Hardwiring Leader Evaluations Flagler Hospital Bill Bielenda www.studergroup.com © 2010 Studer Group

What you will learn today… Importance of leader accountability and goal alignment How to develop effective goals The basics on accountability tools

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

Execution Framework Evidence-Based LeadershipSM Meeting Title Here (on Notes Master) Rev 4.8.11 Execution Framework Evidence-Based LeadershipSM 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®) Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results Agreed upon tactics and behaviors to achieve goals Re-recruit high and middle/solid performers Move low performers up or out Processes that are consistent and standardized Process Improvement PDCA Lean Six Sigma Baldrige Framework Software Second most important foundational slide next to flywheel is this slide focusing on the execution framework – Evidence-based leadership. Process improvement, re-engineering, etc. This is not a stand alone item – it will not get you there. We focus a lot on the aligned goals (dark blue) and Aligned Behavior (yellow) Aligned Behavior: Tactics and Behaviors Dealing with low performance Aligned Goals: Biggest miss is aligning goals. Don’t evaluate on competency….but rate on outcomes. Is your evaluation system outcome oriented and weighted? Skill/Leader Training: Key part of outcomes and success. www.studergroup.com © 2009 Studer Group®

Meeting Title Here (on Notes Master) Comparison of those organizations that have the leader evaluation process hardwired and those that do not Source: Studer Group® October 2008 Measurement Spreadsheet; Organizations that hardwire the leader evaluation process in their organization, show patient perception of care ratings that are significantly higher than those that do not. Patient perception of care mean score average includes all partner selected vendors including Arbor, Avatar, Gallup, HCAHPS, Healthstream, Jackson, NRC, PRC Picker, Press Ganey, RPM, and Statisquest. www.studergroup.com © 2009 Studer Group®

Meeting Title Here (on Notes Master) Year 1 – Goals Issue Reduce Costs / Improve Financial Performance Provider of Choice (patient satisfaction) Employer of Choice (employee satisfaction) Improve Care (Quality, Safety, Effectiveness) Information Management Goals Achieve financial margins of: 4.0% in FY ’06 YTD 4.6% more detail> 5.0% in FY ‘07 Achieve organization-wide average patient satisfaction scores of: 93.7 for “Overall quality of care/services” YTD 93.5 76.1 for “Would you recommend” YTD 73.5 Reduce overall turnover of: “permanent” positions to11% YTD 14% more detail> “permanent” core RN positions to 13% YTD 16% Achieve 90% compliance with CMS measures: Community Acquired Pneumonia 3>90% - 5<90% Surgical Infection Prevention 1 >90% - 2<90% Heart Failure 2>90% - 2<90% Acute Myocardial Infarction 5>90% - 2<90% Achieve 90% compliance with evidence-based practice for prophylaxis of the following: DVT/PE, Post-op UTI, Post-op Pneumonia, Post-op AMI, Pressure Sores, Post-op Sepsis Implement Employee Satisfaction Assessment process during 2005 Create projected timeline for the implementation of the Advanced Point of Care (APOC) clinical system Here is an example of goals and results from an organization. Note the low performance of many of the goals. www.studergroup.com © 2009 Studer Group® 6

Leader Evaluation Results – Year 1 Meeting Title Here (on Notes Master) Leader Evaluation Results – Year 1 Even though this organization was not achieving the 2006 goals, note that when you look at their leader evaluation results, 73.8% of the leaders were still rated as “substantially exceeds”. www.studergroup.com © 2009 Studer Group®

Meeting Title Here (on Notes Master) Year 2 – Goals Excellence Service People Quality Finance Growth Increase Patient Satisfaction (Inpatient) Goal = 62nd Current = 51st Decrease Mortality Index Goal = .77 Current = .77 Operating Margin Goal = 5% Current = 5.6% Reduce Annualized Turnover Goal = 14.5% Current = 16.7% Increase Inpatient Admissions Goal = 2.7% Current = 7.6% Reduce FTE per Adjusted Discharge Goal = 1.15 Current = 1.15 They realigned their goals and established and implemented the LEM. The positive goal achievement is noted by the green boxes. Increase Outpatient Visits Goal = 5% Current = 8.0% Increase Patient Satisfaction (Ambulatory) Goal = 62nd Current = 65th Increase Employee Satisfaction www.studergroup.com © 2009 Studer Group®

Leader Evaluation Results – Year 2 Meeting Title Here (on Notes Master) Leader Evaluation Results – Year 2 With the LEM in place and goals being met, look at the leader evaluation results. A perfect bell-curve is achieved. Note: Percentages noted account for 93% of the leaders who have entered data as of 6.7.07. www.studergroup.com © 2009 Studer Group®

Financial Impact: Hospital Acquired Infections Metric Reduction Hospital Acquired Infections 156 Incremental Costs $1.93 million Bed Days Avoided 984 Percent of HAI Over Admissions Tactic and Tool Implemented: Objective Evaluation System Source: Arizona Hospital, Total beds = 355, Employees = 4,000, Admissions = 10, 188 HFMA article, “When Hospital Infections Go Down, Pay Raises and Bonuses Go Up at UMC”, July 2009

Why Have Leader Evaluations Based on Objective Goals? Meeting Title Here (on Notes Master) Why Have Leader Evaluations Based on Objective Goals? Clearly connects the goals of the organization to individual leader Provides prioritization roadmap for leader Reduces unnecessary work and duplication of efforts because clear expectations are set Keeps leaders focused on what is really important Allows senior leader to continuously monitor leader performance Provides for organizational agility Competencies do not guarantee desired outcomes . www.studergroup.com © 2009 Studer Group®

Goal Alignment & Balance

What is goal alignment? Insuring that individual leader activities are consistent with the goals of the organization.

Vertical Alignment ORGANIZATION GOALS DIVISION DEPARTMENT LEADER / UNIT

Horizontal Alignment ORGANIZATION GOALS DIVISION DEPARTMENT

How Organizational Balance is Defined MISSION Integrating and connecting the vision, value and goals of the organization into daily decisions, behaviors and actions Innovation Quality Service Community Finance www.studergroup.com © 2012 Studer Group

Goal Development Process Senior leaders set organizational goals Organizational goals are shared with all leaders Each leader determines their goals and preliminary weights Goals are reviewed by each leader’s reporting senior Goals are shared within leadership team to insure everyone's needs are addressed Goals are audited for continuity Leaders finalize their goals

Goal Development

Goal Development Tips Develop quantifiable goals.

2 = Partial Accomplishment 1 = No Accomplishment Goal Scales 5 = Stretch 4 = Partial Stretch 3 = Goal 2 = Partial Accomplishment 1 = No Accomplishment

Increase the number of visits to 200 5 is ≥ 250 4 is 225 to 249 Example Goal with Rating Scale Goal Increase the number of visits to 200 Rating Scale 5 is ≥ 250 4 is 225 to 249 3 is 200 to 224 2 is 150 to 199 1 is ≤ 149 www.studergroup.com © 2012 Studer Group

LEM Score Distribution 3 3 2 3 4 1 2 3 4 5 Opportunity Target Excellent

Example LEM Results Average Score = 3.07 1 2 3 4 5

Goal Development Tips Develop quantifiable goals. Use language that everyone understands. Connect goals to purpose. Fewer, rather than more goals, are better.

Goal Development Tips – Cont. It is not always practical to have a goal under each pillar. Goals should be aggressive yet realistic. Focus on results, not tactics or projects. Examples of CT Scanner – this is a project Goal is actually CT volume 25

Goal or Tactic? Conduct employee evals on time Improve staff productivity Round on 100% of inpatients Attend all leadership development sessions Pass OSHA inspection

Define how much time goal must be sustained For fiscal year-to-date (FYTD) For the month of December For the 4th quarter For last 6 months of the year

SMART Goals are Specific Measurable Attainable Realistic Time-bound

What might not fit as goals: Standards of performance Subjective and vague statements Tactics to achieve goals Maintaining regulatory compliance Routine job activities

Middle Management Common Goals (Examples) Budget Patient Perception of Care Interdepartmental Satisfaction Employee Engagement Core Measures Patient Fall Rate

Tools of Accountability Leader Performance Evaluation Leader Report Card 90 Day Plan

www.studergroup.com © 2012 Studer Group

No Surprises MONTHLY QUARTERLY YEAR END

Thank You! For valuable tips on creating a culture of organizational excellence, visit our web site at www.studergroup.com Bill Bielenda 850-934-1099