Pam Beitlich, RN, MSNStuder Group

September 16, 2010

Hardwiring Excellence A Foundation to Get There

Hardwiring Excellence A Foundation to Get There

Commit To Being An “Excellent” Adult Learner

Silence cell phones/beepersBe totally present; engageListen as if you were going to teach itWrite/draw/diagramParticipate: laugh, snort, question Relate vs. compareOwn it

Why are we here today?

Understand the foundational principles of Hardwiring Excellence

Take away 3 things that you can begin immediately in your workplace

The Foundation-

Bottom-line Results – Everyone has a role(Balanced Scorecard)

Service Quality People Finance Growth Community

Reduced claims

Reduced legal expenses

Reduced malpractice expense

Physician Satisfaction

Patient Satisfaction

Improved clinical outcomes – decreased nosocomial infections

Reduced medically unnecessary days and delays

Reduced re-admits

Reduced medication errors

Reduced turnover

Reduced vacancies

Reduced agency costs

Reduced overtime

Reduced physicals & cost to orient

Improved operating income

Decreased cost per adjusted discharge

Improved collections

Reduced accounts receivable days

Reduced advertising costs

Higher volume

Increased revenue

Decreased left without treatment in the ED

Reduced outpatient no-shows

Increased physician activity

Increased Philanthropy

Nine Principles®

Commit To Excellence

Build A CultureAround Service

Measure TheImportant Things

Create And DevelopGreat Leaders

Focus On EmployeeSatisfaction

Build IndividualAccountability

Recognize AndReward Success

CommunicateAt All Levels

Align Behaviors With Goals And Values

Must Haves®

Aligning Leader Evaluations with Desired Outcomes

Rounding for Outcomes

Employee Thank You Notes

Employee Selection and the First 90 Days

Pre and Post Phone Calls

Key Words at Key Times

Purpose, worthwhile work

and makinga difference

®

Healthcare Flywheel®

Bottom Line Results

(Transparency and Accountability)

Self-Motivation

Prescriptive To Do’s

Courage

Execution Winning

Standardization AcceleratorsMust Haves®

Performance Gap

Objective Evaluation

System

Leader Development

Foundation Breakthrough

STUDER GROUP®:

Rev 6.7.10

Agreed upon tactics and behaviors to achieve goals

Rounding for Outcomes: (10pts)

Thank you notes: (2 pts)

Selection and the First 90 Days (8 pts)

Key Words at Key Times (5 pts)

Post Phone Calls (10 pts)

Re-recruit high and middle performers

Move low performers up or out

(12 pts)

Processes that are consistent and standardized throughout the company

(8 pts)

Leader Eval ManagerTM

Patient Call Manager TM

Aligned Goals Aligned Behavior Aligned ProcessCreate process to assist leaders in developing skills and leadership competencies necessary to attain desired results

(15 pts)

Implement an organization-wide staff/leadership evaluation system to hardwire objective accountability (Must Haves®)

(30 pts)

Evidence-Based LeadershipSM

Case Study

Journey of achieving personal and organizational excellence

Becomingthe leader

I’ve alwaysdreamed of

Why I Care About Making a Difference

Building a Culture of Excellence

A “Roadmap”

Creating a great place for employees to work, physicians to practice,

and patients to receive care

Creating a great place for employees to work, physicians to practice,

and patients to receive care

A Culture of Excellence

Attracts and retains talentAchieves excellent clinical outcomesSparks employee generated ideasPerception of care high level – “would recommend”Grows according to planFinancially outperforms competition

The Knowing – Doing Gap

There is a huge gap between knowing the importance of operational excellence - and doing it every day.  What kind of culture do you really want to create and keep at your organization?”  

Strategic Direction

“To be the best health care organization in

the country”

Word of Mouth

66% of healthcare choice decisions are based on

word of mouth

AHA Reality Check II, AHA, 1998

A Simple ConceptA Simple Concept

“If the other guy’s getting better,

then you’d better be getting

better faster than that other

guy’s getting better . . . or

you’re getting worse.”-- Tom Peters

The Circle of Innovation

CEO’s Top Issues- 1998

Building / Expanding /Renovating

Developing new services / Diversifying business lines

Merging /Consolidating

Developing a medical services organization

Controlling costs

Forming a physician-hospital organization

Re-engineering clinical services

Recruiting physicians

Upgrading technology / Information systems

Re-engineering business processes

12%

13%

50%

54%

58%

82%

85%

88%

88%

91%

99%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Integrating system / Forming a provider network

AHA News, March 9, 1998

CEO’s Top Issues – 2003

Biodisaster Preparedness

Capacity

Patient Safety

Technology

Quality

Governmental Mandates

Malpractice Insurance

Physician/Hospital Relations

Reimbursement

Care for the Uninsured

1%

7%

9%

12%

17%

18%

24%

26%

26%

28%

58%

73%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Personnel Shortages

American College of Healthcare Executives, Nov 26, 2003, CEO Survey Reveals Top Issues Facing Hospitals

Patient Satisfaction

Care for the uninsured

Technology

Capacity

Patient satisfaction

Governmental mandates

Personnel shortages

Financial challenges

Physician-hospital relations

1%

2%

9%

16%

22%

26%

30%

32%

43%

77%

41%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Patient safety and quality

American College of Healthcare Executives, 2008, Annual CEO Survey of Top Issues Confronting Hospitals

CEO’s Top Issues – 2008

Constant for years

Moves up and down

Issues about not-for-profit status

Disaster preparedness

Series1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

1%2%

7%

7%

13%15%

25%30%

32%37%

53%76%

January 11 Modern Healthcare, American College of Healthcare Executives, 2009 Annual CEO Survey of Top Issues Confronting Hospitals; 525 Hospital CEOs

CEO’s Top Issues - 2009

Constant for years

Moves up and down

Care for the Uninsured

Technology

Capacity

Patient Satisfaction

Physician Hospital Relations

Governmental Mandates

Financial Challenges

Patient Safety and Quality

Healthcare Reform Implications

Governance

Disaster Preparedness

Personnel Shortages

New update

One Hospital’s Journey…

Leadership Meetings

No more turkeys

Can We Change the World?

“To be the best Community Hospital and Health System

in the United States”

To be“The best place to work,

practice medicine and be a patient”

Focus on Measurements

Patient Satisfaction

Staff Satisfaction

Physician Satisfaction

Quality/Safety

Financials

Beginning of “No-Secrets” Culture

Standards of Behavior

Always Make a Positive ImpressionMake Communication EffectivePractice Professionalism/TeamworkDevelop and Use Service Recovery

In 2006, added:Patient Safety Standard for ALL staff

It’s all about the leader…

Every single one of them

“If you want to change the world, you have to start with yourself.”

Great Organizations -

Have leaders who model behaviors that positively influence employee perceptionsConstructively coach others to increase their skill levelMentor new leadersShare lessons learned

What differentiates your organization from your

competitors?

Rude – Good - Memorable

Good or Great?

Service is Married to Quality…

99thPercentileHospital

64thPercentileHospital

1’s 2’s 3’s 4’s 5’s

1% 2% 7% 24% 66%

1% 2% 8% 34% 55%

2% 2% 8% 36% 52%35thPercentile

Reference: Sample distribution of inpatient satisfaction score responses to achieve excellence, Press Ganey and Associates, March 2007

Let’s look at Service – 4 vs 5 Top Box Loyalty

HCAHPS Recommendations

HCAHPS CATEGORY TACTIC TO MOVE OUTCOME

Doctors always communicated well Physician Note Pad

Nurses always communicated well Hourly Rounding

Pain was always well controlled Hourly Rounding

Patients always received help as soon as they wanted Hourly Rounding

Staff always explained about medicines before giving them to patients Key Words at Key Times

Yes, patients were given information about what to do during their recovery Post Visit Phone Call

Patients who gave a rating of 9 or 10 Leader Rounding on patient

Yes, Patients would definitely recommend the hospital Post Visit Phone Call

Percentile Rank ComparisonHow do Studer Group Partners Compare vs. Non Partners

The graph below shows a comparison of the average percentile rank for Studer Group Partners that have received EBL coaching since 2007 and non-partners for each composite. HCAHPS results are for patients discharged between July 2008 and June 2009. It is sorted to show composites with the highest Studer Group partner average percentile rank on top.

+22% +24% +26% +20% +18% +13% +7% +9% +7% +6%

Must Haves®

Aligning Leader Evaluations with Desired Outcomes

Rounding for Outcomes

Employee Thank You Notes

Employee Selection and the First 90 Days

Pre and Post Phone Calls

Key Words at Key Times

What is Rounding with Outcomes?

Proactively, engaging, listening to, communicating with, building relationships with and supporting your most important customers (employees, family, patients, physicians, and other departments)

Rounding for Outcomes is NOT…

The proverbial wave

Management by wandering around

Focused on “what’s wrong”

Being “out there”

Happenstance

Rounding Works

Rounding will have the biggest impact on your employee and customer satisfaction results

Builds the team – elevates performance

Breaks down barriers, fixes systems, ensures right tools and equipment are in place

Emphasizes the positive instead of negative

Turnover and Vacancy Rate New update

FY10 Goal

1Q FY10TD(annualized)

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

10.0%

5.5%

Turnover

Perc

entil

e

FY10 Goal

1Q FY10TD(annualized)

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

8.0%

4.2%

Vacancy Rate

Perc

entil

e

Source: Florida Hospital System, Admissions=69,107 Total beds = 1,218

Employee Satisfaction Increase

Source: South Carolina Hospital, Admissions=25,837 Total beds = 594, vendor = PRC

2009

Overall RSFH 99%tile

Corporate Services 100%tile

Bon Secours St. Francis

99%tile

Roper 99%tile

 When leaders provide follow up on rounding at their staff meetings, they should say:

“During the past 30 days, I have rounded on 32 employees.

As a result of my rounding we have been able to acquire 3 blood pressure cuffs, 2 key boards, as well as rework the supply cabinet.  

I also was able to recognize 10 individuals that you suggested receive recognition. Thank you for your help.”

Round With Patients

Set clear expectations

Focus on key questions

Outline what to do if

problems are discovered

Closing statement

Reward and recognize staff

Questions for Patients

Do you know your nurse’s and CNA's name today?Do you know your schedule?How has your nursing care been?Have we managed your pain well?Do you have any concerns or questions?

Leader Rounding on Patients“Did a Nurse Manager Visit You During Your Stay?”

Overall Nurses Section Response to Concerns/

Complaints

Likelihood to Recommend

0102030405060708090

100 81

9094

87

914

1

13

Yes

No

Tactic and Tool Implemented:

Leader Rounding

Per

cen

tile

Source: Arizona Hospital, Total beds = 355, Employees = 4,000, Admissions = 10,188; updated 2Q2010

n= 608

n= 106

n= 604 n= 561 n= 601

n= 104 n= 96 n= 105

New update

Financial Impact

Metric Impact Reduction

Falls Quality 50%

Decubitus Ulcers Quality 14%

First Year Turnover People 66%

Readmissions Growth 33%

No Shows Growth 70%

Tardies Growth 60%

Call Lights People 38%

Must Have #6 - Key Words

Things said and done to “connect the dots” and help patients, staff and physicians understand why we do things and

what is going on

Studer Group Five Fundamentals - AIDETSM

A Acknowledge

I Introduce

E Explanation

T Thank You

D Duration

Managing Up

Positioning Others in a Positive Light . . .

Makes you better

Makes your organization better

Aligns everyone

The Great Erasers

“We’re short-staffed”“Can’t; But; No; Our policy”“That’s not my patient”“You know how Administration is around here”“That’s not my job (problem)”“I can’t believe they kept you waiting so long”“No one told me you were here”“We have real emergencies ahead of you”“We can’t get good help”

Health Care Initiatives Have Not Been Sustained . . .

Why Organizations Do Not Achieve Desired Results

1. Dots are not connected consistently to purpose, worthwhile work and making a difference

2. Do not achieve critical mass - Lack of balanced approach

3. Absence of an objective accountability system

4. Leaders do not have the training to be successful

5. Too many new behaviors introduced at once – need for sequenced approach

6. No process in place to re-recruit the exceeding and achieving performers and address low performers (HML)

7. Inability to take best practices and standardize across organization

8. Failure to have leaders “always” do desired behaviors

Rev 3.08

Studer Group – Lessons learnedSince 2000

Objective evaluation is the sustainer

Sequencing of tools are vital

One should not move on to the next tool/tactic if the preceding tool/tactic is not hardwiredSM

Difference between cookie-cutter approach and evidenced-based leadershipSM

This is a lot harder than anyone thought – Why? Trying to align behavior of more

people than other initiatives As your organization improves,

inconsistencies become apparent Non-documented performance

issues It is not a patient satisfaction/service excellence program. It is putting into place an operational framework for: Alignment of resources Accountability of people Execution/Implementation of plans

and processes

“Everything Rises and Falls on Leadership”

The only legacy we leave behind is to those

we teach-Quint Studer

It is all about Results…

Series1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

1%2%

7%

7%

13%15%

25%30%

32%37%

53%76%

January 11 Modern Healthcare, American College of Healthcare Executives, 2009 Annual CEO Survey of Top Issues Confronting Hospitals; 525 Hospital CEOs

CEO’s Top Issues - 2009

Constant for years

Moves up and down

Care for the Uninsured

Technology

Capacity

Patient Satisfaction

Physician Hospital Relations

Governmental Mandates

Financial Challenges

Patient Safety and Quality

Healthcare Reform Implications

Governance

Disaster Preparedness

Personnel Shortages

New update

Consider…

What do you want to be known for?

Do you create memories for your patients?

Can you be exceptional or extraordinary?

Leaders capture the hearts and minds of their staff…

“You cannot lead by hitting people over the head –

that is assault, not leadership.”

– Dwight Eisenhower

You must keep raising the bar

– everyone else is

Connect to Purpose…

Our patients depend on us and we depend on you. Yours might be the first face they see when they come through our door. Yours might be the voice they hear right after a surprise diagnosis. Yours might be the eyes they look into as they

are pushed in a wheelchair to a frightening procedure. Your attitude reflects us and

everything we are proud of in this organization. You have chosen to help serve our patients and

we appreciate you. Thank you.

~ Quint Studer ~~ Quint Studer ~

Never Underestimate the Difference You

Can Make

Never Underestimate the Difference You

Can Make

Thank You!

Pam Beitlich

www.studergroup.com

(850) 934-1099