#HASummit14 Session #23: $74M in Healthcare Operational Improvements: How Texas Children’s Hospital Is Delivering on its Vision Mark Mullarkey, Senior Vice President Pre-Session Poll Question On a scale of 1-5, how effectively is your organization using healthcare analytics to drive operational improvements? 1)Not at all effective 2)Somewhat effective 3)Moderately effective 4)Very effective 5)Extremely effective 6)Unsure or not applicable

#HASummit14 2 Texas Children's Hospital, located in Houston, Texas, is a not-for- profit organization whose mission is to create a healthier future for children and women throughout our global community by leading in patient care, education, and research. We are proud to be consistently ranked among the top children’s hospitals in the nation.

#HASummit14 Our Improvement Opportunity In 2006 Texas Children’s Hospital (TCH) launched a health system wide initiative named “Vision 2010” that included $1.5B investment in expansion and IT. Upon completion in early 2012, TCH identified the need to improve financial performance of the health system by over $50M:  Federal and state funding reductions driving most of this gap.  Higher margins crucial for replenishing capital and expanding TCH facilities.  Competitive threats driving expected gap closer to $75M. 3

#HASummit14 Our Improvement Opportunity 4

#HASummit14 Delivering on the Vision (DOTV) “Delivering on the Vision” (DOTV) became the operational improvement effort following TCH’s rapid facility expansion. To achieve DOTV, TCH would need to improve the quality of patient care, increase revenues, and reduce costs. TCH strategy for DOTV encompassed several efforts. Goal: To close an anticipated >$70 million gap. The common denominator in these efforts was a need for sustained, transparent, easily visualized data, and measurement. 5

#HASummit14 Our Approach and Results 6

#HASummit14 Use of Analytics to Hardwire for Success 7 Labor Expenses Non-Labor Expenses Physician Services (Provider productivity, Practice management) Clinical Operations/LOS Clinical Documentation Improvement EDW Platform Focus on improving performance in every key operational area

#HASummit14 Poll Question #2 8 What is your organization currently leveraging analytics for? (Select all that apply.) a)Provider productivity and practice management b)Financials (statement of operations, revenue cycle management, labor productivity, etc.) c)Patient satisfaction d)Clinical quality improvement (reduction in sepsis mortality, lower CHF readmissions, etc.) e)Operational efficiencies (LOS, throughput, etc.) f)Other

#HASummit14 9 Improved Schedule Template Utilization

#HASummit14 10 Improving Operational Efficiencies

#HASummit14 Surgical Sections – Y/Y Change in wRVU per cFTE 11 The Pediatric Surgery Sections reflect a marked improvement in provider productivity by comparison to both the prior year and the 50 th percentile benchmark

#HASummit14 Medical Sections – Y/Y Change in wRVU per cFTE 12 The Medical Sections reflect a marked improvement in provider productivity by comparison to both the prior year and the 50 th percentile benchmark

#HASummit14 Labor Expenses – Results 13

#HASummit14 Length of Stay – Results aaa 14 LOS up 7.5% CMI up >11% Severity adjusted LOS down 20%

#HASummit14 Success with Clinical Documentation Improvement Drives SOI and CMI Up 15

#HASummit14 DOTV Results FY13 the hospital had an operating margin of $70.2M on a budget of $42.5M; a $79.9M improvement from prior year. FY14 the hospital finished the year at $77M. FY15 the hospital is projected to approach near $90M in operating margin. 16

#HASummit14 Future Plans Continue to broaden the use of healthcare analytics in support of a growing number of improvement efforts designed to achieve higher-quality care, reduced costs, and a better patient experience. 17

#HASummit14 18 Lessons Learned Clear Focus  Specific Goals  Prioritization of initiatives  Targeted improvement strategies  Time sensitive Consistent Approach  Data driven - hardwired  Process improvement strategies (PDSA)  Best practices  Governance structure Cultural Alignment  Patient-focused access  Questioning attitude  Fiscal stewardship  We can do more and better Right People  Physician Engagement  Admin & MD Alignment  Internally Driven  External experts Improved Patient Experience & Financial Performance The key ingredients driving our success…

#HASummit14 Analytic Insights A Questions & Answers 19

#HASummit14 Choose one thing… 20 Write down one thing will you do differently after hearing this presentation

#HASummit14 Thank You 21

#HASummit14 22 Session Feedback Survey 1.On a scale of 1-5, how satisfied were you overall with this session? 1)Not at all satisfied 2)Somewhat satisfied 3)Moderately satisfied 4)Very satisfied 5)Extremely satisfied 2.What feedback or suggestions do you have?

#HASummit14 Upcoming Sessions Breakout Sessions – Wave 4 (1:15 PM – 2:00 PM) 26)Panel – How Community Hospitals Thrive with Analytics John Wadsworth, Vice President, Technical Operations, Health Catalyst 27)Quality Improvement in Healthcare: An ACO Palliative Care Case Dr. Robert Sawicki, MD, Senior Vice President, Supportive Care, OSF Healthcare Roopa Foulger, Executive Director, Data Delivery, OSF Healthcare Linda Fehr, RN, Division Director, Supportive Care, OSF Healthcare 28)Clinical Standards Work To Improve Evidence-Based Care Delivery: A How-To Workshop Charles Macias, MD, MPH, Chief Clinical Systems Integration Officer, Texas Children’s Hospital Terri Brown, MSN, RN, CPN, Assistant Director, Clinical Outcomes & Data Support; Research Specialist, Center for Research and EBP, Texas Children’s Hospital 29)Five Months to Improvement: How Stanford Built an Improvement Program the Gets Results Spencer H. Kubo, MD, Associate Professor of Radiology (Pediatric Radiology), Stanford University Medical Center 30)Breaking Down Silos: Resolving Academic, Medical, and Research Interests Once and for All Samuel L. Volchenboum, MS, MD, PhD, Assistant Professor of Pediatrics, Director, Informatics Program, The University of Chicago Medicine) 23 Location Imperial Ballroom B Imperial Ballroom A Grand Salon Murano Venezia