1. Strategic Partnerships Between St
Strategic Partnerships Between St. Louis Children’s Hospital and the Department of Pediatrics
F. Sessions Cole, M.D.
Assistant Vice Chancellor for Children’s Health
Chief Medical Officer, St. Louis Children’s Hospital
Paul Scheel, M.D., M.B.A.
Associate Vice Chancellor for Clinical Affairs
Chief Executive Officer, Faculty Practice Plan

2. Institutional Relationships
Washington University
BJC Health Care
Board of Trustees
Board of Directors
Chancellor
CEO
Affiliation Agreement
School of Medicine
Teaching Hospitals:
BJH/BJWC
SLCH
Community
Hospitals
Dean & Executive Faculty
Faculty Practice Plan

3. Medical School/Departmental Strategies
Enhance University mission (clinical care, research, education)
Dean estimates WUSM will need $550,000,000 for programmatic investment over next 10 years to maintain research, educational, and clinical care productivity
$10,000,000/year from increased philanthropy specifically for WUSM
$20,000,000/year from BJC HealthCare
$25,000,000/year from WUSM Clinical Departments
Department of Pediatrics expected to generate >$1,500,000/year as contribution to Dean’s initiative
Departmental initiatives to standardize clinical full time equivalent (FTE) by defining ambulatory expectations

4. St. Louis Children’s Hospital Strategies
Centralized strategies established by BJC HealthCare
Control costs through standardization and elimination of waste (LEAN) across BJC HealthCare
BJC/SLCH Operating System (Children’s Transformation System): Protected time, Operational Readiness (e.g., unit level start up huddles, visual management), Tiered Escalation Process (e.g., tiered huddles), Leader Standard Work, Problem Solving System (readiness and improvement idea workshops), Goal Cascading (targets to improve, key performance indicators)
Challenging costs in 2018: Depreciation on new Washington University Medical Center buildings (SLCH and Parkview Towers) and deployment of EPIC
Affiliation agreement aligns incentives of Washington University Medical School faculty and SLCH
Affiliation agreement (December, 2017) provides for 45% of SLCH/BJH/BJWC annual margin to be allocated to WUSM

5. Superior Patient Experience
Children’s transformation System
Superior Patient Experience
Safe & Effective Care, Exceptional Service, Exceptional Environment
Our Vision
Safety & Quality
Service
Access & Delivery
Stewardship
Engagement
Our Direction
Are our employees and patients safe?
Are our processes reliable?
Does our care produce the outcomes intended?
Are we providing outstanding service to our patients, families, internal team members and referring MDs?
Are we meeting the rate of demand of our patients?
Are we managing our resources/ costs to deliver high value care?
Are we creating an exceptional destination environment for our employees, trainees, medical staff and donors?
Are we creating a safe and inclusive environment for all?
“True North”
Preventable Harm
Employee Injuries
Patient Satisfaction (SLCH & WU)
MD Satisfaction
Volume Growth
Time to Next Appointment
Productivity
Supply Costs
Employee Retention
Foundation Dollars Raised & Number of New Donors
Our Metrics
Our Work Streams
Strategic Projects, Daily Improvement Projects, Infrastructure Projects
Our Methods
Leader Standard Work, Daily Management, Strategy Deployment, High Reliability, People Development
To do what’s right for kids…better
Every Patient - Every Family - Every Team Member - Every Day
Our Mission

6. St. Louis Children’s Hospital Strategies
Goal Deployment Process (GDP)
Process to establish hospital goals
SLCH goals for 2018:
Quality and Safety: Reduce preventable harm (e.g., CLABSI)
Access and Delivery: South County and Illinois initiatives; Behavioral Health initiative; increase ED volume and flow; increase OR volume; Women and Infants initiative
Stewardship: Improve value by increasing efficiency and decreasing cost (reductions in 2018 operating margin: EPIC training $1,517,000; EPIC overhead $6,700,000, new tower depreciation $6,600,000, RN specialty pay $990,000)
Engagement: Reduce SLCH staff turnover; increase diversity
Service: Improve patient satisfaction through improved service standards, improved communication with families

7. SLCH Executive Responsibilities for Strategic Partnerships
SLCH/BJC governance
Joan Magruder – President, SLCH; Group President, BJC HealthCare
Peggy Gordin, M.S., R.N., NEA-BC, FAAN – Vice President for Patient Care Services
Michele McKee – Vice President of Finance and Chief Financial Officer
Rick Majzun – Vice President for Strategic Operations and Planning; Interim Vice President for Women and Infants’ Program
Sandra Young – Vice President for Human Resources
Gary LaBlance, Ph.D. – Vice President for Quality, Service, and Information Management
Malcolm Berry – Vice President for the St. Louis Children’s Hospital Foundation
Alexis Elward, M.D., M.P.H. – Associate Chief Medical Officer for Quality and Safety
F. Sessions Cole, M.D. – Chief Medical Officer

8. SLCH Executive Responsibilities for Strategic Partnerships
Each SLCH Vice President accountable for specific areas
Peggy Gordin: All patient care services except Radiology
Rick Majzun: Radiology, Children’s Direct, Facility Services (including campus renovation planning), Pharmacy/Clinical Laboratories, Offsite Services (CSCC, MBMC, PWHC), Women & Infants’ Services
Michele McKee: Admitting, Planning, Physician Services, and Transplant Financial Services, Finance, HIM and Care Coordination, OR, Supply Chain
Gary LaBlance: Emergency Preparedness, Patient Experience, Food and Nutrition, Information Technology, Therapy Services, Audiology, Performance Excellence, Center for Clinical Quality and Safety, Medical Staff Office
Sandra Young: Human Resources, Marketing and Communication
Malcolm Berry: St. Louis Children’s Hospital Foundation
Each Vice President has Directors who report to her/him; Unit Managers report to Directors; front line staff report to Unit Managers

9. Department of Pediatrics Administrative Structure
Gary Silverman
Chair
Interim Executive Director,
Business Affairs and Strategic Planning
Gary Yuhas
Vice Chairs
Education – Andy White
Outreach and Strategic Planning – Mark Lowe
Quality and Safety – Alexis Elward
Executive Vice Chair – F. S. Cole
Directors of Clinical Operations
Research Administrators
Pediatric Computing Facility
Ambulatory Operations
Division Chiefs
Medical Director, Pediatric Computing Facility

10. Principles for Leveraging Strategic Partnerships
Important considerations
Leverage (not add) infrastructure (i.e., FTEs) (approximately 3,000 SLCH employees)
Reallocate/reduce rather than add resources through LEAN or Six Sigma methods
Build on strong medical, academic leadership, and partnerships
Identify critical success factors for project
Estimate start up and operational costs and impact
Establish project governance to mirror both financial risk/benefit and medical leadership

11. Example of Leveraging Strategic Partnerships
Women and Infants’ Program
Neonatal, pediatric, and cardiac intensive care profitable for both SLCH and Department of Pediatrics
Requires medical leadership across multiple Medical School Departments (Faculty Practice Plan)
Allows BJH to reduce cost/delivery by increasing clinical volume and use vacated space to achieve a phased campus redevelopment plan
Favorable impact on SLCH and BJH labor per stat, VPI, and margin
Favorable impact on Medical School’s mission and financial performance of multiple medical school Departments

12. Summary
Leveraging strategic partnerships between Department of Pediatrics and St. Louis Children’s Hospital
Harmonizing Departmental, SLCH, BJH, WUSM, and BJC HealthCare missions and sustainability
Planning with Departmental administration, FPP, SLCH, BJH, and other involved Departments
Committing to patience, listening, and mutual education