© HTS |Page 1 Building Leaders – Transforming Hospitals – Improving Care Building Skills for a Lean Culture in Healthcare – Part 2

© HTS |Page 2 Faith M Jones, MSN, RN, NEA-BC Director of Care Coordination and Lean Consulting Faith Jones began her healthcare career in the US Navy over 30 years ago. She has worked in a variety of roles in clinical practice, education, management, administration, consulting, and healthcare compliance. Her knowledge and experience spans various settings including ambulance, clinics, hospitals, home care, and long term care. In her leadership roles she has been responsible for operational leadership for all clinical functions including multiple nursing specialties, pharmacy, laboratory, imaging, nutrition, therapies, as well as administrative functions related to quality management, case management, medical staff credentialing, staff education, and corporate compliance. Sara Stanton Vice President, Business Development Sara Stanton is responsible for marketing and business growth for both new and existing clients. She is a business development leader with over 15 years of experience in healthcare strategy, consulting, data analytics, and patient communications. Sara has worked with large provider organizations, community hospitals, regional health systems, national ASCs and specialty providers, and the largest IDN’s in the nation. This experience and exposure has given her a broad understanding of the American healthcare market and the initiatives, challenges, and mandates that hospital executives are facing. Stanton earned a BA in Communication Studies from Baylor University.

© HTS |Page 3 45 Years of Delivering Superior Results Strategy – Solutions – Support

© HTS |Page 4 Turnaround Strategy Financial Operations Corporate Compliance Board Development Regulatory Compliance and Accreditation Preparation Lean Process Improvement CHNA Gaffey Revenue Cycle Management CrossTX Population Health Platform Optimum Productivity Execuitve Recruiting Interim Executive Placements Mid-level and Specialty Placements Formerly known as Brim Healthcare we have a 45 year track record of delivering superior clinical & operating results for our clients. We believe that the combination of People, Process & Technology transforms healthcare & provides the required results Our Company Our Executive Team has experience in managing hospitals from multi-billion $ healthcare systems to community hospitals Our TeamOur Mission Management Placement Consulting Technology Strategy – Solutions – Support Strategy – Solutions – Support

© HTS |Page 5 Opex Categories % RevenueCumulative Salaries and Wages41% Fringe Benefits10% Contract Labor2% Total Labor Expense53% Supply Expense14%67% Purchased Services9%76% Physicians Fees4%80% * Data from HealthTechS3 Comparative Financial Benchmark Database 80% of Hospital Operating Expenses Fall into 4 Categories Executive Search Productivity Management Software Benchmarking Lean Projects Executive Search Productivity Management Software Benchmarking Lean Projects GPO Services Cost Benchmarking Lean SC Consulting GPO Services Cost Benchmarking Lean SC Consulting GPO Services PPM Consulting Physician Comp Consulting GPO Services PPM Consulting Physician Comp Consulting Increasing Efficiency/Reducing Waste Increasing Efficiency/Reducing Waste Our Mission Management Placement Consulting Technology

© HTS |Page 6 HealthTechS3 is a trusted partner our hospitals. We are fair, honest, professional, and provide ongoing support. IntegrityIntegrity HealthTechS3 has been around for 45 years and successfully navigated many hospitals through an ever changing healthcare market. LongevityLongevity HealthTechS3 knows how to work with community hospitals and health systems to best leverage their assets and resources to serve their market and maintain independence. MarketMarket HealthTechS3 is flexible and affordable relative to many large national consulting firms who focus on strategic work and ideas rather than implementation and impact. ValueValue HealthTechS3 is an award winning healthcare services company. We are a renowned management company with award winning hospitals, health systems and physician practices with CEOs of long tenure. PerformancePerformance HealthTechS3 only has consultants with deep experience; Consultants are former hospital leaders and executives, clinical resources are best in the industry. ExpertiseExpertise Who we are and what drives us?

© HTS |Page 7 HealthTechS3 – currently provides hospital management, consulting, turnaround, supply chain management, and professional and physician recruitment services to: – More than 50 hospitals and health systems nationwide – Community hospitals, Critical Access hospitals, district hospitals, non-profit hospitals – Most operate physician clinics – Net Revenue between $20M and $400M – Business Partner Illinois Critical Access Hospital Network (ICAHN) – Preferred vendor with California Critical Access Hospital Network and Texas Organization of Rural and Community Hospitals A Nationwide Client Base A Nationwide Client Base Management

© HTS |Page 8 January 2015 Becker’s 50 Rural CEOs to Know Nicole Clapp, Grant Regional Health Center John Gallagher, Sunnyside Community Hospital Chandler Ralph, Adirondack Health Phil Stuart, Tomah Memorial Hospital April 2015 HealthStrong Top 100 Hospitals (iVantage Health Analytics) Barrett Hospital & Healthcare Carlinville Area Hospital Grant Regional Health Center Hammond-Henry Hospital Hillsboro Area Hospital Tomah Memorial Hospital May 2015 Becker’s Top Hospitals for Physician Communication (scored 92% or higher ) Spooner Health System – score 94% Tri Valley Health System – score 93% Grant Regional Health Center - score 92% June 2015 Becker’s 100 Great Community Hospitals Adirondack Health Grant Regional Health Center Hammond-Henry Hospital  June 2015 Top 100 Critical Access Hospitals (iVantage Health Analytics) Barrett Hospital & Healthcare Hillsboro Area Hospital Tomah Memorial Hospital July 2015 Most Wired Hospitals – Small & Rural (published H&HN magazine) Hammond-Henry Hospital Sunnyside Community Hospital September 2015 Becker’s 50 CAH CEOs to Know Nicole Clapp, Grant Regional Health Center Florence Spyrow, Hammond-Henry Hospital Ken Westman, Barrett Memorial Hospital Client Recognition and Awards Management

© HTS |Page 9 Strategy Growth Strategy Market Positioning Network Collaboration and Development Physician Relations and Integration Turnaround Strategy Financial and Operational Restructuring Risk Advisory Creditor Consultancy Transaction Advisory Merger Integration Deal Structuring Contract Analysis and Negotiations ACO Transition Analysis Payment Strategy Transitions Financial Modeling Capital Sourcing Operations Financial Budgeting/Financial Planning Capital Programs Supply Chain Labor Productivity Managed Care Negotiations Risk Advisory Revenue Cycle Business Office Consolidation Clinical Documentation and Coding Reviews Operations Lean Workflow Analysis and Redesign Patient Access, Throughput, Level of Care Corporate Compliance Clinical & Quality Quality Improvement Quality Program Development Clinical Process Redesign Care and case Management Process Benchmarking and Reporting Regulatory Compliance and Accreditation Preparation Survey Readiness Plans of Correction Public Reporting of Quality and safety Indicators Evidence Bases care Population Health Management Care Coordination Transitional Care Management Governance & Leadership Board Advisory Education Retreats Hospital Governance Management Licensing Advisory Services Regulatory Strategy Development Annual Report Preparation Expert Led Solutions Consulting

© HTS |Page 10 Developing a Lean Culture “I can't overstate the value [lean] is providing. It not only benefits our staff that has developed professionally, but also community members…the class is focused on improving the Triple Aim for our patients.” 1 L EAN I NSTRUCTOR N ETWORK : 1 13 H OSPITAL F ACILITIES : O N - SITE I NSTRUCTORS : L EAN C OURSES : P ARTICIPANTS /P ROJECTS : 291 In 20 Months… Projected Annualized Lean Project Savings: $7.6 MILLION Projected Annualized Lean Project Savings: $7.6 MILLION Reduced Process Variation & Non Value Added Tasks = Happier workers Happier patients Increased capacity for work Lower operating costs Consulting

© HTS |Page 11 Finding The Right Leader Finding The Right Leader Peter Goodspeed leads our Executive Placement Services group. With over 30 years experience Peter understands the unique challenges of today’s hospitals. Whether finding a candidate for a rural hospital or searching for a multi-hospital system, we focus on your desired qualifications and specific needs. Services include: Interim Permanent Executive Search Process 45 Years of Excellence HTS3 has been recruiting Senior Executives for over 45 Years Our extensive understanding of hospitals & healthcare helps us find the right candidates for you. Placement Management Placement Consulting Technology

© HTS |Page 12 33% Productivity Improvement Proprietary billing & collections management platform Total AR Mgmt. & Transparency Complete Business Intelligence and AR Management Proven & Trusted Technology ■ 200+ Hospitals & Health Systems ■ 37 States ■ $ 14 Billion in Revenue Collected ■ 26 Years of Innovation Proven & Trusted Technology ■ 200+ Hospitals & Health Systems ■ 37 States ■ $ 14 Billion in Revenue Collected ■ 26 Years of Innovation Industry Expertise ■ Leadership - RCM experts ■ Run our own CBO ■ We use all of our technology ■ Continually innovating Industry Expertise ■ Leadership - RCM experts ■ Run our own CBO ■ We use all of our technology ■ Continually innovating Predictable ROI ■ 1-4% Increase in NPR ■ 33% better productivity ■ 85%+ clean clams rate ■ 20% cost reduction Predictable ROI ■ 1-4% Increase in NPR ■ 33% better productivity ■ 85%+ clean clams rate ■ 20% cost reduction Unmatched Service■ Active monitoring efficiency ■ Reduces cost of ownership ■ Improves your productivity ■ Creates Innovation Loop Unmatched Service■ Active monitoring efficiency ■ Reduces cost of ownership ■ Improves your productivity ■ Creates Innovation Loop Best Technology Technology= Best Results Best Technology Technology= Best Results Revenue Cycle - GAFFEY Revenue Cycle - GAFFEY Technology

© HTS |Page 13 Technology Solutions that Target Key Areas of Pain Revenue Attrition / Automation & Efficiency / Closed Loop Learning Increase in Clean & Complete Claims Claims Management Lack of Collection Automation AutoStatus Poor Workflow & Task Efficiency AlphaCollector Under Payment & Revenue Integrity Contract Calculator Correct Patient Information Integrated Eligibility Integrated Reporting & Process Insight AlphaAnalytics Revenue Cycle - GAFFEY Revenue Cycle - GAFFEY Technology

© HTS |Page 14 The Complete Solution. The Optimum Productivity Enhancer program provides you with the tools and support services necessary to ensure your success in addressing today’s productivity challenges. For over 40 years, our experienced Consulting Staff have been assisting hospitals in developing sustainable financial improvement solutions. Optimize Productivity Performance. HealthTechS3 provides your managers, supervisors and C-suite the confirmation needed to accurately calculate workload staffing and appropriately adjust staffing on a timely basis. Productivity– Optimum Productivity– Optimum Technology

© HTS |Page 15 HealthTechS3 is a partner with CrossTX to bring a cloud based Care Coordination Platform, Community Connect, to both independent and affiliated physician groups. This platform equips providers and care coordinators to plan, coordinate, track, and document all care giver relationships and episodes of care according to the CMS reimbursement requirements. Community Connect Platform Population Health : CrossTX Population Health : CrossTX Technology

© HTS |Page 16 The estimated average approximate reimbursement is $42.60* per patient per month, which amounts to over $500 per year that your primary care providers are eligible to be paid. With an average patient panel size of 3,279 1 this can add substantial revenue to your organization’s bottom line. Patient Panel Size 1 3,279 % of Panel on Medicare % Medicare Patients716 % of Medicare patients CCM Eligible % Number of CCM Eligible Patients491 Annual Billing for CCM Patient$ Annual CCM Revenue Potential$250,999 Population Health : CrossTX Population Health : CrossTX Technology Community Connect Platform

© HTS |Page 17 Building Leaders – Transforming Hospitals – Improving Care Building Skills for a Lean Culture in Healthcare – Part 2

© HTS |Page 18 The Right Tools for the Job Welcome 2 nd webinar in our 3 part series on building skills for a Lean Culture in Healthcare – Culture and Engagement – January 26, 2016 – Power of Observation – Today – The Patient Perspective – March 8 th

© HTS |Page 19 The BHIS (Better Health Improvement Specialist) Background of a Lean Culture

© HTS |Page 20 Agenda Power of Observation Understanding the Current State Socratic Questioning

© HTS |Page 21 Really understand how work currently happens is essential before trying to fix it! Power of Observation Power of Observation

© HTS |Page 22 Gemba Walk Go See Go See Ask Questions Ask Questions Show respect Show respect Going to Gemba Going to Gemba

© HTS |Page 23 Power of Observation All work redesign is based on DIRECT OBSERVATION OF THE WORK – Not how you think it is or how you believe it should be or what the policy says it is – It is what is actually occurring – Seeing something a million times is not the same as doing an observation and really “seeing” it 23

© HTS |Page 24 “Seeing it” What are you looking for? – Purpose – Process – People 24

© HTS |Page 25 Prepare 25

© HTS |Page 26 Current State Current State

© HTS |Page 27 Direct Observation Direct Observation

© HTS |Page 28 Documentation and Sharing Documentation and Sharing

© HTS |Page 29 Socratic Questioning Socratic Questioning Socratic questioning seeks meaning and truth Connected with critical thinking Art of questioning is important to excellence of thought Systematic In depth Interest in assessing the truth or plausibility of things. 29

© HTS |Page 30 Socratic Questioning Socratic Questioning Clarify Thinking/Doing ‘Why do you say/do that?’, ‘Could you explain further?’ Challenge Assumptions ‘Is this always the case?’, ‘Why do you think that this assumption holds here?’ Gather Evidence ‘Why do you say that?’, ‘Is there reason to doubt this evidence?’ Alternative Viewpoints ‘What is the counter-argument?’, ‘Can/did anyone see/do this another way?’ Implications and Consequences ‘But if...happened, what else would result?’, ‘How does...affect...?’ Question the Question ‘Why do you think that … asked that question?’, ‘Why was that question important?’, ‘Which of your questions turned out to be the most useful?’ 30

© HTS |Page 31 Appreciative Inquiry Appreciative Inquiry 31

© HTS |Page 32 Problem Solver to Coach Problem Solver to Coach 32

© HTS |Page 33 Don’t Fix – Observe - Listen 33

© HTS |Page 34 Faith M Jones, MSN, RN, NEA-BC Director of Care Coordination & Lean Consulting Contact info: cell Next Steps 1.Questions 2.Recording of Presentation may be accessed and shared with your team 3.Join me next month when we discuss The Patient Perspective 4.Contact me if you would like assistance on your Lean Culture Journey