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Bold, Innovative Leadership; Achieving Results, while igniting pride and passion in its people JUNE 3, 2014
CCHL BOLD LEADERSHIP CONFERENCE
BANFF, ALBERTA
Panelists Eric Hanna oPresident & Chief Executive Officer, Arnprior Regional Health
Ron Gagnon oPresident & Chief Executive Officer, Sault Area Hospital
Janice Skot oPresident & Chief Executive Officer, Royal Victoria Regional Health Centre
Gino Picciano o CCHL Board Member & Healthcare Consultant
What keeps you up at night? 1. Finances
2. Safe, Quality, Reliable Care
3. Staff Safety
4. Staff Engagement
5. Physician Engagement
6. Patient Experience
7. Alignment of Priorities
8. Management Strength/Consistency
9. All of the Above
10. Are there others?
Given these “stay awake” items…..
VIDEO TO INSERT HERE………………
Dryden Regional Dryden
Sault Area Hospital Sault St.Marie
Arnprior Regional Arnprior
Ottawa Hospital Ottawa
Montfort Hospital Ottawa
St. Joseph Health Care London London
Hanover and District Hanover
RVH Barrie
Headwaters Health Orangeville
Trillium Health Mississauga
Alexandria Marine and General Hospital Goderich
6
This is My Why….
7
SAH Overview
300 bed community hospital providing primary, secondary and limited tertiary care, oncology and renal services for district
First ever satellite radiation treatment suite
120,000 people in catchment area (Algoma district)
1,900 staff, 130 physicians and 450+ volunteers
$230 Million top line
Successful Foundation
Call to Action
CEO released Quality issues Morale is poor Staff safety is a
concern Patient and families
are not happy Confidence is down Reputation is ? Deficits are growing New hospital on the
horizon
Our Journey… 2007 Studer partnership began
Senior Leader, Board, MAC and Manager learning
Focused goals and alignment
Implementation and associated challenges
Ongoing monitoring, coaching and tools
Partnered with other Studer hospitals to learn, share and improve
Rebranding to “own” - Strategy
Seeing results
First Canadian Partner
Execution Framework Evidence-Based LeadershipSM
Standardization Accelerators Must
Haves®
Performance
Gap
Objective
Evaluation
System
Leader
Development
Foundation
STUDER GROUP®:
Agreed upon tactics and behaviours to achieve goals, such as:
Rounding for outcomes
Stop Light Reports
Huddles
Thank you notes
Monthly meeting model
AIDET®
Hourly Rounding®
Re-recruit high and middle performers
Move low performers up or out
Processes that are consistent and standardized
Standard meeting agendas
Process Improvement
CQI TQM LEAN
IT/IS
Continuum of Care
Care Redesign
Transformation
Aligned Goals Aligned Behaviour Aligned Process
Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results
Implement an organization-wide staff/ leadership evaluation system to hardwire objective accountability (Must Haves®)
Alignment and Focus
Inputs to 2013/14 Corporate Targets
Strategic PlanCurrent performance
HIP & PR+ +
Please do not edit or modify provided text in Columns A, B & C
AIM MEASURE CHANGE Quality
dimension Objective Outcome Measure/Indicator
Current
performance
Performance
goal 2011/12 Priority Improvement initiative
Methods and results
tracking Target for 2011/12 Target justification Comments
Safety 1)
2)
… N)
1)
2)
… N)
1)
2)
… N)
1)
2)
… N)
1)
2)
… N)
1)
2)
… N)
Space for additional
indicators
Effectiveness 1)
2)
… N)
1)
2)
… N)
1)
2)
… N)
Improve organizational
financial health
Total Margin (consolidated): Percent by which total corporate (consolidated) revenues exceed or fall short
of total corporate (consolidated) expense, excluding the impact of facility amortization, in a given year. Q3
2010/11, OHRSSpace for additional
indicators
Access 1)
2)
… N)
1)
2)
… N)
Space for additional
indicators
Patient-centred Please choose the question that is relevant to your hospital: 1)
NRC Picker / HCAPHS: "Would you recommend this hospital to your friends and family?" (add together
percent of those who responded "Definitely Yes")
2)
In-house survey (if available): provide the percent response to a summary question such as the "Willingness
of patients to recommend the hospital to friends or family" (Please list the question and the range of
possible responses when you return the QIP)
… N)
Space for additional
indicators
Improve patient satisfaction
Reduce clostridium difficile
associated diseases (CDI)
Reduce unnecessary hospital
readmission
Reduce unnecessary deaths in
hospitals
Reduce unecessary time spent
in acute care
Reduce incidence of Ventilator
Associated Pnemonia (VAP)
HSMR: number of observed deaths/number of expected deaths x 100 - FY 2009/10, CIHI
Improve provider hand
hygiene compliance
Hand hygiene compliance before patient contact: The number of times that hand hygiene was performed
before initial patient contact divided by the number of observed hand hygiene indications for before initial
patient contact multiplied by 100 - 2009/10, consistent with publicly reportable patient safety data
Avoid falls Falls: Percent of complex continuing care residents who do not have a recent prior history of falling, but fell
in the last 90 days - FY 2009/10, CCRS
Reduce rate of central line
blood stream infections
Rate of central line blood stream infections per 1,000 central line days: total number of newly diagnosed
CLI cases in the ICU after at least 48 hours of being placed on a central line, divided by the number of
central line days in that reporting period, multiplied by 1,000 - Average for Jan-Dec. 2010, consistent with
publicly reportable patient safety data
Avoid new pressure ulcers
ER Wait times: 90th Percentile ER length of stay for Admitted patients. Q3 2010/11, NACRS, CIHI
Readmission within 30 days for selected CMGs to any facility: The number of patients with specified CMGs
readmitted to any facility for non-elective inpatient care within 30 days of discharge, compared to the
number of expected non-elective readmissions - Q1 2010/11, DAD, CIHI
Percentage ALC days: Total number of inpatient days designated as ALC, divided by the total number of
inpatient days. Q2 2010/11, DAD, CIHI
CDI rate per 1,000 patient days: Number of patients newly diagnosed with hospital-acquired CDI, divided by
the number of patient days in that month, multiplied by 1,000 - Average for Jan-Dec. 2010, consistent with
publicly reportable patient safety data
Reduce wait times in the ED
ER Wait times: 90th percentile ER Length of Stay for Complex conditions. Q3 2010/11, NACRS, CIHI
Pressure Ulcers: Percent of complex continuing care residents with new pressure ulcer in the last three
months (stage 2 or higher) - FY 2009/10, CCRS
VAP rate per 1,000 ventilator days: the total number of newly diagnosed VAP cases in the ICU after at least
48 hours of mechanical ventilation, divided by the number of ventilator days in that reporting period,
multiplied by 1,000 - Average for Jan-Dec. 2010, consistent with publicly reportable patient safety data
QIP
+ Provincial &
LHIN context=
2013/14 Goals
• Reduce Total conservable days by
12% to 16,476 days (20%)
• Hand Hygiene compliance (all
moments) of 100% by March 31,
2013 and 80% for entire year (10%)
• Reduce Severe and Critical events
by 26% to 22 or less (5%)
•HSMR <= 94 for last 4 quarters
• Unplanned readmits <= 14%
• Increase Employee
Engagement by 10% to
66.2% (10%)
• Increase Physician
Engagement by 10% to
65.7% (10%)
•Reduce New Lost time
days to 282 or less
•Improve Patient satisfaction to
94% (5%)
•Meet provincial target for
wait times x% of the time:
- ED 90% (10%)
- Surgical 82% (5%)
- DI 88% (5%)
• Total Margin >= 0.8%
($1.5 M) (20%)
•LEAN projects and ROI
Quality
35%
People
20%
Service
25%
Partnerships
Operational
Efficiency
20%
2013/14 Goals (Draft)
• Patient Experience as measured by
% Excellent (20%)
• Conservable Days (10%)
• ED Throughput Times (10%)
• Overall rating of care
• HSMR ≤ 94 for last 4 quarters
• Unplanned readmits ≤ 14%
• Employee Experience
(15%)
• Physician Experience
(15%)
• Partner/community
engagement measure (15%)
• Total Margin ≥ 0.8%
($1.5 M) (15%)
• LEAN Projects and ROI
Quality &
Service
40%
People
30%
Partnerships
15%
Patients & Families
Operational
Efficiency
15%
2013/14 Targets
• Improve Patient Experience as
measured by % Excellent Score by
9.5% to a rate of 45% (20%)
• Reduce Conservable Days by 4%
to 18,630 days (10%)
• Improve ED Throughput Times by
6% to meet Provincial Targets 93%
of the time (10%)
• Overall rating of care by patients of
> 94%
• HSMR ≤ 89 for last 4 quarters
• Improve Employee
Experience by 5 to 10
points (15%)
• Physician Experience
by 5 to 10 points (15%)
• Reduce unplanned
readmission rate for selected
CMGs by 15% to a rate of
15.40% (15%)
• Total Operating Margin
≥ 0.8% ($1.5 M) (15%)
• LEAN Projects and ROI
Quality &
Service
40%
People
30%
Partnerships
15%
Patients & Families
Operational
Efficiency
15%
From Board to front line
Other tools and behaviour
Leader Evaluation Manager®
Rounding with purpose
AIDET/Key Words at Key Times
PDCA
Values based (Ownership)
Vision
To be recognized as the best hospital in Canada and an active partner in the best community health care system in the country
16
Mission
Exceptional people working together to provide outstanding care in Algoma
For Our Patients… Patient satisfaction – now focused on % Excellent!
84.0
85.0
86.0
87.0
88.0
89.0
90.0
91.0
92.0
93.0
94.0
95.0
Baseline 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14*
1
1.5
2
2.5
3
3.5
4
4.5
5
5.5
6
2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14*
For Our Patients…
MRI wait times among SHORTEST in the Province!
ED throughput times reduced 54%!
For Our Patients… HSMR - continual improvement in Quality
60
70
80
90
100
110
120
130
2007/08 2008/09 2009/10 2010/11 2011/12 2012/13
For Our Patients…reduced infections
HAI down 68% from baseline
C. Diff down 89% Cost avoided/saved
$7.2 MILLION*
* Public Health Agency of Canada website. $13,973 per HAI (1999/2000)
For Our Patients…High Quality Hospital
Accreditation With Commendation in 2013
98.2% achievement on over 2,000 standards
Ontario Lab Accreditation in October 2013
97% compliance, including 100% Point of Care Testing
20
25
30
35
40
45
50
55
60
Baseline Now
20
30
40
50
60
70
80
Baseline Now
For Our People… Employee – overall satisfaction
with organization.
Up 46%
Physician – overall satisfaction as a place to practice.
Up 67%!
0
10
20
30
40
50
60
70
2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14
For Our People… Lost time injuries reduced by 81%! First ever NEER Rebate.
$7.9 MILLION+
saved*
*$24K/incident per WSIB + NEER savings
For Our People and Operating Efficiency… Annual overtime and sick-time reduced by 22%.
-
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
8,000,000
2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14*
$8 MILLION saved!
For the Health of Our Organization…
Operating deficits to sustainable SURPLUSES! Balance sheet strengthened INVESTING in health care through Innovation
(15,000)
(10,000)
(5,000)
-
5,000
10,000
15,000
20,000
25,000
2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14*
For Our Community - New Hospital Celebrated our 3rd anniversary on March 6, 2014
On budget and ahead of schedule
Beyond all expectations and getting better!
Largest fundraising per capita
Back to the “why” We have much of which to be proud
It all starts with our people and is for our patients
$-
$5,000,000
$10,000,000
$15,000,000
$20,000,000
$25,000,000
Investments Return
Return On Investment
Conservative
Part of the solution
Great people are key!
Plus $45 MILLION of working capital relief funding!
820% ROI!