Shared Governance in Action – Quality Panel Dialogue Randy Axelrod, MD—Executive Vice President, Clinical and Patient Services

Shared governance in action Providence Health & Services | 2014 SHARED GOVERNANCE ANNUAL REFRESHER Panelists: Chuck Watts, MD, System Board Quality Committee Chair-elect Doug Watson, CMB Chair, Providence Senior & Community Services (PSCS) Robert Hellrigel, SVP & Chief Executive, PSCS Rick Waller, MD, Vice Chair, Oregon Region CMB Doug Koekkoek, MD, Regional CMO, Oregon Region Moderator: Randy Axelrod, MD, EVP Clinical/Patient Services

Highlighting Select Shared Governance Themes Engaging our clinicians Clinical privileges and credentials Quality and safety across the care continuum PH&S Board Quality & Patient Safety Committee Providence Health & Services | 2014 SHARED GOVERNANCE ANNUAL REFRESHER

Utilizing “Expert to Expert” collaboration across clinical areas and care operations is how and where we start clinical transformation Providence Health & Services | 2014 SHARED GOVERNANCE ANNUAL REFRESHER Clinical priorities Cancer Cardiovascular Musculoskeletal Neurosciences Women's and Children's Care operation priorities Critical Care Imaging Lab Pharmacy Surgery

Clinical Focus Groups are driven by the clinicians, staffed with Portfolio Director and project managers and facilitated by robust information. Each focus group has a physician and executive lead the work Providence Health & Services | 2014 SHARED GOVERNANCE ANNUAL REFRESHER

Challenge questions are designed to emphasize the key opportunities Resource Costs – What areas can we identify cost savings through preferred selection and contracting? Care Pathways and Quality – What guidelines can be rapidly adopted to limit variation and improve clinical outcomes and patient experience? Innovation, Technology and Research – How should we assess new technology and research opportunities? Advanced Care Models – What opportunities exist to “package” our care and change our reimbursement models to our market and communities Population Health and Prevention – What programs should we promote to improve the overall state of CV care and population health? Epic and Data – What are the data and support needs to improve outcomes? Providence Health & Services | 2014 SHARED GOVERNANCE ANNUAL REFRESHER

Clinical privileges Case example: Privileging for robotic surgery Shared governance topics: – Adjudication of local resistance to system-developed standards – Consideration of stewardship implications beyond local geographic boundaries Providence Health & Services | 2014 SHARED GOVERNANCE ANNUAL REFRESHER

Quality & Safety across the continuum Case example: Supporting regional efforts to reduce hospital readmissions Shared governance topics: – Who owns “quality” in the continuum? – Maintaining open, effective communication and priority setting Providence Health & Services | 2014 SHARED GOVERNANCE ANNUAL REFRESHER

PH&S Board Quality & Safety Committee Monitor how we move quality, safety, and innovation across critical areas of patient care and clinician engagement – moving from concept to “hard-wiring” Facilitate expert to expert coordination across all of our CMBs Assist our leadership with coordination of key relationships and enabling capabilities to optimize and highlight all CMBs efforts Providence Health & Services | 2014 SHARED GOVERNANCE ANNUAL REFRESHER

Table Discussion How are these and other shared governance challenges being discussed within your regions? What are the barriers CMB members and management will need to address to ensure success? How can we facilitate these issues? – “1-2-4-All” approach – By yourself – 2 minutes – In a pair – 3 minutes – As a table – 5 minutes Report out top 1-2 Providence Health & Services | 2014 SHARED GOVERNANCE ANNUAL REFRESHER