Pam Beitlich, RN, MSN Studer Group September 16, 2010 Hardwiring Excellence A Foundation to Get There Pam Beitlich, RN, MSN Studer Group September 16, 2010

Commit To Being An “Excellent” Adult Learner Silence cell phones/beepers Be totally present; engage Listen as if you were going to teach it Write/draw/diagram Participate: laugh, snort, question Relate vs. compare Own 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) Meeting Title Here (on Notes Master) 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 www.studergroup.com © 2009 Studer Group®

Nine Principles® Commit To Excellence Build Individual Accountability Measure The Important Things Align Behaviors With Goals And Values Build A Culture Around Service Communicate At All Levels Create And Develop Great Leaders Recognize And Reward Success Focus On Employee Satisfaction

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 making a difference Healthcare Flywheel® Bottom Line Results (Transparency and Accountability) Winning Execution Prescriptive To Do’s Purpose, worthwhile work and making a difference ® Self-Motivation Courage

Evidence-Based LeadershipSM Rev 6.7.10 Meeting Title Here (on Notes Master) Breakthrough Foundation STUDER GROUP®: Objective Evaluation System Leader Development Must Haves® Performance Gap Standardization Accelerators Aligned Goals Aligned Behavior Aligned Process Implement an organization- wide staff/leadership evaluation system to hardwire objective accountability (Must Haves®) (30 pts) Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results (15 pts) 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 www.studergroup.com © 2009 Studer Group®

Meeting Title Here (on Notes Master) Case Study Meeting Title Here (on Notes Master) Journey of achieving personal and organizational excellence Becoming the leader I’ve always dreamed of www.studergroup.com © 2008 Studer Group

Why I Care About Making a Difference

Building a Culture of Excellence A “Roadmap”

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 talent Achieves excellent clinical outcomes Sparks employee generated ideas Perception of care high level – “would recommend” Grows according to plan Financially 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?”   Now there is not that much “new” and exciting in this. In fact, there are over 9,000 articles on the internet about customer service. But as one of my favorite CEO’s says here There is a huge gap between knowing or believing in something and doing it every day.

“To be the best health care organization in the country” Strategic Direction “To be the best health care organization in the country”

choice decisions are based on word of mouth 66% of healthcare choice decisions are based on word of mouth AHA Reality Check II, AHA, 1998

A 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

Integrating system / Forming a provider network CEO’s Top Issues- 1998 Upgrading technology / Information systems Integrating system / Forming a provider network Developing new services / Diversifying business lines Re-engineering business processes Recruiting physicians Re-engineering clinical services Forming a physician-hospital organization Controlling costs Developing a medical services organization Merging /Consolidating Building / Expanding /Renovating AHA News, March 9, 1998

CEO’s Top Issues – 2003 Reimbursement Personnel Shortages Capacity Care for the Uninsured Physician/Hospital Relations Malpractice Insurance Governmental Mandates Quality Technology Patient Safety Patient Satisfaction American College of Healthcare Executives, Nov 26, 2003, CEO Survey Reveals Top Issues Facing Hospitals Biodisaster Preparedness

CEO’s Top Issues – 2008 Constant for years Moves up and down Financial challenges Patient safety and quality Care for the uninsured Physician-hospital relations Personnel shortages Moves up and down Governmental mandates Patient satisfaction Capacity Technology Issues about not-for-profit status Disaster preparedness American College of Healthcare Executives, 2008, Annual CEO Survey of Top Issues Confronting Hospitals

Meeting Title Here (on Notes Master) CEO’s Top Issues - 2009 Meeting Title Here (on Notes Master) New update Constant for years 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 Moves up and down January 11 Modern Healthcare, American College of Healthcare Executives, 2009 Annual CEO Survey of Top Issues Confronting Hospitals; 525 Hospital CEOs www.studergroup.com © 2009 Studer Group®

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 Impression Make Communication Effective Practice Professionalism/ Teamwork Develop 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 perceptions Constructively coach others to increase their skill level Mentor new leaders Share lessons learned

What differentiates your organization from your competitors? Good or Great? What differentiates your organization from your competitors? Rude – Good - Memorable

Service is Married to Quality…

Let’s look at Service – 4 vs 5 Top Box Loyalty 99th Percentile Hospital 64th 1’s 2’s 3’s 4’s 5’s 1% 2% 7% 24% 66% 8% 34% 55% 36% 52% 35th Percentile Reference: Sample distribution of inpatient satisfaction score responses to achieve excellence, Press Ganey and Associates, March 2007

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 Patients always received help as soon as they wanted 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

Meeting Title Here (on Notes Master) Percentile Rank Comparison How do Studer Group Partners Compare vs. Non Partners Meeting Title Here (on Notes Master) 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% +6% Studer Group Average includes EBL partners since 2007 Non-partner Average includes all hospitals in the Hospital Compare database with 300 or More Survey Responses www.studergroup.com © 2010 Studer Group

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

Employee Satisfaction Increase Meeting Title Here (on Notes Master) 2009 Overall RSFH 99%tile Corporate Services 100%tile Bon Secours St. Francis Roper Source: South Carolina Hospital, Admissions=25,837 Total beds = 594, vendor = PRC www.studergroup.com © 2009 Studer Group®

 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?

Meeting Title Here (on Notes Master) Leader Rounding on Patients “Did a Nurse Manager Visit You During Your Stay?” Meeting Title Here (on Notes Master) New update n= 608 n= 604 n= 561 n= 601 Tactic and Tool Implemented: Leader Rounding Percentile n= 106 n= 104 n= 96 n= 105 Source: Arizona Hospital, Total beds = 355, Employees = 4,000, Admissions = 10,188; updated 2Q2010 www.studergroup.com © 2009 Studer Group®

Meeting Title Here (on Notes Master) Financial Impact Meeting Title Here (on Notes Master) Metric Impact Reduction Falls Quality 50% Decubitus Ulcers 14% First Year Turnover People 66% Readmissions Growth 33% No Shows 70% Tardies 60% Call Lights 38% www.studergroup.com © 2009 Studer Group®

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 Acknowledge I Introduce D Duration E Explanation T Thank You

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 Rev 3.08 Dots are not connected consistently to purpose, worthwhile work and making a difference Do not achieve critical mass - Lack of balanced approach Absence of an objective accountability system Leaders do not have the training to be successful Too many new behaviors introduced at once – need for sequenced approach No process in place to re-recruit the exceeding and achieving performers and address low performers (HML) Inability to take best practices and standardize across organization Failure to have leaders “always” do desired behaviors

Studer Group – Lessons learned Since 2000 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 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

“Everything Rises and Falls on Leadership”

The only legacy we leave behind is to those we teach -Quint Studer

It is all about Results…

Meeting Title Here (on Notes Master) CEO’s Top Issues - 2009 Meeting Title Here (on Notes Master) New update Constant for years 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 Moves up and down January 11 Modern Healthcare, American College of Healthcare Executives, 2009 Annual CEO Survey of Top Issues Confronting Hospitals; 525 Hospital CEOs www.studergroup.com © 2009 Studer Group®

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.

Never Underestimate the Difference You Can Make ~ Quint Studer ~

Pam Beitlich www.studergroup.com (850) 934-1099 Thank You! Pam Beitlich www.studergroup.com (850) 934-1099