daily 10.9% increase in food satisfaction rates $1.00 decrease in food costs 17.1% increase in job satisfaction 13.9% increase in quality of service 12.8% increase in client service levels
Average cheque performance indicator—consistently more than $3.45 target; current average $3.69 Designed and built new Central Bistro (Starbucks, Booster Juice, Induction cooking, Grill, Deli, Salad Bar, Pizza Pizza, and Tim Horton’s, separate location) Added credit and debit card payments in retail operations Pilot Mackenzie Health swipe card payroll deduction for retail services Implemented CaterTraxTM online catering ordering system
Implemented a modern central call centre that is the main point of contact for dispatching non-clinical services Now able to measure call volumes and report response times Centralized calling system—390 calls per day Comprehensive tracking system for hospital service and maintenance Quick response to the various needs of hospital staff and departments Formally trained call centre representatives focused on client service satisfaction Efficient, dependable service Added 9 additional processes
Implemented Sodexo Health and Safety program into environmental Services Created and external grounds slips trips and falls program – 0 falls to date and reduced service costs by $40,000
Implemented MinuteManTM technology to track work orders, preventive maintenance schedules, scorecard, and SLAs for all the clinical technology
Central equipment distribution
Sodexo orientation program Mackenzie health–specific orientation Customer-service training Scripting program
equipment 15.7% improvement—life support PM completion 37.6% improvement—General PM completion 42% improvement—corrective maintenance completion Number of jobs requiring 2 staff members decreased by 20% Average age of work orders decreased by 10% Overall PM compliance increased by 30%
3 additional standardized processes ○ Red—Repair ○ Green—Clean ○ Centralized Request
3 additional locating/monitoring systems through RFID ○ Equipment locating ○ Quota management ○ Condition monitoring
Patient watches
Introduced ComfortKeepersTM to efficiently and effectively manage patient watches Increase in watches—140/week 100% CPI Trained Improved patient satisfaction 98% fill rate within 2-hour response time Centralized request system
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LEARNED OUTCOMES
Successful facilities environments
The Mackenzie Health-Sodexo partnership has demonstrated that an integrated support service outsourcing model helps to improve patient experiences and staff engagement, create balanced budgets, and drive innovation. Future outsourcing models will offer even greater advantages to the healthcare system.
Visits with family and friends can have a positive impact on the healing process and, when appropriate, family members may be encouraged to participate in patient care. Maintaining facilities that are inclusive and that encourage interaction and collaboration between healthcare professionals, patients and families can lead to shorter patient stays and healthier outcomes. Successful environments create warm and receiving atmospheres that empower visitors and comfort patients, foster nurturing behaviours through friendly and understanding staff, and uphold patient dignity by creating privacy and providing multi-purpose spaces.
Better quality of life for patients through integrated support services 1. Support: A friendly welcome and orientation can reduce patient stress. For example, throughout a hospital visit, Sodexo’s human touch reduces patient and family stress. Each employee goes through a series of customer-service training sessions to help them deliver the very best care to all who enter the facility. 2. Comfort: Meals to improve patient well-being and aid in a quick recovery. For example, Sodexo offers a range of customized food options that are adapted to the nutritional requirements and preferences of patients. 3. Privacy and dignity: Hygiene, clean linen, and minimal noises and odours are all vital to well-being. The patient’s belongings and privacy are worthy of respect. For example, Sodexo has developed specific behavioural training after extensive healthcare research and observation. The training focuses on understanding patient habits and vulnerabilities and instituting a culture of compassion and respect. 4. Safety: Patient risks are minimized when a comprehensive and managed approach is used to drive infection control and to manage the healthcare facilities’ air quality, temperature, and level of hygiene.
Better quality of life for healthcare professionals through integrated support services A hospital’s most important resources are the people who work there. Increasing staff satisfaction and reducing stress with a pleasant and thoughtfully structured work environment helps the hospital attract and retain the best talent. Ensuring quality of life in healthcare facilities means guaranteeing that functioning medical equipment is provided in the right place at the right time; using a single provider to integrate processes and optimize interaction, reduce time lost, and promote clarity and accountability; and enhancing employee benefits and services to alleviate pressures that can affect work-life balance. Sodexo’s programs - expressly tailored for healthcare professionals - improve motivation, enhance the attractiveness of hospitals, and help reduce employee turnover. Putting quality of life at the heart of its processes is an excellent performance guarantee for outsourcing partnerships with healthcare facilities. And as a Canadian leader in services that improve quality of life, Sodexo is helping
Figure 4. Key reasons for using Sodexo’s value. (Colour version of the figure is available on-line.)
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healthcare providers meet the needs of patients, family members, and employees.
APPENDIX.
SUPPLEMENTARY INFORMATION
Supplementary material associated with this article can be found in the on-line version at http://dx.doi.org/10.1016/j. hcmf.2014.01.009.
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